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Home My WebLink About14500-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Soufhold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17386 Date NOVEMBER 18~ 1988 THIS CERTIFIES that the buildin~ ADDITION Location of Property 520 PRIVATE ROAD #12 SOUTHOLD~ NEW YOtAK House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 6 Lot 6 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 25, 1985 pursuant to which Building Permit No. 14500-Z dated JANUARY 14, 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 BATHROOM & DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to CHARLES & CLAIRE WOOLLg¥ (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N748623-MAY 8~ 1986 PLUMBERS CERTIFICATION DATED NOVEMBER 10, 1988 Rev. 1/81 Building Inspector TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14500 Z Permission is hereby granted to: ..... £~..~.~....~.,o.~,~. H.~. AM .5. ............. .... ~.~Q...S.~,~v..~.o~ ..~..; .................. .... ~.u.~t~.~.~....?.~....~,.....~.~.~..t ~o ..... .C.O.L.~...~..~.C~...~.~........~... ~-~.~.~.-4~.~....~.........~....~..~.CC.~.o.~...~ ............... ...... ~___~L-~.~..%.....~.,.~,~.c:.....'~.~......C~.~...~..C~.~.~Lk6.~.t L~ at premises I~ated ,, ...~Z~....~.~...~..~...~.~...~ ............................................... ..................................................................................................... ~,~a.~..~.~,... County Tax Map No, 1000 Section ,.~,,.~, .,.,~,..,. Block .,..C~..~:;~ ....... Lot No...C~.{:~..C ....... pursuant to application dated .~:~.(~...~... .......... .~,..~..'~.. ................. , l~..,~and approved by the Building Inspector. Rev. 6/30/80 / c/rv~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: // FIELD kI N~S I~EC~ION FOUNDATION COM'~ENTS ~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,%uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplvicate A. This application must be filled in typewriter OR ink, and submitted to zhe Building Inspec- tor with the following; for new buildings or new use: 1. Final survev 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 (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topogreph ic 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex~st~ng dwelh g $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ..... ,~....-..'.. ~..~..~ ..... New Building ..... ~ .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ' Off.. n House No. Street Hamlet Owner or Owners of Property ...................................... County Tax Map No. 1000 Section ~..' .~./~. ...... Block ....~. . ........ Lot. ...... ~ ....... .. Subdivision ~ .... Filed Map No. ot No. Permit No. .. Date of Permit . .Applicant ............ :, · · ~ ............. Health Dept. Approval .~-~' "''- ' - ..... Labor Dept. Approval ..---.~.?..J~,..~. ............ Underwriters Approval ..~.. f..z~...~.0..?.~.~r.3 ..... Planning Board Approval., /[~ Request for Temporary Certificate .................... .Final Certificate .... ~ ............. Fee Submitted $ .... . ,~,.00,. . .................. . Construction on above described building and permit meets all applicable codes and regulations. Applicant , ~ ..................... Rev. 10-10-78 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 ~00L~q (please print) Plumber -~r.)~-~O~, ~-~51~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this /~ day of 19 otary Publ ~/- N6t~ry Pub~i~ ELIZABETH ANN NEVILLE County Notary Publlo, State of New Yo~ No. 52-8126850, Suffolk Cou~W Term Expires October 31, 19 ¥/1 ' UN E WR!T R O R E S :"THE,,~NEW YORK~ BOARD OF FIRE : Jib-l:' I!!i':': ' 8S JOHN STRIEET NEW YORK NEW YORK10038:. ' , ~ Ma7 8,1986 , ~ , , ,~..~,~.~,o.~oo.~t~ 597890/86, :~ , N the electrical e~uip~nt ~ ~scr~bed below and lntrod~ed by the applicant named on the abo~ appllcatlo~ ~u~bor in the premiss of C. ~: ~oolley, Pr'Sva~e}Rd.'? Off MaSh BayvSew, Rd.,.Ceda~ Dr., Sough01d, / / NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 NOV 261985 ..~/. TEL.: 765-1802 Examined .~,~'~...l .~...,19~.. ? ~eceived ........... ,19... Disapproved a/c / ~. .