HomeMy WebLinkAbout14064-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y,
Certificate Of Occupancy
No. ZI5643 Date April 14, 1987
THIS CERTIFIES that the building .... .O.n.e...f.a.m.i. 1..y..d.w..e .1.1.i.n..g.. ....................
· 980 Stars Road East Marion
Location of Property .................................................
House NO. ' ..... '~'t/e~[ ' ' ' Ham/et
County Tax Map No. 1000 Section ...0.3. [ ...... Block 04. .... Lot 4
Subdivision Soundcrest Woods Filed Map No. .5.315. LotNo. 4
conforms substantially to the Application for Building Permit heretofore filed in this office dated
J u n e 1 I, 1985 pursuant to which Building Permit No. 14 06.4 z
dated ...J.u.n..e..1.9.:..1.9.8. 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, attached 1 car garage.
The certificate is issued to ERICK AND JANET HEINS
..................... io'a;n'o;', ~;~ 'fffffffff~'~& ~'/ .....................
of the aforesaid building.
Suffolk County Department of Health Approval 85 - S O- 8 2 Ap r · 3, 1987
UNDERWRITERS CERTIFICATE NO ............. N 783/*.23.. J~e c o..1. [,. ·1·9.~t 6 ...........
PLUMBERS CERTIFICATION DATED: March 24, I987
Building Inspector
Rev. 1/81
FO]II,~ NO. e~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF TNE WORK AUTHORIZED)
NB 14064 Z
Date
Permission is hereby granted to:
......~......~..~ ...... ..e...:......~..~ ..............
~~~.,..x~,?....:~ ........... ~-~ ............ .~.......:....~ ............... ,. ............... , ...........
at premises located at ..~ ....... .~,~....~.~ ........... ...a~......Q~.....~........~.~ ......................
pursuant to application dated ........ ...~..~.....~.~ ...................... , 19..~...~..'~ and approved by the
Building Inspector.
Fee $ ...................
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
A. This application must be filled in typewriter OR ink, and submitted i ~ 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 (prior 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.
C. Fees:
1. Certificate of occupancy $25.00 -- BUSINESS $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10,00
o.o. $ o.oo
5.Updated C.C. $ 50.00 Date .................
NewC°ns truc~i°n ...... Cid or Pre-existing Building ............ Vacant Land .............
Location 0f Property ~'~
House No. Street Ham/et
Owner or Owners of Property .~C~.. ~. ~L'~'. ...............................
County Tax Map No. 1000 Section ...~.;k ....... Block .... ~. ......... Lot..~. ...........
S~bdivisio,~..~..~'. .......... Filed Map No. ~Jl~.Lot No..~ ...........
........... ,
Perm[tNo ~0~ Date of Permit ~l ~ l ..... App icant~..~..~.~ .............
Health Dept. Approval .. ''~. ................... Labor Dept. Approval .................... , ....
Unde~ritersApprova~ I~J~ ~ Planning Board Approval .....
Request for Temporary Certificate ..................... Final Cerdf cate .....................
FeeSubmitted$~¢~¢ Oo ~ ~'~
Construction on above described building an.~oer,~.~.~ym77 all applicfible codes and regulations.
App.cant. ..................................
Rev. 10-10-78
'I~LD'~S~'ECTION
FOUNDATION (lst)
COMMENTS
FOUNDATION (2nd)
~ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
lOOlO?:~ T H E
THIS CERTIFIES THAT
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 1003B
Appl,~.,,o. ~o. o.J.e ~m~3~/~ N 783473
in the foltowing locatloq~ ~. Base.lent~ ~
only the electrical eqtt,pment as described below and introduced by the applicant named on the above application number in the premlses of
A¥ic I{eins, Sts~ Road, E~st ~arion~
1st FI. ~ 2,,d ~T, ~ect~on Block
and found to be in contpliance u, ith the requlrett*ents qf this Board,
FIXTURE
OUTLETS SWITCHES
FIXTURES
DRYERS FURNACE MOTORS
SERVICE DISCONNECT
S V I
NO. OF CC COND A W G. NO OF HI.LEG
~ RANGE~e
]
iPECIAL REC'PT
OF HI-LEG
OTHER ~PPARATU$:
Lot
EXHAUST FANS
DIMMERS
· 4/0
-t-G.F.C.I. t-~ao~, Detector~
C~S Electric
Box 215
Southold, N.Y.
119'71 Lic. 578E
GENERAL MANAGER '
11
Per'
This certificate must not be altered in any manner; return to the office of the Board if incqrrect, inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THiS COPY OF CERTJFICA~.,E ~UST~OT BE ALTERED IN ANY MANNER.
,TEL. 765-! 802 '
TOWN oF sO oz,v
OFFICE' OF BUILDING IN,$PECTOR
P.O. BOX 728: :
~ TOWN HALL
SOUTHOLD N.Y, 11971
Building Permit
~,~ I certify that ~he,:,,$0~der'used in the water supply system
contains less than 2/10 of 1% lead.
(plumber's signature)
NO'
to befor~
,day o
-Notary Public
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 7654802
July 13, 1987
Janet Heins
870 Stars Road
East Marion, N.Y. 11939
Bear Mrs. Reins~
This letter is a follow up to our con-
versatio~ on Friday regarding your house num-
ber.
If you will please mail me your original
Certificate of Occupancy I will make the nec-
essary changes.
Thank you for your cooperation and under-
standing in this matter.
Yours truly,
Secretary
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN IIALL
SOUTHOLD, N.Y. 11971
TEL. 76S-1802
This is to advise you that the job u. nder building
permit no. 13530Z issued to Nancy
Radmzn
on __3_1/9/84 for Accessory is completed and
a final inspection }las ( ) has not ( x ) been done.
