The URL can be used to link to this page

Home My WebLink About14110-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16450 Date December l, 1987 Pool and fence THIS CERTIFIES that the building ................................................ 280 Henry's Lane Peconic Location of Property ............................................................... House No. Street Hamlet County Tax Map No. ]000 Section .... 7.4. ...... Block .... ?.2. ........ Lot 35 Subdivision ............................... Filed Map No ......... ]Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.u.l.y. I, 1985 . pursuant to which Building Permit No. I4 110Z dated July 5, 1985 . wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Inground pool and £ence~ attached to the house. The certificate is issued to ,JOHN E. BOKINA (owner, ~r-o~ ~,~r~ ~ of the aforesaid building· Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO N 702736 PLUMBERS CERTIFICATION DATED: N/A · in~ Ls ...... Rev. 1/81 I~OB,~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ,~.UTHORIZED) 14110 Z Permission is hereby granted to: ~ ~ '~ ~..,~ .~.. · ~.~,~.~....~:..~.:.....:~...~..~.~.~ ..... at p~mises I~ated at .~. .. ......... .... %"'~'~"~'~"'"';';'"':~ ......................... ';"2 ........................... :'~:z .......... c~ r~,u~ uo. ~ooo s,~o~ ....... ~.::...~ ....... ~k ........ : ............. co, uo ........ ,,.~ .......... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1,8,02 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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 pZ~operty 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 $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupj~-¥-~_ ,$1.00 4.Vacant Land C.O. r $5'0~'~ $15.00 Date' ' ~' '~'"'/' '~'!/' '~' ' '7' ' ' New Building */ Old or Pre-existing Building Vacant Land Location of Property ................................... /.( .~ · House No. Street Hamlet Owner or Owners of Property ...~..~ ~ ..................................... County Tax Map No. 1000 Section , .~ ...... Block ...~ ....... Lot..~ ~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./. ~/./..~J..~.. Date of Permit ,', ......... Applicant ~;/~Z//.~. ¢'.~/.'~. ~'... ~... Health Dept. Approval ........ ' ................ Labor Dept. Approval ...... - ............. ,N, 7..3 -' Underwriters Approva ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate '/ Fee Submitted $ .7~.~...¢~. ................ Construction on / , above described building and per~it meets ail applicable codes and regulations. Applicant ~... , .~;~-~... ~,,, . . ./~,~, ' ,~, L~.~,%~.,:~r'.~ ................ Rev. I0-10-78 7/2 ROUNDATION ( 2nd ) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL ~MENTS: ELY '~ -,-------FIIDDLE I~O___~D .--5.~ N,4~ 09BO W, FE.,HOU,,~E THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001381 BUREAU OF ELECTRICITY rah NEW YORK 1 038 in the following location; [] Basentetgt [] 1st FI. July 25, 19~5 [] 2nd Fl. O~tsi(~e Section Block and Jound to be in compliance with the requirements of this Board. Lot FIXTURE OUTLETS SWITCHES 1 1 2 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS NCANDESCENTJ FLUORESCENT DRYERS ~UR~ACE ~OTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: (SWIMMING POOL)THIS C~R'Z'TFICAT~ COVERS CO~PLIANC~ AT Tfi~ DAT~- OF /~$P~CTION ONLY. '~ UNUSUAL ~NVIRO~NTS ~T I~i ADVISA~L~ ~ ~VE ~QU~NT TEST AND/OR REPA~R~ ~ADE BY A QUALIFIED P~.RSON. Jody P~millo Pat T;ane L42x~tituck, NY 11952 Li¢$Z300E This certificate must not be altered in any manner; return to the office of the Boord if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MU~T NOT BE ALTERED IN ANY MANNER. Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 'FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Buil&ng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG, DEPT. · TOWN OF 80UTHOLD Received ........... ~19... 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. ..... i c. ...... (Signature of applictmt,'"~or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... /~ - (as on the tax roll or latest deed) If~~LP°~i°n~ °71Y auth°rized °fficer. · · '11'c'''~' .......... Y' ''-~''-'~'rT' "~t~'~ ..... .L~.. / .... ( ,NT. e and ii~16 ° f c°rllgr/f~.