HomeMy WebLinkAbout14494-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date July 7, 1987
THIS CERTIFIES that the building ONE FAMILY DWELLING WITH ATTACHED GARAGE
"'~'c'~' '~'dO~' '~'g C f( .... ~ ...................
Location 980 Stars Road East Marion, New York
of Property//~ds~ h]ol ....................... ~}/e~t' ....................... //~r~/e}
County Tax Map No. 1000 Section 03 I .Block 04 .Lot 004
Subdivision M/o Soundcrest Woo~s .Filed Map No. 5315 .Lot No. 5
conforms substantially to the Application for Building Permit heretofore filed in this office dated
~.gy.e.m.b..e.r..[8..,. 1985 pursuant to which Building Permit No. 14494. Z
dated......................January 7, 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 .........
ONE FAMILY DWELLING with ATTACHED GARAGE & ATTACHED WOOD DECK
The certificate is issued to KBD DEVELOPMENT CORP.
..................... ?oh;n'o;,'f~'lOh~'~ .....................
of the aforesaid building.
S ffolk Co nty Depart t f H alth App 1 85- S o- 123
u u men o e rova ..........................................
UNDERWRITERS CERTIFICATE NO P E N D I N G
PLUMBERS CERTIFICATION DATED:
June 29, 1987
Building Inspector
Rev, 1/81
FO~ NO. ~
TO~N OF $OUT~OL~
BIJILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 14494 Z
Permission is hereby granted to:
......
...... L~..o**....~r:~.,~**..~ ~**.~ ....~***o.***,~.~....
....~..~.....~...~--~..~..~..~..~...~.., ....... (.L.o....~ I
~ -. ~ , ~. ...
~o ............ ~..~.~.T..~...~..c~.........Q~.~.....~.~.~ L c~.~......~.~..~..~.....%. ....................
at premises located at .o...~.~.~. ....... ~.'~..J...~...~......~..~..~.....~...~...~.~..~....~.~L~.~(..h.L.~4.:..~'
...... ,,~ ~ ~ .~.cr,~.~. ~C....%.%~.~.~ .......... ***':~**...~'.~..~-':***** .............. C~**':C*****-~..~ .......
County Tax Map No. 1000 Section ....~....~...1 ......... Block ....~....'~.. ......... Lot No...~.....C?...'~... ..........
~urs~ont to op~cot~o, dat~ ...~., ........ !..~ ..................... , ~..~ o~ oppr~ ~ th~
13uildlng Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N,Y, 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
q OF gOU F[-~O,
Instructions
This application must be filled in Wpewriter OR ink, and submitted emi 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.
§. Submit 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 pz"operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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: Additions $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory,S10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwet~ing $ 50-. 00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..........................
NewConstruction ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ......................... .- .....................
House No, Street Hamlet
Owner or Owners of Property .~..~.2) ~. ~.~4+~~.~
County Tax Map No. 1000 Section ...... ,~/ ..... Block ...... ~, ....... Lot ..... z~, .........
Subdivision...~..O..L)./~.O..~.~..~...~.~..~.1,.~,~. ~Filed Map No, . .-~, .'-~./.~... ,Lot No.
'-7-'~ Applicant .~.~., ~
Permit No.//Z<.~. ~.~/..'~.. Date of Permit ............... ~ .....
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.
Rev. 10-10-78
SCALE 1"-,.~-.~' ' '
~A~m.v DVVEL.~NG om.v '"
WATER GUPPLY FAG&I'I~ FOR TH~
INSF~GTED BY TH~ DEP~ AND
DRAWN BY .~--~.~
WILLIAM R. SIMMONS III
138 WOOOLAND ST.
EAST ISLIP, L I., N. Y.
PAGE GRID
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No. /.~/L~ ~
(please print)
/
Plumber/~ ~O;~ ~FL~C~ ~,
(please prat)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
Sworn to before me this
-U
Notary Public, ~~L3Dounty
UNDA J. COOPER
Notary Pubtic, State, of New Yofkflf'/
No. 4822563, Sunolk Coun~X
Term Expires December 31, 1~~
Not~ry
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 15T [ ] ROUGH PLBG.
[] FOUNDATION 2ND [] I/NSULATION
[ ]FRAMING
RE:MARKS:
/ /
FIE~D II~PECTION DATE
FOUNDATION (1st)
FOUNDATION ( 2nd )
ROUGH FRAME &
.~_ ~~~
INSULATION PER N. Y.
STATE
ENERGY
ADDITIONAL COMMEN
765-1802
BUILDING DEPT.
