The URL can be used to link to this page

Home My WebLink About14029-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... z. .1.4 .6.6. 5. .... Date ....... .J. ql. y..1.8., ................ 19 .8.6. THIS CERTIFIES that the building .... .O.n.e...f.a.m.i. 1. y..d.w.e..1.1.i.n.g ..................... Location of Property ...3.9.0...A.l.o.i..S. Lane, Mattituck, New York House No. ' ............... 'S'~,:e3i ....................... h$,~iel County Tax Map No. 1000 Section 12 3 .Block 0 6 .Lot 4.1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.u.n.e..1. Q~ ......... 19..8.6pursuant to which Building Permit No..1.4.0.2.9, .Z .............. dated ...J.u.n..e..1. Q, ................ 19.8..6, 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 The certificate is issued to . .C.h.r.J:.s.L..op.h.~.r...R.~.hm & Adrienne M. Rehm " ' ..................... of the aforesaid building. Suffolk County Department of Health Approval ............ 8.5.7 .5.0.-.2. .5 ..................... UNDERWRITERS CERTIFICATE NO .................. .N.7.4..6 7.3.3. ....................... Plumbers Certificate dated July 11., 1986 Building Inspector Rev. 1/81 · 'OB~[ NO. ~ TOWN 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) No 14029 Z .....'J~.~.~.....A.~ ............................................... ..~.~....~.:.~..,..J.~.~...~. ................... ........... at prem,ses located at ...[c~.....~. ..................................... C~....¢~.. ............... ~(..J...~ .......... County Tax Mop No. 1000 Section .... ../....~...~.~ ....... Block ...... ....(~....~. .... Lot No ........L~...:..../. ....... pursuant to application dated ...... ...~...,(~,<~L........~.T .................. 19,~.,..~.'~., and approved by the Building 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 Instructions 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 sifnilar 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. 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 unusua~ 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. 1. Certificate of occupancy $5.00 2. Certificate of bccupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 $15.00 5. Updated C.O. $15.00 Dat .z New Building .... ~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~. ~.~. ...... ~../4¢~.'/.~': .....~? .~..~..~..' ........... . .~..~..~, Z~?..~.~f~, .... House No. ~ ~ Street, Owner or Owners of Property ~..~.<£/.~ .~..~'.~..~..~7...."~P/..~(¢~~. ~.. .... ~ .~.~./~. ~..Hamlet..... County Tax Map No. 1000Section .../. ~...~. ...... Block ...... ~ ....... Lot ...... ~.. ....... Subdivision~y4~./.¢~/.~ . ./~.//'~d//~..¢.-f~.~.~:...F lied Map No.! ......... Lot No 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 p~Tnit me. ets all atzplicable code.~nd re.g~l~tions. cc) z- TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Buildin9 Permit No. / ~/~ ~ 9 ~- Owner ~//p/~/~/~/~ ~ .~/~/~ ~- ~ (please print~ ' (please ~rint) ' I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this 19~ · Notary Public, (plumber's signature) ~, ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~t BUREAU OF ELECTRICITY ~.~.~85~ JOHN STREET, NEW YORK,~=/~;~,NEW YORK 10038 Date Application No. on file N THIS CEP~TIFIES THAT onl ~ he flectrica e ui ~ as described b ~ and i troduced b ,the lie $ n e ' ' and found to be in cornplia~tce with the requirements of this Board· EIXTURS FIXTURES RANGES COOKING DECKS OVENS OUTLETS FANS OTHER APPARATUS: SYSIEMS E R V I C E NO OF CC. COND. A.W G GENEI~AL MANAGER PeL This certificate must not be altered in any manner; return to the office of the Board if incorrect. I~spectors may be idemi~ied by their credentials. ...... COPY EORBUILDJNGD~PA~I~MENT3t.JJS_COP,'~ OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FIELD ~NSF~CTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY ODE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] I~ULATION [ ] FRAMING //~FINAL REMARKS: ~~ DATE _?~/~//~,~//,INSPECTOR ~ 7GS-'~8Q2 BUILDING DEPT, INSPECTION [ ] FOUNDATION ZST [?{]~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION / ~,,,] FRAMING [ ] FINAL REMARKS: DATE//' :'/' ~/ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y. 11971 TEL,: 765-1802 Examined Approved ....~t~'-.-:.*-. ...... ,19... Permit No ............ / Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .................. , 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 Depaxtment 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 demolitiont as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing c~ode, a34d regulations, ansi, to admit authorized ~nspectors on premises and m building for~ne~ssary inspecJ¢cns. /~1 -// // // _ ~(~ignatuLe of applicant, or name, if~a corporation) · l .'