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Home My WebLink About15087-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~.!~80~ ....... THIS CERTIFIES that the building ....~.n. cj[r. 9.u.n.d...s.w.i..mLn..i.n.g..p.o.o.~... ................. Location of Property ..... .4.1.7.0. O ............ .R.o.u.~e...2.5. ................ .p.??.o.n.J:? ..... House No. Street Hamlet County Tax Map No. ] 000 Section ..... 8..6 ..... Block ...... 1. ........ Lot ..... 6.: 2 Subdivision ............. ;g ................. Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated July 10, 1986 15087Z ...................... pursuant to which Building Permit No ...................... dated .... July 14, 1986 ........................ 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 ......... Inground swimming pool. ADOLPH H. & THERESA A. WESTERLUND The certificate is issued to ..................... io~n'd','~j~'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .................. ~1 [ ~. .................... N762705 UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FOILM NO. ~ TOWH OF SOUTHOLD BUILDING DEPARTtv~ENT TOWN HALL SOUTHOLD, N. Y. N°. BUILDING PERJv~IT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o~7 z ~o,~....]..~ ........... !.~ ................... County Tax Mop No. 1000 Section ...(~..~.~. ...... Block ....~..( .......... Lot No..4~::~ ......... pursuant to application doted ,.~.(,~:.C..~... ....... t.O. ...................... , 19.8~:~, and approved by the 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 A. This application must be filled in typewriter OR ink, and submitted m Ia,re,sam 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 $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50,00 3. Copy of certificate of occupancy $ 5.'00, over 5 years $10.00 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..xe~... t~4~..~...¢..O, .~3. ..... DZ.-.'-¢..o..~../'¢.....~..,.%.../,L.?.:... House No. Street l-lam/et Owner or Owners of Property . .~. C~..D.[rtQ..~1....~.q...~-... County Tax Map No. 1000 Section ..... ~',.~ ....... Block ..... /. ........ Lot.., Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.' ./?,~O.~.7. ,~. Date of Permit. ~./.~...Applican{~),~d~./~./~... ,~/.;. Health Dept. Approval ....................... Labor Dept. Approval ................... Underwriters Approval.../.~. ,~..~..~7Z72~' ....... Planning Board Approval .... ./?,/,/~. ............ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~.~.--., .3,D. ................. Construction on above described building and~rmj~ meets all applicat~le cod~s and reg~ions. . .~. ,~ ~,ppdcant . (,,~. ~¢'~'...'~/~'~. ~ ~~ ........... Roy, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK '10038 THI~ CERTI~IE~ THAT only the electrical ~uipment ~ ~scrib~ b¢~w a~ int~duced by the applicant ~med on the a~ve application number in the premises of in the following Iocation~ ~ Ba.soment ~ Ist FI. ~ 2nd ~7. ~t~de ,s~ot~o, Bto,~ ~s examDwd on Ju~yo~, '~' ~ and found to be in compliance with the requlretnent s of. this Board, FIXTURE / FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SW[1CHRSINCANDESCENT FLUORESCENT 1 1 DRYERS FURNACE MOTORS FUTURE FEEDERS TIMECLOCKS UNIT HEATERS JULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT $ E R V I C NO OF CC, COND. PER ~' OTHER APPARATUS: 1-G.F. C[ · panelboards: 1-Scir. ~emps m~5{I~lI~_~L~) r~his certificate covers ~liance at the date of inspection onl{. Because of unusual environments it is advisable to have frequent test/and or rep~&irs made by a qualified person. F~a~ T, Stepnoski 42C Little Neck Boed C~tchogue, N.Y, 11935 MC. 120~ GENERAL MANAGER 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 B~ILDING DEPARTMENT. THIS COPY Ol:: CERTIFICATE MpST NOT BE;ALTERED IN ANY MANNER. 