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Home My WebLink About15172-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buiidin8 Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NoZ16247 Date October 5, 1987 THIS CERTIFIES that the buridmg . Ox~e. f ~il y. J.~e 11 ~.~g ............ Locatmn of Property .. 385 ,Shep.ar.d.D.r.iv.e ...... S..out.hold /tous'~ ~o .... Stre~i ................. /4~mie't County Tax Map No I000 Section . 07.8 ...... Block .. p I ......... Lot ...I.8. ........ Subd~wmon W. est .C..re.e.k .Es.tat..es .... FriedMapNo 3848 .LotNo. 41 conforms substantially to the Apphcahon for Building Permit heretofore Cried m thru office dated .,Au,g.u. st../4,. [9..86.., pursuant to which BuHdtng Permit No. . .I .5.1. 7 .2 .Z .......... dated August. , . 6,. 1986. . ..... ,. was~ssued, and conforms to all of the requirements of the apphcable prowsions of the law. The occupancy for wtuch ttus certificate is issued ts ....... ..Ope,.£a..mi.ly d.w.el.l, zn~g, at.ta, qh. ed..2, c.ar..$9.r.a, ge.: .................. THOMAS AND THERESA BERKHAN The certificate is xssued to ............ id~vno'r,~ss~ ........... of the aforesaid building Suffolk County Department of Health Approval .. . 86. qS.07.7.9 .9/.1.4/8.7 .......... N823852 7/30/87 UNDERWRITERS CERTIFICATE NO ........................................... PLUMBERS CERTIFICATION DATED: Stephen, O'Connor 7/1/87 Buridmg [t~Spector Rev 1/81 l~Wr NO. ~ TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING P E P~AIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 15172 Z Perm~ssron ~s hereby granted to' ..'-2~..~.,..a ...~ ................................ ........ ,o at premises located at ...'n~...~...'~.. ............................. County Tax Map No I000 Sec~,~ C~"~..~... pursuant to apphcahon dated Budding Inspector Block .... .~... ~. ......... Lot No .... J. "~-- ...... ~' . .., 19~...~ , and approved by the Building Inspector Rev 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s apphcat~on must be filled ~n typewmter OR ink, and submitted m ~ to the Buildmg Inspec- tot w~th the followmg, for new bui[dmgs or new use: 1. F~nal survey of property w~th accurate locat~on of all buddmgs, property lines, streets, and unusual natural or topographic features 2. F~nal approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commermal buildings, industrial buddings, Multiple Residences and mmilar buildings and mstalla~ t[ons, a certificate of Code compliance from the Architect or Engineer responmble for the budding. 5. Submit Planning Board approval of completed rote plan requirements where apphcab[e. B. For existmg buddmgs (prior to April 1957), Non-conforming uses, or buddings and 'pre-ex~sting" · land uses' 1. Accurate survey of property showing all property lines, streets, buddmgs and unusual natural or topograph m featu res 2Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buddmgs or premises, or other pertment informa- t~on reqmred to prepare a certificate. C. Fees: Additions $25.00 1. Certiflcate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-exmting dwe[hng $ 50.00 3 Copy of cert~fmate of occupancy $ 5,00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 .~.~i 5.Updated C.O. $ 50.00 Date .. :,.¢~._..;.~..'~.& . NewConstructzon. . ~.. Old orPre-exlstmg Budding ............ Vacant Land ............ Location of Property . .... House NO. Owner or Owners of Property .'~..~ Q/~t.~, .S.. County Tax Map No. 1000 Section . , ~ .--~.~. ...... .... Block ...... ) ........ Lot ...}.~ ......... %-So - Health Dept. Approval ..................... Labor Dept. Approval ....................... Underwmters Approval...~2.3.