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Home My WebLink About14395-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. C~RTIFICATE OF OCCUPANCY No Z-20363 Date NOVEMBER 20~ 1991 THIS CERTIFIES that the buildin~ Location of Property 875 HENRYS LANE House No. County Tax Map NO. 1000 Section 74 Subdivision ADDITION Street Block 1 Filed Map No. PECONIC~ N.Y. Hamlet Lot 15 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 16, 1985 pursuant to which Building Permit No. 14395-Z dated OCTOBER 25~ I985 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 ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to JOHN & LAURA HELF (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH ~PROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED H-025609 - NOVEMBER 15~ 1991 NOV. 6~ 1991 - JOHN HELF / B~ilding Inspector Rev. 1/81 ~O~W NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OP THE WORK AUTHORIZED) N9 14395 Z Permission is hereby granted to: .............. ....................... ...... ~.~....~.~...~. ......... ...... to ~' "~-"~ ~ -~ ~-~ ~ ' ........ ~c~:~.~--~.... ~.~..~../../..~.,~....~.~..~-~...~/./.:....c~...,~..~..Z.~.~:~ County Tax Map No. 1000 Section ..... ..~...~....~.. ...... Block ......(~..../. ........ Lot No..~../...w~...~. ...... pursuant to application dated ....... ~.Z ......... /......~.. .................. , 1~~'.., and approved by the Building Inspector. Fee $ .../.(~/~- ....... Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN UALL 765-1802 APPLICATION FOIl CERTIFICATE OF OCCUPANCY · \. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of ware? supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and · pre-ex~st~ng land uses: ~ I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. · 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimm~ing pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $i00.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Conm~ercial $15.00 Date ..~?.~..Z/.~/. ~ew Construction ........... Old Or Pre-existing Building..~.. ....... Location of Property .~.~.... ~/d/~.~' X./~.~ .~.~.~.~t//~ House No. Street Hamlet Onwor or Owners of Property...~..~./~. ~ .~.~.~..~.~ County Tax Map No 1000, Section .... ~..~..~. ..... Block..dPK · · ~ t ~2/.~ ....... · /~. ~- · ............... Filed Map ............ Lot ........ ~ ~.. Applicant ,~?. {~. V .............. Permit No. · ..... Date Of Permit .... !{ealtb Dept. Approval ....................... ''' Underwriters Approval ..................... ?11eeing Board Approval ' Reqncst for: Temporary Certificate ........... Final Certicate .... ?ce Submitted: $ .......... ~~.~. ~ CO~03~ ~/ ~APPLICANT TOWN OF $OUT[IOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL 8OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION (please print) (please print) I certify that the solder used in contains less' than 2/10 of 1% lead. the water supply system Sworn to before me this 19_q HOtary Pu c, ~,,~, ' County Notary Public THE NEW YORK BOARD OF FIRE UNDERWRITERS ~: ~ ~J'l~}¢,(~'~ ' BUREAU OF ELECTEICITY ~- 85 JOHN STREET, NE[W YORK, NEW YORK 10038 THIS C~IFIE~ THAT in thefollowlng h,catlon~ ~ Base~ent ~ Ist ~. ~ 2t~d FL Section Bilk Lot DRYERS SYSTEMS NO. OF FEET C No OF HI-LEG A W C, NC) OF NEUTRALS A W G OF HI.LEC) OF NEUTRAL )THER APPARATUS: COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NO~;BE:ALTERED IN ANY MANNER. "iELD INSFECT~ON ~ vLv~'~l~ ~ ° ?OUND~TION (1st) 'OUNDATION (2nd) ~OUGH FRAME~'~ PLUMBING iNSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] .~OUGH PLBG. ./ FOUNDATION 2ND [//]' INSULATION [ ] FRAMING [ ] FINAL DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] F/OUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE 765-1.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [,~NAL INSPECTOR~~/~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [ il INSULATION' FRAMING FINAL DATE ,,/~/4/z/~2 INSPECTOR TOWN OF SOUTI{OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner ~}^! (please print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this day of O~T Notary Public, Examined .~ .-'~. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL S~UTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19 .~..~._S-" ., 19ff.~..'-Permit No . ./..~f. ~...3~. / BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... Disapproved a/c ........... ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date C-r /3 19e - 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 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 inspectS. /~ " ......... ih'aili'~i ~(~c~r"e'ss of applicant; "'/ ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. .,z..o.'-¢ ...................................................... : ................. Nameofownerofpremises ..&.~.'~.O:d.&f..~g..c.~.6(?..'~..- /4'~L"t~' · .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................ .~../~. · · Plumber's License No ........ ~ ~~. EIectrician'sLicenseNo...(,O~.~.~.''.~ .......... 1. Location of land on which proposed work will be done .................................................. .......... r: ........... ................... HouseNumber ~1~, ~g~ ~a~.L ~,~C. / ................... ................... County Tax Map No. 1000 Sect~ ~ C6.5. ~/o A ~ , ~-~ ~i.c.e~z ~:. . ~.~ ............. ~i~a ~ ~o. .~ ~ . ~ ~o~ ............... Subdivision... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...................................... k. Intended use and occupancy . . ~ ......................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition i ~. ·. ..... Alteration .......... Repair .............. Removal .... .......... Demolition ......... ; .... Other Work ............. (D ripti ) 4. Estimated Cost .~O~.~.OO Fee ~ .~. 2r..~. ......... ~' (to be paid on filing this application) 5. If dwelhng, number of dwelhng un~t~ ............... Number of dwelhng umts on each floor ................ If garage, number of cars ..... 6. If business, commercial or mixed occupancy, specify naflure and extent of each type of use ........... / .......... 7. Dimensions of, existing structures, if any: Front,, .~,~, .......... Rear . ,3,~, ( .... :... Depth . .~..~. ........ Dimansions of same structure with alterations or additions: FrOnt ...G ~. .... i ....... Rear . ,~.~. ........... 8. Dimensions of entire new construction: Front ..... ...... Rear . ~. ~.. ......... Depth . .~,,g ............ 9. S~zeoflot:rront ........ O ............. Rear.../...~.' ..... Depth /.~.~. .. 10. Date of Purchase ...... ./~.~ .................. Name of Former Owneri ............................. 11 Zone or use district in which premises are situated 12. Does proposed construction viola.te~any zoning law, ordinance or regulation: ..~ .............................. 13. Will lot be regraded ...................../f/fi , ......Will excess fill be remoyed from premises: ~ No Name of Architect ..... '~.. (-['~ ~/..~. . ~-Z.m.~.,~ ~. .......... Address ............. : ......PhOne No ................ Name of Contractor . . . Address ...... .. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, ~ndicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street nanles and indicate whether interior or corner lot. STATE OF NEW YORK, S.S cou .NT _Z E .. ................ (Name of individual signing contract) above named. ........ being duly sworn, d!poses and says that he is the applicant He is the .... f~. ,~'7,~/1'C'7'0 ,'~ (Contract6r, agent, corporate officer, et~.) 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 this ............. /.~. ....... day of .... .(~>.~,..~...' ....... 19 i.. Notary Public, ;,!<51 ,' I~ ~10;ni: ~Ji.'i.~] i~:~,}i,~ ~ ~7 " ........ (Signature of applicant) ON LE7~D C()]'T7~UNT BEFORE ~f cppper tubing is used {'or water distributing · ~¥s em; piping shall be of types K or L only Phone 47%0400