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HomeMy WebLinkAbout13771-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. AMENDED CERTIFICATE OF OCCUPANCY No Z-13818 Date NOVEMBER 14~ 1986 THIS CERTIFIES that the building. NEW DWFJJ,ING Location of Property 5895 INDIAN NECK LANE House No. Street County Tax Map No. 1000 Section 86 Block 6 Subdivision Filed Map No. PECONICr N.Y. Hamlet Lot 16 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCU 12r 1985 pursuant to which Building Permit No. 13771-Z dated MARCH 21~ 1985 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 DW~TJ,INGWITHATTACHEDDECKS. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. THOMAS & ELIZABETH DONOVAN 14-SO-225 - AUG. 20~ 1985 N-702082 - JULY 26~ 1985 Building Inspector Rev. 1/81 · OB,~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13771 Z Date 19..g.~.~ Permission is hereby granted to: ~ ...... ~. ...... ~.....--...T...~..~ ......... ...... :..t~..~...:~ ..................................................... ...~...~.~Mu..~ ........ ~.~.~..~ ....... ............. ....... at premises located a ~ ................. County Tax Map No. 1000 Section ..... ..~...~..~. ........ Block ..... ..~...~. ........ Lot No .......~...Lf. ............ ~uo~, to o~,,,~o,on ~ed ....~~..L.~ ....................... . l~.~ on~ o~ed ~ ,~e Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13818 Date ....... S.e.p.t.e..r~..e.r..4.. ......... 1985 THIS CERTIFIES that the building .... .N??...D.w.e.1.1..i.n.g. ............................. Location of Property 5830 Indian Neck Lane Peconic h36s3 io: ....................................... ................ Street Hamlet County Tax Map No. 1000 Section ...0.8.~. ...... Block ..... 0.~. ........ Lot .... .0.~ ~. ......... Subdivision ....... X. ....................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 12 19.8..5pursuant to which Building Permit No. 137.71Z dated ....... .M.a.r.c.h...2.1. ........... 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 ......... ..... New Private One Family Dwelling ..... The certificate is issued to DEMPSEY, JOHN R. INC. ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval 14-SO-225 N702082 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ I1~ 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 "pra-existing" land uses: 1. Accurate survey of p;Coperty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ...,.......o.~ Old or Pre-existing Building $15.00 Date ..... ~q~..~,..1.~... ............ Vacant Land ............. 5?30 Indian Nec~k Lane, ?ecor!~c, ~:i Y... 11958 Location of Property ..................... · House No. Street Ham/et Owner or Owners of Property John i~. ~empsey, Inc. County Tax Map No. 1000 Section 86 Block 6 Lot .... 16 Subdivision ................ Filed Map No ........... Lot No .............. Permit No. 1 ~ ?~ 1 ~ Date of Permit_. Applicant .......... · Health Dept Approval attached Labor Dept Approval Underwriters Approval attached Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. 5.00 Construction on above described building and permit meets all applicable codes and regulations. , ~0 ~ ~ ~<~ ~ ~ Applican ~ ~q%o~ " ;' ~ '" Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st), COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: BUILDING DlUlT, INSPECTIOH [ 'l FOUNDATION 'IST I] 'l ROI, NtH pI.B4. I] '1 FOUNDATION ;ZND [ ]] INSULATION [ ] FIL4MIN~ ..,~LFINAL REMARKS: ~ DATE ~ ~q.__._~~_~:NS~ V"¢ 4.. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~f00121 BUREAU OF ELECTRICITY 8B JOHN STREET, NEW YORK, NEW YORK 10038 "a~, Z.'~y 2e,1585 ~,pp,i..,io. No.o./i,e 3r~730/85 N 702082 THIS CERTIFIES THAT only the electrical equipment az described below and introduced by the applicant named on the abo~e opplication nu mher in the premises of John R. Dempsey, 5830 Indian Neck Lane, Peconic, New York in the following location; ~ Basement [] Ist FI. [] 2nd FI. Section Block Lot was examined onju 1~ 2 2 # 19 8 5 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS 26 RECEPTACLES SWITCHES 39 30 DRYERS FURNACE FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS INCANDESCENT FLUORESCENT 26 FUTURE Af~PLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. Of FEET SERVICE DISCONNECT OTHER AP~RATUS: Special Ret'pt.- 1-30amp., Motors- 1-1 G.F.C.I.- 3 Smoke Detector- 1 Track Lighting- 16· o" S E R V I C E PER ~ OF CC. COND. OF HI.LEG OF NEUTRAL 1/o NO' OF1NEUTRAL 1-50amp. 8-lites Paul Burns 275 Town Harbor Lane Southold, N.Y., 11971 Per ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. ~nspectors may be identifie credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANN~R. