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Home My WebLink About14354-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy Date February 29, 1988 THIS CERTIFIES that the building .... .0.N.E...F.A.M..I .L.Y..D..W.E.L.L.I.N..G ..................... Location of Pro err 1220 Grand Avenue Mattituck, New York P Y hi,, hid ....................... ....................... County Tax Map No. 1000 Section 107 .Block 08 .Lot 38 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in ttfis office dated September 23, 1985 14354 Z ...................... pursuant to which Building Permit No ...................... dated............................Oct°bet I0, 1985 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 & ATTACHED DECK The certificate is issued to . RURAL LIFE CONCEPTS, INC. .................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ........ 8. 5. T .S.O.-~ !.4 .8 ........................ UNDERWRITERS CE RTIFICATE NO ................ N. 8..5 .3.6. 8. 4. .......................... Feb. 24, 1988-Michael Dohm PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 FOIt~ NO. B 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) 14354 Z Permission is hereby granted~to: /~ - . '....~,.%,o..~.....~.~..-9., ............................................. ....... ,o Cou.ly Tax Mop No. 1000 S~ction .... .L.O....~. ......... Block ..... (~J'..~ ......... Lot No....~ .............. pursuant to application doted ....~.~....~....~...~ ...... 19.~..~..~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southotd, N.Y, 11971 ~: BL G. ~PT. TOWN OF SOUTHOLD 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, Industrial buildings, Multiple Residences and similar buildings and instatla- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5. Su bm it 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 property showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to usel 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.O0 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5oUpdated C.O. · $ 50.00 Date ....... New C OhS t r u c ~; i on ..V/_.. Old or Pre-existing Bu ilding ............ Vacant Land ............. Location of Property .... /.~,~-.~. ............ Z~../-/'~ b .... ~z~. ~,. ¢~. ......... House No. Street Hamlet Owner or Owners of Property ...... ~F. ~./~...2_. ,j~.~.~.:.. ~,~.~.,~.,,~. ~.. ~7. ~..~, .................. County Tax Map No. 1000 Section ...... /.o..'Z .... Block ....~).~. ........ Lot .... .3.~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. 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 permit meets all applicable codes and regulations. Applicant ....... ).~/~/'~.C ./$",~...~,,~.;~t~.~./2~,C. ~../4~. ........ Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INsPEcToR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 C E RTI F I C AT.I ON Date /FJ2 Buildinq Permit No. Owner ~6~ A ~,'~ · Jplease print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~ ' (~lum~e~'s -signature) Sw.~n to before m~his day of ,' 19 ¢ . Notary Public, ~/~ County Notary Public 1000314 THE NEW YORK BOARD OF FIRE UNDERWRITERS' DUPLICATE N841901 ' BUREAU OF EI_ECTRICIT¥ OF. : 85 JOHN STREET~ NEW YORK, NEW YORK 10038 eleclric~uipment ~ ~e~d ~ .~ intr~ced by t~ ~p~icart m~d on the ~e ~pplic. t~n n~m~r in the prem~s of October , 19987 .... . . : . DRYERS: SWITCHES ~:3 0 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FURNACE MOTORS TIME CLOCKS [INIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEE1~ OTHER APPARATUS: 1-Smoke Detector J. Electric '~ ' · ~.Stillwater Avenue S E R OF CC. COND. L 1/0 This certificate must not be altered in any manner; return to the office of the Board if incorrect, inspectors may be identified by their credentials. F±ELD Ik{SFECTION ~u~'l~o FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA~ COMMENTS: \ 76S-1802 BUILDING DEPT. INSPECTION [] FOUNDATION 1ST [~/ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: Examined .~.~.../9..., 19 Approved..O.~. !.O .... 19 ~ .~. Permit No. }. ?..~.~..q .-~.. Disapproved a/c ..................................... 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 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 ~t 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 insl~tions. ...... l.~.Ol. Cl, q L . ~.,,'J~:¢. . ~.~. .'~. . (r°~ iU. fiT. .-?~./.~. . (Signature of applicant, or name, if a corporation) · (Mailing address of applicant) I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... Name of owner of premises .. ~../J~..F.C~./-.'