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Home My WebLink About14725-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15430 Date November 26, . .................................................. 19.. 86 THIS CERTIFIES that the building ... New Dwelling Location of Property 80 JACKSON STREET NEW SUFFOLK-- House No. Street Ham/et County Tax Map No. 1000Seetion ...1.1.7. ...... Block 10 .Lot 1 BLD ~1. ' Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .F.o~.... $.8 ........ 1,9.8..6pursuant to which Building Permit No. 14725Z dated .. A~.ril..2 ................. 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 ......... ...... Raco=s.trucg..a. or~e..t~u.5,1.7..d.w.e. 1..1.i.n.g .. ................................. The certificate is issued to . .K.E.N.N.E.T..H..~.:..~.K.E.S..O.N..K.I.~p.G.E.N. ?.R' ?.9.Z?!.C. 9.~?~.¥ ......... (owner, k~eXgfX~grF~x of the aforesaid building. Suffolk County Department of Health Approval ....... I~1[.~. ............................... UNDERWRITERS CERTIFICATE NO ............... Ig7 6.2.4 8 9 ........................... Rev. 1/81 PLUMBERS CERTIFICATE Nov. 22, 1986 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW~ HALl.. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~T.o 14725 Z Date ..... ~. Permission is hereby, granted to: County Tax Map No. 1000 Section ....... ).~..~. ......... Block .... J..(~ ............ Lot No...~....~!.~J...L pursuant to application doted ~......'~....~. .................. 19.~..~_., and approved by the Building Inspector. Rev, 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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~ 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 iprior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~perty 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 bu ildings. 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: I. Certificate of oc_cupancy $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 .......................... NewC°nstructi°n· ~ .. Oki or Pre-existin g Buildin g ............ Vacant Lan d ............. Location of Property House No. Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section .......... Block ..... (.q ....... Lot.. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ ................. Fee Submitted $. Applicant . .~../~.~'~/~, ,-d'~,~ ..................... Rev. 10-10-78 cd ,z /C 3¢ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Halt Southold, N.Y. TEMPORARY Certificate Of Occupancy August 20 1986 No. Z14822 Date ................. ', ,, THIS CERTIFIES that the building ....... .0.n.e.. F..a.m,i. 1. y..d.w.e. 1..1 .i.n.a .................. : Location of Property 80 Jacl~son Street .Ne.w.S.u.ffol.k.,..N .Y House No. Street Harnle~ County Tax Map No. ]000 Section ... ~ ~ 7 ...... Block ..... ~ 9 ........ Lot .. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated February 28, 19 .8.6. pursuant to which Building Permit No. q 4725 z dated April 2, 19 .86, 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 ......... One famil, y dwelli.n.g. The certificate is issued to ....................................................... Kimogenor Poi.n.t Com~a.n7 (owner, ~aJ~e,~ of the aforesaid buildiag. Suffolk County Department of Health Approval ........ .P.~r~ ~1 ~_~ ......................... N7.624.89 UNDERWRITERS CERTIFICATE NO ................................................ Plumbers Certification Pending This Temporary Certificate of Occupancy expires October 2, 1987 Building Inspector Rev. 1/81 INSUECTION COMMENTS FIELD FOUNDATION (1st) FOUNDATION (2nd) 2. / ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF $OUTHOLD 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 -, ~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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 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. O0 ,~ /J ,~/1 f 5 .Updated C.O. ,// $15.00 Date .