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Home My WebLink About15159-zFORN~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buitding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Tl-IIS CERTIFIES that the building One family dwelling Location of Property 125 Lighthouse Road Southold House No. Street Hamlet Courlty Tax Map No. 1000 Section 054 .Block 03 ...Lot p/o ' 26 Subdivisio~ ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated 3 u 1 y 30, 1986 pnrsuant to wtfich Building Permit No. 15 159 Z dated . .J.u, 1. y.. }.1. ,...1 ~.8.7. ........... 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 ......... 9?.. ;.~.m. ~. ~..y..d.~ .~ D.~.~..~.,' .~.t..r .~.h.~. d...o.~.~., .~.~.~...g.~?.~.g. ?..~.~.d.. ?y.~.~.h. ?.sd' . .d??.k...~.~.d. side porch. The certificate is issued to .................. T. !.M..D.A,L..Y ................................ (ownor, Xe'~C~cKOzliX~t~Krg)X X X X of tile aforesaid building. Suffolk County Department of Health Approval 86-$O-123 Oct. 26, 1987 UNDERWRrrERS CERTIFICATE NO .......... .N.8.2.6. 2..3.8. ,A.u..g.u.s.t.. !.1.,.. !.9.8.7 ............. PLUMBERS CERTIFICATION DATED: K & K Plumbing 10/22/87 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15159 Z granted to: . ~ Permission is hereby ........... ~::~ '~ ...,..~..~~ ........ ~.~.~...~.~.~. ...................................... tO .... '~ ........ et premises located at ..../.~....~. ................. County Tax Map No. lO00'~Section ...... C~.~...~. ...... Block .,...~..'~. ......... Lot No...~...,.'~....~.'. ....... Building Inspector. 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 TOWN OF SOU'fHOLD A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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. I~. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 requ ired to prepare a certificate, C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$ ]0.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $i0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land Location of Property /c~' ~-J.G.I~-.'[-. ~.0.q~...~,Q 5~,J-~'~ .~ House No, Street Nam/et Owner or Owners of Property ...~ L~e~/ .... ~. I~ ~ .~ ......................................... County Tax Map No. 1000 Section . .(~. ,~...~ ....... Block..(~3 ......... Lot. ?/o...~..~. ...... Subdivision ................................. Fired Map t',to .......... Lot ~o ........... Permit No.L~. J.,~.l... Date of Permit 3.1.~.~...Applicant ..... ~)10~... 2C,~..~. · · .... 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 all applicable codes and regulations. App,cant Rev. 10-10-78 C.o',z FOUNDATION (1st) !!DATE FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. Y. STATE ENERGY CODE Z FINAL ADDITIONAL COMMENTS THE ~0009B3 a. te AuguSt THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 only the electrical equipment as d~scribed below and introduced by the applicant named on the above application number in the premises of ~ ~_ ~ ~o.m~ ~rL~ in ~he following location; ~ Basement .~ ~x..,~.~d o. JuX~ 2 7, ~9F~7 and found to be in compliance .'ira the require.~ents qf this Board. FIXTURE OUTLETS 2~ FtXTURES SWITCHES 40 3~. 24 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS NO. OF FEET RANGES OVENS DISH WASHERS EXHAUST FANS SERVICE DISCONNECT S E R OTHER APPARATUS: NO. OFpER~C~.COND AWG OF CC COND C NO. OF Hr-LEG AWG OF HI-LEO NO OFNEUTRAL$ OF NEUTRAL pane~.boards~l-2(c~.r)100amps~ Chris MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE M~ST NOT BE ALTERED IN ANY ~NNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. I~--1~ Owner T%~ ~%~ (please pkint) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Swor,n~o before 3~e this ~- day of _~//~z/ . Notary Public ,~/~~ County 76S-1802 BUILDING DEPT, INSPEi TION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL INSPECTOR 7GS-IU2 BUILDING DEPT. INSPECTION FOUNDATION 'IST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [/~}-11~ULATION [ ] FRAMING [ ] FINAL 765.t802 BUILDING DEPT. INSPECTION FOUNDATION lIST [~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: ~,~ '~/.~/~. ~ ,~., ~'~--~ DATE 765-Z802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ,[ ] FINAL 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Appr~)ved...TA~..~/..., 19~.~. Permit No.]. ~..]...~...