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Home My WebLink About14635-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou{hold, N.Y. Certificate O[ Occupancy No. Z15067 Date . November 5 ................................................. 19 86 , o o THIS CERTIFIES that the building .... .I.ng.r.o.u.n.d. pool and fence, Location of Property ..... .5.89.5. .I.n.d.i.ap. Neck La.ne. Pec.onic House No. Street Hamlet County Tax Map No. 1000 Section . . .0.8.6 ....... Block . ...0.6 .......... Lot ....1.6 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore f'ded in this office dated .... &e.b....2.8 .......... , 19.86 pnrsuant to which Building Permit No..1.4.6.3.5.z.. i ............ dated . .M.a.r..~.8 ..................... 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 ......... C. onstruct .~.~g.r.o.~.d. po, ql and fence. The certificate is issued to ............ %I~Qi~ .& .1~I~I.~ .~.E.T..H..3.O?.QV..~. ..................... {owner, ~..l~g~.~ of the aforesaid building. Suffolk County Department of Health Approval ........ N../.A. ............................... UNDERWRITERS CERTIFICATE NO ................ ~7.43~fi5 ........................... Rev. 1/81 Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 14635 Z Permission is herebt granted to: /'~, C~ ............ ~...o....~.....~..~..~ ....................................... ......~,.~~...~.:.V.:....u..~.~:.~... , ~ County Tax Mop No. 1000 Section ..... ..~...~,..~. ..... Block ...... .,.(~....~.. ....... Lot No.....J....~o. .............. 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 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEFL TOWN OF SOU"FHOLD Instructions This application must be filled in typewriter OR ink, and submitted ma,--=--=, 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 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 applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZt)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 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 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 / /.~.~. 5.Updated C.O. $15.00 Date ....... ~ .~.(o .......... New C on s t ru c t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~ ¢ ',~ O .... ) ?. 0!AA].. ./[/E~/~.. L~M. ?. . House No, Street Ham/et Owner or Owners of Property . .'.~J;} .o/~. ~ .~ ~. ELI 2A/Je.-~-F( ~0~.~1/,/~/~). og& oCo County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ............ /~ .................. Filed Map No ........... Lot No .............. Permit No. I fl.O .~.F..~. Date of Permit . .~. !~. !~.(0..Applicant....~J.~..~.~.3. .... OP.~ ~.17.~./. ........ 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 pe~rm~ meets ~1 ar~able codes and regulations. Applicant ................ ~~ ......................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001~81 BUREAU OF ELECTRICITY ]~k! 85 JOHN STREET, NEW YORK, NEW YORK 1003~ THIS CERTIFIES THAT only the el~trical equlpmen~ ~ described belo~ and introduced by tke applicaut named on the above applicatio~ number in the premises of Thom~s Do~mv'an~ 5895 Indian Neck Lan~, Peconic~ New York in the following locatlon; ~ Base.tent ~ lst FI. ~ 2nd FI. o~ts~de Section Block Lot ~ ~d o. Apr il 5,1986 ..d yo..d to ~ ~n ~o~p~..~ ~tb .~ ~q.i~,.~,,t~ al t~ ~o.~d, FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE OUTLETS SWITCHES FLUORESCENT ORYERS SYSTEMS E R V I C E NO OF CC, COND A WG NO OF HI-LEO G.P~C.I.-1 (Swimmiz%s Pool)This c, ortificate COVERS on'[y, Becausc of nnusual environments it is advisable to hsv'(~ and/or repairs ~,ade by a ql~ali{~ed person. Jody Pumil lo Pat Lm~e b~att~.tu,.k~ N.Y., 1],952 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 their COPY FOR~UILDING DEPARTMENT, THIS COPY OF CERTIFICATE MIJsT NOTBEALTERED IN ANY MANNER. 765-18~2 ~,~/~ BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION I' ] FRAMING [ ] FINAL REMARKS: DATE ~/'2~/g~' INSPECTOR F~%LD ~_~FECTION COMMENTS FOUNDATION (lsd! FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL / // ADDITION[L iO. MMENTS: Examined..~..6~..~...~ .... , 19 .o'7.~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 9OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ,7/2? Date ..................19 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,9~f 1,ot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed de)&ik~6O&f~g, out of property must be drawn on the diagram which is part of this appli- cation. c The work covered by this':appl~c,~t~n~rg%~; not be commenced before issuanc~ of Building Permit. d. Upon approval of tins api~ltca~i~.