° fficer) Builder s License No ......... Plumber's License No Electrician's License Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ........... iq ........ .... ......... ,.c ,. . . .o.. House Number Street Ham[et County Tax Map No. 1000 Section ....... ~ .~. ....... Block .... .~. ............ Lot...3 .-5..~-. .......... 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 ........ f~ ~/~. ~).T.~../rrx.. ................................ b. Intended use and occupancy .............. .~./~../~..~..~. ................ ..: ......................... 3.' Natu e of work (check whY apphcable): New Building .......... 'A Jdition... Repairs.. ;... ~... Removal .............. Demolition .......... 4 Estimated Cost ..... ~ O.~. .~. (..gXb ee 5. If div~lling, number of t]weliin~ units ............... Number of d, If garage, number of cars .... : ............................... 6. If business, commercial or mixSd occupancy, specify nature and extent ff each type of use .................... 7. Dimensions of existing stmctm es, if any: Front ............... Rea .............. Depth ........... Height ............... Nu: nber of Stories ......................................................... Dimensions of same structure dth alterations or additions: Front .................. Rear .................. Depth .................. ~ .. Height ...................... ~mbor of Stories ...................... Dimensions of entire new cons' motion: Front Rea Depth ~ 9. 10. 11. Height ............... btu] aber of Stories ................... Size of lot: Front .......... : ............ Rear ............... Date of Purchase .......... ! ................... Name of Forme Zone or use district in which p~emises are situated ................. 12. oes proposed constructmn ¥~late any zomng law, ordinance or regula 13. Will lot be regraded ...... ~ ................. Will excess fill 14. Name of Owner of premises 4~..~lril.~r~... Address Name of Architect ... ~ .... i ................ Address ....... Name of Contractor ~.: f~J~.' .ff~.' ~'.~.~... Address ~.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propos property lines. Give street and block number or description according to dee. interior or comer lot. STATE OF NEW YORK, COUNTY OF ................. S.S ............................ ,. being duly (Name of individual sighing contract) above named. ~'EE NO' leOLI 2, R~ ALL 'r~F DE~C ...... Alteration .......... (to be paid on filing this application) ~lling units on each floor ................ ?ricer, etc.) meed the said work and to make and file this best of his knowledge and belief; and that the ~ith. f sad owner or owners, and Js duly authorized to perform or have perf application; that all statements contained in this application are true to th~ work will be performed in the manner set forth in the application filed there Sworn to before me this i ............. /~. ....... day ;f .... ~ ............. 19 ?'.5.~- Notary Public ..... ~. :~..~.~. d~/...~... County ¢~,._HOTAB¥ HELENpuBLiC.KjDEState: VOEM Hew ' York '' .... Z~ No. 47117'8T8, ~uffolk C0unt~., Term [xp re~ Mit'ch 30 19~2/ He is the ..................... i .................................................................... (Contractor, agent, corporate d, and, indicate all set-back dimensions from and show street names and indicate whether APPROVED AS NOTED [802 9 AM TO 4 PM FOR THE · OWING INSPECTIONS: )UNr~ATION - TWO REQUII~ED )R POIJRED CONCRETE IUGH - FRAMING & PLUMBING 'qULATION qAL ~ CON'STRUCTION MUST C~Pr r~E FOR C. O, CnNc-rR~CTION SHALL MEET RF~' "DFMENTS OF' THE N.Y. ' CPNq. TRUCTION & ENERGy ~. NOT RESPONSIBLE FOR N r.,,, CONSTRUCTION ERRORS. 7orn, deposes and says that he is the applicant ....... Depth ...................... : Owner ............................. ~on: ............................ b fr ' e removed om premises: Yes · ~.. ~..~ .... Phone No ................ .......... '.. Phone No. · ~.~ .... Phone No.