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Home My WebLink About14463-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18723 Date JANUARY 17, 1990 THIS CERTIFIES that the building Location of Property 1180 SAGE BLVD. House No. County Tax Map No. 1000 Section 53 Subdivision ADDITION GREENPORT, N.Y. Street Hamlet Block 5 Lot 9 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVF~ER 6, 1985 pursuant to which Building Permit No. 14463-Z dated DECEMBER 10t 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 BATHROOM & DECK DJ)DITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to MURRAY & SELMA JACOBS ( owner ) of the aforesaid building. SUFFOLK COUNTY DEP~RTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-767745 - SEPT. 5, 1986 PLUMBERS CERTIFICATION DATED JAN. 11~ 1990-MATTITUCK PLUMBING & HEATING ~Bu~ Iding Inspector Rev. 1/81 ~OBI~ NO. ~6 TOV~'N 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) N9 14463 Z pursuant to application dated .l'~,~,(~../....~,.....~ ........................ , ) .9~....Tand approved by the Building Inspector. Building In.~ector Rev. 6/30Z80 FOEM NO. 6 TOWN OF $OUTHOL~ Building Depaffmenf Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOWN OF SOUTHOLD A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: I. 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-g form or equal). 3. Approval of electrical installation fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, 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 (prior to April I057), Non-conforming uses, or buildings and "pre-existing" land uses: l. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date o{ any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 / / 3. Copy of certificate of occupancy $1.00 /~ Dote .................................. New Building .................... Old or Pre-existing Building ...... .v..._. .................. Vacont L~nd ............................ ~.ocot'o, Of Property ..//~,~,..~.~,,~,.,.,/,.~'.~...~./...~/~j~,.~..,~,,,~,./..~& ,~..,. ...................... Owner Or Owners Of Property ....~.;;~..~/../~.~.~..~...J~......~...~..~....~..'.~.~....~......~'~.... ..................... Subdivision ..., ............................................................ Lot No..-~..'~:.;q~lb-¢l~.N._~......~.... Hou~lo.....~...../~ Permit No. Z'~,,~.~.~,... DoteOf Permit ............ ~~,~,,~,,.,?~.~,~.~,~~ Health Dept. Approval ............................................ Labor Dept. ApprOVal ....................~.~ ................ Underwritem Approval .............................................. Planning Board Approval ........................................ Request For Temporo~ Ce~ificote ........................................ Final Ce~ificote .......................................... Fee Submitted $ ~..~ ....... .............................................. Sworn to be,ore me this ................ dQy of ............................................ ~-/ (stamp or seal) Notary Public .................................... County TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner (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 ~v~day of ~7~/~/~ , Notary Public,%~/~-~L/~County Public, State o~ New York No. 492075~ ~alifi~5 b 8~ffoik Ooun~ (plumber '~ Notary FIELD INSPECTION COMMENTS FOUNDATION ~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [ ]ROUGH PLBG. []FOUNDATION 2ND [ ]INSULATION []FRAMING []FINAL REMARKS: ,~(/~,-5~'c~.~.x~F-~ 2~/ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~..~,<~..[..~. ..... , 19 .~.?~ .~ Approved '.{~.~... l .~. ..... , 19 .~.?~ermit No. ! .Ct~.~. d F. Disapproved a/c ............... ~ ............... Received ........... ,]9... APPLICATION FOR BUILDING PERMIT Date 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, housin~'6~, and regulations, and to admit authorized inspectors on premises and in building for necessary inspection~ o ,~ ~[(/t~, ................... .... " (Signature of applica ~, or-nat , ' p ' ) :.'S..t. ! ?3 ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises .... .~. ?..~'..~..~.~...~. ~ ?..'~. ~. ............................................... (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 ........ .~.t..~ ............. Plumber's License No ....... 7..~.~. ?. ........... Electrician's License No ...... .,~..o~..~. ~ ......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ............... Block .............. Lot ................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy [ ~4,~, ~ b. Intended use and occupancy ..... : ....... : ·: .~'. .... ,:,W~/.~,;. ,W~;t:!.:~.,,~. ,~.~...~:~ .~.I~ t'C1 " ...... ,/ ......... '~," · '1 10. 11. 12. 13. 14. Locate clearly and distinctly property lines. Give street and bloc interior or corner lot. Nat~r~)[~b~ ¢15 ~licable): New Building.. ' 'Addition. ~ .... Alteration .......... Repai~ i.: ........... Re~?ai ....... Demolition .............. Other Work ............. ~ ~ ~ : ~.~ (Description) Estimated. Cost .......... ~..~ ........................ Fee. ~...~.~...."? ......................... "' ~" (to be paid on filing this application) f dwelhng, number of dwelhng umts.. I ...... Number of dwelling units on each floor.. ! If garage, number of cars ' If b si ommerci 1 or mi:< d o cy specify_ e and xte t of each type of '-' u ness c a e ccupan , natur e n use ..................... D'tmens~'ons of existing structu~res, if any Front % o -,a *- Rear '~ o .~ ~ Depth .~. ° ' ?. ~ Height .. ~'1. -~ ~ Ntlmber of Stories Dimensions of same structure with alterations or additions: Front .... ~. ~. ?..~-. ..... Rear .. ~ ..'~. ~ ........ Depth .... .-~.'-x..'79.. ~ ...... [ .... Height ..... I..'~..-~..% .......... Number of Stories ..... I ................. Dimensions of entire new construction: Front ....q'. )..-~..g .... Rear .....n/~...'?-2. ~ ....Depth ....g?..'9.. [ .... Height ... ! .~...'~..~ .... Nfimber of Stories ...... .~ ................................. 4 ............... Sizeoflot Front It~6'o . Rear ..... .~..'?~..77.~ ...... Denthl~'.-.- 1~%-0 Date of Purchase ......... : .................... Name of Former Owner ............................. Zone or use district in which ~remises are situated ............................. Does proposed construction violate any zoning law, ordinance or regulation: .. ~,,J~:> ........................... Will lot be regraded ....... i ....9 ............... Will excess fill be removed'from premises: Yes NameofOwnerofpremises /~.o.~nv~4,f..~'.~...~$, .... t~, ~'~ {,a~t~r~.o,~ oe-~ Address ................... Phone No ..... "/ .......... Name of Architect ....... ~ .................. Address .......... ~ ........ Phone No ................ Name of Contractor .~.... ~?..~..'~9 ........... Address ~'i~e9. ~..t.~ .~ ~.. ?? ?.v..,~..,~. Phone No. '3.~..<3.'..-~..~.X.''. . .. PLOT DIAGRAM 11 buildings, whether existing or proposed, and. indicate all set-back dimensions from k number or description according to deed, and show street names and indicate whether STATE OF NEW/YO.R~K,, x COUNTY OF ~ ..... i S.S ...... '/~F2/.~//~d~../~v45.O2&Td5 ................... 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 liave performed the said work and to make and file this application;that all statements conltained 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 ..... /.c~ ~ .......... day ~f.. ~d. ..... 19 .~? Notary Public, . ................... County ff ~ NOTARY Yt~lJ~, 8t~t~ M ~¥~ .................................. i ~.4a~li~.suff~co,~ (Signature of applicant). :Term Ex~lrM MM~h ~0,