The URL can be used to link to this page

Home My WebLink About14410-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... .Z.l.5fi. 0..8 ....... Date ................................ November 18, - , 19 86... THIS CERTIFIES that the building .O.n.?. f.~.m..i.~.y..d..~.e.l.l.~ .n.g. ?.~ .g.h..a..g.g.a.c.h.? .d..g,a. ,r,a.~.e & deck Location of Property . 9.2.5...Ypp. n.g .~..~.qa..d., ......... 0. F.i?.q g. ~..N.e.¥..Y.q~..k ............... House No. Street Hamlet County Tax Map No, ] 000 Section ...0.1.~. ...... Block .. ,0,1 ........... Lot 0 06.. ;.. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated O tober 2s, 0..z ...................... b9. pursuant to which Building Permit N ............... dated 9.c.qq b..e.v..2. 0. ~ ............... 19. ~, .5, 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 & deck The certificate is issued to TR I-POD ASSOC ZATES (owner, ~:¢s~r-~ ~ x x of the aforesaid building. Suffolk County Department of Health Approval 8 5- S 0- 1 9 5 UNDERWRITERS CERTIFICATE NO ..... N ? 7 6 8 2 2 Plumbers Certification. dated July~ 18 1986 Rev. 1/81 ~ilding .... Inspe' ~ c't;; ............. FOB,Bf NO. fJ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BI:: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 14410' Z Permission is hereby granted to: ........... .... /.x~o.....~-,.~.~..~.......~..: ....... .......... ~.(Q~.~'z'.z'Zu.. ................. .0.,.....~ ...... .~...~...~.~.~.P.. ....... F,,,.~...~. .................. V. ................ County Tax Map No. lO00 Section ...~../.~.., ....... Block ..~../. ............ Lot No..(~.~....~... ........ 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 - I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 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 iprior 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 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. 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 $15.00 Date ,/~ .- ................. Ne~vCons truction Old or Pre-existing Building Vacant Land Location of Property ................... ;' . ........ House No. / I Street Hamlet Owner or Owners of Propertv .l~..~< ,%/~,~, .o/ .., ,~,~ .O,C.~/: ....................... Co tyT Map No 1000S cti ~ /.'~' BI ck ~.~./', Lot .zf~.. un ax . e on o ..... . .... . ...... Subdivision ................................. Filed Map No ........... Lot No .............. ~,Y/,~ Date of Permit ,Z~,;-.~. j..S..Appllcactt .~. ,Z~. ,/~, ,c.%~..~.,"~.~,~,~. ~q~c~ ~0 PermitNo. ~ ....... ' ,~ $~ . - 3 , ,~ Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....~ .............. . Foe Submitted $ ............................. Construction on above described building and permit meets all applica~,~s and regulations. Applicant./~.~...~. 'j~~.~.~.~ . . .; .~.~.!~ ........ ~c~ 3o73~ TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION D te_ '?-/£' FJ Building Permit No. /~/~/~ (please print) (please p3'in~ ) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this (plumber' s s~nature) BARBARA STEPNOWSKI N0taty Public, Stateof New Yo~k No. 4844752 Qualified in Suffolk Counw Commission Notary' Pub lric Notary Public ,~,~q~ oo o71 THE NEW YORK BOARD,, OF FIRE UNDERWRITERS 'J_ BUREAU OF ~LECTRICITY ' STREET, NEW YORK, NEW YORK '10038 / 3.00167/86 o,t~ October 16,19~%JOHN ,4pptie. tlo. ~o. o,/il, N 774822 THIS CERTIFIES THAT only the electrlcaI equipment ~ ~scrlb~ be~w a~ interlaced by the applicant ~med on the a~ve application n~ tuber in the promises of ~atbew McKiernan, Young St., w/s' Opp: Private Road, Orient, N.Y. in thefollowlng Ioca~ion~ ~ Basement ~ 1st ~. ~ 2nd ~7. Section Bilk Lot ~s examined on 0~ ~ ~ ~ ~ l 1 ~ ~ ~ ~ ~ , and found to be in compliance with the requlretnents ~f this Board. FIXTURE OUTLETS 24 DRYERS OTHER APPARATUS: G.F.C.I.