....~. j~..2-...,~..~ ./-r. ....................................... (as on the tax roll or latest deed) If applicant is a co~on, signat)3~ officer. ........ Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... ~ '>--be ~'done· m&/~YOIW ~ . .~...eq. . ./~...~.../~./..~?.~.~./ 1. Location of land on which proposed work w)ll....,....-.. .............. gow. .............................. , .............................. ................... / Street ;Hamlet House Number County Tax Map No. 1000 Section .... /.~...7 ......... Block O0 / 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 ..................................................................... b. Intended use and occupancy ................. ~l ~v,4.-t 3. Nature of work (check which applicable): New Building .... dltlon J ......... Alteration ..... Repair .............. Removal ............. Demolition .......... i .... Other Work ............... 4 Estimated Cost .'~. ~~r~°° Fee~ ~,~1/, ~ Z_ (Description) *~ (to b~e paid on filing this application) 5 Ifd lling fd mb 11' p' chfl · we , number o welling units ............ Nu er of dwe lng u its on ea eot ............... If garage, number of cars .......... ~.i . ~,~.'~. ..................... i .......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. 7. Dimensions of existing structures, if any: Front ............... Rear ..... ~ ........ Depth ............ Height ............... Number of Stories .......................... [ .......................... Dimensions of same structure with alterations or additions: Front .......... ! ...... Rear ............... Depth ...................... Height ...................... Number bf Stories .................... Dimensions of entire new construction: Front ............... Rear ...... ......... Depth ............. t-I¥. ~ht , 10. Date of Purchase :/,~t~. ~.f. ................ Name of Former Owner i ~J~ .~.~ ~'' .... ~ 11. Zone or use distric~,~n which premises are situated ....................... ' ............................. 12. Does proposed construction violate any zo.n, ing law, ordinance or regulation: .. ! ...... /~.0 ..................... 13. Will lot be regraded ................. /~. 9 ......... Will excess fill be reNo ~ed from premises: Yes_ 14. Name of Owner of premises .~.../~..~.~..~.O..0.~..,~.~... Address ................... Phone No. ~...~. ~..d~/.4~.... Name of Architect ........................... Address ............. i ..... Phone No ................ Name of Contractor .~.. ~../~.1.~ ?.0..~.~.. ~. .... Address ............. ] ......Phone No.. ~ ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. G~ve street and block number or description accordmg to deed, and show street names and mdmate whether interior or corner lot.. STATE OF NEW YORK. ...... .... V..~. ~.~..~ ............ being duly sworn, de ~oses and says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................... 1 .............................. (Contractor, agent, corporate officer, e[c.) of said owner or owners, and is duly authorized to perform or have performed the said 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me, his Q fSO,O '~ LSO. O ; %ALE-'40'-~ i' ,...¢N,...E~, , ..,, ,- i h4C AS SURVEY' E ~' _ u N,~, ,985 R?I~.R.1C~ VAN T~...~L. P.C. , . LICENSED LAND SURV~YORS SUFFOLK CO. HEALTH DEPT. APPROVAL H. $. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK DEPT. SER~ SUFFOLK COUNTY DEPT. OF HEALT SERVICES -- FOR APPROVAL Of CONSTRUCTION ONLY DATE: ~ '~.-d) -~,~' H. S. REF. NO.. ~ APPROVED: __ SUFFOLK CO. TAX MAP DESIGNA' DIST. SECT. BLOCK PCL. OWNERS ADDRESS: T£$T ' E, AN ~Y LOAf'.4 SEAL SUF,~OLK COUNTY DEPART,~NT ~ SINGLE F;~,~IEY DWELUNG' pATg FFB 2 4 1988H.S. R/F. The sewage dispose~ and w~ter supply location h~ve been ~rs~edted by this R~,l~J~ VAN ~L, P.C. LICENSED LAND SUR~YORs gREEN~RT NEW YORK SUFFOLK CO. HEALTH DF--~PT~' A~PROVAL NO. 8~-ecO-I'~ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAl[ SYSTEMS FOR THIS RESIDENCE WILl[ CONFORM TO THE STANDARDS OF tHIE SUFFOLK CO. DEPT. OF HEALTH SERVtCE~ (s) APPLICANT SUFFOLK COUNTY DEPT. OF HEALT~ SERVICES -- FOR APPROVAL CONSTRUCTION ONLY DATE: H. S. REF. NO., APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL, OWNERS ADDR ESS: DEED: L.4942 P.g- (. ~'~: TEST HOLE STAMP SEAL m ,l '1 / ~, ~,,~,,,I/i," -,,I., ,--, . ~' ~rl ' ,~--? ~- .- ~ .... ',' / !\ .I