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Home My WebLink About14819-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15238 Date February 2, 1987 THIS CERTIFIESthatthcbuilding ONE FAMILY DWELLING WITH ATTACHED GARAGE Location of Property 2650 STARS ROAD EAST MARION, NEW YORK . County Tax Map No. 1000 Section 0 2 2 .Block 04 .Lot 2 5 Subdivision M/o Soundcrest Woods. Sec.~'[ I Filed Map No 5315 20 ........................................ Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 21, 1986 I4819Z ..................... , . . pursuant to which Building Permit No ...................... dated May 3, 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 ......... ONE FAMILY DWELLING WITH ATTACHED GARAGE The certificate is issued to HARRY & DOROTHY BROACH ..................... ?oYn'dr,' eY 4 × .................... of the aforesaid building. Suffolk County Department of Health Approval 8 6- S O- 6 9 UNDERWRITERS CERTIFICATE NO. N 777318 November 24, 1986 PLUMBERS CERTIFICATION DATED: Rev. 1/81 I~ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14819 Z Permission is hereb/granted to: .~.~.~..,..~.~..~.~.:.,...~..: ....... ..l..a.~......~.' ~....~.'. ................... ~ .......... ~~....~.:¥.,.....l.L.t~..~. ......... 0t ~re~,~es ~o~o~ed at...~.~.~. ...... ...~....~....~..., ...... ....~......~....~.~~.....~..~.'. .... County Tax Mop No. 1000 Section ...(~...~.....'~... ....... Block ..... ..~...~. ......... Lot No....~,.~'~.. ............ pursuant to application dated ...~.~.......~-.~. ......................... , 19..~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 natu rat (Jr 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 building. 5. Submit Planning Board approval of completed site plan requirements where applicabte. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peoperty 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 bu, ildings 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 or land use $5,00 3. Copy of certificate of occupancy $1.00 Date ...... ..... ?. ........... New Building .... .~'.. ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....................................... House No. Street Hamlet Owner or Owners of Property. ......... ..................... County Tax Map No. 1000 Section ..... .~.~.. ,~,... Block ....~ .......... Lot...~..0~.. ......... Subdivision...~.l~q.. ?..~'...~..~..~..~.[~.~j~ ~..Filed Map No...5.:~,~. ~.~'..Lot No..~;3 ......... Permit No. J.~ .~.l.~J . . Date of Permit ...~*J.3/?.(~ .Applicant., .L~.;.~.~5, 1~.~!-[; ,~.,~..1~.'.~..~..~. , ..... 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 [~r~m'~ts all applic~ab~ee codes and regu latij~, Applicant/.,, .~..~... ,~..~.. ,~.~..~'~/'-// ~/ ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS loo0771 BUREAU OF ELECTRICITY ~118 STREET, NEW YORK, NEW YORK '10038 B5 JOHN ..,e ,~ow.~.r 04. ~.~8~ ~,,~.,,o.~o.o.~.~ 4~o~/8~ N 777318 THI~ CERTIFIES THAT o~y the e~ctrtcal equipment ~ bacribed belo~ and introduced by t~ ~ppllcant ~med on the a~e application nu tuber in the premises of Ratty ~roach, ~/$ Sta:s ~oa~, 900'~/O W~i~ D~., ~ast ~ri~, NY ~s examined on O~[o~r ~ ~ and found to be in coo~plle~tce ~'ith the req~dre.~ents qf this Board FIXTURE I FIXTURES I ~ RANGES~2.] C~KINGDECKS *~T [ W OVENS DISHWASHERS EXHAUST FANS [/o Motors ~ ~-lhp, ~ I-G.E.C. [. 1-Smoke de~ec~or P.O. Box ~43 tmC~tuck, ~Y 119~2 Lie~24~ GENEEAL MANAGER Per_ This cedlficate must notbe a tered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COpY FOR B ILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUS~NOT B~.~ ALTERED N 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. Owner ~1~9~. (please priht) (please print) Plumber I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber s signature) Sworn to before me this Notary Public,~m~f~ County Notary Public FIELD INSFECTION FOUNDATION __//~{ } s t ) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING COMMENTS INSULATION PER N. STATE ENERGY CODE ADDITIONAL TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 To Whom This May Concern, We are unable to complete your Certific~ of Occupancy because,of the following reason~ /_~ An application for~~%Certificate of Occup~ is not on file.