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Home My WebLink About13930-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z15771 Date May 2l, 1987 THIS CERTIFIES that the building One family dwelling Location of Property 3715 Hortons Lane Southold ........................................................ Street Hamlet County Tax Map No. 1000 Section 054 .Block 07 . .Lot 23.6 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...M.a.y.. 6 .... I. ~ i5 ~ ...... pursuant to which Building Permit No. 13930 Z dated . ?..a.y..9.:..1.9.8. 7. .............. 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 & 2 car garage The certificate is issued to MICHAEL G. & SANDRA E. DAVIDS ..................... ................... of the aforesaid building. Suffolk County Department of Health Approval 14 - S O- I 74 D e c. 5, 1986 UNDERWRITERS CERTIFICATE NO ..... ~. 8..0.88.7. .5 ...... .~.a.y. 11, 1987 PLUMBERS CERTIFICATION DATED: May ]9, 1987 R~v. 1/81 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) 13930 Z Permission is hereby granted to: ..... .~...~. ...... ~~......~. ....................... ~...~...~...~.:....!./..~.~..L ........ County Tax Map No. 1000 Section ....~...~.. ....... Block .......... ~ ........Lot No. Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 765- 1802 T£ Z.O APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted mi m,i,ii 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 pxoperty 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: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory,Si0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0. ~)0 3. Copy of cert[ficate of occupancy $ 5.00, over 5 years $]0.00 5.Updatect C.O. $ 50.00 Date ............... Location of ,ropertv. ¢~ .~. ~ ,~. ........... '.. ~.f,cCY~.~...,~,. ~.- .......... Owner or Owners of Property /~ , . .'.~'/~.'b..~.. F .~... County Tax Map No. 1000 Section .... ~'~ ...... Block ........ 7 ...... Lot.. ~.~.: f4'. ....... ,Subdivision ................................. Filed 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 permit meets all, applicable code§ and reg.ulations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS lOOlO?l BUREAU OF ELECTRICITY F1 1~5 JOHN STREET. NEW YORK. NEW YORK 10038 ,,,,,. N 808875 THIS CERTIFIES THAT o~tiy the electrical eqttlpment as described below and introduced by the applicant named on the above application nu tuber in the premises of Mike Davids, Hortons Lane(~rd on left) N/of Rt. 48 4th Bldg., Southold, i. ~heyo.owl.gl,,c.~io.~ ~ .a..~en, [] ~, F~. [] ~nd ~'~. S~,io. m~ rot May 4,3987 RXTURE FIXTURES RANGES COOKING DECKS OVENS ISH WASHERS EXHAUST PANS 24 36 30 24 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: G.F.C.I.-i Smoke Detector- NO, O~C~,¢OND, O~ A'CC,W'COND,G' NO, O,c HI.LEG 2/O 2/0 G & S Eleo. Box 215 Southold, N.Y., 1].971 GENERAl. MANAGER Per _ rhis certificate must not be altered in any manner; return to the office of the Board if inco~'rect may by their credentials. cOPY FOR BL{ILDING DEPARTMENT. THIS COPY OF CERTIFICA~EiM~JST~NOT:BE~LTERED N ANY MANNER TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner /3 ~ ~ (please print) Plumber ~/~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~__day of _~/~.~/~L/~ ., 19_~. Notary Public, ~fl~c~d~,'~ _County (plumbor's signature) Qualified in Suffolk County ~..~ Comm~ssion E,~pires March 30, 19,~ F1EL~ IN~ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING 12nd} INSULATION pER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: INSPECTION FOUNDATION XST [ ] ROUGH~PLBG. FOUNDATION 2ND, [ ]INsuLATION' FRAMING £ ] FINAL REMARKS:,: ', 7GS-X802 BUILDING DEPT. INSPECTION ]FOUNDATION XST ROUGH PLBG. ] FOUNDATION 2NDe] INSULATION, [ ] FRAMING [ ] FINAL /1 ATE_ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2.D[/~ULATION ]FRAMING [r-~FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING~ REMARKS: [~INAL / // DATE 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOi.,D I 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 ~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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ¢ 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 legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to Ldmit authorized inspectors on premises and in building for necessary insge~tioy3g./ ,~-'~ ~ /7 (Signature of applicant, or name, if a corporation) ... .......