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Home My WebLink About14824-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. g15721 Date .. May 4, 1987 THIS CERTlFIES that the building One family dwelling Location of Property 11 l0 Lighthouse Road Southold House No. Street Ham/et County Tax Map No. ]000 Section 0 5 0 .Block 5 . .Lot 9.2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · I4824Z .....~,a.r.c.h...2.8.:..I ,9.8.6~ ~ pursuant to which Building Penmt No ...................... dated . ~.a.y...3.,.. ! .9 .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 ......... One family dwelling and porch, The certificate is issued to CHRISTOPHER W. OLSEN & CLAUDIA E. HEYERS ..................... ................... of the aforesaid building. Suffolk County Department of Health Approval 85 - § 0- I 14 UNDERWRITERS CERTIFICATE NO. , N 7 9 9 6 9 7 - PLUMBERS CERTIFICATION DATED: March 11, 1987 Building Inspector Rev. 1/81 ]FORM NO. ~ 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) 14824 Z County Tax Mop No. 1000 Section ...... ¢:L~...~. ....... Block ...... .,0....~.. ........ Lot No.....~..'.....2:m'., .......... pursuant to application dated .... .~....~.~ ....................... , 19~.~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'I FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southotd, N,Y. 11971 765- 1802 T N OF 'SOUT~OL APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter 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. 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 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: Additions $25,00 I. Certificate of occupancy New ]:)well~n8 $25.00, Accessory,S10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ % 0. ~ 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $[0.00 4.Vacant Land C.O. $ 20.00 /.~.~ 5.Updated C.O. $ 50.00 Date .. .Z.[.,[c~'7 NewCOnstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .j.[~.(D /--./(~//r/-/O 5/~. /~.b D.O..O.{~..~.L.b' .... House No. . Street /Yam/et d f,o_ Owner or Owners of Property IJc~LS .T~,PtIE~ , Oi,~lf~ ui~t ~, Y!~£YZ/~b County Tax Map No. 1000 Section ...r~..:~.f~. ...... Block ~ Lot....(~,.; .~. ,Subdivision ................................. Filed Map No ........... Lot No .............. ..... . ' ' PermitNo I.~.~; ~-- Date of Permit .Applicant ~hq.. Fd.~( . ............. Health Dept. Approval ~.~..%SO. :-(4.~( .... ' .'~¢'~.. · .~'-....Labor Dept. Approval ........................ Underwriters Approval .~.777N~ .7..: Board Approval ...................... Request for Temporary Certificate ................... . .~in~al~ertificate .... ~([ ................. Fee Submitted $. ,.~,5';OO Construction on above described building and permit m~ts all applicable codes and regulations. Applicant ................................... Re~. 10-10-;'8 THE NEW YORK BOARD OF FIRE UNDERWRITERS '[000'J 2~' BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT Christopher Olsen~ Lighthouse Roa~ ~1~10~ Old ~o~th & in Ihe followlng location; [] Basement ~ Ist FI. ~ 2nd FL Section Block Lot ~-- I~ rrwflB# ? FIXTURES I RANGES ICOOKINGDEC~-I OVENS IDISHWASHERS 34 56 37 34 [ 10.4 1 1.2 i~~ ~ I~/° ~ ~/o EXHAUST FANS OTHER APPARATUS: 4-G.FoC.~. 1 Smoke Detector DIMMERS 275 TOWn Harbor T.a. ~//,/ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ident~ied by their credentials. ~ . C0~Y FORB~I~DING DEPARTMENT. THIS C~PY OF CERT!~A.~E MgS~¢NOT B,~ ~?