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Home My WebLink About14843-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~J, 46.7.7. ......... Date . .Jg.~.Y...2.2 ........................ 19 .~.6. THIS CERTIFIES that the building Ingr.o. und pool and fence . Location of Property 4175' Ole Jule Lane Mattituck County Tax Map No. 1000 Section12.2. .......... Block 05 .Lot 012 Subdivision ............................... Flied Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ~r. qb..1.~ .......... 19.8. 6. pursuant to which Btdlding Permit No. 1. .4 .8.4.3.g. .............. dated ....~.q3~y..8 .................. 19.8.6., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .. ,I,n.q .rg.u.n.d.. pp. ql., .a.n.d.. f.?.n.c. 9 .. ........................................ ::. ....... The certificate is issued to ERNEST E. WILSBERG of the aforesaid building. Suffolk County Department of Health Approval ......... [q/~ ............................. N540734 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 [~O]B~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereb/granted to: ...~~...~.;.....~..~ ......... .~~~...~..;.~.....;..;.t...~........~. ..... ~ ................................................... 7'X ......... ~'"":: ........... f~ ............ ~' ............... ;""~ .......... ';i' ......... at prem ses ~o,ed at ...~..: Z.~.~. ......... ...~.......~....~..~ ....... ~~ ...... County Tax Map No, 1000 Section .... L.~.,2~,. ....... Block ..... ..0...~.. ....... Lot No. ~ j ~' pursuant ,o application doted .... ~.~ ........ L~. ................. , 19.~.~ and opprov~ b~ the Building Inspector. ,J Fee $. ~.~.. .............. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Soathold, N.Y. 11971 ,i,~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation'from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre--existing" land uses: 1. Accurate survey of p~perty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ...... 3. ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..................... .(~.~-..~.~[-~...~.~. ~. ..... .~. ~:k J-7.'I~'~. ~.C-~.-.-~. House No. Street Ham/et Owner or Owners of Property .. . :. .J./'. ~.];~.~ ........................... County Tax Map No. 1000 Section . .2.'~3...~. ........ Block .... (~.~ ........ Lot .... D] 3~ .-~.-. .... Subdivision ................................. Filed Map No ........... Lot No .............. 7 Permit No./.~.~.~ .El.. Date of Permit .... Applicant . .-~. ~..~%T....L~! ~. ,~,~, ............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Approval , /~'.-,~,¥~. ~,-~',~, ......... Planning Board Approval ....................... Underwriters Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ........................ Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 0~ 00~3 BUREAU OF ELECTRICITy ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 TH,S CE~T,~P~9, 1981 ..pl,co.,o. ~'o.--S~'~ 145077-81 N 5 4 0 7 3 4 ~-.--.~o. October 26, 1981 RXTURE i 3 2 2 ~ 2nd FI. Pool S~ction Block Lot and found to be in compliance with the requiremen ts of this Board. FIXTURES i 3 ' SERVICE DISCONNECT R V I C (Sw~_nming Pool) This Certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. _i-G.F.I. Gler~ R. Bradley, RFD 169 Horton Ave., Mattz~EucR, N.Y. 11952 Lic 1227 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. .[~LD INSFECTION COMI~ENffS .--~ .~__ OUNDATION ( ls t) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y~ STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ,__ __.~__ ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 3OUTHOLD, N.Y. 11971 TEL.: 765-1803 Exa~ninea . .'~Q~., ~ ..... , 19 Approved ..~.. ~P.. ., 19~.k. Permit No. t.q..~. ~/.~ .~.. Disapproved a/c ....................... (Building Im APPLICATION FOR BUlL Received ........... ,19., , Datg ....... ~ ,-..).). ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~jas. ...... .............. (Signature of applicant, or name, if a corporation) (Mailing fiddress of applicant) ~ ~ C~ ~,-~.~ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner o f premises ... ~- .'/.~,k':-k%-:~.~... [~, N. 6£t f f~.b.~: ta ~ ....................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) _<..~_jb- [ -,~ Builder's License No .... :.:.-: .-.-~. / ....... . Plumber's License No ......................... Electrician's License No .... .,{ .~ .-,~ .~ Other Trade s License No ...................... Location of land on which proposed work will be done .................................................. ...... .':T ............. ............... a. qr.,k ................. House Number Street Hamlet County Tax Map No. 1000 Section .... ./~. ~ ........ Block .... ~2 .......... Lot .... ~/,;2.~. ......... Subdivision ..................................... F.[led Map No ............... Lot ............... (Name) · ~, State existing use and occupancy of premises an~5,ptended ~aW~ccup~ncy of proposed construction: a. Existing use and occupancy......~?~'L~.....~.~ ..~~.~..C?'&--%. ....... (7~ ......... b. Intended use and occupancy .~.. ,~....~.. f,~~l.. ~ ........ . · .(7~ ~ · 3. Nature of work (check which a~plicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition ........... Other Work. ~oe.L. ........ ~ (Description) 4. Estimated Cost ~ .................... Fee . r...~.....-Y'~-r.. ................... i ~' (to be paid on filing this 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=~si~tcffy nature and extent of each type of use ..................... 7. Dimensions of existing structure%, ~t~F~]~'~ ............. Rear .............. Depth ............... Height ........... m~/,O ~ ~1~1~ tie' '~ i;Ct II ................................................. of sam~s~l~'w~th'itl[oltll~o~li~s: F~r~t .... . ............. Rear .................. Dimensions Depth ............... '~ - --'"~n. I{~..~ ~.j....t, ·-...,~t~ lk.'l ~. ..... Number of Stories ...................... 8. Dimensions of entire~las~tignj. F/,~I~_~'~.~..I.~'.. Rear ............... Depth Height .......... ~"~'~?'...._~ ~11t~ ~l~St~j~a,I.~' --'-'~'--:.'. ................................................... Sizeo iot: ront...mn,UUU.': .... ...................... Depth Date of Pu,cha e ... :''" ' Name of o=er Owner ............................. Zone or use district in y~ .~%~,' ~s,~uated ..................................................... Does proposed constructt~* vioTate any zoning law, ordinance or regulation: ................................ Will lot be regraded ..... ./.~.O .................... Will excess fill be removed from premises: Yes No~ Name of Owner of premises ~.*~2¥£=a'f. StU'~ [¢b~*,~.. Address .~.27~.. ~/-~-E~t.o./-~,. Phone No.o~.~ ~-.-.~.J,~. .... Name of Architect ........... i ................ Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or proposed, and~ indicate all set-hack dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. i APPROVED AS NOTED ~r~: ~Tl~ ~I~ING DEPART~T AT 7~6.1~2 9 AM TO 4 ~ ~ THE FOLLOWING 1 ~UND~IbN ~ REQ~REO FOR POUHED ~N~ETE 2 ROUGH FRAMING & ~UMBING R. FINAL CO$STR~CTION MUST ALL CONSTrUCtiON SH~ MEET THE REQUI~MENTS OF ~E N.Y ~ CONSTR~ON & ~ERGY Coo~ anT.~~E ~oN OR CONS~ON ~RORS, STATE OF NEW YORK, S.S COUNTY OF ................. .................................. . ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................... i ............................................................. i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that alt statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this It ~ .... ,...day of; .~....d-A~. ......... , 19 ?.co'~ Notary Public, ...... ~....~.~ .~ .~'/..d~--. .... County I~[/.~'N K, DE VOE NOTARY (~UB[ C, St}~ e of New York N0. 4X07878. $i~I/01k 0our*tm ; J (Signature of applicant) /7