~.. ~,..~..~. .... Location of Property... f~.... ~..~. · ./z./~. ~...-'~..~ Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section . ./. [.7 ........ Block ../.~. ......... Lot..l..../~...~... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. f.z'/..~...Z-. Date of Permit y~:-:-/~/'. .Applicant'S..~.~..~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters APprovalN'~. t~/~...¢~...~/~..~"~ .Planning Board Approval Request for Tempor.~y Certificate ..... /~. .............. Final Certificate ....................... Fee Submitted $ ....~/ / ~.,. ~'~ ....... Construction on above described building and permit ~~e.s an~regulations. Applicant ....... ~D~.. ~ ~ .................. Rev. ~O-lO-7a 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION []FINAL REMARKS: ~DATE INSPECTOR , THE NEW YORK BOARD OF FIRE UNDERWRITERS ]000045 BUREAU OF ELECTRICIT'~ ~'~.~L E5 JOHN STREET, NEW YORK, NEW YORK 10038 ..;, August s,:~g~6 ~,.pl,~.,,o. No.o.~,e 4o:Lsss/~6 N762489 THIS CERTIFIES tHAT only the eJe~tricel equipment as ~described below and introduced by the applicant named orr tI~e above appl~cat~o~ ~u mtoer in the premises of Kenith Ackerson, Jackson St., Komeginal Pt., New SuffoJ. k, N.Y. in the following location; ~ Basement ~ Ist FI. .~.e..,,d.~do,~ July 31,1986 FIXTURE OUTLETS 69 66 DRYERS FIXTURES 84 69 MOTORS FUTURE APPLIANCE FEEDERS ~ 2nd FL ~ectlon Block and found to be in compl,ance uqth the require nents o.f thiz Board. Lot SERVICE DISCONNECT ITHER APPARATUS: Smoke Detector-1 OF CC. COHO 250mcm EXHAUST FANS MULTI-OUTLET DIM/~ERS SYSTEMS NO. OF FEET E [~ OF NEUYRALSl a,W O 1 25 Om cm B. S. Electric Stillwater Ave, Cutchogue, 1.1955 GENERAL MAI~AGER COPY:, FOR, BI~I:LDING DEPARTMENT. THIS COPY: OF CERTIFICATE. ' : MUS~r,NOT.: BE A~TERED, ,. IN ANY MANNER 76~-~802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [, ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ INSULATION [ ] FRAMING REMARKS: [ ] FINAL DATE~ .... ~/~!/~/ 7654802 BUILDING DEPT. INSPECTION FOUNDATION '"ST [ ] ROUGH PLBG. FRAMING ,r ] FINAL ~~..~ / REMARKS: 76S-XSOZ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND ~ INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE .~////~(~ ,NSPEL~I'OR ~~~ 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. Owner ~,~/~;7~ n~)~o/~, (~iease pri (please print) / I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~l~day of ~ ~_3 Notary Pub County (plumber s signature) Votary Public FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Z14822 TEMPORARY Certificate Of Occupancy Date ........ fi..u.~.u.s, t}...2.0., .............. 19 .8.6. THIS CERTIFIES that the building One Family dwelling · Location of Property 80 JacR.son S.t?.qe;t .~... New Suffolk, .lxJ.,.Y.. ........ 1213t~s~ '~1'o: ............. 'S"t~'; ............... Hamlet County Tax Map No. I000 Section ... 1 ~ 7 ...... Block ..... 1 0 ........Lot.. 3..I31 clg... 1 o.. '. Subdivision Filed Map No Lot No ' conforms substantially to the Application for Building Permit heretofore filed in this office dated Fe.b.~.u. ar.y. 28~ ,19 .8.6. pursuant to which Building Permit No. 14725Z dated P:. P..v .~.1.......................2, 19. ..86, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued il~. ........ On.e fa.mily dwelling ,-,. The certificate is issued to K.$.mp.g.e.n. 9? P. 9;i.n.t. Com~an.y [owner, l~reTo~ of the aforesaid building. Suf~Ik County Department of Health Approval 2qn$ ir~g . · UNDERWRITERS CERTIFICATE NO .............. ~ ~.~ ~ ~ ............................ Plumbers Certification Fending This Temporary Certificate of Occupancy expires October 2, 1987 Building Inspector R~. 1/81 Memorandum from... · BUILDING INSPECTOR'S OFFICE TOWN OF $OUTHOLD TOWN H^LL, So~'rHOLD, N, Y. 11971 765-1802 Examined . .~-~....~. · Approved . · .~.. , .2,.. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19 :~.~' ., 19 .~.~. Permit No, .J..~.~..~...~'..