-I Smoke Detectors-2 FIXTURES SWITCHES 27 24 MOTORS ! FUTURE APPLIANCE I~EDERS RANGES PECIAI- REC'PT R tcOOKINO DECKS I OVENS I DISH WASHERS - 1 1. ~Rr V I C B EXHAUST FANS DIMMERS AWG. OF NEUTRAL 4 G ~ S Electric Box 215 Southold, 11971 GENERAL This certificate must not be altered in any manner; return to the office of the Board if incqrrect. Inspectors may be by their credenffals. COPY FOR BU~ILDING DEPARTMENT. THIS COPY OF CERTIFIC;ATE M, UST: N~T BE A~TERED IN ANY MANNER. 765.1~02 BUILD]NO DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBO. FOUNDATION 2ND ~ INSULATION FRAMING [ ] FINAL REMARKS: ~_ ~v'~~ DATE BUILDING DEPT. INSPECTION [ ] FOUNDATION :I, ST [,~ROUGH PI. BG. [ ] FOUNDATION 2ND []INSULATION ./~FRAMING []FINAL Lz. : (?. .41- '"~ . ' I .,~ ~, . b 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION []FRAMING []FINAL REMARKS: ~~ BUILDIN~ DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE ,,INSPECTOI~> 76S-1802 BUILDING DEI)T. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE ]65-t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ]FRAIVII~,NG ~ [ ]FINAL REMARKS~/ ~/~ DATE ,, iN~SPEC,~iON COMMENTS [,'£LLD ~ ~. _ FOUNDATION (~st} VOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~,ODE EINAL ADDITIONAL COMMENTS: 'FORM NO, 1 3'OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~°OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examine ..... ,19.F . Disapproved a/c ........ APPLICATION FOR BUILDING PERMIT ~LDG. DEPT. TOWN OF SOUTHOLD Received ........... ~19.. , 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 codec, housing code/and regulations, and to admit authorized inspectors on premises and in building for necessary ig~pe~tions/ ~ ,~ ~/ff (Signature of applican~or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ./f~ .~ff/~..~ (~.. .~..c.4~' /.,.o.~.....~ .-.. .~'.,~...~..~. ..................... (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. ~'~ / ~ Electrician's License No...~.?../../~. ............. Other Trade's License No. ~q~ / ~' Location of land on which proposed work wilt be done .................................................. ... 5 .57.. ............ ¢o. ................. ,o..r. .......................... House Number Street Hamlet County Tax Map No. 1000 Section . . . .~../. ?. ......... 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 ... ~/. ~/.~..~..t~..V..~..~..~.. ............................................. b. Intended use and occupancy / 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration R~pai~ .... ,. .......... RemOval ............ Demolition .............. Other Work ............... 4. Estimated Cost . ~. ~. ~<3.~. ~'i ~P ....................... Fee ........................... ~ 4, (to be paid on filing this application) 5. If dwelling, number of dwelling; units .... ~. ......... Number o f dwelling units on each floor ................ If garage, number of cars ...c~. ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensionsofexistingstructures,~ if any Front ............... Rear .............. Depth ............... Height ............... Number of Stories ................................. .................... Dimensions of same structure With alterations or additions Front ................. Rear .................. h ' Dept .... Height . ..