INSPECTION
?
FOUNDATION 1ST [~ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
FINAL
REMARKS:
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS: ~//,/~...~
DATE
INSPECTOR
7GS-180~
BUILDING DEPT.
INSPECTION
FOUNDATION ZST
FOUNDATION
FRAMING
ROUGH PLBG.
INSULATION
FINAL
REMARKS:
DATE
SURVEYED FOR:-J~7'P
LOCATED AT
LOT ~
SC~E 1"~'
SUFFOLK COUN~ DEPARTMENT OF
HEALTH SERVICE
The water supply and sewage disposal
~stems for this residence will conform
) the standards of the Suffolk County
,epartment of Health Services.
FO~I AI~I~O¥,AL/OF CONS11~UCT~.O~ ONLY
SINGLE FAMILY DWELLING ONLY/~z_~
FILE NO./~
WlLLI.~ R. SIMMONS III
138 WOODLAND ST,
EAST ISLIP, L L, N. Y.
PAGE GRID
~ yt'~ 777a
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1802
Examined .~/'~. - · ~7 ..... , 19~.g
Approved.Z. . ...3 ......
Disapproved a/c ....... .~x~ ..................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG. 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 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 inspections.
& ..............
(Signajgure of applicant, or name, tf a corporation)
· ~,:.~.a&. N.~.*.,..~..~.~../.or.,a .... /.,.q.z. t ......
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises /~t~./) .~D..e E~./.o .//.~..~..e_.~..~....~??~.: ........................................
............. (as on th6 tax roll or latest deed)
If applicant is a corp~ation, signature of duly authorized officer.
(Name and title of corporate offi )
Builders License No...c~,..t:.~.o../.~..
Plumber's ~icense Noj
Electrician s License ~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. i000 Section ...... .~..~ ......... Block ....... .~. ......... Lot ...... ~ ............
Subdivision··J...~. ~. ~.:...~.... ...... Filed Map No. ,.,<~3f~-' Lot..5~
(Name)
2. State existing use and occupancy of preT2es and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....... V..d-...~...15...~...~., ................. :~':"' ......................
b. Intended use and occupancy ~t~q[~ /~g4t; .~..~.t..ff.~.~.~.5.}:... .......
3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration ..........
Repair ..... ;..: .. ......... Removal .............. Demolition .............. Other Work ...............
4. Estimated,Cost .... .o.o...O. ............. Fee ...........................
.~ . ~'~. ~ % (to be paid on filing this application)
5. If dwelling, number of dwelling units / .. Number of dwelling units on each floor .... .~.' ~ ·
If garage, number of cars ~ ' '~>~ ......... ~ ..........
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... .O....~7. ,' .........
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure ~yith alterations or additions: Front ................. ' Rear ..................
Depth ................... i. · · Height ...................... Number of Stories ......................
8. Dimensions of entire new'construction: Front ............... Rear ............... Depth ...............
Height ............... Nurpber of Stories ............ ; ...........................................
9. Size of lot: Front ...... /Off.!: .O.O ........ Rear ... ./.o.O, t~/ ........ Depth ....~..o..~.,..~.$. ..........
10. Date of Purchase .... .~..~/'~/. i./.~. ~'~ ............ Name of Former Owner .~.~Ot:~o~-,~..',~-4~ .~-~.~.~-/~ ....
11. Zone or use district in whicl{ p~emises are situated .....................................................
12. Does proposed construction violate any, i~oning law, ordinance or regulation: ....... ./~.o.: .................... ...
13. Will lot be regraded ........ ' . ....?',.~. L6.· . ......Wili excess fill be remnv.~d fl:am premises Yes ~: No
14. Name of Owner of pre .m~ses~..~.~..~>..~?.~.~°.tq../.n..~_~r-..... Address ..~ .~..e~..~.~.~.~. Phone No..~.~.*r. 77.7. t2 .
ame of Contractor ....... Address .....
PLOT DIAGRAM
Locate clearly and distinctly all bBildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NE~ ](ORK~ o o
COUNTY OF . .~/4~-o~tef~. · .... o.o
· .~..]~ .~ ................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
~porate offi~ etc )
. (Contractor, agent , .
of said owner or owners, ~d is d~ly authorized to perform or have ~erformed the said work and to m~e and file this
application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfom~~er set forth in the application filed therewith.
Sworn tongue,before m~his
Nota~Public, . . , ..... - ~.:.. County
,~'X£/a,v, ,¢y
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