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Home My WebLink About14220-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .....~lq59A ...... Date ~ul~ .~ ........... 19 Bd THIS CERTIFIES that the building one-family dwelling Location of Property 300 ' .India.n Neck Lane ~.e.c.o.n..i.c Houae No. Street Haml~ County Tax Map No. ~000 Section .... 8.~. ...... Block ........ ? ......Lot ..... ~.: .~. ....... i Sll~t~/~e;t~, Peconic Bay Cpve .7.1.5..9 4 ....................................... Filed Map No .... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..JulX l~. ~422oZ ................. ,19 .8.5. pursuant to which Bu/iding Permit No ...................... dated .. Y:ugust 27 i98..5.,wasissued, and conforms to atl ofthe requirements ¢ of the applicable provisions of the law. The occupancy for which this certificate is issued ii ......... Priva. te one-fa.m, il~r dwe.llin~ The certificatei~i~ued to ..... RALPH & ELIZABETH SCHEIDER ................ i~'~, ~4~ ...................... of the aforesaid building. Suffolk County Depa~ment of He~th Approv~ · 85- S0- 125 UNDERWRITERS CERTIFICATE NO .............................................. ~748593 . .. Building Inspector Rw.l~l l~,U.M NO. 0 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 14220 Z Permission is hereby granted to: ,..~ ......... z~/~...z-../.....~..~z~..~.._.~ ...... ~......~.....~/...£,~.~_"~ · ...Z~.~..,..~..~ .......... ,~ ........ .~¢.~~,...~......~.~~ ..... ~.~,.~....~.~ ........... ~.:~ ................ ~...~ .......................... Building Inspector. Fee $....-ZT..~. ............... 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 A. 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 natura~ 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 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 $15.0 0 3. Copy of certificate of occupancy./ $1.00 ~n.~..c~ 4.Vacant Land C.O. $5°00 5.Updated C¢. $15.00 Date ............ New Building ....v. ........ Old or Pre~existing Building ............ Vaca t Land ............. Location of Property . .~...~, .0 ..... .~...~..~.~ ¢¢~...~.¢~.~. House No, Street Ham/et 4 I County Tax Map No. 1000 Section .............. Block ............... Lot ..... : ........ Permit NoJ.Z~r,~.~ .0..~.. Date ofPermit ~'~:'~.-~../.~,5',~/,~j Health Dept. Approval . ,~.'/~;~/,;~.~2 ......... Underwriters Approval .~/..~'/~ .~.~Q$. ........... Request for Temporary Certificat~ ........... eeSubm,tted $.. .... anning Board Approval ..... .~/,~, ............ .... Final Certificate ..................... Construction on above described building and permit meets all applicable codes and regulations. App icant .................... Rev. 10-10-78 -" THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIES THAT only the electrical equipment ~ described b~ and i~trodu~d b~ the appiieunt ~med on the able application number in the premises of ~ the following Ioc.tion; ~ Basemen~ ~ ls~ g& ~ ~ FL Section Block Lot DRYERS FURNACE J~OTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNiT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E 1 2/0 1 ~/0 This certificote must not be altered in any mannert return to the offke of the Board if incorrect. Inspectors may be identified by their credent/ols. ~t-IDv I:~,'[ ~1 Iii r~JN~ r~I=OAGITEAJ=N'r TI~I~ ~_~l~V f~l: i~_;l~?l;It~A'l'l: ~1 IRT N~F RI: AL~FR;D IN ANY MANNER~ 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION JST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN~I.AI~ON [_ ] FRAMING ~-]~'~NAL REMARKS; DATE ~ , INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [/~ FINAL REMARKS: /~/~ ~'°/~OU~z?J'3 , TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /q~:kOT_ " (~lease print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber '~/~ignature) Sworn to before me this 2~~-- day of ~ , 19 6 Notary Public, ~O~"{& County Notary~ic LINDA McNAL~.'t' Notary Publit;, Stat~ oi N~v York No. 52.4503707 Qualified in Suffolk Gou~lTiy Commission Expires March $0,19~ FIELD IHSPEC'~ION , COMMENTS FOUNDATION (1st) FOUNDATION (2ndl 2. ROUGH FRAME & PLUMBING INZULATION PER N. STATE ENERGY ~ODE Yo FINAL ADDITIONAL COMMENTS: THOMAS D. REILLY, P.E. CONSULTING ENGINEER 4 Bezel Lane SMITHTOWN, NY 11787 THOMAS D. REILLY, P.E. CONSULTING ENGINEER 4 Bezel Lane SMITHTOWN, NY 11757 CHECKED BY ~CALE SHEET NO.-- ~'~'~ ~ OF CALCULATED BY [~P~ DATE 765-~8~2 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ?~]% FRAMING [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL REMARKS: ..... DATE~ .... ~ INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 J J[ t 219u~ BLDG, DEPT~ TOWN OF SOUI'HOLD ,~_. TEL.: 765-180:3 "~-' -'~ - - '~ Examined~..77 .... ,19~ff ,~ Received ........... 79... ' WY/ .-,. ~e" /~TZO ,z ~,,~,.- ~ Approved/~...~:. / ..... , 1 .~ff2Permit No..t..T:...~..~. /O.<x2~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............ , A / INSTRUCTIONS i a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 )r 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 ~hall 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 g Certificate of Occupancy ~hall have been granted by the Building Inspector. iAPPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. z:. ~ ~. .c?. ~. ,.~ ,. ? : /~T: f.r//. .z. &J.,. .r) :~.,,.~. .~. .,v., . ./ : 7.z:7.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ ............ .o., .~..a.¢.~. .......................................................................... ~ne of owner of p~emiscs .: d: X( . . .' : ~. ¢.q C. j ......... 5./. ::'.: ~. :.f./.5 .3)/'. :'} ...................... (as on the tax roll or latest deed) :f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... , .............. Plumber's License No.../.~ff..~..~...f.~.a.'..~..'.~-/~ .~. · · Electrician's License No. "7 :,~4 .'~... ~ .......... Other Trade's License No ...................... Location of land on which proposed work will be done ........... ~ ...................................... .... ..~.o..o. ............ <~ .~:.4~.....,(~-.c/.c../..w..y¥ ........ '?.~.c.o..~.,.c. ............................ House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..~.* ......... Block ...~. .............. Lot .... /.l .~. ........... Subdivision .-~..~.C. 9.N.I.%..-~..A.y...('?..0~;. ........... Filed Map No.."J. I. 5 .~. ...... Lot..4 ............ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: E i ti and p ney \lAC ~-I~F' a. x 8 nguse occu a ..................................................................... b. Intended use and occupancy O*,,I .~ - ~-/I ~-~ IL .~i*~CT,~---'~zt:'~"~"~'r'~4..',~,,~.?i~:~,. , 3. Nature ofwork (check whieh applicable): New Building..........J Addition .......... Alteration ......... (.~ ~. ;x ...... Removal .............. Demolition ...[ ..... . ~ ...... Other Work .............. 4. Est~ated Cost ............................... Fee~ ............................. ~, i (to be paid on filing this applicatio,: 5, If dwelhng, number of dwelli~ units .......... Number o elling units on each floor ................ 6. If business, commercial or mixed occupancy, specify nature and extent bf each type of use ..................... 