~/~J~ /--/ No Underwriters Certificate on file. /--/ The check is(o~=~lA~=~/not on file.)~P /~/No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matte] Thank you for your cooperation. Building Permit # ~ ~ ~7~/ ~_ ~' Building Dept. ***/--~No Plumber Solder Certificate on file.! ( all permits involving plumbing bein! issued after April 1,1984 ) TEL. 765-180 ey 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL DATE / ~' INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 2ND[~] INSULATION [ ] FRAMING [ ] FINAL [ ] FOUNDATION 1ST 765-1802 ~ ~ BUILDING DEPT. INSPEC:TION [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE INSPECTOR 7GS-~802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ~ FOUNDATION 2ND [ ~ INSULATION FRAMING FINAL INSPECTOR 765-1802 BUILDING DEPT. INSPECTION ~/~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ /~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined...%09..~ .... ,B. .... , 19 ?.~. Approved ...~ .o~.,~ ., 19 .~.~. Permit No..}.q.~./.g..'~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TOWN OF $OUTHOLD Received ........... ,19... a. This application must be completely filled in by typewtiter 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. Th~ work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building,I'hspector 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 {~ 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 pumuant 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 in~pections.t,~ .~.': .~.'¢/~ ..'.. .......... ...... (Signature of applicant, or name, j( a corporation) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. .......................................................................... Name of owner ofpremises ~.~.' '~'..~..~..~.~...~..~1....¢ .~..~...C: .~. .......................................... (as on the tax roll or latest deed) If applicant i~o~ration, signature ofsl2d~ authorized 9,~ficer. ~~~tlcerj Builder's License No .......................... Plumber's License No...0. ~ ~J.~. ~..~...~....~/. ~-~,~tq Electrician's License No. ~,,~(O~..V0....~.l.~..9~..t~?.k.~ Other Trade's License No ...................... ..9.(O~,_t. ,~'.. 1. Location of land on which proposed work will be done..~/~' House Number Street Hamlet County Tax Map No. 1000 Section ..... O..~..~1.~_. .......Block ..... .~. ........... 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 ...0.~..~ ...... [ ....... '~{.'.~. ~o... ' .... 3. Nature of work (check which applicable): New Building .~...~. ..... Addition . Repair .............. Removal .............. Demolition ........ 4. Estimated Cost ...... If?. ~ .~..~ .')m~'~.~ .................... Fee ....... (to be ........ Alteration ...... - .... ~'.. Other Work ...... (Description) ~aid on filing this application)~ 5. If dwelling, nqmber of dwelling units .... ~'"...... Number of dwelling unit. on each floor ................ If garage, number of cars ...... O~.L~ ................................. , ................... , ........ 6. If business, commercial or mixed occupancy, specify nature and extent of each typ of use ..................... 7. Dimensions ofekisting structures, if any: Front ............... Rear ....... i ..... Depth ............... Height ............... Number of Stories ............................ ~ ........................... Dimensions of same structure with alterations or additions: Front ........... i .... Rear .................. Depth ...................... Height ........ ,..,.~ .......... Number of, Stories ............ t · · .t~ ..... 8. Dimensions of el~ire new construction Front .(~. ....... Rear . ~.~". ~ . Depth ,~. Height ] ~.' Number of Stories odL~''' . ' .................... 