~n order to complete this file, it is necessary that
;1 Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a check
for $10.OOpaynble to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this offlco for an inspection date
Ocenpnecy or use i.q unlawful without a Certificate of
Occupancy. Please. he]p ns to clear up thfa matter so that
legal action does not have to be taken. ~
Thank you for yot~r prompt attention.
Vet! truly~,
Victor Lessard
Executive Administrator
VL:gar
765-18~2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
DATE.
765-X802
BUILDING DEPT.
INSPECTION
[ ] FRAMING
[ ] FINAL
/
DATE INSPECTOR
7GS-X802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION SST [ ] ROUGH PLBG.
~/] FOUNDATION 2ND [ ] INSULATION
~ [ ]FRAMING [ ]FINAL
REMARKS: _~__~G ~
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined.._.~.....ur~N%....
Approved .~gle'e4~..~ .~.., 19~. Permit No. ).qg..~.~
Disapproved a/c .....................................
Rece±ved ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date
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 ~ireas, 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 Bhilding Permit.
d. Upon approval of this application, the Building Inspector wilt issued a Buildh~g 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.
......... ............
(Signatt~e of applicant, 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 ..... ~...~.: ~J .' ./~......O/...L~... ~...~..: .(~J~/~'~.'.O~ .........
(as on the tax roll 6~ 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 ......................
1. Location of land on which proposed work will be done ..................................................
..... ............... ....................
House Number Street Hamlet f
County Tax Map No. 1000 Section . .O..~.[-.O.0 ..... Block ..: ~....O. 0. ....... Lot ..... '. · ./~J~. ~ .....
Subdivision...::~..~.~ ....... Filed Map No...~..~J.~'~.. .... Lot...~..~. ........
(Name)
2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n:
h(,a. Existing use and occupancy ..... .~.~ .....................................................
b. Intended use and occupancy.. ~. ~~. ~~ ...........................
3. ' Nature of work (check which pplicable): New Building .......... Addition .......... Alteration ....
Repair .., . ~ .o . Removal .............. Demolition .............. Other Work ..............
~ . (Description)
timated C .~.1, .D. ~ 1D
4. Es est ........ . ........................ Fee ...................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...............I Number of dwelling units on each floor ................
If garage, number of cars
6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use .....................
'm ..... pth
7. D~ ens~ons of ex~shng structures, ff any: Front ............... Rear.. ............. De ...
'ght ' ' ...........
; He~ ............... tuber of Stones ....................................................
Dimensions of same structure ~vith alterations or additions: Front ................. Rear ..................
Depth .................. i ' ' ' Height ......... ~..; ......... Number of Stories ......................
8. Dimensions of entire new construction: Front ....L0.~ :.q.! ...... Rear .. tiP.{ :,.~.t~ ......Depth . .3.@~, ..........
Height ............... NUmber of Stories ..... ~ .................................................
9. Size of lot: Front .... ,I .0.(2 .t! .............Rear ....... ! .O.O.' ........... Depth . .~..O.~.: .I .q/ .........
WI0. Dare,of Purchase .........
11. ' Zone or use district in which premises are situated .... ~LA~/~t~0 ..................................
12. Does; proposed construction vilolate any zoning law, ordinance or regulation: . Ig).¢) ...........................
13. Will lot be regraded ...... (k%~ .................... Will excess fill be removed from premises: Yes (~
14. Name of Owner of premises ~?.
Name of Architect ./5-~ .~i i i i i Address i~ ./~..t~i i Phone No ................
Name of Contractor ..... ~.% ............... 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 {DF .................
............................... being duly sworn, deposes and says that he is the applicant
(Name of individual si~ning contract)
above named.
He is the
~! : ~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have 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 man,er set forth in the application filed therewith.
Sworn to before me this '
........', ..... ~ .......... day Of...
Notary Public, ....... ~ i ~.-. h~ ,~, ,o~, County
NOT,~R¥ PUBLIC, State ~ t~ewi¥orl~ ......
RODERtCK VAN TUYL. P.C.
LICENSED LAND SURVEYORS
GREENPORT NEW YORK
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO.
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLK;kCO DEPT. OE HEALTH SERVJCESi
(s} ~-~ ~. ~4 ~
/~LICANT
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES -- FOR APP/~O~/AL Of
CONSTRUCT,ON ONLY r--
'DATE:
H.S. REF. NO. ~' - ~'~0~
APPROVED' ~ ~
8INGLE FAMII V nl~, ~ ~'..
SUFFOLK CO, TAX MAP DESIGNATI~)N:
DIST. SECT. BLOCK PCL,
OWNERS ADDRESS:
DEED: L?-/A
TEST HOLE STAMP
SEAL
fl~ SUFFOLK CO. HEALTH DEPT. AppROvAL
J
~. ~ t '- (/ - ~, ~-. :. THE WATER SUPPLY AND sEWAGE DI~OSAL
..... ~.2~ ~ ":~ ~ SYSTEMS FOR THIS RESIDENCE WILL
7~+~' ~ ~ I. CONFORM TO THE STANDAR~ QF THE
~- /' SUFFO.~.CO. ~PT. OF HEALTH SERVICe.
, ~ t , ~ % e~ ~ / SUFFOLK COUNTY DEPT, OF HEALTH
~ ~ CONSTRUCTION ONLY
~) / ' APPROVE D:
{ ] ~~ ~ SUFFOLK CO, TAX MAP ~GNATION:
ONLY
FACILI ~ , r. ~ 3~ .... ~.. ,,
LI~O LAND ~R~YORS
GREEN~RT NEW YO~ .