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, eneneer, general contractor, electrician, plmnber or builder. Name of owner of premises ~ .. ~fC..'~ .'4:~../(. · .~ · .~. · .~.'qd./.r'~.~. .~. · · '~. '. · .~.~. · .~./.'~..~. (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...~.D.:..~...~..~../~. ....... Electrician's License No..~.~...~.....~..//6.~. Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...... .~-..4/~. ' ........ Block ...... .~. .......... Lot ..... .e~..~.. ! .~. ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of pren~.es,, -~and intended use and occupancy_, of proposed construction:_ a. Existing use and occupancy ...... .{~.~..~0':~ ./i'" ......... ~ ..... '"' ....... i ....... " .................... b. Intended use and occupancy . .. 4 3. Nature of work (bheck which ~tpplicable): New Building . ~' Addition .. Alteration Repair Removal Demolition Other Work · .':~ ,~o (Description) 4. Estimated Cost ....... . ~..:.. ........................ Fee ...................................... ' ! ~' (to be paid on filing this application) 5. If dwelling, number of dwelling[units .......... Number of dwelling units on each floor ................ If garage, number of cars .... t ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structur0s, ifany: Front ............... Rear .............. Depth .............. Number of Stories Height ...................................................................... Dimensions of sarhe structure ~ith alterations or additions: Front ................. Rear ................. Depth ................... i · · Height ............ ~r ........ Numb. er of ~ories ............ ~... ?¢ .... 8. Dimensions of entire new construction: Front .... .~.~..%~: . Rear .. ~.?.:~.~.' ..... Depth . .~..~../.~. ...... Height ............... I~u/nbol: of Stories ....... J. ............................................. 9. Size of lot: Front ...... ,/~..t.~.~. ........ Rear ...... ~.~..~. :~.~. ........ Depth . .. ~. ~.'.~..~ ........... 10. Date of Purchase ..... .-~../. ~. ~.. .............. ;~anm_of Former Owner . ,~ ~.~., .(~2. no~2f~. ......... 11. Zone or use district in whic~ prjemises are situated... '~. ~..~.~./.~.~.7~.*t/('7 ~..~. C ~ ~..~.i~ ............. 12. Does proposed construction violate any zoning law ordinance or regulation: .......... ~.~ .................. 13. Will lot be regraded ........ i .......... , ......... Will excess fill be removed from premises: Yes ~ 14. :Name of Owner of prej~itses ~Dt~.~. ~/~. ,~f~. {'.Y2.'U ....Address .~O..~[~r~,f. t~.c~ .... Phone No.. ~..~'5 ~.~.~. ~ Name of Architect "-r,--F'--~'~ ~..~ff~ ~.~,-~,~ ...... Address ~.~ .~'. ~...~.f. .... Phone No..~.~. 7'.~..~.4..~... . .re rJ, l.. ............ Address................... Phone No ................ Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& 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 OF ................ ............................ i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, age,t, 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 cohtained in this application am 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 ....... o~ ........ ,19 .~ ' Notaw Public, . ........ County ...... H~LEN K. iD~'voE,, . . ' NOT^~y PU~U¢. $iat0 0f ~e~v York (Signature of applicant) I Iqo. 4707878, SoMo~k Co!rely SUFFOLK £O, HEALfH DEPT APPROVAL STATEMENT OF INTENT SUFFOLK COUNTY DEPT. OF HEALTH CONSTRUCTION ONLY DIST SECT BgOCK PCL:~ ~ ~ ~" ' OWNERS ADDRESS: SINGLE FAlViiL¥ DWELLING ONLY pre~y is I~ated in en agricultur~ ~ea, the poss~i~ exists ~t the ~ supply ~oy c~tein trace ~nts of pest~ ~ / ~ nitrates. S~c~l analysis~l~ r~uir~. RODERICK VAN T~L~L P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK TEST RoLE STAMP SEAL I:or w=ter ,'listributing system; piping shall be o[~ types K orl only ,"" - '~ ' '~ " o~- ~qOTI,FY BrJIUD NG DEPARTMENT. AT ,,"' ~'' : '.],,, ~m~,,A?ION ~0 ~E~UtRED ' ' "*" , : , ' 2¢ RO~GHC 'FRAMING & PLUMBINd :' '~ ~ ~ .' ' , '~:[:~,C~t ',.'C~[ON g~ALL MEET q( TFIE N.Y, ' , ' & FNrOG~ , '.. poNs*sL~ m~ 'PLUMBER TIFICATION STRUC¥ION. ERROr5, ,CE~ ~r ' ,,'"':' ,', ", ~" uPAN CY .... CERTIFICATE OF OC'C ~ SOLDEE .... ' CANNOT ' .... ' ' SUPPLY SYSTEM ' .-, ~A~T H (¢.1 l~one \ \ fi