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Home My WebLink About13878-zFORM NO, ¢ TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z13878 Date September 20 THIS CERTIFIES that the building ................................................ 475 Parkview Lane Location of Property 2.05 ..Plum Island Lane Orient House No. Street Hamlet County Tax Map No. 1000 Section 015 ...Block 05 .Lot 024.29 Subdivision..O.r.i.e..n.t..B.~;..T.h.e...S.e.a. ......... Filed Map No. 6160 .Lot No. 180 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .A.E.r..i.1' . .1..7 ....... 19 .8.5. pursuant to which Building Permit No.. 13878Z dated ....... A.p .r.i.1.. 1..8 ............ 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 ......... ..... Private One Family Dwelling ls.t Fl?or Occupancy ..... The certificate is issued to ............. BLAIR, GARY & DORIS {owner, levee ~-temm~) of the aforesaid building. Suffolk County Department of Health Approval ........... 85-SO-50 Pending UNDERWRITERS CERTIFICATE NO ................................................. Building Inspector Rev. 1/81 FO~ NO. ~ TO~N 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) Date . .~..,~...~../.. ~ N-° 13878 Z .~...~.. ..... ~...../... ...................... Permission is hereby granted to: ....... ~..~.~....~.~. .................... ...~../....z~ ....... ~./.~.:..~.~.~/~....~..~: .... ..... ~.~..,.~.~.~ .~...~..:. ~....././.~2: .~.~.~.~.c.~ ....... /....~t.,~ .......... ~..~..~..~,,.~....'..~.~ ............ et premises located at .,...C~... ,~,,,..~,,(~</,~,f:..~.,~, ,Z~,~'~a-x~/~......,~,.,..~ ....................................... ............. ~.-.. ,./.~.4~.~..~. ~.~ ...... ~..~.~....~..~. ~/c,..~..~.~ ....X./-/~..~.~ ........... ~......~ ............................ ~.~.-.<~....~.. ....... Coun~ To× Mop No. ~000 Sec.a.....~/..~..--.. ...... B~oc~ ..C2...~. ......... Lot No.~...~:.~.~.... pursuant to application doted ..... ~..//~/..(~r......./...~.. .................. , 19~and approved by the Building Inspector. ..................................................... Z"...;..~ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD IE]u ilding Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia~ 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZ~3perty 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O.. $5.00 ~//2~//~>~' V// Date ....................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of PropErty '.~...?~... ; .~5~L-. ........... ~ ............................ House No. Street Ham/et Owner or Owners of Property~b~j , .~.,.~:,. ~` .% ............................................... County Tax Map No. 1000 Section (~/~'. Block ..... ..(~..~ ...... Lot..(~.~..~. ..... Subdivision...07.1..~..~ 7.~ .c~...~...~.'.~ .... ~..Filed Map No.~./.~?. ..... Lot No. <~.~...., ..... Permit No./.~..~~, .~..%.. Date of Permit .~..>./~ ~!..Applicant...L~..~..~..~..~.~....~. ~..(~ ~..pl. ........ Health Dept. Approval . .~?.~ .~.~ .~..~..~. ........ Labor DePt. Approval ........................ Underwriters Approval ??T, ,~,~.'..~,, Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted ............................. Construction on above described building ~/~rmit meets all ~~s and regulations. Or~ I~l Applicant ...... ~-/,~~ ....... ; ............... Rev. 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO. /~ print) (please prin%) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~:,~ If~- day of ~~ Notary Public, ~O~fo /~ (plumber' s signatu~e~ / Notary Public MARJORIE L. HOWARD County NOTARY PUBLIC, State o~ New No. 52-4601157 Qualified in ~ffolk County Comm~ ~pi~ Mamh 30, COMMENTS FIELD '[~SPg~TION 1. ~OUND^TZON (ls~j. FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY %ODE 4 o FINAL ADDITIONAL COMMENTS: __ 1000129 Date THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10058 ~- :['7, ~as ~p.,ie.t,o. No. on/i,e 3~83~/~S N '7 THIS CERTIFIES THAT only the e/ectr~cal equipment as described belo~ and introduced ~ the applicant ~amed on the able application ~umber in the premises of 180 inthefollowinglocation; ~ Basement ~ lstFt. ~2nd FI. ~tS~ SecUre, Bl~k ~t w~ examined on ~'~17 ~]. ~ ~ ~8~ and.found to be in compliance with the requirements of this Board. 28 44 RANGES COOKING DECKS · OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS ~'IME CLOCKS UNIT HEALERS MULTi-OUTLR1 DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R ¥ I C OTHER APPARATUS: NO, OF CC COND, A W.G. NO OF HI4EG A W G NO OF NEUTRALS A, W. G. PER ~' DE CC. COND. OF HI-LEG OF NEUTRAL 1 2 1 2 L~3x 12 Lie. 100~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors GENEI~AL tl / ~ may be identified by'thelr ~ ANy MANNER. rFORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL EOUTHOLD, N.Y. 11971 TEL.: 765-11303 Received ........... ,19... Disapproved a/c ..................................... .................... . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necess~6~g.f~.....~.~ ~ (Signature of applicant, or name, if a corporation) g/.~. . o(.o. 7g~. . .zq. , . .xf ~ .~. .,.r. .~. .~. .'q.'.Y'. . . /./. eJ:. ~ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...(~...~.l~.'.~..g-/..~...O.~-,, [ .~. ~ L'Ct ~ ff,. ..... (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. W~.~..~.~.0..~...~..00. ....... Plumber s License No. ~g-[...I.~/q..ti ............. Electrician's License No Other Trade's License No ...................... 1. Location ofland on which proposed work will be done. . O[~ ['10'~ .'..-==-== -: = :-::=::. :. . . .......... ..... House Number Street~ ...... ~Ha~et (~ ~O ~__~ County Tax Map No. 1000 Section . .g }.~ .~ ....... Block .... ~ ........... Lot .'~ .~. w (Name) 2. State existing use and occupancy of prgmisgs and intended use and occupancy of proposed construction: a. Existing us~ and occupancy 0 ~ e ~ ~T b. Intended use and occupancy O~ ~'~ ~.O.~{~L /~gN.~ 3. Nature of work (check which applicable): New Building ..... Addition .......... Alteration Repair .............. RemOval .............. Demolition .............. Other Work ............... · ' ~7~ ~ (Description) 4. Estimated Cost ~lqLo00 Fee ~.. (to be paid on filing this application) 5 lfd ' ' fd .ngu · · welhng, number o welh nits ...... I ........ 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 .'.-'7~'"~'. ......... Height ~ Number of Stories ~ Depth ................... i... Height ...................... Number of Stories ...................... 8. Dimensions of entire new const:ruct~on: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .... I. ................................................... ' R pth Size of lot: Front .......... ~ ............ ear ...................... De ...................... Date of Purchase r3~F°b~ ~ ~[ .......... ~ ................... Name of Former Owner ............................. Zone or use district in which p~emises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: . ..~.. ...................... ... Will lot be regraded ....~ .~.3.. .................... Will excess fill be removed from premises: CYe~ No Name of Architect ........ I ..... Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate 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 corner lot. \ STATE OF NEW YORK, i S.S COUNTY OF ................. S ~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... : .................................................................... i (Contractor, agent, 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 app!mat~on; that all statements co[tamed m th~s 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. Sworn to before me this Notary Public ............. . .~.-...~.L...~..~-~.... Count.?~, ~ ~~..~..~. ~ ll[I.[i,l K. BE VOE ................ N01^W/PUBLIC,, $lattJ of New g01[t ~ (Signature of applicant) No. 470~878 gu[f01k C~t nty " SUFFOLK CO. HEALTH DEPT. APPROVAL ~. ~' ~ ."!-Z~.,..~ >__~:'.--._ _:. ...... ' . :-- - ' ~ ' '-~ '-'" -~' { STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO/cT~E STANDARDS OF THE SUFFOL'< C¢¢'NTY DE T. OF HEALTH ~ CONSTRUCTION ONLY I H.S. REF. NO.: APPROVED: ~ v,.~-,--,-,- ·- SINGLE FAM4Ly D~/Ei'LLIN~.,~ y i',, SUFFOLK CO. TAX MAP DESIGNATION: I! DtST, SECT. BLOCK PCL, ~ 727- 'O'TCQ i : DEED: 'L. I'4~A P. ~-? SEAL ' ;,,..,,: ,/~;;/EL,,.., 0,.. ,,~:l;i ¢~ ROD~RtCK VAN TUYL, P.C, LICENSED LAND SURVEYORS GREENPORT NEW YORK t f85,~ POOL O~ief ~ S.C. DEPT, OF HEALTH SERVICI~S SUFFOLK CO. HEALTH DEPT. APProvAL H.S. NO. 8~-.5C~.~c~. ,, 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: H. S. REf. NO.. - ~- ~-~ APPROVED: suFFOLK CO. TAX DIST. SECT. BL~ ,t~'--~L.- oWNERS IADDeE~: . .~o. ~'~.~ ~. -' ' .... ~ ~, ,,.,~ DEED: , p, TEST HOLE STAMP SEAL W ili 'i C i iTiFiCATE OF OCCIIPA C¥ SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 oj'1% LEAD. PLUMBER CERTIFICATIOI~' ON LEAD CONT'ENT BEFOR~ CERTIFICATE OF OCCUPANCY coPPer tubing is used for water distributing em; piping sha~l be sy~ typeS ~ FR.O .N'T ~E L.~ r:: V/~,-'F' 0 ,"'4 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: L~, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 9, ROUGH - FRAMING & PLUMBING Phone 47%0400 Main Road GREENPORT, N.Y. 11944 E~JE V A-T~ ~( SCALE L