~. ,~. ,~ ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Fmal Certdicate ....................... Fee Submitted $ ,3, ~', ~ Construction on above descrlbedApphcant'/,~r~, · -bufldmg and permit meets~ .... apphcable~~codes and .................... regulations Rev 10-10 78 C TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P O. BOX 728 TOWN HALL SOUTHOLD, N.Y 11971 TEL. 765-1802 CERTIFICATION l/ Building Permit No. / (please print) [p±ease prxnt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me thzs I day of ~ , 19 ~7' Notary Public,~County Notary Publlc FOUNDATION (1st/ FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION ?ER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS I ,- // ,,// 765..1802 BUILDING DEPT. INSPECTION DATE INSPECTOR 765-18~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION ~,ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~F~MING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION FRAMING REMARKS: [ ] ROUGH PLBG. 2ND [ ~'~NSULATION FINAL iNSPECTOR~,~f //~~._ 765-1802 ,~/ BUILDING DEPT. ~~ INSPECTION · X ~/c ~ ,o~.~,,o, ,~ ~ ~o~. ,~,,~. [ ] FOUNDATION ZND [ ] INSULATION [//]~RAMING [ ] FINAL DATE ~~":NSPECTOR 7GS-XS02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ '-~ '~ ~ ~ ~-~ ' [l~-~h IF ~,~,~ ? DATE //'~//~ ~ INSPECTOR 7GS-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: DATE ,,INSPECTOR 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PI. BG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE INSPECTO BUILDING DEPT. PECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [,] FO/.UNDATION/. 2ND £ ] INSULATION [~J FllAMiNe [ ] FINAL I OTHER A~ARAIUS - 275 lov;n Ila~bor L,ane gouthold, N.Y. 11971 lic.~282E ~ Th~s ce~d~cate must not be altered ,n any manner, return to the offmce of the ~ard ~f tncorrect Inspectors may be [~enhTied by the{r credent,ais COPY FOR BUILDING DEPARTMENT TH~CERTIFI~TE MU~D IH ANY Approv~ ~','~Y'-'. ~O.. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 , 19 ~{~. Permit No. l.:~1."7..3..'~ D~sapproved a/c ...................... (Bml&ng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19 a. This apphcahon must be completely filled m by typewriter or in mk and submitted to the Bmldmg Inspector, w sets of plans, accurate plot plan to scale. Fee accordmg to schedule b. Plot plan showmg locahon of lot and of bmldmgs on premises, relatlonshtp to adjotnmg premises or pubhc sl or areas, and g~vmg a detmled description of layout of property must be drawn on the diagram which m part of thru cation. c. The work covered by tlus apphcatmn may not be commenced before issuance of Budding Permit d. Upon approval of this application, the Building Inspector will issued a Bufldmg Penmt to the apphcant. Such p. shall be kept on the premises available for mspectmn throughout the work. e. No budding shall be occupied or used in whole or tn part for any purpose whatever until a Certfficate of Occup shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmlding Permit pursuant Buil&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmanc Regulations, for the construction of bmldmgs, ad&hons or alterations, or for removal or demolition, as herem desct The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housmg code, and regtflatlons, ax admtt authonzed inspectors on premtses and in bmldmg for necessary in,~pe.cnons. (S~gnature of apphcant, or name, if a corporatton) go.. 5 o-t. ho/O, a. (Mmhng address of applicant) State whether applicant ts_owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or but ..0 O0. .C ................ Name of owner of prem,ses ~t>.r'O -r~-',q. JC.T]Oe£~--~°~-.. i''.~'i.~.; ~''.~i .......... (as on the tax roll or latest deed) If apphcant ~s a corporahon, s~gnature of duly authorized officer (Name and title of corporate officer) Braider's L~cense No . .E q- l .-~. ..... Plumber's L~cense No Electnman's L~cense No Other Trade's License No 1. Locahon of land on which proposed work will be done ...... 3¥0 .S. hs?r. O, 3 Be., %o&holJ, to,/.... House Number Hamlet County Tax Map No 1000Section 0 q~ Block ... [ ..... Lot.. .I.g .... Subdtv,sion 6$ Creek FdedMapNo ~g.. Lot ~.1. (Name) State ex~stmg use and occupancy of premmes and ~ntended use and occupancy of proposed constructmn a Exlstlng use and occupancy ~/t ¢>. ~ OS. Y~-~... LO-J[ .................... b. Intended use and occupancy . . Y e~&..f ~.Oork~} .~-~o.~...~- ..................... 