7. D~ensionsofexistingstmctupes, ifany: Front ............... Real .............. Depth ............... Height Number of Stories D~ensions of same structure with alterations or additions Front ' Rear epth ................... .... Hm~t ...................... Number~of Stories ....................... D~ensions of entire new consimction: Front .... ¢~f ....... Rear~'...4~ f ....... Depth .. (. ~. '. { ~ '.' .... Height ............... Number of ~on .... ~ ....... ~ ........ ~ .................................... 9. Size 0flot: Front . .4~9.(..~ ............ Rear...4~ .~.' ..... ~ ....... Depth .~ ~ ............ 10. Date 0fPurehase ...~~ ................ Name of Fomek Owner ~O!gg./~'~-~(. ............ 11. Zone or use district in which. cruises are situated .: ........... ~ .................................... 12. Does proposed construction vi~late any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .... ~ ¢} ..... . ......... . .....Will excess fill be removed from premises: Yes Locate cle~ly ~d distinctly ~1 buddings, whether ex~stlng or proposed, ~d. ~ndacate ~set~ae~d~ensaons from prope~y ~nes. Give street ~d bloc c number or description accord~g to deed, ~d show street nines and indicate whe~er interior or corner lot. · 8. STATE OF NEW YORK, COUNTY OF ................ S.S "~/gt_ ~ ¢ ~ c.~ ~ ~. 12.' being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named· i i He is the ............................................................. .... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dOly authorized to perform or have performed the said work and to make and file this application; that all statements con~ained 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 there~ Ath. Sworn to before me this day df.. Notary Public, ....~..!~.....~.~t~.ff//..~f~.... County (Signature of applicant) STATEMENT OF ~NTENT ~K~ ~ THE WATER SUPPLY AND SEWAGE DIS~AL CONFORM TO THE STANDARDS OF THE ~ SUFFOLK CO. DEPT. OF HEALTH SERVICES. ~..~. ~t ~ ~ ~ APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH DATE: ~/ APPROVED: ~m ~ ~] SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BL~K ~L. ~ , . ~. 0 LAND SURVEYORS r , , ~REEN~RT NEW YORK ~fRES T~O YEARS /DATE OF APP.R,?~AL 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 CO. DEPT. OF HEALTH SERVICES (s) ,, APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF DATE:CONSTRUCTION ONLY H. S. REF. NO.. ~'~-' ~ (}* ~ ~'-'~" APPR OV ED: ~P~ SING~ FAMH y n~/,~L~ ~FOLK cO. TAX MAP DESIGNATION: mST. SECT. m. OCK PCL. OWNERS DEED: L. t~/~;~ P. SEAL SINGLE FAMILY DWELLING ONLY ~lF~OL~ COt~TY, H~LTH DEPARTI~EI~2 ~, ~p~ ~ ~-'~s~ ,. ~. ~. ~ ~-~ ._/e./ / ...F-,,A-Z 0 ---:"-t I SUFFOLK CO. HEALTH DEPT. APPROVAL 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. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE' APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDRESS: (~:. ~ DEED: L N/~ P. ' 'TE~ HOLE ' ~AMP ...... SEAL F OCCUPANCY OR USE IS UNLAWFUL INITHO~T CERTIFICATE OF OCCUPANCY I I ,I I t I iii_ i-] ' - for water distributing system; piping shad be of types K or L only ? PL['fMBER CERTIFICATIOiV ,ON LEAD CONTENT BEFORE ~ERTIFICATE OF OCCUPANCY SOLDER U,:'~Eb ]N HOTTER ,~8UPPL Y SYSTEM CANNOT !, .EXCEED 2]10 of 1~ LEAD. AFfllOJ/ED AS 'NOTED DAT~'JE~J/~SB.P.--''-~ ~ NOTIFY BUILDIN6 DEPArtMENT AT 765-1802 9 AM TO 4 PM FOP, THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REC!UIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CON'ST~UCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY COD~S. NOT RESPONSIBLE FO~ DESIGN OR CONSTRUCTION ERRORS. I'I '7.J- o __L I I .j × 0~ · F ,,] 0 -q , J4 ~0 -c~ J, ~o -c'~' 'Tc~NL ov~l~ I , I d . / / .114 A-C SoFfIT _._R,._~.. ¢. 5 Il'a,." i i350 C~N,T k~ Z×lO- I G,"O r-- IFa" ,~" cc:lac ~LA~