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y, 11971 TEL.: 765-1803 ,pproved.. ?y\q~J~ .\^1 .~-.I., 19 ~.~. Permit No. 1. )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ,19... Date .~.a?.qh.. 9 .......... 19 .~5 a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 Its of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatiohship 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 ~ail 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 mil 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 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. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to flmit authorized inspectors on premises and in building for necessary inspections. .... g..gb.n..13. :. ~e.r?. p.s.e.y. ,..I-.ri. e... ................. (Signature of applicant, or name, if a corporation) .... ?..o. ~.qx.. ~.,.. 9.u.~.qh. 9t~.u.e..,. E ...y..... ! .~ .9.~.5.... (Mailing address of applicant) ¢tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 9..wn.~T.,' general contractor . . ............................... ~ameofownerofpremises O. 9.h.n' ~: D.e.~p~e.~ Inc. (as on the tax roll or latest deed) f applicant is a corv_olation, signature of duly autliorized officer. ... ~.oDf~..~,. ~.e.m-p.s.e.×,. nr~.sA~.e..n.t ........... (Name and title of corporate officer) Builder s L~cense No .......................... Plumber's License No.. ~.eorp.e .Ma~J.~.e.k .... G.O. Electric Electrician's License No. ; ..................... Other Trade's License No ...................... Location of land on which proposed work will be done .............. · .................................... ~_~o,~ Indian ~:eck Lane, ?eeonic, N.Y. House Number Street Hamlet County Tax Map No. 1000 Section 86 Block 6 Lot 1.6 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use aud occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant land b Intended useandoccupancy one family dwe]lin~ 3. Nature of work (check which applicable): New Building X.X..' .... Addition .......... Alteration .......... Repair . . ~ ~. [. ,~. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost.. ~.~50,000 Fee .......................... °o. (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 ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Denth Height .......... Number of Stories ...................... 8. Dimensions of entira new construction: Front ...~(.4 .......... Rear .... ~ .......... Depth ., .5.2. ~ ......... 0. . .. N Former O~vner . ' ........... I. Zone or use district in which premises are situated ...... re~5.~ er~t±a] .................................. 2. Does proposed construction violate any zoning law, ordinance or regulation: ..~,o. ........................... 3. Will lot be regraded ..... .rlo ...... . .............. Will excess fill be removed from premises: × Yes No 4. Name of Owner of premises . .,T..~..I).e.m.~. ~ 9~,...I.n,l~ddress 1~..0. ~qx...~.,.. ?.u?:.e.h..o1~e No... 7.3.4.. 9.0.5..8... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ,roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. su~ey attached ;TATE OF NEW YORK, S.S ?OUNTY OF ................. .......... ?.o.h..n..R.:..De.m.p.s.eX .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. te is the ...................... o..w.n.e.r. ~..~.e.~..~.r.~.l...e.o.n.~. ?.a.q~ 97' .................................... (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and ~e this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this .................... .... x9 YT.s. No 47078?'8. Sufloik Te~m Exp*res March SUFFOLK CO. HEALTH DEFT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL .................................... ~UFFOLK CO. DEPT. OF HEALTH sERvICE~. APPLICANT ~' %/ ~' ~' SUFFOLK COUNTY DEPT. Of ~EALTH, SErV}CES ~ FOR ~PPROVAL CONSTRUCTION ONLY DATE: H. S. ~Ef. NO.: ~. ~. ~l/~-~e-~$ D~ST. SECT. StOCk eec. ~CALE - ~'~ ? DEED: L.6672 P. ~E~ S~, LEVEL, . i5~ or, lY ~t~ ~°~ ~r ~ su~ ]' ~CE. o~J t~i~, Gu~~ere~ I6' SEAL VAN TUYL, ~.C.{ I GREEN~RT NEW Y~K ,¸1 SUFFOLK CO. HEALTH DEPT. APPROVAL H S NO. STATEMENT OF iNTENT ~HE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOr THIS RESIDENCE WILL CONFORM TO THE STANDARDS Of THE SUFFOLK CO DEPT OF HEALTH SERVICES, SUFFOLK COUNTY DEPT OF HEALTH SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY H S, REF NO,~~ APPROVED, SINGLE F~ ~Y DIST. SECT BLOCK PCL OWNERS ADDRESS'