3. Nature of work (check ~,hich applicable) New Budding .. I'/ Addition ...... Alteration Repmr .... Removal ........ Demohtlon ....... Other Work .......... 4 Estlmat~d Cost -"~ ] 3 0 I- OD O ~ (Description) " (to be paid on filing th~s application) 5. If dwelling, number of dwelling units.. ~. ... . Number of dwelling units on each floor .......... If garage, number of cars ....... ~. ......... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............... 7. Dimens~ons of existing structures, if any Front ---- Rear ~ Depth Height .... Number of Stones ............ Dnnenslons of same structure with alterations or ad&tlons Front .......... Rear .......... Depth ............ Height .............. Number of Stones ............... - 8. D~-nenslons of entire ne~v construction Front ~ O.t. .. Rear . 1~ D. r Depth .-~ ~ ' Height [~ .~ ~fg.',r . ~,g . Number of Stones 2~, ......... 9 S~ze of lot Fr~$nt . I. [ .ID f. . Rear .... I. ~ {>. · .... Depth .... l ~--~./. ....... 10. Date of Purchase ~.~)iut.· .t. 21. ].~.~ . .. Name of Former Owner 11. Zone or use dmtnct in which premises are situated ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation . .1~ .0 ..................... 13. Will lot be regraded .................. Will excess fill be removed from premises' Yes 14. Name of Owner of premlses .~' ~.~.r. ~/,~q.~..r~ Address ~.~S' .~./M.~....~V~..PhoneNo' Name of Architect . ~)~.e ~ .t,,...~.O.m C.5... Address I~.o..tB~.C~..[,O.,f. .... Phone No ..- ........ Name of Contractor .. .(~..o4 .,~.q f7 ...... Address .............. Phone No ..... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLO7 DIAGRAM Locate clearly and distinctly all buddings, whether exlstmg or proposed, and indicate all set-back dnnenslons fro~ property hnes. Give street and block number or description according to deed, and show street names and ~ndmate whethe interior or corner lot STATE OF NEW YORK, S.S COUNTY OF ....... .................... bmng duly sworn, deposes and says that he is the apphcar (Name of ~ndivldual signing contract) above named He is the ............................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Is duly authonzed to perform or have performed the said work and to make and file th apphcatmn; that all statements contmned m this application are true to the best of his knowledge and belief, and that th work will be performed m the manner set forth m the apphcatlon filed therewith. Sworn to before me this /-f day of ~ .... 19 ~7.~. No;~ry';ubh~,' ' .i.~.~..~; ..i County // /,..O]~ // N0~w ~.~ ~t~ ~ ~ ~k (Signature of apphcan No 4707878, ~ ~ ~ Term £xo~res Ma~h ~1, L -[ DIP, ES TWO YEARS FROM ',DATE OF APPROVAL SINGLE FAMILY DWELLIN,~ 9',.H. Y EXPIRES TWO YEARS FROM DATg OF ~E,S_ LE 4q RODERICK VAN TUYL, PC LICENSED LAND SURVEYORS GREENPORT NEW YORK H S NO STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO/J~HE .STANDARDS Q~ THE SUFFOLK COUNTY DEPT OF HEALTH SERVICES - FOR APPROVAL OF H S REF NO ~ APPROVED ~ 0 SUFFOLK CO TAX MAP DESIGNATION DIST SECT BLOCK PCL OWNERS ADDRESS 1864 .... C.~.:- .-"/-- "94' ~" ' DEED L. :'~:A P TEST HOLE STAMP.... .'~ SEAL VA~ 1'7, O.OO 4.9 L~ SUFFOLK COUNTY DEPAP~TMENT OF HEALTH SERV CES DATE ~* $'\REF N?. ~ The ~wage disposal and wa~er supply facilities for this location have been inspe'i~t~l$ Department and/or ef J~i B f W ste~"~ Ma a~ement Chi ureau o a r n _5> ALE- 40:j" g]- MOI'qU~,iENT 2 I~CK30 -. F A~ -~,__~i~__V~ t,- Y[ l~ -- NO~V I, Jg~~ RODERICK VAN TUYL, PC STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT OF HEALTH SERVICES (SI ....... APPLICANT SUFFOLK COUNTY DEPT OF HEALTH SERVICES -- for APPROVAL Of CONSTRUCTION ONLY DATE ...... h S REF NO APPROVED SUFFOLKCO TAX MAP DESIGNATION DIST SECT BLOCK PCL. ~oco 0'~8 I oWNERS'ADDRESS 755- 1862. DEED: L. N~A P. ~ESY I~6LmE .... ST~ LICENSe, ED LAND SURVEYORS GREENPORT NEW YORK i I l ~IM/~S COMP/. Y l l MULL FIRST' FLO0~ PLAN SCALE 5o-'0 _? L L_ -I 9 F u~:x VINYL SIDING heatm~, Plumbing and el~¢~rical ~ a ~ervice ': :: e~ors or mtsinter~ret~to. ~' ~ P~s iS left1'o ~h~ ~ ' ~ Wllhin lhese 0