HomeMy WebLinkAbout13662-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No...g3~4053 ......... Date ..... .l:).e.¢~h~;..5 ................ 19.8.5.
THIS CERTIFIES that the building ........ 9.n.e.r .~.a.m.~.~y..4w..e..~.~.~n.q.. ................
Location of Property ...260 ............... .M~j.qz; '. ~..~.z~t .h ............ .S.qu..L.h.o.~ ......
House No. Street Hamlet
County Tax Map No. 1000 Section .... 5 ~ ...... Block ......... 2. .....Lot .... ~ ............
Subdivision ............ X .................. Filed Map No .... X. ....Lot No ........ .X .....
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... .D.e. Cerab.~:c. 2.4 .... , 19 ~.4. pursuant to which Building Permit No ..... .~ .3. 6. 6. .2 .Z ..........
dated .... .J~P,u~ r y..7. ............. 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 .........
P~iV~Le O~-f~Y d~qellin~.
The certificate is issued to ........... C..~A..R.L..E.S...I~...R.R.Y..&...N.A.N.C..Y.
{owner,
of the aforesaid building.
Suffolk County Department of Health Approval ............... 3,47 .~.O.-x2. 5. .0 .................
UNDERWRITERS CERTIFICATE NO ........................ ~8B.9.~ $ ..................
Rev. 1/81
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Yo
CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NE 13862 Z Dat~......:..~. ................. , ~9....~.
v
Permission is hereby granted to: .~ ~.- .
.....
.... ~ ~.
...................................
............ : ............................... ~~;.-~~ ........... ~ ..........................
,, ~,~,,, ,,~,~ ~,. uz~ ..... ~~.~.....~
..................................... ~ ............. ;..;.;........~..._......;;.;.; ...............................................................
~..~ ~ ~ ,~. ,ooo ,.~,,o~Y ..... ~,~, .m.~......~,,ox~& ...........
Building Inspector.
Fee $/...T..C~. ............
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m ~ 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 featu res.
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 property 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancv on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
$15.00
Date..~.f..~...~. ~/~.~..~C~. .......
New Building ....... ~ .... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .... .'~..~..~. .... ./~.. ¢~. .......~. · .~. · .... .~..~ · .~..~..'~.~?, ..............
House No, Street Ham/et
Owner or Owners of Property . .~.'~/~,f....~.~. r~.. ~ .,~..~, .c,,~....~....,/~ f.~,/<'.~//.~..~. .......
County Tax Map No. 1000 Section .... ~.~. ..... Block .... Q.o'~, ....... Lot .... ~,4~.,~, ......
Subdivision ................................. Filed Map No ........... Lot No ..............
..... /_ K
Permit /2G ? Oate of Permit .. pp,oant ...... .................
Hea~th Dept. Approval ....... Labor Dept. Approval ........................
Underwriters Approval .~ .~.~, ,~..~..'~v..~ ........... Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ..... ~ ..............
Fee Submitted $ .~ .......................
Construction on above described building and permit meets all applicable codes and regulations.
(~.'~ '~ :~ ~ 0~%~ Applicant ~~ . . . ///~. ,--.L,..~.~ ...................
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~- 0~. 85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIE~ THAT
only the electrical equipment as described below and int~duced by tlw applicant natned on ttm above application number irt tim premises of
L~y ~c Cormick, Ma~or's P~th off
in the followiag location; ~Basement ~ ls~ FI,
FIXTURE
OUTLETS
Mouton La., Soutt]old~ N Y
[] 2nd FI. Sect~o,~ Block
and found to be in compliance with the r~quirements of this Board.
Lot,
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS ~APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
E
2
Service only
Box 574 ~ ~
L~urel, N.Y. 11~ Lio 'Z~ E GENEE~AN
This certificate mpst not be altered in any manner; return to the office of the Board if incorrect. Insp~ctm may be identified by their credentials.
COPY ~Ofl BUILDING DEPAflT~E~T. THI~ ~OPYOF CE~TIFIOATE ~U~T NOTBE ~?EnED ~ ANY MA~NEfl.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No.~.t~ ~
(~lease prxnt)
P lu~er~~ ~~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber' s s~gnature)
Sworn to before me this
Notary Public,
MARK T, GAGSN
,NOTARY PUBLIC, S~ale of New York
No. 4695650
Qualified ul $offolk County ,.,,,..,,
Gem[mss,on Ex~l,es March 30, 19~
-- ' Notary Pu~ic
County
FIELD INSPECTION ~
'FOUNDATION
(1st)
COMMENTS
FOUNDATION
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION
PER N. Y.
STATE ENERGY
~ODE
FINAL
ADDITIONAL COMMENTS:
~FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~,OUTHOLD, N.Y, 11971
Examined , '/.~t~?.,..,.~. ..... , 19: 9...
Approve~ ~& Z l~ce±vTct ....., ...... ,1
· :. ....... , .... :... !
Disapproved a/c .... : '..'... ~ ................. -
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 thc
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
a dmitauthorized in spectorsonpremises and in b uiRlingfor ~,ff~..~ :~
necessary inspections. Q .
(Signatuye 6f appacant, or name, if a corporation)
....... .......
' (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................. O. .OJ, O. ¢. ~. ..... ......... ' .......................................................
Name of owner of premises .... ~.~../~.~....~.X....~.~. 4 ~g .................................................
