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Home My WebLink About14122-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g.1 fi. 339 .......... Date ...Ap.r. ~ .1..1.5. ..................... 198. .6. THIS CERTIFIES that the building .... O..ng..F..a..m.~.l.y...d.~.e.]: 1..i.n.~ .. .................... Location of Property ... J ·1.1.30. ~.quo~ty.:~¥..A.v.e., ... Southold County Tax Map No. 1000 Section ... 5 .4 ....... Block .... 0 b ......... Lot... P/.o..Q 9 ~ ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. J.~CLy. 3 ........... ,19.8.5 pursuant to which Building Permit No.. J .~.1.2.2..Z ............. dated .... .J.u:L y. B. ................ 19 .8.5., was issued, and conforms to all of the requirements of the applicable provisions of the lawn The occupancy for which this certificate is issued is ......... ·.. l~no. £aan ± l.y..dweZ.L~.r~g ....................................................... The certificate is issued to ........~e l;.e.p.. I~0..~ l~-.~rl~ ~B ...L..u.hvs row~e~, 1~ e~m;~ ~ ~ .......... of the aforesaid building. Suffolk County Department of Health Approval ..... .8.5.~ ~. .0.-.1. 9. ........................... UNDERWRITERS CERTIFICATE NO ............. ?.e.~..d .~.~.g; ............................ ?lumbers Certificate 4/7/86 Building Inspector IPO~'M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIUAIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14122 Z Dote ....................................................... , 19... Permission is hereby granted to: ~...~' ~ ..... ..~.~..,~..- .~.~....,~..~..,....~c .......... ,y...~...~.~...~. ....... .......... ~o~_~.=.~..~......~ /..~Zz ~o ........ ~~~......~....~z~ ....... ~....Z~.~.....~ ........... ...................... ~...~.~.:...~(~...z~......~ ........ Z.~ ........................... County Tax Map No 1000 Section ................ .(~...~... .............. · .~.~...~.. Block ........ Lot No ~. ~...~.~.. pursuant ,o application dated ..... ~../'/,,.../.. ............................... , 19 ,~,,,,,~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 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 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 naturai 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. For existing buildings (prior to April 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~perty showing all property lines, streets, buildings and unusum 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~./:~.~. 5. Updated C:/~/ $15.00 Date ................. New Building .... V ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property //.~.~....~6..~.,?&/.c.~... /~...~. ,1 ................................... House No. Street Hamlet Owner or Owners of Property . , .~,/'., ,~,.... ?. ..... /?,~,~ ......................... County Tax Map No. 1000 Section ...~..~. ......... Block .... ~ .......... Lot. ~..~....c~.. ...... Sa bdivision..~.<a~',~,. L... ~,~/~: ..... i,~,~7~..Filed Map No ........... Lot No../ .......... Permit No..//~/:~,..~.. Date of Permit ......... Applicant:..~6.~.~ .... &./- .~..h./.'. ............. Health Dept. Approval .. ~.~ .................. Labor Dept. Approval ........................ Underwriters Approval .. y~.~ ................. Planning Board Approval ...~.'. ................. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $,~.~.~. ....................... Construction on above described building and permit meei~ll:~:ble codes and regulations. Applicant. ~ .... :. ~, ,~ ,~ .......................... TOWN OF $OIJTI~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /~/~ Owner ~(p~l~ea~sepr~' ~ ~int ) Plumber ~ ~- ~ ~V ( '~- L-~-- (please print) I certify that the solder used in the water su y system contains less than 2/10 of 1% lead. /,- / / /~/ ~/(p[um~er' s signature) Sworn to before me this 19 ~ Notary Public Notary Public, ~ County FIELD INSPECTION COMMEN'f~ ........ ~____~ , FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,ODE ADDITIONAL COMMENTS: 76S-Z802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RouGH PLBGb FOUNDATION 2ND ~iNSULATION FRAMING ' [ ] FINAL REMARKS: DATE ~INSPECTOR 7L5-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~ROUGH PLBG. FOUNDATION 2ND[ ] INSULATION ~IrRAMING [ ] FINAL r 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE ~INSPECTOR ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,, SOUTHOLD, N.Y. 11971 TEL.: 765-11~03 Examined. · .~'~./.~' .....~...., 19~. ·r Approved .~7~/~..F .... , l~..~.eermitNo../~//~..~ Disapproved a/c .......................... · · ..,~ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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, ci~hspections~ ,, ~ ·..z:Z/~.../&.~.~. ;...L%:/~.oc.'~:..~¢.. .... (,(Signature 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. ................. .b., .~.~.\ .~mc. ................................................. Name of owner of premises . ~,- ~-,-.~./.......O?.O ....... \.C.~..~x.~-e... : ..... O.'~ ....................... (as on the tax roll or latest deed) If appliqant is a corporation_, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... .J.