The URL can be used to link to this page

Home My WebLink About14964-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-14934 Date: 10/01/86 T~IS CERTIFIES that the building NEW DWELLING Location of Property: 835 EDS RD. & 75 COLONIAL RD. SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 6 Lot 24 Su]~division Filed Map Mo. Lot Mo. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 12, 1986 pu~snunt to which Building Pezmit No. 14964-Z dated JUNE 9, 1986 was issued, and conforms to all of the requirements of uhe applicable provisions of the law. The Occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED DECK. The certificate is issued to ROBERT JOHNSON of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF P~ALTH APPROVAL 86-S0-65 ELEC~ICL~L CERTIFICi~TE MO. N-766461 PLUMBERS CERTIFICATION DATED 09/22/86 RBT. JOHNSON 09/26/86 08/29/86 Rev. 1/81 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) 14964 Z Permission is hereb/gronted t,~-) .- -'1'- ..... /..~.~-~T,,.....~./~..~.....,~ ...... ...... ~.o~.~..~..~....Y~...../_~..7/.. ,o ..... ..C_~z~.~~ ....... ~.z~.~...~.,~.Ar...(~......'~......(-~,u~../.~C? .............. ............................................................................................................ .~..~r.~.z:.~..o.~. =~.:..~ County Tox Mop No. 1000 Section .... .~....'~...... Block ..... .0..(:~. .......Lot No, ...O.....~-,...~... ..... pursuant to application dat,d ...... ~.~...].~. .................... , '9.~.., ond approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of / Occupancy No. Z14934 D~/ October 1, ............. ate ................................ ,19...86 THIS CERTIFIErS, that the building . . ~0n.e/ fami,ly dye.lli.n with attached deck Location of Property/~.~..8.3.0..E..d.~..R.i .a~/j. ', ............. i;u~[h'~ ~ i[ '~[i ~'''~ ..... ~x~°' r / Street ................ County Tax Map No. 1000 8 etlon .0 ~ 9. !Block 0 5. Lot 024 . ............................... Subdivision .............. ~ ..... / ......... Filed Map No ......... Lot No .............. conforms substantially to the A~pli~tion for Building Permit heretofore filed in this office dated May 12, dated June 9~ of the applicable provisions of the to wlfich Building Permit No. .1 4 9 6.~ Z 19..8.6, was issued, and conforms to all of th~ requirements cupancy for which this certificate is issued is ......... O.n.? family d..welli{~g, w .th att ~ed deck The certificate is issued to .... ! ....R.q Ip 9 F.~. .'~ 9b.n.s.e..n ..... / \ to~.er, tes~g~'K,~bhi~k ................... of the aforesaid building. / ~ Suffolk County Department o/Health Approval~.~ 86-S0- FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE Instructions 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, Bo 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 unusua~ natural or topographic featu res. 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 occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land $5.00 5.Updated C.C. /,, $15.00 Date .... .~.. 2- ~..'~. ........ NewConstruction ...... t/'m Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........ ~..'~ ........... ~ .... ~F~'~4 ~ ~ ~ ,ouseNo, ~ ~ .~.~Street Hamle, Owner or Owners of Property ....... C~. ..... ~ 9.~.~ .............................. County Tax Map No. 1000 Section ...Q ~ .~ ...... Block ...... 0.~ ...... Lot.. ~ .~ ........ Subdivision ................................ Filed Map No. ~'x'- ....... Lot No .............. Permit No./..~.~.~.//..~-Date of Permit ~.'T.~?%~..Appl cant... .e~. l....~./~..~.~L~.'.'~. ........ Health Dept. Approval ........................ F~roval ........................ Underwriters A'pproval.. ~. ................ .~o--~--= ~_-ard-Ap.Qr~val ................. ..... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... ~.. .................. .,/~) / / Construction on above described building and parietals a~/e ~codes and regulations, /// ~/ Applicant ...... ~/'.