~R~? IN ANY ~NN[R. TEL 765-1802' OFFICE OF BUILDING I "TOWN HALL '" . Building ';"'', Owner i' , Plumber X~ · I certify that ~'~el ~older used inthe water supply system contains less than 2 ' ,~' ~,, ' (plu~er s S Notary Publ; COM~ENT~S FOUNDATION ~_~(lst) FOUNDATION ~ 2. ROUGH FRAME & ?LUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDZTI COMMENTS: i 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING DAT£'~/~ ,,,INSPECTOR 7654802 BUILDING DEPT. INSPECTION f ] FOUNDATION 'IST ~ ] ROUQH PLBQ. [ ] FOUNDATION 2ND [,-a'/IINSULATION [ ] FRAMING [ ] FINAL 765-'~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION :~ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: r INSPECTOR 76S-1802 BUILDING DEPT. iNSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLB~I. FOUNDATION 2ND £ ] INSULATION [ ] FRAMING r REMARKS: [ ] FINAL 76S-1802, BUILDING, DEPT. INSPECTION [ ] FOUNDATION SST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 76§-180:~ ., .,Permit No.! Disapproved a/c ..................................... ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERIVIlT BLDG, DEPT. TOVVf~ OF SOUTHOLD Received ........... ,19.. · March 28 ~6 Date INSTRUCTIONS .~ a. This application must be completely filled in by Wpewriter 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 i~~t,(~~~/.~' a(~¢-ta~/~n ?o0. Box 520 Southold, N.Y. 11971 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Co- Owner/General Contractor Name of owner of premises ........................ ('ak 'o'n' it~e tax r~'---~ la'-tes-7 ~;;d) ....... If applicant is a corporation, signature of duly authorized officer. .... N ..4.. ............... (Name and title of corporate officer) Builder's License No .......................... P.umber s Lmense No~ ..................... X Electrician's License No. ~..Z'~. · 4. · .~. ?.. -~ff. · ~. .... Note: Christopher 01sen will be general contractor in nameI 'Victorian Homes/David Dowd will serve as construction manager~ and will be arranging subcontractors. Other Trade's License No...~ ................... ~ Ill O ' eas~-~idc of LSghthouse Rd. 1. Location of land on which proposed work will be done~ .. 7 ................ . ................. ............. 01d .,~rth l~d ~nd m~o~e, Southold, N.Y. House Number Street Hamlet County Tax Map No. 1000 Section .... ~.0 ............ Block ...... .5 ........... Lot ........ .9...2. ....... Subdivision...h/..e~..~r.+.b..s.e.t..-?.f.f...4./.1.d.8.5 ........Filed Map No...~.7.~). ........ Lot... [ ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... Vacant Land b. Intended use and occupancy Private Home Construction XXX 3. Nature of work (check which applicable): New Building .......... Addition ........ Alteration ....... ~.. Repair .............. Removal .............. Demolition ............ Other Work ....... , ...... (Description) 4 Estimated Cost ~90,000.. 00 .................... Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling un)ts; .............. Number of dwelling uniti on each floor ................ If garage, number of cars ..... g./[ ................................... ~ ........................... 6. If buslness, commercial or mixed occupancy, specify nature and extent of each typ~ of use .... N..., .A. ,. ............ 7. Dimensions of existing structures, if any: Front .... N.,.A, ...... Rear ....... i ...... Depth ............... . Height ............... Number of Stories ............................ i ................... : ........ Dimensions of same structure with alterations or additions: Front ' Rear Depth ................... Height. Num e 'to 'es .... 2,0,, ......... ...... 8, Dlmensmns,,oef.ent~re new constructmn Front ~ Rear. ~.~.. De th ).2 I Ox (~lus Height z , Number of Stories ~ ..... ...,~....ay..w.i.n¢o~w ,a, nd stnd B:Llco 9. Size flot' t 209.78 w~ 108,~3'6 ~. _506.66 Door~ o . Fron ........................................ ~ . ~11.12, DZ°oen,~ °r us~distric~n ~hicnh. premises,a, re situoated..~7..R..e.~, a.i~d.°~n.]c?.ir.~.-{.r.~..~.~c..u~i i i:. i i i i i i i i i i i i i i i · proposed corn .ru. rio._ violat, e any zonin~ !aw, ordmance or regulation: .. ~. .......... ~ ........ 13. Will lot be re raded No (rgutzne back~.lI) · · · X~tx g ·., ....~.~ .....a .............. Will e~c~3s fiJl~%e r~emo¥od fr~ premmes~,',,,, Xe~ 0 No 14. Name of Owner of ~remises ~±a.e.n/?~.e~[e~s Aadm~u ~z ~ou~no± e of Architect ...................... ?on~ t z~r~L~'~-~ n .............. 1... Phone No ....... ........ Name ofContractorViotorian. Homesl~ianagerAddress .She. l~..eF..I..s;., .Phone No, .7.?.9. 7.1.~.f.? ..... 15.Is this property located within 300 feet of a tidal wetland? * Yes ..... No · If yes, Southold Town Trustees Permit may be required. , 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. SEE ATTACHED SURVEY STATE OF NEW YORK/ COUNTY OF...S.u.~f93.k. ...... S.S .C, hristoph,er W. 01sen being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. /. Heisthe.,C°-°wner (with ~wi.fe) / General contractor J , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the shid work and to make and file this application; that all statements contained in this application are true to the best ofhig knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~'~--~"~' '.,~2 ~ '.~'' ''~ ''' 19 '~' i' Notary Public, ....(~/~/~ .......... CountyD/~. , j/) [ ~ / / ..... ' / ~c;°?0. i,q~ ~ '" (Signature, of appliea:nt) ,/ OCT. SUFFOLK ¢O. HEALTH DEPT. APPROVAL h. $. NO. STATEMENT ~F 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. DEED: l.~7 p. TEST HOLE ) STAMP f SEAL ,/ , *, ,., u ,."'~A t,, ....... ,-,, ~ -o .J, *,,, ~.:_~l x,,;?.,i_b!X..;{.. I.A__ *O~ERICK VAN 'ruYL; P.C. L,CENSED LAND SU~*'YEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL h.S. NO. STATEMENT (~F INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS, FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. Of HEALTH SERVICES. (S) APPLIOANT SIN~AMILY DWELLING QN! ~' SUFFOLK COUNTY DEPT. OF HEALTH SERV,CES - FOR APPROVAL OF CO N ST R U C T~2 N... O~/""Y..- ~ DATE: ~/ "' I H.S. REF. NO,.~-'~ _-~0-'": lit/ APPROVED: O'). LL,,.,,'"'----.-~ SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDRESS: DEED: L.~; , P. TEST HOLE STAMP SEAL TELEDYNE ~05T N41,535 SUFFOLK COUNT~ HEAl, TH DEPARTMENT TH~ $~A6E DIS~L AJ~ID WAT~E*~ ~UP~Y,FAOtL!TIE$ F~R L~A~ HAVE BEEN INSPECTE~ ~y TH~S DEPARTMENT ~ F~ND ~ BE ~TISFAC~ORY, ,,, ', :~f ~f w~tewat~ Ma~a~t ~ctt~ SUF~ / ,, / RODERICK VAN TUYL P.C. LICENSED LAND SURVEYORS GREENPOrT NEW YORK ?FOLK CO, HEALTH DEPT. APPROVAL H s NO. STATEMENT (~F INTENT WATER SUPPLY AND SEWAGE DISPOSAL EMS FOR THIS RESIDENCE WILL fORM TO THE STANDARDS OF THE ;OLK CO DEPT OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOr APPROVAL OF CONSTRUCTION ONLY DATE: , , APPROVED:__ SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT, BLOCK PC;L. OWNERS ADDRESS: DEED: L,¢z TEST HOLE 'STAMP " SEAL SinGLE FAMILY DWELLING ONLY H~D, REF~ NO; CODES, NI)T RESPONSIBLE FOR ,-,~.GN O(l CONSTP, UCTtON ERRORS, ,g /