~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19.. · 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 Law% Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin 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. (Signature of applicant, or name, if a corporation) .5.% (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .-~.~ ...... ~>. [~..~ .~. ...................................................... (as on the tax roi1 or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No ...... · .~....~..~ ......................... Electrician s License No ....................... ~' Other Trade's License No ...................... 1. Location of land on which proposed work will be done., k .~.~.~{.~ .... BO.u.S. .... .................. House Number Street , Hamlet County Tax Map No. 1000 Section .... ~.~. ........... Block ...0 .............. Lot. ~2~,.-2~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and\( \~intended u~nd occupancy of proposed construction: a. Existing use and occupancy .............. . .M.~?,~9,-kk"d-'' ............................................. b. Intended use and occupancy ~.'1. ['4.(~.. [~... ~. a.~. ,kt ~/ .... ~.~T;xS.k l). ~..~N}.~_~ ........................ 3. Nature of work (check which applicable): New Building .. ~, Addition .... ...... Alteration .......... Repair .............. Removal .............. Demolition .......... ;... Other Work ............... (Description) 4. Estimated Cost..~(~.(0.O.(,~.; ....................... Fee ......... ' ............................. ' (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, specify nature and extent of each type of use .... F:'. .............. 7. Dimensions of existing structures, if any: Front ............... Rear ...... ........ Depth ................ Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... ' ..... Rear ............... Depth ............... Height Number of Stories ~ .. '. . . Size of lot Front ~'~,.~4~ . Rear ~.~ r,~_,u ')t.,~6~ Zone or use district in which premises are situated.., ~$ l ~ lE, ,~,~-[I~-L~., ,. ........................ : ... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~../~.C~). .................... ,.. 1 3. Will lot be regraded .... J',~, ,Oz_. .... : ..... , ......... Will excess fill be removed from premises: Yes ')([~o. 14. Name Of Owner of premises .~[.¥.Y't~. ~l~.\fi( ....... Address ~.511~.~.~$~'. ~..10ore,hone No.."l {[.~ .! .2.. '.2~..a~.... Name of Architect . .2 .. Address ........... . .... Phone No ................ Name of Contractor .......................... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal ,wetland? *Yes ..... No '~... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. .... J'.. ~ ~. .... .~ u~ tg~dO~, O. 1~. ' ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ........ : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed thee said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith, Sworn to before me this ............ "-¢" ?'~'/,/) /~/ZQ,day of....& ....... . '. :, 1 .9~.. NOT~ ~St~ .?NOw¥~ (Signature of applicant) No, 47078111, Suffolk Term Expires ~rch 30, ~OD~mF~ VA,~?%UVL. P.C. L)ICEN~£D LAND SUR'V£YORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL h.S. NO. STATEMENT OF INTENT T.E W~R sUPPLY A.D S~WA~E O,S~OSAL SYSTEMS ~O~ ~.,S ~S,O~NC~ W,~ co.~o~ ~o ~H~ ST~O~OS Or ~H~ sur~o~ .co. ~ .~T. s~.v,c~s. ~', ~r~ SERVICES -- FOR APPEOV, AL OF APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST, sEcT. BLOCK PCL, O'WN £1~$ ADDRE~: TE~I HOLE STAMP w~ll lc: COUNTY OEPARTM~ 0¢ HEALTH __ SlNflJ.EFA.MItY DWELLING DATEO[~T Z ~' ~g~'IH.$.REF. NO' ~ The smvaEe disposal mid water supply facilities for this location have been inspected by this Department and/of othe, al~esl~nd fou)~to ~e4~tJsfa~,tovry. Cfii~f o[Bureau of Wastewater'Management ~-00 6.0 ~c, O~pr° 'fl STATEN~NT C~F INT~ m£ wATgW ~Y ANO ~WA~ IYST~ F~ THIS R~I~NCE WILL ~NF~M TO THE STANDARDS OF THE ~K CO. DEPT. O~ H[ACm ~WCES. ~ICANT SUFFOLK ? COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CO~TR~T ION ONLY A~ROVED: ~,, , ~FF~K CO. TAX M~ DE~NATION: DIST. ~CT ~K ~L, OWNERS ADDRESS: ' /~ 1~ ~ ~ED: L. ~M P. TE~ H~E STM ROI~RlC~ VAN T~,IYL, P.e. LICENSED LAND ~LIRVEYOR$ QI~EENPORT NEW YORK FOLLOW~N~ INB~C~ONS: FOUI~ON ~ REQ~ A~ CONSTRUCTION S~ALk MEF~ ~ T~ ~QUIREMENTS ~ rile N. x ~ CONducTIoN ~ ENERG~ ~. NOT ~E~NSIaLE FOR ~tGN OR CONS~ON U? I