The URL can be used to link to this page

Home My WebLink About13979-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14585 Date. .J.u..ly. 1 ... ........................................... 19 86 THIS CERTIFIES that the building .. 0~ ~a~a;L.lCg. SlW.e.l. 1..i.n~... ................ Location of Property 555 Lloyds Lane Mattituck /~/~s~ ~Jo: ....................... ~r'e~ t' ....................... /~/~r~l~ County Tax Map No. lO00 Section ....0.9.9. ..... Block .... .0.3. ........Lot....4...3..3:. ......... Subdivision HQp~s.L~.k.l.e...H.~.l.~.s. ...... Fried Map No. 7019 .Lot No. 11 conforms substantially to the Application for Building Permit heretofore fried in this office dated .M.a.E...2.3 .............. , 19.8..Spursuant to which Building Permit No...1.3.9.7..9.g ............. dated ..... M..ay..2.3. ................ 19.8..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 ......... .O.r~. Family .d.w..e.1.].J:n. 9..' The certificate is issued to GEORGE PALUblBO ..................... ?o¥.;;, ..................... of the aforesaid building. Suffolk County Department of Health Approval 13-.SO- 2 0 8 UNDERWRITERS CERTIFICATE NO. N7 3 4 8 3 8 PLUMBERS CERTIFICATION 6/30/86 Rev. 1/81 FOR.~ NO. ft TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PEI~V~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13979 Z 19.~..~..-" Date Permission is hereby granted to: .... ~.~...~~.~. ................ ...~..~....~....~...~ ................... ~...~ ,,., · J; I~ ...... ~~.~ ...... :.~ ......... ]... ,o ~'i .............................. 1~'~ .......... ~"" ..................... '~ ........................................................... at prem ses located at ....~....~....~...~ ,.~..~., ~ .... County Tax Map No. 1000 Section .... ,.,~.,.,.~..,?J ...... Block ....,.,(~,..,~. ....... Lot No .......,~./,.,/J, ........ Build~ng Inspector. Fee $ ........................ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in dupl~cateto This application must be filled in typewriter OR ink, and submitted 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pz,z)perty showing all property lines, streets, buildings and unusual natural or topograph ic featu res. 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 preoare 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 4.Vacant Land C.O. $5.00 _{ I,~., Date .... './,/( .,/.,~ .............. / New Building /// - ............. Old or Pre existing Building ............ Vacant Land ............. Location of Property... ,~,~, ,~, .~,,7... ~'~,. d~-s~A-~ ............. ~ ~ ........ House No. .(/. Street Ham/et Owner or Owners of Property .......... ~x ~.,~-...-r~/~. ..................................... County Tax Map No. 1000 Section ...~. ~./~.. ....... Block .... .~.-.~. .......Lot .... ~.'. [/ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... . .~..o. 0. .................. Construction on above described building and permit meets all ~ca~es and regulations, Applicant ~.~, ~--. ~.-;-,~..T ........................... Rev. 10-10,78 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. /~ ~ Owner ~O~ ~0 (please print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. /(plumber' s signature) Sworn to before me this ~ day of z~/~-~_ 19~-~ . Notary Public,~~_~County Notary Public . mrm p. ~'~s M~,fch 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [/~e~.Ua~.~ '7~, ,]~HN STREET, NEW YORK, N~~O3S THIS CERTIFIES THAT only ~e ele~rical eauioment a~ des~bed b~l~w ,a~ int~d~d~ the aooli~a~t named on th~ above a~catio~ umb r in e ' ~.;~o ~aJ.~, s/s Z,.~O~ :~ane~ ~o0 w/~ ~oun~vxew AVe, ,"~t~.~C~ ~.~[~,,,~o/ ~ X X 11 was examined on and found to ~e in compliance with the requirements of this Board. OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS EXHAUST DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATER MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S* E R V I C AW, G, PER ~ OF NO. OF HI-LEG OTHER APPARATUS: Future App.Lia~ce G.FoC.I.- Track Lighting- 20'--0".-. 7--lites OF HI-LEG NO OF NEUTRALS A. W, G, E ectrlcal Ventures P, O. B. ].BI Ce*~.te~ ~oriches, N.Y. ~ 11934 Per ~'~ ~ Cerfi~Cicate mus~ not be all'~red in on¥ monner; relurn ~o ~he off{ce of lhe Boqrd if ~n¢or~'~¢L Inspectors mo¥ be identified by ~heir credentials. FI~LD ~NSFECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) C OMM EN TS ~ INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ~.xamined....~.C~2[~.., 19~ Approved ............~...~. .21.~.., 19~..~. Permit No.[ .~.~.D..cl..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Eeceived.~'~ 9... 