HomeMy WebLinkAbout13859-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.~ l ~ 5)5. .......... Date ...~.u..1 y..5. ...................... ,19.85.
THIS CERTIFIES that the building ...... A.D..D.I.T.I.O..N .................................
Location of Property 3400 DEEP HOLE DR. MP~TTITLTCK
House No. Street Hamlet
County Tax Map [No. 1000 Section . .1.1.5. ....... Block ..... 1. 7 ........ ]Lot ....O. 1. 1 ..........
Subdivision ............................... Fi]ed Map No ......... ]Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
...... B.P.C $ .1..8. ...... , 198. 5. pursuant to which Building Permit No. 1 .3.8.5. 9 ¢ ...............
dated .h.p.p. J:, .1. J.1 ................... 198. 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 .........
.... Cp.d..~'~ pp.P.. ~.e.d.~ 991n.,' .b. ~..t.h..~t .n.d..~ j~y.~.n.g, rp.qm.. ~.d.d.~..~ .~9.n... .................
The certificate isissued to ALICE & FATRICIA DE YRIES
(owner, ~e~o~ Xe/~ X X X
of the aforesaid building.
Suffolk County Department of Health Approval lq/A
UNDERWRITERS CERTIFICATE NO ................. ]~?.~. ~ P.I.N. 9 .......................
PLUMBERS CERTIFICATION 6/28/85
Rev. 1/81
Building Inspector
I~OBM NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to:
.......... ~.~.<Z.....~/....o..~..~. ........................
..........
...........
,o ............................... ~ ................. .~. .............. ~.... ~..~ ........ ~.A~.~o~........,..~. l
......
at premises ,dated at ....J-~, .......
.........................................................................................................
County Tax Map No. 1000 Section .~././..'~... ........ Block ..... /....~, ......... Lot No.....~..././.. ..........
pursuont to opplication doted ..~.~.~..L.~...,..Z ................... , 19.Z...,~, ond approved by the
Building Inspector.
Fee $.....~..~.....~..
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
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 i~l~ 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. Subm it Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or ~i[dings and "pre-existing"
land uses:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic 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 prepare a certificate.
C. 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
$15.00
Date ..........................
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property .~...~.~. O.~.~..~-/~... ~.D..,~. ~;. ~.~J.~.. ~; ./Y'~.. //~. ~ .....
House No, / Steer ~ I Ham/et
Owner or Owners of Property ~. [~¢. ~T[~.~.~...~ ~[ ~. ....................
County Tax Map No. 1000 Section ..//~ ....... Block .../.~ ......... Lot...O.// .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No./~. ???-". ?.~.~'. Date of Permit .~/~.///~9.-'.Applicant'.~./~.~..
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 p~mit meets all,~pplicable code~regq~ation~,-,~ /
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No.
OwnerS-
(please print)
P lumber T~\~
(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
Notary Public,~County
Notary Publi~
UNDA J, COOPER
NOTARY PUffiJC, State of New York
No. 4822563, Suffolk Cour,~
Term Expires March 30, 19~-<~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1000121
h BUREAU OF ELECTRICITY
g 85 JOHN STREET, NEW YORK, NEW YORK 1OO3E
Date July {)g t 1985 /lpplication No. on file 331723/85
T-,S CERTIFIES TH^T N 699148
only the electrical equipment as described below and introduced by the applicant nalned on the above application number in the premises of
Alice DeVries, Deep Hole Drive(New S~ffolk & Theresa Dr)Mattituck, NY
in the following location; [] Basement
was examined on
June 27, 1985
FIXTURE
OUTLETS
IECEPTACLES SWITCHES
16
NCANDESCENT FLUORESCENT
16
DRYERS
OTHER APPARATUS:
1-G.F.C.T.
2-1~moke detectors
Paul Burns
Town Harbor Lane
Southold, NY 11971
[] 1st Fl. [] 2nd FI. Section Block
and found to be in co,npliance with the r~equ rements of this Board.
FUTURE APPLIANCE FEEDERS SPECIAL REC'P JUNIT~IEATEg~
TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET
NO OF EEET
S V I C
NO'OFpERCC~,COND / OF A'W'Gcc COND '~ NO, OF HI.LEG oFA' W' O'Hi. LEG NO OF NEUTRAl
1 3
Lot
EXHAUST FANS
DIMMERS
OF NEUTRAL
This certificate must not be altered in any manner; return to the office of the Board f i~cor~ect Ins ector~
FIELD INSPECTION.
FOUNDATION (1st)
COMMENTS
FOUNDATION
2.
ROUGH FRAME &
PLIJMBING
(2nd)
INSULATION PER N.
