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Home My WebLink About14642-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate O[ Occupancy THIS CERTIFIES that the building ............. .O.n.a.. ?.a.n! ~..~ y..d.w..e .1.1.i.n. g ............ 650 Sunset Lane Greenp. ort ...... Location of Property P3~s~ 3V'o~ ....................... ~r'efi t' ...................... Hamlet County Tax Map No. 1000 Section ... 0..3.3 ...... Block .... 4. .......... Lot ..... 7.7 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated F e b. 27, I 986 . pursuant to which Building Permit No. 1/4642 Z dated ...........M a r c h I .... 2, ..........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 ......... and front porch. The certificate is issued to ........... 9.~ZA. n. P.!N.~.. ~.~.hb.A.S ............................. (owner, ik~e)C )~X~r1~g~ X of the aforesaid building. Suffolk County Department of Health Approval .... ~ .6L.S.Q = .1.3..N. 9 .v....2. 6. ,.. 1.9. 8..6 ............ UNDERWRITERS CERTIFICATE NO. N781463 December 1, 1986 PLUMBERS CERTIFICATION DATED: Nov. 4, 1986 Rev. 1/81 FOEM NO. ~ TO~N OF SOfT'OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N, Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...~.~.~....~..,.~..,....(.~.9..~..~.. .......... ;. , o, _. ,_~ o,...~.~.....~..?~, ....... ~~ ............... County Tax Map No. 1000 Section ...... ..~.,..~..~. .... Block ...... ..~1..~. ....... Lot No ...... .,~....~. .......... pursuant to application dated ....~.~.~.....~...."J ............ , 19.~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO. Owner ~,~.~z~ (~' (please print) (please prin~) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this Notary Public, ~~/C2_ ~C°unty THE NEW YORK BOARD OF FIRE UNDERWRITERS ]O010"~J. BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 1003,6 THI¢ CE~IFIES THAT only the electrical equipment ~ ~scribed below and introduced by t~ applicant ~med on the a~ve application number in the premises of ~. Basetoept ~.lst FI. ~ 2nd FI. Section Bilk Lot the followlng locatlo~ was examined on ~0~ ~ [ ~ ~ and found to be in cm.pliance u'ith the requlrement s qf thls Board. FIXTURE OUTLETS ~ECEPTACLE$ SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 41 36 30 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R OTHER APPARATUE: 1-GoF. C.I. 1-S~oke Detector AWG. O~ CC COND ~/0 C 2/0 C~S Electric t~x 215 Southold:, N.Y. llgYl ,~c. 578~' GENJR&L MANAGER 11 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentlals. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATEMUSTiNOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: 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, ~ndustrial 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 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 / NawConstruc tion..¥.o. O~d or Fre-existing Building Location of Property .~::~. .... ..~ ~,.~ ~3 ~- 7- .~.../fl...af.~. ¢ ......... ~-/~'~.~../-(./~. d House No. ' ............ Street .................. /Y' ' Owner or Owners of Property ............... .J ?.~.~.. .... .2..~..$. County Tax Map No. 1000 Section ...~...~. ~. ...... Block ..... .~. ........ Lot .... ;7...~. ....... $15.00 Date...~..¥7. ~: ..... .'"~..~. ...... ............ Vacant Land ............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./..~.~. ~.~...~. Date of Permit .~//.~/0°.~..Applicant ... ~..~].-~..-~.~..~. ;' .-9'..~7.....'~..~7..~. .~. ¢~..~... Health Dept. Approval .////..~.~/~¢.../~.; :~.: Z.3. .Labor Dept. Approval ........................ Underwriters Approval .... ~ ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... ~ ............. Fee Submitted Construction on above described building and permit meets all applicable codes and regulations. Applicant...../~......~..~..~.. ~..--.'.'.'.'.'.'.'~.. ................... FIELD INSt~ECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING 2nd) INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: 7GS-'~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL [ ] FRAMING REMARKS: BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [~I~'SULATION [ ] FRAMING FINAL 765-t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~'~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE 7GS-X8OZ BUILDING DEPT. INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION 1ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [~/ FOUNDATION ZND [ ] INSULATION FRAMING REMARKS: FINAL DATE INSPECT~OR 765-1802 BUILDING DEPT. INSPECTION ~'/~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: .... ~OM.O Z 'i. Examined ..~. !.%... Approved . .~..o4~. ! .~.. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~.OUTHOLD, N.Y. 11971 TEL,: 765-1802 ., 19 ., 19~..~. Permit No. j.~.~..$t.