765.1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [~FINAL INSPECTO~~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD. N.Y. 11971 TEL. TO Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons. ~ An application for Certificate of Occupancy is not on file. ~ --/~L~ No Underwriters Certificate on file. The check is(outdated/o~ on file.) ~-O~ /Z/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. __Building Permit # a~/ .J O f ~ Z ~Po~0 Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FIELD INS[gCTI~N COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY GODE ADDITIONAL COMMENTS 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1802 BI.DG. DEPT. TOWN OF SOUTf'~OLD APPLICATION FOR BUILDING PERMIT ¢(IQ Date ........ ..... ,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 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. , ..... ~:. ~.¢..~.~....,7~. ,,...' ._~.. ~., ........ (Signature of applicant, or name, if a corporation) · ~.. ~..?~.%..&~./;7~z~. ~.7.....l~. (Mailing address of applicant) State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .......... .~. ~.~.~.~. ~...C.o.~ .~...~..c..&FCA. ....................................................... ~an, e of owner of premises .. ,/'~..b..CF././.....'Z..'~..... 7',7'/~.,'fZ.~ ~. ..... .~...*~.' ..F~'-~ .<, ~,~.~. ............. (as on the tax roll or latest deed) If ~0~a~t isa corporatio]{),~ig~re of/uly authorized officer. ' ' '~' '~t/~a' e~o}" ' ' · i fi0e;) ......... Builder's License No ...... /(,.) ................ Plumber's License No ......................... Electrician's License No.../~..~..~).....~...~..-J~..LC,_ Other Trade's License No ...................... Location of land on which proposed work will be done.., g.~.... ~...~. ..... ~..~ .-~..AI..I..~. .... ,/~,g: ........ ...~.1.7~ ~ ............ g,.+. ...... ~.~.. .................... ~....~r?~.~..o... ~.. F. ............. House Nmnber Street Hamlet County Tax Map No· 1000 Section ........ ~'..~. ...... Block ...... / ........... Lot ..... ~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (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 .......... ........................... ~ ' · ~'~*~ ~.'~u'~.?:~ ~'..*'. ,~ '~ ........ ..... , . · Nature of work (checl~ which apphcable): New Building .......... Addition .......... Alteration ........ ,... Repair ' ....' R~m'oval ..... Demolition ........ · . ......... · ..... Other Work ............ ~' ~' 9. ~.0(~' c~ .~..~....~ (Description) 4. Estimated Co .... ',~. · · · ·, Fee . : o ~ i ~to be paid on fihng thru apphcatlon) 5. If dwelling, number of dwellir~g 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 eacl/type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... lteight ............... Number of Stories ........................................................ Dimensions'of same strncture ~ith alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... tteight f 1;i:'~;~'~t ........ Number of Stories ............ · ' 9. raze o .......... ; ........... Rear ......... ; ............ Depth ...................... 10. Date of. Purchase .......... i.... ..... ... ......NameofFormerOwner . .............. ........... . . . 11. Zone or use d~stmct in which pr~mmes are situated .................................... 12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ...................... , ......... 13. Will lot be regraded ........ i . ' Yes No , .,: .~ ......... . ......Will exe~ fill be removed from premises: I4. Name of Owner Of premises ...I,,~. ~5'.~.(.~.,? .tO Address .~..L-'~..l.c_ . ./F .~f.,' Phone No Name of Architect ......... ~ ................. Address Name of Contractor .~.'..~.E'./.6./, .... f..~ff. C~,,L~... Address i ~t.'j~'~ i~'i Phone $o.Ph°ne No. i5. Is this property located iwithin 300 feet of a tidal wetland? *Yes ..... No .~.. · If yep, Southold Town TrUstees Permit maybe required. i PLOT DIAGRAM Lc cate clearly and dmtmctly allI buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .................. I.S ............................. , ................... being duly sworn, deposes and says that he is the applicant ~Name of individual signing contract) above named. He is the ' 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 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 mannerlset forth in the application filed'therewith. Sworn to before me this Notary Public .............. .~-..~..Ofr'~. · ..... County ~l~ 4,~~7 '~ e of applicant)