STATE ENERGY
%OSE
FINAL
ADDITIONAL COMMENTS:
' FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Disapproved a/c .......... : ......... ..~.. ....
APPLICATION FOR BUILDING PERMIT
Date ................. 1
INSTRUCTIONS
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,~o,~ removal or d~molition, as herein described·
The applicant agrees to comply with all applicable laws, ordinances, bull0,~ code, housinj~ code, ~/nd regulations, and to
admit authorized inspectors on premises and in building for necessa~W~tions. _j/ ~
· .' ._..~....JzZ.~ .¢.-.~....~. ? ...................
(Sig~atu. r~9~ applicant, or name, if a corporation)
..... ./-"--' .,-. ....
(Mailing address of applicant)
State whetfiesr applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
II
........ .~..,~.q W. . g~.(2 .~..4~. . .......... . ...........................................................
Name of owner of premises..' .~..L~.~.....~.~. J~L'~:~ ......... ~ ~..~:.'..~..~..).~.'i ?. & .................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
, ~
Plumbers License No. 7~.~.[~... ~/'~ ~..
, ~
Electricians License No. /.,~-~'~../.~c~-ff~.~.. ?(.
Other Trade's License No ......................
1. Location of land on which proposed work will be done .......................................... ~ ......
.............. ......
House Nuznber Street Hamlet
County Tax Map No. 1000 Section ...]./.~.~. .......... Block .... }'1 ............ Lot .... //. ............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... ~)/~r.~...~..~..~.. ~..~..'../5~ ......................
b. Intended use and occupancy....~.~ · . ;7~-~./· · .~.. · .~.~.,~. · · .~.~ · .~. · .~./..~.' ./?~.. ~. · .~r~ ........
3. Nature of work (check which Applicable): New Building ' Addition ..... ~.... Alteration ..........
Repair ; ............. Re~poval .............. Demolition .............. Other Work ...............
. t...mt $ ~qt~ (Description)
4.: Estimated Cost ..... . ,, ,_..O... Fee
(to be paid on filing this application)
5. If dwelling, number 6f'dwellin'g units ............... Number of dwelling units on each floor ................
If garage number of cars '
6. If business, commercial or mi ed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structulres, if any: Front... .... Rear .............. Depth ...............
Height , I : ....... '.N~mberofStories
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ' Height Number of Stories
8. Dimensions of entirenew construction:' ' Front .... ........... Rear ............ ... Depth ...............
Height ............... Number of Stories'· .......................................................
Size of lot: Front ......... i ............ Rear ...................... Depth ......................
Date of Purchase ......... , ................... Name of Former Owner .............................
Zone or use district in which premises are situated .....................................................
Does: proposed construction vilolate any zoning law, ordinance or regulation: ................................
Will lot be regraded ........................... Will excess fill be removed from premises: Yes No
Name of Owner of premises ................... Address ................... Phone No ................
Nam¢ of Architect ..(...-~....~ i~.~11~..i: .... Address ....... 9*. .......... PhoneSo.
10.
11.
12.
13.
14.
property lines. Give street and bloc
interior or corner lot.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
c number or description according to deed, and show street names and indicate whether
STATE OF NEW YORK, S.S
COUNTY 'OF ................
being duly sworn, deposes and says that he is the applicant
(Name of individual si~ning contract)
above named.
He is the ....................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and ~s d¢ly authorized to perform or have performed the said work and to make and file 'this
application; that all statements corttained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith·
Swam to before me this ,
· .' ............ ~ ......... dgy ~f ..... ~t{~ ........ , 19~.~.
........ Oo
t~01~RY PUBLIC, State of flew. Y0rk, -'-' -'atUre'Of ~' 'licant)"--'
I ~ 47~7878, Suffolk Cou~hL ~
JNOT,PFY ~!LDiN6 DEPART,MrZ.,<4~-~
765-1502 ~ AM TO 4 PM FOR
FOLLOW,N3 ~F(S~CT[ONS:
~ FOUNDAT;oN - TWO R~qUfRED
~ FO~ POURED CONCRETE
2. ROU3ki - FRAMING & PLUMBING
¢. ~NSULA-U3~ ~
4. F[NS~L - C~NSTRUCTIqN MUST
THE REQ~.¢,~z ~4ziqTS OF TH: N Y
DESIGN O~ CON~RUOlON
l
:opper tubing is used
mr w~ter distr!.buting
s ,s:em; piping dali be
of b/pes K or L only
SOLDz~ ~ ~:~:D IN W.4_TER
SUPPLY ,~YSTEM CANNOT
EXCEEi,) 2/1,0 g 1% LEAD.
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