~.,l~,.~u.'il~p'ector will ~ssued a Bmldmg Permit to the applicant. Such permit shall be kept on the premis6s availahl?, fo,r insl~b~to~rblg~dagl~out the work. e. No building shall be occfipi~(~.~,6r..ufeO~p~ale or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildin'~ I~is~)~cto~. APPLICATION IS HEREBY MADE to the Build~ng Department for the ~ssuance of a Bmld~ng Permit pursuant to the Building Zone Ordinance of the Town of XdCt~thold, Suffolk County, New York, and other apphcable Laws, Ordmances or Regulations, for the construction of buildings, al~ ,or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appJig~l,~{~;'~lt~ttl~es, building code, housing code, and regulations, and to admit authorized inspectors on premises and ~, ~,,~,~,~.~ o~t~ inspections. "' (~ili~g a~dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .~Z~.*~..4..,- ...... q.~..r~.~q.*.~.,~ ...................................................... Name of owner o f premises .... . .~'. ~.O t'~l. ~.~.....~. '. ..... [~D~/. 0 ~r/~/td ................................... (as on the tax roll or latest deed) I;.a;~;.~. o.~:. 1.~ ?~t.~ri~e~. ifficer. J~ (Name and title of corp~tcrofficer) 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 ........... l?..~.../~./.~.....~.. ~..~ ..................... .... .o7..~. ~.~..'7 .... ~/~..~( O.~.....~.e.z.l.c.. ~ ~../ ......... P~..o ~.~.c... ~. ~,. ~..,.~. .............. House Number Street Hamlet County Tax Map No. 1000 Section ....... 0. l~1~ ...... 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 ......... .~...~. · ! ./~..~...~..//f~.. · ............................................ b. Intended use and occupancy ' . .~...k~. (.t'2..g-.?? ?. ( .~..C- .... ~..~..o~..L~ ................ 3. Nature of work (check which applicable): New Building ...... ' ..... Addition .. ! ..... .~..,~c~ratlzn .......... Repair .............. Removal .............. Demolition ........... I · Other Work ............... {.tO(~..t~. ~ . ~ (Description) 4. Estimated Cost ...................... Fee .......... ; ......................... (to be Paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage, number of cars ............................................ ! ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each typle of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... i ....... Depth ............... Height ............... Number of Stories ............................ ~ ............................ Dimensions of same structure with alterations or additions: Front ' Rear Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ........ ! ....... Depth ............... Height Number of Stories . Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of~Former Owner . i ........................... Zone or use district in which premises are situated .... /'.~..~. / ~ .~...Ty..///5. ~ Does proposed construction v[ql~te any zoning law, ordinance or regulation: ...~11 ................ ~ ....... Will lot be regraded ...... ./~..o..~. .......... ....... Will excess fill be remove~ from premises: ~¢0 No Name of Owner of premises- ~ .~.h ./~. ~q/~. ..... Address ,27qg. t./~.. ~.&C.t¢. k~/tA.< Phone No ................ Name of Architect ........................... Address ............... i... Phone No ................ Name of Contractor . . ~,. ]2/<.~.t,/, q.,+-..~7o~. ..... Address ~.o.X.. ~.~. ~/P/~./~dCPhone' No.. ~.~'.~.~.~'~'" .... 10. 11. 12. 13. 14. 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. STATE OF NEW YORK, COUNTY OF ................. S.S APPI ~OYED aS NOTED qOTiFY B~j~;.D~NG ~PART~E~T AT i,-~ '"',, ,D ' h ~, F~N:-.. , ~' - ~ ~TIO ~ MUST 'file t:, ' :.[::. "~"': ~ q *~F rile N.Y ................................................. 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 iknowledge and belief; and that th6 work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. · ~...~. ..... day of ...... .~.6~'..~-~.. ......... 19 .?'.,~. ,, Notary Public, .... ~-~rr... ~...~..~...~/..~. ..... County .,,.,...~,,,,, ...... ~,. ......... ~) t !;.' ...... '-7..,,~:w ......... ~ r,U°~l~. ~ d ~. York ~ z, (Sigr~t~e .of appl, cant) No. 4707878, Suffolk County.. ~ .... Dt ~ FJ(plres Morch 30, CANT ,,,. ~ ~. .. ~u~. ~ .... , ..... , -