~...--?~/, ~. ~~ .................... Rev. 10-10.78 / P, ,c TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Plumber Building Permit No. /q ~-.~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~ (plumb~i/ signature)/ Sworn to before me this Notary Public, THE NEW YORK BOARD OF FIRE UNDERWRITERS [~01071 BUREAU OF [LECTRlClTY 85 JOHN STREET NEW YORK, NEW YORK 10038 , Date AUgust 29, 1986 ~4ppltcatio,, No.o, yHo 11976/86 ; ' THIS CERTIFIES THAT ' ' : '' ' only the electrical equipment ~ ~scrlbed below and introduced by t~ applicant named on ~he a~ve applica~n number in ~sexa.tinedott AugQst 21, 1986 andfoundtobqmco.tph?icewcththereqtttre.tentsqftbi~Board. 18 38 . 25 18 TIME CLOCKS [JNIT HEATERS MULTI-OUTLE DIMMERS SYSTEMS NO, OF SERVICE DISCONNECT OTHER APPARATUS: ' tl_G.F.C.i. lSmoke 'Detector G. & S Electric Box 215 Southold,N.¥ 11971 This cerfif;cafe must not be altered i. any manner; refurn 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FINAL [ ] FRAMING REMARKS: DATE ~INSPEL'~rOR 765-'"802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ~ROUGH PLBG. ]r.~QUNDATION 2ND [ ] INSULATION ]~FRAMING [ ] FINAL DATE INSPECTOR ,..~~ 76S-1802 BUILDING DEPT. INSPECTION ~/FOUNDATION 1ST [ ] ROUGH, PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL INSPECTOR., c~/'~P ~ 7GS.'1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [~] RO~UGH~/ PLBG. []FOUNDATION 2ND [¢/] INSULATION []FRAMING [ ] FINAL REMARKs: ~/~"~/~/~/,~/'~. ,~ FIELD I~SPE~TiON DATE FOUNDATION FRAME & ROUGH ~/PLUMBING ~ ~_~.j~ ~ ~ ~ STATE ENERGY C~ODE -- 4. ADDITIONAL COMMENTS: TEST HOLE EL. 45.5 ~.,o ~ ;. 0 9~I SUFFOLK COUNTY D~"PA~TAtFFIT OF ~¢:'"!l'H ,~RVICES J FOR ,~J:~FR-)V,',J. ( - ( h,",,, ~ : ~ ~ J '// LlC. NO. 49668 // , .~ ~ /j// MAIN ROAD ~.....~urds ~or title su~eys ~s estoblished by SOUTHOLD, N.Y. il971 the LI.A. LS. aha ~ppmved ~nd odepiea ;..~ ;, T;.. ;;.. ;'..; ;~.~, t...J JifJe ~ociofion. ELEVATIONS ARE TO ASSUMED DATUM. SURVEY FOR ROBERT JOHNSON AT BAY VIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y I000 - 079 - 06 - 024 SCALE I"= $0' MAR. $, 1.986 MAR. 26) 1986 CERTIFIED TO: COMMONWEALTH LAND TITLE INSURANCE COMPANY ROBERT JOHNSEN 86 - 148 A TEST HOLE EL. 45.5 0 Prepared in accordance with the minimum standards for title surveys as established by the L.I.A. LS. and approved and adopted for such use by The New York State Land Title Association. BLDG DEPI 'town OF $OUTHOLD N.Y, S. 15,E CON lC SURVEYORS (516) 765 - 502.0 P. O. BOX 909 MAIN ROAD SOUTHOLD, N.Y. 11971 LIC. NO. 49668 ENGINEERS ~ P. C . EL EVATIONS TO ASSUMED ARE REFERENCED DATUM . SURVEY FOR ROBERT JOHNSEN AT BAY VIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y lO00 - 079 - 06 - 024 SCALE I"= 30' MAR. $, 1986 MAR. 26, 1986 JUNE 13 , 1986 CERTIFIED TO: COMMONWEALTH LAND TITLE INSURANCE COMPANY ROBERT JOHNSEN 86 148 A SUFFOLK COUNTY HEALTH DEPARTMENT SINGLE FAMILY DWELLING :). REF. NO. / SEWAGE DISPOSAL AND WATER HAVE BEEN INSPECTED UND TO BE SATISFACTORY, 9f of FOR THIS Y I.~OL E 1~404 ~ TO ASSU~ED DATUM. Prepared in accordance with the minimum ctandurds for title surveys as established by the L.I.A. LS. and approved and adopted far such use by The New York State Land Title Association. SURVEY FOR ROBERT JOHNSEN AT BAY VIEW TOWN OF SOUTHOLD .SUFFOLK COUNTY, N. Y lO00 - 079 -- 06 - 02.4 1516) 7'65 - 5020 R O. BOX 909 MAIN ROAD SOUTHOLD, N.Y. 1197I SCALE I"= 30' MAR. 63, 1986 MAR. 2 , 1986 JUNE 13 , 1986 JULY 51 , 1986 CERTIFIED TO: COMMONWEALTH TITLE INSURANCE ROBERT JOHNSEN LAND COMPANY 148 C 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ~'~.~..~'..~....~....., 1~ Approved~t'..~......~. ..... 1 .~.. Permit No./..~. ~..~.~. '/~ Disapproved a/c . 5T7.~.~....~...~ .................... ........................... ? .