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Home My WebLink About14860-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the BuiRIlng Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1Z~937 Date October 6, 86 Addition THIS CERTIFIES that the building ................................................ ]Locatlnnr~fPron~rt'~ 1275 Nakomis Road~ Southold, N.Y. , House IVo. Street Hamle~ County Tax Map No, ]000 Section ...0.7.8. ...... Block . ...0.3. ......... Lot ....3.0.: ,1 ......... Subdivision ............................... Filed Map No ......... ]Lot No .............. conforms substantially to the Application for Building Pemfit heretofore filed in this office dated .M.a.y. 2, 1986 pursuant to which Building Permit No. 14860Z. dated M ay 8, 19 , 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 ......... Addition to existing one family dwelling. The certificate is issued to Don & Linda Lubov .... (own r, of the aforesaid building. N/^ Suffolk County Department of Ilealth Approval .......................................... N771451 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev, 1/81 FOEM NO. st TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14860 Z Permission IS hereby granted to: /')__ ..~.~ ............................... ~~ ..... L.~..~-.......~...~..~.....~.., ....... ~_~~~. ~o .~. :...//..?..7..t ...... at premises I~ted at ,.,// ~~~ ~.~ ...... ~.~ ..................... County Tax Map No. lO00 Section ....... .Q)...-~..2... Block ...... ..~..;~. ......Lot No ..... ~..(~.,..I ....... pursuant to application dated ...... ......~......~......~.. .................., 19...~.(~, approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 TOWN OF SOUT~OLD 765 - 1802 APPLICATION FOR C£RTIFICATE OM OCCUPAMCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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. C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of o~;cupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 f / /'~'/'~'/' '~' ' ' 4.Vacant: Land C.O. $5.00 5. Updated C.O./~, $15.00 ~ite ............. NewConstruction ...... Old or Pre-existing Building .......... Vacant Land ............ Location of Property ~.~, ~'~ ~),~ .............. ,~,, ¢ ........... ... ............... Owner or Owners of Property ..~.~ ............. L,,t-:-¢,~,~.,V', .................... County Tax Map No. 1000 Section .......... Block ............... Lot... .~. ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /..~,~. ~. ?-. Date of Permit .~./~/~ .~..Applicant...~ . .~....~..75~... ............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $... ~.¢.~.. ................... Construction on above described building and permit meets ali applicable codes and regulations. Rev. 10-10-78 lqq57 . m .il T. t'<w,~ ~5 Nl K LUBOV 1275 H,~J(OMIS ROAD H' $' R"rF' A~nov~ ~'TA*r~M r NT OF.I I~I'I~NT DISPOSAl. 8YI~I'EM~ ~OR THIS DEN~ Wl~ C~F~M TO · TAND~ OF ~UFFO~K ~ D~. *OF H~. SERVIa. looo259 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ,.~el~c~'t'l~z' 26, lg~ JOHN STREET. NEW YORK, NEW iORK 1OO~8 Jppllcation No, on fie · .,s c~.~,.,~s ~.~, ~ N 771451 the el~trlcaJ equipment ~ ~scribed belo~ and intuited by t~ applicant ~med o~ the a~ve application nu tuber in the prem~es of FIXTURE OUTLETS DRYERS SWITCffES FIXTURES 6 4 2 and found to be in compliance teith th& require.tents qf th s Board. RANGES "OOKING DECK OVENS DiSH WASHERS EXHAUST FANS FURNACE h FUTURE APPLIANCE FEEDERS UNIT HEATER MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-G.F.C.I. Electric P, oo~a He~ters: '~ 1-G.F.C, I. S E R V' NO, o~pE~c~co~o OF ~c,WcoOho I C E NO OF HI-LEG AW, G NO / AWG OF HI-LEO OF NEUTRALS OF NEUTRAL E]r~nt Electric Co., Inc. ~r~ver Smithtown, N.Y. 11787 Lico GENERAL Per_ this certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERT FICATE MUST blOT BE ALTERED IN ANY MANNER FIELD I~S ['EQ, T ION COMMENTS FOUNDATION FOUNDATION (1st). ROUGH FRAME & PLUMBING PER N Y STATE CODE FINAL ADDII COMMENTS·, 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE INSPECTOR ,~~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [] FRAMING ~,~FINAL REMARKS: ~-~ ~ ~, O, DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: (//~//~ FOUNDATION 1ST [] ROUGH PLBG. FOUNDATION 2ND [] INSULATION [] FINAL DATE iNSPECTOR 7GS-'~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL DATE '7//~6/~'~/ INSPECTOR ,~~ · ,.,:-~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined.. ~ .... ~..., 19~.&. Approved . ~/90.c~.~.., i9~.¢. Permit No..}.~/..~..&..0..-~. ~Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... 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, inspections..___ __-__ .___ .~...q.:~. ~.~..~. ~] ..~. ~L.O. (Signature of applicant, or name, if a corporation) .... t..~ .~.... ~/....~. ~..~.~ ...... ~.~_..: .... ..... .... ..... Y.../ ..... /. ..... (mailing addPess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... 0. t0n.exT. ................................................................................. Name of owner of premises ... ~D.oD.. ]..¢.~>.0 .~. ....................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) 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 .................................................. · ...... ............ House Number Street Hamlet County Tax Map No. 1000 Section .7.~: .~. ........... Block ....3 ............. Lot...~../. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy o,f proposed construction: ..... '-. - ................................... fl. Existing use and occupancy b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... ~Addition '. ..... Alteration ' Repair .............. Removal .~ ............. Demolition ......... : .... Other Work ............... ~.. [~./ -~..~. : (Description) 4. Estimated Cost ..... G.O.G. ....................... Fee .. .*.. (to I: ,~ paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .......................................... 2 ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ifany: Front....~..: ..... Rear .... ,~ ~. Depth ~.. Hmght Number of Stones. Dimensions of same structure with alterations or additions Front . Depth ..... ~.~. .............. .Height .... t"~f ............. Number 6f Stories ..... [.~.~. ............ 8. Dimensions of entire new construction Front Rear ~ / n~n/h ! '~ [ ' Height ~ ~ t. ....... Ngmber of Stories ... ! . . 9. Sizeoflot Front l]~.. Rear '''~}'.~! ........ '~k;~ .... ~:7~5b'" ............ 10. Date of Purchase .... /.q 7.7 .................... Namg,of F.o..rmyr Owner i. J.~i ll~./~ ~ d../-/~ ~a.~ . 1 I. Zone or use district in which premises are situated .E./.~j./..e~..'p..~J. ....... i ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..;D. 0. ...... ~ .................... 13. Will lot be regraded .... 10/~ ....................... Will excess fill be rem,o~ed from premises' Yes No 14. NameofOwnerofpremises DOn Lu, bqV Address )~7.o~. ~.a.,~r~t~¢ .................................... one Pq o.(~. ~. ~. ~.,. ~. ,~q:...7.. Name of Architect ........................... Address .................. Phone No ................ Name of Contractor .......................... Address ............. ; ..... Phone No ................. 15. Is this property located withinl;O0 feet of a tidal wetland? . Yes ..... No ..~... * If yes, Southold Town Trustees Permit may be required. : PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and sh6w street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S (Name of individual signing contract) being duly sworn, deploses and says that he is the applicant above named. ~ He is the ............................................................ ! ............................ (Contractor, agent, corporate officer, etc0 of said owner or owners, and is duly authorized to perform 'or have performed the ~aid work and to make and file this application; that all 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 Nota~ Public, .... ~ ~ County (Signature of applicant) mrm ~xpires m~h ~, ?~ / ~