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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. .. & .................. (Signafure of applicant, or name, if a corporation) .../.~g ./g.,.,~o..~¥ ..~....F¢~.. ~.,/F.,.2~. W..1<'../?~..~.. (Mailing address of applicant) State whether applicant is~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . . 71..~..~.(v.~. (.(r....~.~:...~..~?. ?.~... (as on the tax roll or latest deed) If apptic,ant ista~on, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... /.'/. l, ~ , Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..... .o. ...... .... ............. .............. House Nmnber Street Hamlet County TaxMap No. 1000 Section./.[.7. ............ 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 ....... ~../~..~...~..~..~w...~..&?.3',/~...~..~..~.~.~. ................................ b. Intended use and occupancy ............ ~ ~...g~. ........ /..~..~'7..~..~..~. .................... 3. Nature of work (check which applicable): New Builffing ..... ', .... Addition .............. Removal ............. ........ 4. Estimated Cost ........ /.~ . .0. 0. .0 ....................... Fee · i · · Other Work ....... i ........ (Description) · (to be paid on filing this application) 5. If dwelling, number of dwelling~u~its ............... Number of dwelling units on each floor ................ If garage, number of cars .... .~. (Y ........ ' ............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ./fl~..o ......... i ' ' '. 7. D~mens~ons of existing structures, if any Front. ~..2--... Rear ~. ~' ~ /O De-th Height .... 2,~ ...... Number of Stories .'"'/~.'a,, ........... ! ...... ~ ........ . ....... Dimensions of same structure with alterations or additions: Front .... .~'..~.. .... } .... Rear . .'~...'P. Z ~./.~.~. .... Depth ....... '~.~'. f. .......... Height ..... ~,~'f ............. Number of Stories .... /..P~'~ .............. 8. Dimensions of entire new construction: Front ..... ~..7<. ...... Rear .~..~..t'~'!q ..... Depth ...~.1' .......... Height ...... ~-~.: ..... Number of Stories .../. t~.~,. ..................... ! ........................... 9. Size of lot: Front ... i .................. Rear ...................... Depth ...................... 10. Date of Purchase .... ]¢Pl ..................... Name of Former Owner . 'i..~.~..t~..~. .................. 11. Zone or use district in which premises are situated ............ i . · : . 12. Does proposed construction violate any zoning law, ordinance or regulation:' i ~.' .~[ i . i i i i i i i i . i i i i i i i '. i i i i i i i . 13. Will lot be regraded ...... : . '.' .~.o.:; '~ .... :, ....... Will excess fill be r~move~ from premises: Yes 14. Name of Owner of premises .~.~.~.~.Tq .w.,.~??.~fy ... Address/gg/Ot.,~o~e~(/-d_.i,~_~al~. Phone No 7~° Name of Architect .......................... Address ............... i... Phone No. Name of Contractor ~..~. .$.,'q;/.~. ................ a,~,~,.,~ ~'~? ~,~,~ c~t~tr l '~...~ ~. '. '~,.~ ~ ..... ......... 7'-'-'~Z'O~/d ',~'?~'$,,~ · . 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 ~ndma e whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .... S.S ................................................. 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 the said work and to make and file this ?pplication; that all statements contained in this application are true to the best of hlsiknowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .' .......... .0'. .......... day of ........ ? . .,-~.. ....... , 19 .~.,~. Notary Public ...... .c-. ...... County t , ! _ .' ~ ~1~1~ a0, la_2r,.Z : (Signature of applicant) ' ' ' ' APPROVED AS NOTED ., , FEEt ' BY' , ," NOTI~ ~IEDING DEPARTMENT ', 766~{802 9 AM ~0 4 PM ~R THE ,' '.' ' FoLkOw N~ ~U~P~ONS: , :. - : 1 FO~I~DA:CION )~OREQUIRED , ' FOR' ~(~)URED CON~ETE . THE ~EaU n~EkyS OF ~HE N:~ ,',.. ,,,,. ,,, .,,.,.:~.'. ~. :. C j P-.'~ 'f 0 / / ~]