(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 ..... . .~.6~.... A~ .~.. / .... (//r~.t,~_~ ~t/~//~,~.~ )
/3.o.d... ,---/lc,
Plumber's License No ....
Electrician's License No....~..0..~...a,~..~...~.'//Itt-~
Other Trade's License No .......... d~F_)
I. Location of land on which proposed work will be done ..... /~jar5...~.~.~. ).. X°..~..~.~....~./.~..~. ............
................................ ~. ~ ~.~. . ~. ,~'~ ........... ~,.¢~./d ..............
House Number Street Hamlet
County Tax Map No. 1000 Section ...... ~..~.~- -~. ..... Block ...... .2.. .......... Lot ..... ~. ............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n:
a. Existing use and occupancy .... [/.&. ¢ .r~ .~.~. ......................................................
b. Intended use and occupancy ~' t ~ ~ ~, ~4. t~ ....
11.
12.
13.
14.
Nature of work (check which applicable): New Building ..... ')~... 'Addition .......... Alteration ..........
Repair .............. RemoVal ............. Demolition .............. Other Work ...............
Estimated Cost ...... .~.~..Oi.~.O. .............................. ...... .. ......
: '~' (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 .... ~ ..................................................................
If business, commercial or mixed occupancy, specify nature and extent of each type of use . .-wry.. .................
Dimen~on's~iof'ex~Sting s.tr~,ot.~¥~, ]f~ny: Front Rear Depth
Dimensions of same structure Wiih,alterations or additions: Front ................. Rear ..................
Depth ~ ~ Ill i~eight ....... Number of Stories ..... , ......
D~mensmns o~r~ new constructmn: Front ..... .q..q. ...... Rear .... .qAt ........ Depth .. ,~ff. .........
Height ..... ~_t/ ....... Nu.mber of Stories ........ ,/.. ~ ...........................................
Size of lot: Front .../~o.q.~ .......... Rear ..... lff..O ............. Depth ./.37..0. ................
Date of Purchase ... 1 ~ ~ ~./!~. ~t ............... Name of FoTner Owner . .6~.t.l[(a..~4... l-l.~ #.s.c..~ ........
Zone or use district in which prefnises are situated ..... ~.t~ ,'d. .~.(~. ...................................
Does proposed construction viol~te any zoning law, ordinance or regulation: .. j]/.O. ..........................
Will lot be regraded ........ ~.¢ ~'...~ ............. Will excess fill be removed from premises: Yes
Name of Owner of premises ~<y. f. 44 t'.rlt..~t.e/o.~./.t~.~kddress ~.t.~l~{,. ~e~ebd.. ~.. & .et4~f~Phone No. gr. 3..~...~.f77 .
Name of Contractor ...~.ob.. }(.¢.h./. ............... Address ................... Phone No ............ ;...
Locate clearly and distinctly all
property lines. Give street and block
interior or corner lot.
PLOT DIAGRAM
buildings, whether existing or proposed, and, indicate all set-back dimensions from
umber or description according to deed, and show street names and indicate whether
STATE OF NEW S
couN'rY OF ................. ,'
(Name of md~v;dual s~gnmg contract)
above named.
,?
th
He is e ......................
(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
application; that all statements contained 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.
Sworn to before me this
.......... .'~..7....~. ..... day ofi'....~-~ f~. ........... ,19 ~(f.
Notary Public,.... ~ .... ......... County ,j~.///~//~.... _ . ~
.....: .... .......... ..
NOTt~RY ?OBLtO, State 0l New ¥orl~ - ~ . ' ,
(Signature
of
applicant)
No 4107878, Sul elk C!o nltg. ,~
sworn, deposes and says that he is th.e applicant
AVE,
RODERICK VAN T.UYL. P.C.
LICENSED LAND SURVEYORS
GREENPORT NEW YORK
SUFFOLK CO. HEALTH DEPT APPROVAl'
H.S. NO .........
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOr this RESIDENCE WILL
CONFORM T(~)/ tHE STANDARDS OF THE
AP~LiC~T
SUFFOLK COUNTY DEPT OF HEALTH
SERVICES - FOR APPROVAL OF
CONSTRUCTION ONLY
DATE. I~ ~ I ~
, ~LLI~ 0~ y
SUFFOLK CO. TAX MAP DESIGNATION:
DtST· SECT. BLOCK PCL.
OWNERS ADDRESS:
DEED: L .... ~, P ...... . .... ,-
TEST HOLE STAMP
r_~?' C :?-L r¢
SEAL
TELEDYNE E~$T ~ ,635
H.52°05'I0~E.
PATH
/
A
~LDG DEPT.
. TO,.'vr:,t OF SOUTHOLD
LAND ~"iTC~
RODE:RICK VAN TUYL, P.C,
LICENSED LAND SURVEYORS
GREENPORT NEW YoRK
FO
SUFFOLK CO. HEALTH DEPT. APPROVAE
H.S. NO. J4','~-~O '~-~--~O
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS, RESID~'NCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERVICES,
APPLICANT
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES -- FOR APPROVAL (~F
CONSTRUCTION ONLY
DATE:
H. S. REF. NO.: ~
APPROVED:
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BL(~-K PCL.
owNERs ADDRE~:
TEST HOLE
CLAY
STAMP
SEAL