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- :ation. c. The work covered by tkis 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 a Certificate of Occupancy ,hall 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 tuilding 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. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessa~~ / (Si[nature of applicant, or name, if a corporation) ................. :. gY 7.. ./ .... (Mailing address of applicant)/,t 7r2- ;tate whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. {amc of owner of premises ~ .,9~...~ .&. ..................................................... (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .... [.--i .[-.o.~..~..b....iT....c,:--2~... .... ~ ~%..c%..d.c...~.x~..x~.. . .... ............. ................... House Number ~' Street Hamlet County Tax Map No. 1000 Section ......... ~.c(. ...... Block ...... O..~. ........ Lot .... .~.-..// ......... Subdivision . ~~..~ ........... Filed Map No....~. O. [ .c[ ..... Lot .... '.l ......... ~ (Nine)a State existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy ..... '~' ' '~'c~' ' 'c~' ' ' '*' ' i' r ................rr '} .......................... a. Existing b. Intended use and occupancy..~..~.g-....~.~'..3..~.. ~ . i . / 3. Nature of work (check which applicable): New Building ........ ..... Addition .......... Alteration ........ Repair Rem'ova/ Demolition Other Work 4. Estimated Cost ...... "' ' Ooo Fee ... (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars . .~. · · t. · · If business, commercial or mixed occupancy, spec/fy nature and extent of each type of use ..................... Dimensions of existing structu{es, if any : Front J~.'. Rear Depth Height .............. Number of Stories .... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ~ Height Number of Stories Dimensions of entire new cons(ruction: Front .... $'D· ·......' Rear .... . ~7'O.. .....' Depth . . ~ :2_. . ....... Height ...g': .......... Number of Stories ...... ~ ................................................. 9. Size of lot: Front .......... .,.,i{,;..,.~ ..... Rear ...................... Depth ...................... 10. Date of Purchase . .rlQ..aC: .... .t..~r.~ ............ Name of Former Owner ............................. 1 I. Zone or use district in which p~emises are situated .~e.~ ................ 12. Does proposed construction vidlate any zoning law, ordinance or regulation: .. ~(~. .......................... 13. Will 10t be regraded .... ¥~-6_.i ......~ ............ Will excess fill be removed from premises: Yes N 14. Name of Owner of premises .(ble,4~... r.l.~.~.O... Address ................... Phone No. :L7~..O 59 ;~ .... o. Name of Architect ......... I ..................... ~ ........... Address ... Phone No ................ Name of Contractor . ~,~e~o ,~ ~., ..... ~ ~1.. Address .6 .c/."O~ .~ ..... Phone No. ::~.F.~... PLOT DIAGRAM l,ocate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or coruer lot. i ST^ rE OF . ' s s COUNTY OF.~...I · / / (Na~ne of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ~ ~ - ~A.e-c_~ J (Contractor, agent, corporate officer, etc.) of said owner or owners and is drily authorized to perform or have performed the said work and to make and file this pphcatlon that all statements con,tinned m th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be performed in the manlaer set forth in the application filed therewith. Sworn to before me this ~ .............. · ........ ...... Notary Public ............ County ~o,.~o~ ~,,,.. ,..,.~ ~0, ~,. (Signature of applicant) bANE s. 890£$'od'w. /~4.~1' bot I~ lot ~6, ~' ~rea" L.ot I0 d N~"~ serv,e J~=-' 'FFOLK COUNTY DEPARTS, lENT OF HEALTH SERVICES FOR APPR0\~AL OF CONSTRUCTION 0.~LY SURVEY FOR t?ICHAt?D tC. GREEIVFIELD LO)' NO, //~ ' HON~'YSUCKI~ H/ILS" AT MATTITUCt¢ TOWN O~ SOUTHOLD SUFFOLK COUNTY, NEW YORK DATE: NOk'. /,,~ SCALE: /# NO. 83' I0'10 HOT IE CONIITOE~01'O ~ · VALIO ~'RU( COPY H£A|LTH DEPARTMENT-DATA FO~ APPROVAL TO CONSTRUCT RGUARANTEE$ INDIC&TED HEREON ~ld.L RUN OHLY SG ~ C~N~ ~ ~TI6.19~1 ~ R~E N~ 701~ -- ANDLAND SURVEYORNY. S. UCENSENO. I~845 ~INGL~ ~A~ILY DWELLING ONlY , s~ ~TY ~LTH DEP~T~T SU~Y FOR GEORGE P~LUM80 AT MATTIT~ DATE: ~UN~ ~/,19~$ .~he se~a~ ~tsposal and ~ater supply ~WN ~ SOU~O~D SCALE: '1" = ~0' faoilll, te~ fo~ hb[~ location have been ~ ins~eeted by this department ~ found SUFFO~ ~OU~TT, ~ ~K NO. ~$-$~ . , . su~v~ ~ ~ vt~T~o. ~ s~c~to. ?~o~ ~ T~t ~OU~HO~O ~AVINES ' ' -~ ~DER AV $UF~LK C~Y ~ ~ /6;1~1 A~ ELE N~ 70/9 HOW4RD W, YOUNG, LAND SURV[YOR ~L~L(WI,~ICT~N~(STIaCgS~OLS(~)~N~ ~ ~) N,Y.S. LICENSE N0.45893 ,t , t t i L_; - _ ILL+" _./ / 'ii ~upnqt~e!p .~me~',, .mi, "0 r L