~ ] APPLICATION FOB 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 i~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 hqspection throughout the work. e. No building shall be occupied or used in wkgle or in part for any purpose whatever until ~ 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?'~uffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additzons 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 inspection,~d ,,~ -~ ~ (Signature of applicant, or name, if a corporation) ........ ! (Mailing address of appliSant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ ............................ - ......................... Name of owner of premises .~ .~fil .~..~.'~...~'7 .~l(~(a~ .o.n.~e.~a.x.~!l~r~i~t.e~t· ~l~) ......................... 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 LicenseNo ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ......... ............. ............ ........... House Number Street - Hamlet County Tax Map No. 1000 Section ...... .rT...~ ........ Block .... ~ ............. Lot.. ~. ............... Subdivision ....... .~...~.y [/i ~(A-) .... Filed Map No ............... Lot ............... (~'aiG) .... , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... l.. ~..~../'T!/.'/~.....O/../'~..~[./'.P/..~ .................................. b. Intended use and occupan~cy ~ . .~/~,t~...~.... ~ .~. ~...~:~. .............................. 3. Nature of work (check which applicable): New Building ..... '..-}.. Addi/don .......... Alteration .......... Repair .............. Removal '. ............ Demolition .............. Other Work ............... · ~. ~..0'~. · / i (Description) 4. Estimated Cost .... ~. ..................... Fee ..... (to be Paid on filing this application) 5. If dwelling, number of dwelli,ng units .............. .~ Number of dwelling unit~ on each floor ................ If garage number of cars ' 6. If business, ommerclal or mixed occupancy, specify n~,ture and extent of each type of use ........... '/'" 'l'r ..... 7. Dimensions.o,~etxistingstmciures, ifany Front .~ ... Rear .~.¢. i'.- Depth ~ I ~-/'. Height . . [~... Number of Stories [. - i' ' ................ Dimensions of same structure with alterations or additions Front ~ ~-~ . . , Rear ~,~/:~ Depth . . .'~ J./.(l(i/.~ ........... Height .... 1~.~ .......... i i i ~n~b~ ~) ~i;~i;s .... 8. Dimensions of e~ntire new construction: Front ~ .~ .. Rear .. ~.. ;.. Denth {0 . Height .. '~. Number of Stories ..... ./ ............... 'i 'i 'i i'" ',.,,~ i'i ........ Size of lot' Front 1 I t Rear ~,~r ..... i)~tl~ ':"/'Y~.. ........... 10. Date of Purchase ............................. Name of Former Owner ' . .............. 11. Zone or use district in which premises are situated ......................... ..~ ......................... 12. Do~s proposed construction vinlate~adv zoning law, ordinance or regulation: .... /~../~. ........... ~ ....... ' .... 13. Will lot be regraded .......... [.?..'(> ....., ....... Will exacts fill.,b_e removed: from premises: Yes , 14. Name of Owner of premises ~. ~..~.0..0/./.~.~.. Address /'~JP/~/;/'/.~. 1~..A~..!... Phone No. ~o.~.~.--..~/~..'~,~-.. Name of Architect .... ~, .J .... ,_., ............. Address .~...~. .... ii... Phone No ............. Name of Contractor . l~.O~....~J. }~/t'.~/Y].~. ....... Address ;} ~ Phone No..~.' .~.~. ~.~.'. PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 NEW YORK, S.S COUNTY OF . . . ~ .............~. (Name of individual signing contract) above named. : He is the .............................................................. (Contractor, agent, corporate officer, etc.)I of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application;that all statements contained in this application are true to the best of his iknowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to beftore me this .......-- ~...(...2~. ...... day of ..... /~.0.p/ 19~..~ Notary Public, .~%~gc~ ~;~-m'c.) ............... '~'~ ..... County ,..~ ~....?~ NOTAR~ I~JSLI~, Sram of NewYotk ~ (Signature of applicant) T~rm F.~t~8 March 30, 19 w...~(]~o