10. Date of Purchase .... ~'1~ ...................... Name of Former Owner . 4 ~.'~g.,~/gC2 .... .~.~'.7./. .... 11. Zone or use dmtnct m winch pre ~ses are mtUated .................... , ....., ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation...~.C} ....................... 13. Will lot be regraded ....~. ~l ........... .... ~. J.. Will excess fill be r~moved from premises. Yes (~q0J Name of Architect .../ .............. : ........ Address ............... i ' · · Phone No .... :, ........... 15. Is this property located with±nil00 feet of a tidal wetland? * Yes ..... No .~... · If yes, Southold Town Trustees Permit may be required. PLOT D~AGRA~ Locate cleazly and distinctly ~1 buildings, whether existing or proposed, end, indicate M1 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 Y~RK, ~, ,. ,. COUNTY OF~~ .... ~'~ 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 s~ .id 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 thai: the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... · .<~../q~.(~. ~-, . .day of...._..~. ~ ...... ~ [ (Signature of applican?)i to RODERICK VA.~L.TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT. OF HEALTH SERVICES. (si APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY DATE: H, S. REF. NO. APPROVED: SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT BLOCK PCL OWNERS ADDRESS: II ~ '//~.. DEED: L. P. TEST HOLE STAMP r~ SEAL BLDG. DEPT. TOWN OF SOUTHOLD ~-m~-r ///A,~/ON, /,/ ~ RODERICK VANTUYL P.C. v.__ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HE:ALTH DEPT. /Mail, OVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAG~ DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT. OF HEALTH SERVICES. (si ,, APPLICANT SUFFOLK SERVICES -- FOR CONSTRUCTION ONLY DATE: H. S. REF. NO,: APPROVED: COUNTY DEPT. OF' HEALTH APPROVAL OF SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL I,~0 0~ ,~ ~ OWNERS ADDRESS: // ~q, DEED: L. P. TEST HOLE STAMP SEAL ,/ APR 4 198~ S.C. DEPT. OF J~LTH SERVICES R,~DERICK VA,,,N..TUYL, P.C. . V'.,~--.~ d~ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM S ~, AR OF THE SUFFOLK CO.~DL~I~bE HEJM-TH~ERVLCES. is) /, o. AI~LICAqflT SUFFOLK COUNTY DEPT~ OF HEALTH SERVICES - FOR APPROVAL OF CONSTRUCTION ONL~f DATE: * '~' H.S. REF NO. ~ AP~OVED - ~ ~-~ g~V~ [ FA~L~~'~",," SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT BL~K PCL DEED: L. P. TEST HOLE STAMP SEAL · %-- SUFFOLK CO. HEALTH DE"f~r.~....._._AF~OVAL H.S. NO. S.C D[a~ THE WATER 5U~LY AND ~WAGE DI~AL ........... f~_ ~ ~,~H ~/~, , ~ SYSTEMS FOR THIS ~E~OENCE WILL ', ~ CONF~ ~' , .... ,~ SUFFOLK ~O. ~OF/~~R i~! / ~t SUFFOLK COUNTY DEPT. OF HEA~ " CONSTRUCT~N ONLY ~T~: I; *~ov~: ".~ . ,, , SUFFOLK CO. TAX MAP OESIONAT~N: // ._C~J/¢' ~: ~ //I~/EE¢'::/;,, DIST. ~CT. BL~K ~L - ' - ' ' . . , . ¢ -,~.~?z / !i:;~.' i:' ~ TE~ HOLE ~A In e* '. ' ~ '~,'<' % .7 .... ~', · ' ' .". ,~.~ SUFFOI~ COunTY H~ALTH DEPARTMENT '~ ~:' ~ -' LE Y ILY DWELLING ONLY DATE, ~ ..... ~ 2,1 ~' ,/~:,.~..~,:~.~:~' ~:&~h..,~ ~.~,'~-..,. ~,~- ~,~) ~ ,' TH E SEWAGE e¢ ~S~ A~ e ?:' TER SUPPLY ~AC~Lm~S fOR TH~S ' ' ' ' ~[~EEN, II~P~OrED BY THi~ DEPARTMENT AND , , ,. ¢'/: ~ef of W~stewater Management SectiOn ' L)CE~O LAND SURVZYORS .... ~EEN~RT NEW Y~K *..~. SUFFOI ~ coU,~TY H~ALTH DEPARTMENT., ')-:.'.;. -/~o~! SII~ ~LE FA,,~41LY'~DWELLING ONLY H.D. REF. NO. ~ ~ ~- &? DATE, ~ ..... ~'~,1 ~' THE 8EWAGEe~ ~SA~ ~?? TER SUPPLY FAOILITfES ~OR THIS .~~,~EEN. I¢~P~OrED BY THiS DEPARTMENT AND ,~. ¢'/: mf of Wbstewa~er Management SectiOn ', If copper tubing. I~ use~ for wator distributing system; piping shall be of tl~s K or L only PLUMBER CERTIFICATION ON LEAD CONTENT ~EFORE CERTIFICATff OF OCCUPANCY SOLDER USED IN WATER SUFPLY SYSTEM CANNOT EXCEED 2/10 ~! fY LEAD. A~'P~OVED AS NOTED FEE' ~/, ~ ~ BY? ~' ~" ~' NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM ~R THE FOLLOWING INSPEC~ONS: I PO~DA~ION ~0 REQUIRED FOR POURE~ CONCRETE 2 ROUGH FRAMING & PLUMBING