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Home My WebLink About15082-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z. ] ~.4.4. Q ....... Date December 2j 19.8..6 THIS CERTIFIES that the building Addition to existing one family dwelling Locatin~ofP ....... 770 Middleton Road Greenport, N.Y. '\ ~-- ....... · vp~y ........ House Vo. 's't/eet .... County Tax Map No. 1000 Section . . . .0.4.0 ...... Block . .qs. ........... Lot .... 9.8 ....-': ..... '.~ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated d.u..ly..9. ~ .............. 1~9 .8.6. pursuant to which Btfilding Permit No.. ~..5.0.8.2. Z. ............. dated ...J .u.l.y.._! .!., ................. 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 ......... Addition to existing one family dwelling The certificate is issued to William E. Adams Jr. & Carolyn Adams ..................... .................... of the aforesaid building· Suffolk County Department of Health Approval ~ N/A UNDERWRITERS CERTIFICATE NO N 7 7 5 9 8 9 Rev. 1/81 · ~ding Inspector ffO~g,~ 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) Nq ~5082 Z Permission is hereby granted to: ......... ..~.~.~......~..~.~~......~. ............... ..~.~~....,.....~...~.,...~ ............ .V.. ...... o~ ~,~e~ ~ed ~ ....3..3..~......~..~.~...~.~ ......... ~ ........................ County Tax Map No. 1000 Section ....... .C~..,~..°. ..... Block ....... ,,(~.,,~,, .... Lot No ..... ~...~ ............ pursuant to application doted ......... ~.....~. ....................... , 19.~..gt., and approved by the Building Inspector. Fee $..~. ................... Rev. 6/30/80 FiELD INS~'ECTION FOUNDATION FOUNDATION ( 2nd ) 2. k~ ?LUMBING INSULATION PER N. STATE ENERGY CODE C O~-h,~m,~ l S FINAL ADDITIONAL COMMENTS: FIXTU~ FIXTURES RANGES OVENS EXHAUST FANS $ E R V I C E I 4 1 GA~Y DOROSKI 425 HONSELL AVE. CUTC~OGUE, NY, 11935 P~r_ 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. COPY FOR BUILDING DEPARTMENT. THIS THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY O'109~t 8B JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the el~ trical equipment as described below and introduced by the applicant named on the above application nu tuber in the premises of ~ill Adams, 19 Hiddle~on Road, Greenport, in the follotei,,g location; [] B~ement [] Ist FI. [] 2nd Fl. Section Block Lot tt~s examined on Ootober 16 t 1986 and found to be in cotnpliance u'it h the requirements of this Board. FIXTURE 4 1 ~ FIXTURES OUTLETS RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT MVEA~pC~¥ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS HP AMT NO. A, W, G. RANGES ~PECIAL REC'PT R OTHER APPARATUS: V I A, W, G, NO. OF Hi,LEG CC, COND. OVENS DISH WASHERS NO. OF FEET C E EXHAUST DIMMERS A, W, G, NO OF NEUTRALS A.W.G. OF HI.LEG OF NEUTRAL Gary Doroski Per '~ .... ............... rreo nspeerors m~y De ~aentified b ~he~r credenho[s ~; , COP~Y FOE B''~ ............................ ~n'~~~~-~]l ]~ ~ ~ OF CEETIFICA~E MUST~NOT BE ALTEEED IN ANY ~NNER ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted i, ~ to the Building Inspec~ tot 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 featu res. 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 buitding. 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~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 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 C.O. $5.00 5.Updated C.O. $15.00 Date ............. t/NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.. ?. Z'~-J"'~'/d .... ' '/~' '/. '~' '~' 'dc.67~.' Housa No. -- -- -- Nam/et . ~ Street Owner or Owners of Property .~../..~.... ,~.~ .~..~..'.~:. ~'~'~' ~'~5 ~~.,D~., .". ........... - County lax No. 1000 Section ..J ....... Block . ......... ......... Subdivision ................................. Filed Map No ........... Lot No ............. Permit No./.~.~.~, Date of Permit ~./././/~.~.Applicant ~...~.~...~.~Z~...~.~..°.~..~..¢.~.~.~..,'?xS'* Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above described buildin~p~t_ meets all appli~ab~ codes,~nd regulations. Rev. 10-10-78 to 1 5qu 765-:!.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ~LST [ ] ROUGH PLBG. FOUNDATION 2ND [/~ULATION FRAMING [~ FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ~I]IUNDATION XST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: ~'~ FINAL ,,~, ,~. ,WITHOUT OF OCCUPANCY 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ', TEL.: 765-1803 Examined ~ ~%~ '' ,19~{~ Approved.. i .~-~..Il .... , 19'1~.~. Permit No./.