~./. .............. Plumber's License No .... !.~: .~c....T~.. ....... Electrician's License No. fD l ~,~' . . . Other Trade's License No ...................... 1. Location of land on which proposed,work ~v~ll be,~lgne ...................... ~ ........................... · ................ ............... ............... House Number Street Hamlet County Tax Map No. I000 Section .... ~...~. .......... Block .... .~. ............ Lot..../?/.(Ct....o~. ...... ......... lVlSlOn ...... d/.~.. .D. Filed Map No ............... Lot ............. a 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... :~E~.'..V.(.Z-. ~ .C.,r~..'.~. ............................................. b. Intended use and occupancy r~ ~ .O.D .~- 09. ...t4d5~ ! .q ...... Other Work ..... 4'.'~StirnatedCost ~' /~, ./.(-Y~.~ Fe 5. If dwelling, number of dwelling units ...... /. ........ Number of If garage, number of cars ... i ................................ 6. If business, commercial or mix'ed occupancy, specify nature and extent 7.Dimensions of existing structures, if any: Front ............... Rea: Height ............... Number of Stories ........................................................ Dimensions of same structure With, alterations or additions: Front ................. Rear .................. Depth .................. i ' ' Height ............ 4umberof Stories ...................... ' 8. Dimensions of entire new cons'truction: Front .-Zc~. Real .... .7..~. ....... Depth ~0T'.... Height .... ~..q ......... Number of Stones ........ ~ ........ , ................................... 9. Sizeoflot: Front ...... l~0.. Rear I.~.~..~Q ....... Depth .. 10. Date of Purchase ......... i ................... Name of Form~rOwner ........ - I 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or reguls 13. Will lot be regraded ....... ~q,O ................ Will excess fill 14. Name of Owner of premises ['~.~C(~bf~.~ ........... Address . Name of Architect . .,.~., ..... i..: ............... Address ..... Name of Contractor~J...~-C.~ ~. ~.~! ]d-.e-/7'.~.09:/Address .~oJ.qo~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo,~ ff~ ~ (Description) (to be paid on filing this application) ~elling units on each floor ................ )f each type of use ..................... .............. Depth ............... property lines. Give street and bloc interior or corner lot. STATE OF NEW YORK, COUNTY OF ................ (Name of individual si above named. He is the .................... number or description according to dee ¸ S.S being duly s ning contract) (Contractor;agent, corporate o of said owner or owners, and is dOly authorized to perform or have perle application; that all statements conltained in this application are true to the work will be performed in the manner set forth in the application filed there, Sworu to before me this I ........................ day of. Notary Public ..... ,...--~--.. r-r.. ~-'""~ HELEN ~, DE NOTARY PUBLIC, State ol New York NO, 4707878, Suifolk Cotmt~ 'ricer, etc.) med the said work and to make and file this best of his knowledge and belief; and that the ?ith. (Signature of applicant) tion: .... Fi 0 ......................... be removed from premises: Yes . . Phone No ................ ............ Phone No. a-.¢.(a.~q. .. Phone No .... ~d, and. indicate all set-back dimensions from . and show street names and indicate whether ~orn, deposes and says that he is the applicant ............... County /)[ ! o ' ~ SUFFOLK CO. HEALTH DEPT. APPROVAL '- ,~ ?[ ~ X t5 ~,' ~ ~ ~ ,'~'~ ~ ~-- [~ - x ~ STATEMENT OF INTENT , .-~ --~ ~ ......... ~ - ~ ........ ~ - ~ ~ ~ .... ~ '~~ m ~ THE WATER~LY AND SEWAGE DI~AL , ~ ,~ , ,, . ',, ". I~ . "~, ~ ~*~ SYSTEMS F~ THIS RESIDENCE WILL ~ ~'[ m '~' ~ ~ k~ --. ~. ,~~ ~ CONFORM TO THE STANDARDS OF THE ~ CONSTRUCTION ONLY r~ ~ ,. , ~: ~,~ ~ ~ .~ / · ~ ~. ' ~ DATE: · ~%~ ' ,- - ,... - ~. '1' ' - : ' ~INGLE FAMILY DW. ELLI " APR ~: ~ ' '~. ~ ' · ~ , , ~ .. ~ OWNERS ADDRESS: ' ~' faoiliti~ for this loaatloa ~ve been ~ : ~ ln~eoted b~ this da~rt~t ~ f~ J~,~/':'Z'/~] '/k', )~ .'Lm'-'- 4 %o be satisfaeto~. _ -- ' ~ r~ o TE~ HOLE STAMP :' .~D .,~ ~, ~_ ~'~ - , .~ ~ _ , ~. ~..',7 ~r~.~' ~, ..'~ ~ : ~'.o~ ~ ~ '- . . - , . .: , ~ / - ~ v ~.~ ':,~. /~'*" ~ ,~.','~,'~. . . ~ ,-,: ~',. LTL 4P ~ ~.D~ICK VAN TUYL. P.C. V~ LICE~D LAND SURVEYORS GREEN~RT NEW YORK -1 OCCU~CY OR E ~ ~LA~FUL Vdi~¢~ ERZIFICATE t LEFT If copper tubing is used for water distributing sys em; piping shal{ be o~ types K or L onJ~y MBER CERTIFICATION' EAD CONTENT BEFORE IFICATE OF OCCUPANCY ~ED 2/10 DJ 1~ ~' NOTIFY BUILDING DEPA~'T~AENT AT 765-1802'9 AM TO 4 PM FOR THE , ' FOLEOWING INSPECTIONS; . 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ' 2, ROUGH - FRAMING &,PLUMBING, 3. INSULATION; ' · 4. FINAL- CONSTRUCTION MUST BE ~OMPIfi~F. E ~OR.'C. O. 'ALL, CONSTRU,C:UON SHALL THE R~QUIREM_ENT5 gF THE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS· Main Road . N colX ~ ' "F¢ dkCbAT, ¢N i. o I ~ ¢' ,L_ J ' L , i