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Rece±ved ........... ,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 whble 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 fo~moval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildiffg c~6de, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp~~?:_~~ (Signature of appl~tcant, or name, if a corporation) e.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 6ontractor, electrician, plumber or builder. ..... ............................................................................... (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 L~cense No.. ~.~7.. ..~-d~.~ ~ Electrician's License No..~.~ ..... ,'.r ..........~ .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .................. .?4.q ......... £d; ..... 2o.,.d .............. . ?. .77.,o.x. d. ................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~ ?.~'. ....... Block .... ~...6'. .......... Lot...O..~ ~. ........... Subdivision ...... , . .//..t.' .~y,? ................ Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~stmg use and occupancy ..... ~ .c..a:~. { ........................................................ b. Intended use and occupancy .jff.¢.~.u...o~,e .............. ~ '.'."- ;/;e~.; ,~!~.~: ..,'~.'~ ~-. ~ ~...~,: .......... 3. Nature of work (check which applicable): New Building .... 'Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .... Other Work.:.. . , ', ')~ t~ ~ ...................... g ~ -'.~, (Description) ~ : ~, ". (to be paid on filing this application) $.' If dwelling, number of dWelling units .... /. ..... ~,... Number of dwelling units on each floor ................ If garage, number of cars .... ! ........... 2.~.a. .... .O..~..e/~, .................. - ...................... 6. If business, commercial or mixod occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structu~es, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dim fi w th It dditi R · e sions of same structure 'i aerations or a OhS: Front ................. ear .................. Depth i Height Number of Stories .... 8. Dimensions of entire new consiruction: Front ...... ~.O. ...... Rear ....~..O. ........ Depth . o~-.~. .......... ~ ~' Number of Stories Height .................................................................. 9. Size of lot: Front ..... Iff...O.I ............ Rear ..... /. ff...~ ............. Depth .. ~.1~. ................ 10. Date of Purchase ..... O~ :..1it~'. ................ AName of Former Owner ... ~'~.o.[[~.~,.~.¢ 8; .......... 11. Zone or use d~stnct m which premises are s~tuated .... .~.~i ............................................. 12. Does proposed construction violate any zoning law. ordinance or regulation: .~.o ........................ 13. Willl~tberegraded ...J/eCi;..,~;...,4_. ......... : ....Willexceii~l~e~'el~,ove~fr:ompre~n'ises: ~ No 14. Name of Owner of premises . :~ ..bq~ 1...~k~.~.ea. Address ~.~. ..... o.,.d..vt ~ a0M.~Phone No ~-~/.g.~ ... Name of Architect . Address ................ Phone No ..... 741. ............. Name of Contractor ..... w.~..o.q ....Address .................. Phone No ................ 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 show street names and indicate whether interior or 'corner lot. STATE OF NEW YORK, ...... ~O.b.e~.'~. .... ~ .Irma...~[ .~.% ................. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the ............................................................ ~ (Contractor, agent, corporate officer, etc.) of said o~ner or owners, ~d is d~ly authorized to perfom or have perfomed the said work and to m~e and file this application; that ~1 statements contained ~ this application are tree to the best of his knowledge and belief; and that the work will be perfomed in the m~n:er set forth in the application filed therewith. Sworn to before me this . . . . ota. u ,o ..... ..... oun y