~ ............. Number of Stories ..................... - 8. Dimensions. of e, ntlre new const;ructlon: Front . 1~..: ~;../.~.'.. Rear .. ~./... ~.. f~.... Depth ,a~ .~.. ~ ....... Height . ~.~..~ ......... .Number of Stories .... .~' .,,,'~? ............................................. 9. Size of lot: Front . c~.(2..~, f. i ............ Rear...~..~.c~/. ............ Depth . .,f.r~.~/. r .~.~./. ~..~: .~?. 10. Date of Purchase ...~...f .... ~.~ry..~. ............ Name of Former Owner V'~P/?.o. ~ ~.~ .o~. ~q .~. 11. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ...~..o. ......................... 13. Will lot be regraded .. ~...~.-~.; ....... , ...... ~ ..... Will excess fill be removed from premises: Yes ]Name of Architect ~:~b.."F~',; rltM ............. Address ~.' .'f.~O~._ff. ar'~..,~.~."... Phone No..~f.Z.~ .~..~PP... ]Name of Contractor t~'{.,~l,'.c~ ~:q~.d-;~q..~Or~.~eY,~. Address .~.o.~.~.O. ~.c( .t.J/. Phone No..7'.*~': PLOT DIAGRAM Locate clearly and distinctly all buildhugs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocl: number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ......... : (~ame of individual si~in~ contract) above named. being duly sworn, deposes and says that he is the applicant He is the (Contractor , agent , corporate officer , etc . ) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements co~tained 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 ........... , I9 Notary Public, . .............. ,.~'~r.~~.. County <Z/ ~- / '~ /: V *~'~vm'llL~ 8t~o{N~o~ · . ,e..'~ .... ,. , . · · ./~t/~'/../q ....................... : Term F.,~lrw~ Mereh SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. ~.. ~- I THE WATER SUPPLY AND SEWAOE DI~:)~AL : 'v'A .~./*.B?- 5 ~ ~ SYSTEMS FOR THIS RESIDENCE WILL ,. , · t~_.. ,~ ! ~ , ~..__..: CONFORM TO THE STANDARD~ OF THE /'"', ~ ' .~.Y , , ; .....~ SUFFOLK CO. DEPT. OF HEALTH SERVICES. ,~_~-~ ~A.~-~-, ~ :,-~ ~ ~ (S) ,, --' ,+ 100tT~* C~ ]~ ~.J:~ ! EL :"a ,~x ~'~ , --,,. -?, SUFFOLK COUNTY DEPT. OF. HEALTH / '~".': I~ ' SERVICES -- FOR APPROVAL OF · ; TA~., ?' .~.;~':~: :. ~. i :.,~v.../'~.J ,~'LV r':'x": :'~- r,~'~ F, ,, :,.-- 0-~ ~ "b: [ ,.~, .¢..~j , : '~,..~..,..,-, :'-..-', y, CONSTRUCTION ONLY ( ' , ' /' , ~ ~ AF~ROVED: "~ ' : , ~-.w,~,.' ,.,.ZF. LL , j ¢ i ~ [ SUFFOLK CO. TAX MaP OEStGNATION: . :1 / -, , :~', j :.-: t :: > *C-' ~"" - : : ,:. :'4 i: 'fl ~"~ DIST. SECT, BLOCK PCL, i - ,o~: ' "q :'~ i .0 / :,soo O.t~ . 0;. ' ' ~ I,.. ~ /' ':..~- ALE - 50": · ;// ' ~ DATE ~-~"~ ~ g ~J~ /'C "/ ' / ............. I: ~ .~m~,~ THE SEWAGE DISPOSAL AND WATER I~JPI~--LY,EA~ES FO R ~.~i~. / I ~-~A,._, '^---,: -v. ~'='~= ~'~ ~' ~ ~ e'~w / LOCATION HAVE BEEN INSPECTED' By- T~':D~EP'ARTMENT/A~IqD FOUND TO BE Chief of Wastewater Management Section ~,~ , ~Ap AhSENL)E:.D -JULY ~ I,t9~ .............. 5' SEAL L E'L. EL'Au~C~ ~- ...... "' -- l"~E F ~: :~. ~'"' ~-'t~:~<~-- - ' ~ ---,.: .r-~ .., LICENSED LAND SURVEYORS , GREENPORT NEW YORK I[ copper ,ubi~g is used for ~a,~,r disltibutinil sys era,: ..., '~ shall be SOLDER USED IN WATERr SUPPLY SYSTEM CANNO~ EXCEED ~/lO o/ l~ LEAD, ON LEAD CONTENT BEFORE (2ERTIFICATE OF OCCUPANCY NOTIFY B01I_DING DEPARTMENT AT 765 1802 9 AM TO 4 PM FOR. THE FOLLOWING IHEPECTIONS' FOR POURED CONCRETE 3. INSULATION BE COMPLETE FOR C O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ::% --[ ,:,] / Phone 477-0400 ~ Maia Road ,,] LDO F.'L , ..... t , .~ , Phone 477.0400 Main Road Gfl~IrFI'~PORI~. N Y. 11044 Phone 477-0400 Main Road GREENPORT, N Y. 11044 DWG