~%~..R..&.~.... Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 street~ 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 Buildh~g 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 inspecti~ons. ~--> ~/] (Signature of applica, af, or name,qf a corporation) (Mailing address of applicant) State whether applicant is_owner,-ta~%'c;-ag-ed~, a[..9~hi~.e_ct, 5~g~)3.ser, ~ral c?ntractor, el~?~trician, plumber or kuilder. ),Jam~ of nwner o f ~remises - -PI~..~///'° .CRT. · .~.. '..~..~: .~..~..c~/, J~7.a/¢~/~;~./~.. (as on the tax roll~r la'est ~ '~-.: If applicant is a corporation, signature of duly authorized officer. ~?~. '")~,'g77'~/ '--. ~,; 1L~' ~) ~ -- ~', ;' ~ gy ~ ,~t?~,THE (Name and title of corporate officer) .. "I' ~'~'~:Y .~ult. DING OEPART~r~z~n~T Builder's License No ..........................~ r~u~-, ,,~,- , ,-~' --~ Plumber's License No. .~../'r~/~.¢ ..... 2. ROUG,I~.~,,'E> ":,'~[i~ 'r- ta" '- Electrician's License No ....................... -. ¥ - - '-. , ,,~,~ ,*r,,r~,. Other Trade's License No ...................... ' r~", '~ ~' 1. Location of land on which proposed work will be done'../~.~../~./..~.~ ,~.~~' '~<~.') ........ '... t ............. ~4~ ~. r.c ~.~..~ ........ ~g¢~.~ ...... House Number Street Hamlef r,, No. mOO S,,tio ..... ....... ..... ....... .... ........... ~/~ ~ / <~ ' Filed Map No. Lot ~ ...... Subdivision. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~.~.~.~/~..~ ~¢~ ............................. · b. Intended use and occupancy ...~~..~...~.~ ........................... 3. Nature of work (check which applicable): New Building .... ' Addition ......... A/teration .......... Repair .............. Removal~ ....... ....... Demolition .............. Other Work ............... 4. Estimated Cost . · "~ '~.,~..~..."~ __. Fee ...................................... ~ (to be paid on filing this application) 5. ~ dwelling, number of dwelhn~ u~mts ............... Number of dwelling units on each floor. ~. .......... ~ garage, number of cars .. ~. i ...................................................... 6. If business commercial or mixed occupancy, specify nature and extent of each type of use .~ ~. ~ ..... 7.D~mens~onsofemstmgstmctures4fany Front~.,~ Rear ~ Height ff~.. ~.~ ..... Number of Stories . / ......... ~.,. .................... Dimensions of same structure with alterations or additions Front ~ ~ .~ ~d~' '~ ~ ~ ..... Depth .................... i HeiSt Number of Stories Dimensions of entire new construction Front ~.. Rear ~'~// no~,h ///~ ~ '~* ~ ~ -, ~ __' ......................... ~ ............ ~ ....... ,,el~,,~ ...... ~: .... ~um~er of Stories ~ Size°flot:Fr~nt..~.~Q~/~' ' Rear 7~,o~/ ....... &"~/"b'~'U~'~'~'d'~ ,~ .... ~ ........ ~. - . .. uepn /..~z,. .... ~. .4: .... Date of Purchase ~ ~.M~ , a zone o~ use msmc, m wmcn premmes are mtuated. ~A ~z ~Z, . ....... Does proposed construc~o~ violate any zoning law, ordnance or regulation: .~: .............. Will lot be regraded . ~..., ................... Will excess fill be removed from premises: Yes NmeofOwnerofpremises ~..~.~.~ Address ........... '..PhoneNo ............ Nme of Architect .......... 4 ................ Address ................... Phone No ................ Nme of Contractor ; ................ Address ... : ...... Phone No ........... 15. IS thi's proper~y located ~ithin 300 feet of a tidal wetland~ ~ ~ ... ~ .... ' .... · If yes2, Southold To~ Trugtees Permit maybe required. PLOT DIAG~M -.- Locate cle~ly ~d distinctly ~1 ~ufld~gs, whether existing or proposed, ~d~indicate ~1 set-back d~ensions from prope~y fines. Give street ~d block number or desc~ption affcording toed~d, ~d show street nmos and indicate whether intefiororcornerlot. /~~ ~o~~ ~--~ 9. 10. 11, 12. 13. 14. STATE OF NEW YORK. ,, ,, ~ COUNTY OF .~,,~f'.~-~./~f~-.. ~'~ · r~ w'll'... " ...... I.rl., 11~ ....... ~4~... ~. ~ ....... ~eing duly sworn, deposes and says that he is the applicant (Name of individual signing contr~) above named. Heis the ~N~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul7 authohzed to perform 0r have perfo~ed the said work and to m~e ~d file this application; that all statements contaJned ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ne~ set forth in the application filed therewith. Sworn to before me this ......... , $ota~Publ.-Zic ............ dayof..~ ............ 19~ Ct~s. No. 52-6~86685 ......... · "~ ~ / (~gnature qf applicant) 765-1802 BUILDING DEPT. INSPECTION ]FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]~ULATION ] FRAMING I~]"FI NAL