.ct. ~. ............ / ......... d, '/' '~' ' "'~' (Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....... ...................................... .: ........ : .... ................... Name of owner of premises (~>./.~ .~/~Zd'.. ~ ~.///~.'. ?. i~X.Y .'~?..,fl..~.... '.~.. ~';/~..~. · .' ............ (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. Z/~ .e~'t~ac,~ .~JatD~).,oy..S ~o_tkltdq Electrician's License No .... ~. ~ ~ .~' .......... 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.. o~.'.....&/t.:. / ..... 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 ...... .~..~....~: ?/~.~..../.: ...... ......................................... /: -& b. Intended use and occupancy ............... ?~?//~t. / ......... . .~/~/...~.. ........................ 3. Nature of work (check which applicable): New Building .... xlL,.'. .... Addition .......... Alteration .......... Repa~j ~.L.jj ..... Removal ........... Demolition .............. Other Work ............... (Description) 4. Estim'ated Cos Fee "~ (to be paid on filing this application) 5. If dwelling, number of dwellin units . · ' . Number of dwelling units on each floor If garage, number of cars .... .......... 6. If business, commercial or mlxOd occupancy, specify nature and extent of each type of use .................... ' h' ' ' ' pth 7. Dnue slons of ex]sting structures, if any: Front -- ~' ~ Rear ..: ....... De · Heigt~t ............... Nuglber of Stories ........................................................ Dimehsions of same structure with alterations or additions Front ............... Rear .................. Depth ............. i. ·. Height ....... Number of Stories .................... ' ' .... '~ ' ?? ..... ," ,7 / ' ' Dimehsions of entire new construction: Front 7.2,~ ~. Rear . .~...~. ' ~.. Depth 3/. · eight, ........... : .. Nu{n ber~,,o~, Stones ..... ~, .................. Size of lot: Front ... ~, 7.~.,1 ..~. { ......... Rear...~..~.,~.t{~. ~. ......... Depth . ./, .7~....~'.~. 10. Date0fPurchase . ~.,¢'t¢,. .ji ~ . .l.~r.~'.~. . Name of FormerOwner/i~/]~./F/t /.~.. .]~.~t~. ¢~ G. eyf..,~..~. .~ 11. Zone or use district in which premises are situated ....... ffl.<~'. ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. :.. Will 10t be regraded ... ~.~. fi.;.... ................... Will ex,ss fill be removed from premises: Yes 13. Name of Owner of premises ~//~t£ ~L.~/./Z~.~.. ~;-/fta/~fd~ss/.~.~..~t.. ~ ........... Phone No.~'~d. Y~ .~ 14. NameName of Contractor°f Architect ......... ! .................. Address .~.i:.-, /~./~]C' ].~ .......Phone No ................ ........ .................. Address ... ~.~Aex,'/...Phone No ..... PLOT DIAGRAM Locate clearly and distinctly a~l 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 interi°r~ or'qqm_ e_[J°t~' ...... 2.2~ '22~4~ STATE OF NEW YORK, COUNTY OF ................ S.S ........................................ · .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the ; j i (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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the application filed therewith. Sworn to before me this · .. ........ ."~. · · .~. ....... day ~f ...... ~:~ ......... 19 .~-.~..'- '~*'-~"~":"' HELEN K gE VOE "~' ', N0mY puuuc, , NO. 471~7878, Su 10Jk Couatj~ ..... ,-,, ~/,'"' '/'~ .............. ~arch 30. 19~' ~~f'f ,~.~ ~j,, (~Signature of applicant) ,; LICENSED LAND;SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H, S. NO. gE~',"-'.'7 ! · ..;, STATEMEnt OF~ INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOL~Kx~O~ DE??T. OF~EALTH SLUICES. .4 .~ APPL CANT . J SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL Of CONSTRUCTION ONLY //~/~ ~.--~ DATE' i ~ 2/~/~ ~ .. S. ~ef. NO.. ~'S -- ,, ~ 0 ~ ~-~'-- ~'~ OVED- ~6 ~ -;-~"~ ~'~i ¥ SUFFOLK CO. TAX MAP DESIGNATION: DI ST. SECT. BLOCK PC L. -OWNERS ADDRESS: DEED: L.~Og~ TEST HOLE STAMP SEAL 5, 85'B8' tO" E. .~ .... S4JFFO ~", SINGLE FAMILY DWELLING ONLY ~D TO BE SA~SFAC O _ 0 ~ ROD~R~t¢~K VAN TUYL, P.C. LICENSED LAND SURVEYORS SUFFOLK CO. i'7i£AL'I~H DF. PT. APPROYAL STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (S). APPLICANT' SUFFOLK COUNTY' DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF EONSTRUCTION ONLY D ATEh" . , , APPROVED: SU~'FOLK CO. TAX MAP DESIGNATION: DIST. SECT, BLOCK PCL. OWNERS ADDRES,~: DEED: k,~O99 T£ST ~'~LE