~..:~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT~ ' TOWN OF,,~OUT~,OLD,,, Rece 5_reel ........... ,19,, . a. TNs 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 issumme 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 inspec~tors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ...~/...~..~.~. ~z, .~ .~:..~. ~,~... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... .~.-~. ~/~..~.< . . .&-. ......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly autkorized officer. (Name and title of corporate officer) Builder's License No. .~..~..' .>.~.... Plumber's License No.. Electrician's License No. <' Other Trade's License No. ~ ~ ' ~ Location of land on which proposed work will be done. ~7~ x-/ ~ ,' '~ e_~ ~5 · ¢...~... ....... a~.....,~..... ~..~ ............ .~.. ~'~.~.~..~? ............ House Nmnber Street Hamlet County Tax Map No. 1000 Sectiou .... ~..~..~. ........ Block ..... ..~.. ......... Lot .... ~..Z .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended us~nd occupancy of proposed construction: a. Existing use and occupancy ...... ~C..--?~...~..~.~. ~ ....................................... b. Intended use and occupancy ..... .F~.~: ......................... 3. Natu. re of work (check which applicable): New Building ....... Addition .......... Alteration ; ......... Repair .............. Removal .............. Demolition ........... [.. Other Work ............... 4. Estimated Cost . · · ' .................... Fee ......... i ,,, (to i . be paid on filing this application) :~. . Number of dwelling unit's on each floor ................ 5. If dwelling, number of dwelling units ............ If garage, number of cars ........ ~ ~ ..... 6. If business, commercial or n)ixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing strugtures, if any: Front ............... Rear ....... ! ....... Depth ............... Height !Number of Stories ' Dimensions of same structdre with alterations or additions: Front ............ , ..... Rear .................. Depth ............... , ...... Height ...................... Number qf,iStories ...................... Dimensions of entire new ~onstruction Front Height Number of Stories . .(~....~./) t , 10. Date ofP-urchase ......... Name of Former Owner V, 3,;J '*P( .... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..xS../~. ......................... 13. Will lot be regraded ... '. ~gF&. ................. Will excess fill be remove t from premises· ', Yes No 14. Name of Owner of premises ~d g~,~.~d/gO,~. Address .q//.~Oq.~.~./ /~ ' Name of Contractor" Address 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 an~t blo6k number'or d~scription a'ccording t6 deed, and show street names and indicate whether interior or corner lot. 4 STATE OF NEW yOR~, ,,. S.S COUNTY oF ..... ~.g.~/£1/.~.u.%,Oo,,,.~...~g./.[?.4 ...................... being duly sworn, depgses 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 }aid work and to make and file this application; that all statements contained in this application are true to the best of Ms knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before ine this Notary Publi · · ounty . ~,: JI~AN A. ROGER~ NOTARY PUBt. IC, State of New Yor~ No. 52.4~o~, su~tol~ corer ; (Signature of applicant) Term Expires March 30, 19~,'~': SUFFOLK COUNTY HEA~Ti~ D/EPARTMENT SINGLE FAMILY I~E~EING ONLY H.D. REF. NO. _.~-.S',~ /~. DATE ' ~ ~ ~/' N~V ,' ~E S~AGE DISP~AL A~O W~T~ 't ~UPPLY FACILI~ES FO~ L~ATION HA~ BEaN [y'SP[G~'[a Chief oTWCStewater .;gement Section RODERICK VAN TUYL, P.C ' LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. 86=50-1~ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTE~I~~ "~OR' THIS RESIDENCE WILL CONFORM TO THE STANDARDS Of THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (s) APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH ~ ~VICES -- FOR APPROVAL OF ~C:( ISTRUCTION ONLY D 'E: Al ROVED. iUFFOLK CO TAX MAP DESIGNATION: )IST. SECT. BLOCK PCL. 01 IERS ADDRESS: GUh4-~'T L.Ai'q E% 47 7- i650 DEED: L.5t97 P. TEST HOLE STAMP ;5AN r..;',, SEAL ? i4 / RODERICK VAN 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 WI'LL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. Of HEALTH SERVICES. APPLICANT SUFFOLK COUNTY SERVICES - FOR CONSTRUCTION ONLY DATE. h. S. REF, NO. APPROVED: DEPT. OF HEALTH APPROVal OF SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL :COO 0~ ~ '? 7 OWNERS ADDRESS: DEED: LS!g'7 TEST HOLE SEAL SC, DEPT, OF pLEASE NO't~ RODERJCK VAN TUYL, 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 SUF~=OLK ~.. ?F.. H~ LT~H//SE R .VI CES. :,,/(S} ~ 2~'~ ~ _/~-~-~ A APPLICANT~ ¢ ~' 0~~ ~ ~ il l -- 0 0 SUFFOLk COUNTY DEPT. OF HEALTH SERVICES FOR APPRpVAL OF CONSTRUCTION ONLY ~/~/~g/ DATE APPROVED 'suFFoL~ DIST. SECT BLOCK PCL 4? 7' DEED: TEST HOLE STAMP SEAL :4' AppROVED 'L, u Ph6ne 4:77:0400 N.Y. i t944 T GI_EENPOR 1, N Y. 11944