The URL can be used to link to this page

Home My WebLink About13671-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. g.l~6.6.6 ......... Date ......... .~.u.l.y....1.7 ............... ,19.8.5. THIS CERTIFIES that the building ..... o. 0 .e.-.~ a. m..i.l.X..d .~.e.~. 1. .~ .ng... ................... Location of Property .. l 0.65 .............. U..h.1..I~..n..e ..................... 0..v.i.~.n.~. ...... House No. Street Hamlet County Tax Map No. ] 000 Section ... q. ~ ....... Block ......... 5. .....Lot ...... p./.q..2 .6... 1.. Subdivision ~)~.]~$ UT..~¥. ~$~.~, $~...~ 3.T.,.. $ .Filed Map No...3.6. 6. .6..Lot No ..... 1.6. 1, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated · · · ~.~,~oV.Y..7 ........ 19 .8.5. pursuant to which Building Permit No ..... .~.3.6. ~ .~ .Z .......... dated ......... ~t~ ~y..l ~ ....... 19 ~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.n ~ .-~.~ ly..4~ 3-.3~.~ ~ ...................................................... The certificate is issued to ............ to.,.er. ............. of the aforesaid building. Suffolk County Department of Health Approval ............... 4. ~ .- ~.0.~ ~ ~ .6 ................. UNDERWRITERS CERTIFICATE NO ........................ ~ ~ ~.7.~3 ~ .................. Rev. 1/81 Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDIHG 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:/ ,/~ / //~ ) ,/~ ..................... ~....~...~..~...../.. ...... ~......./.../... ......... :, premises ,::~ ================================== Building Inspector. Building I~tor Rev. 6/30/80 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 t3LDG. DEPT, APPLICATION FOR CERTIFICATE OF OCCUPANCY ' Instructions . A. This application must be filled in typewriter OR ink, and submitted ~ IIIIIl~ to the Bud ng 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 "pre-existing" land uses: 1. Accurate survey of p~operty 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: ~' 1. Certificate of occupancy $5.00 v' 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 Date .J New Building ...~/.~. ........ Old or Pre-existing Building ............ Vacant Land ............. I b'/-/L Z -- Location of Property , t9 ,4.~h~.~' C~ House No. Street Hamlet Owner or Owners of Property .~.....~....'~ ....................................... County Tax Map No. 1000 Section . .O. ~.~'~ ....... Block ...,~.. ......... Lot .... ~ ........ Subdivision .O..R.~.~'~'. )~..~(..-~.~.~...~.~..~.T.~-~.'.Filed Map No. 3..~.~..1~....Lot No. j.(~.l ......... Permit No. J~ ~..~. J :~.. Date of Permit &¥H.. ~1~ .... Applicant ~, P. ~...~.~. ~.¢.~...~Y'..~.~.~... Health Dept. Approval~, ¥.{-.~L .l.~-.~..[.~ 9~." ....... Labor Dept. Approval ~ ...................... UndeFwriteFs Approval , . ......... Plannin oard royal ..-' .................. Request for Tempor~/V Certificate ..................... Final Certificate . ~ ................ Fee Submitted $ .... .0 ................... Construction on above described building a d p~.~_~:~it meets all al~plic~le codes and regulations. . Apphcant ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS 1135021 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO38 ..,e 0'~e 20. 1~85 A,,p,e.tio.tNo. onSii~ 331095/85 N697286 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant naoted on the above application number in the premises of Robert Nilsen, 1045 Uhl Lane,Orient, N.Y. in the/ollowi,~ Ioc,tio,~; [] Ba,~e~e.t [] ~t ri. [] ~.d ri. Section 3 BIoc~ rot 161 was exarnlned on ~ 17, 1985 attd found to be irt compliance with the requirements of this Board. FIXTURE OUTLETS 23 DRYERS RECEPTACLES 67 SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT 38 17 6 SYSTEMS NO. OF FEET E OTHER APPARATUS: 1-G.F.C.1. 2 -S~oke Detector. V I C A W G NO. OF NEU~'RALS A. W G PER ,~ OF HI-LEO OF NEUTRAL 1 R OF CC. COND. Three "C" Electric Ino, Route #1 Box 45M Sound Avenue Riverhead, N.Y, 11901 Lic. 5327 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date 7/3 /OO~'-- Building Permit No. /~/ Owner ~ o~ -~-~ (please print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~ day of ~/~L\/ , Notary Public, ~ ~o~;~_County -- - Notary Publi~ UNDA K. DAWSON Notary Publi(=, State of New Yo~k No. 4694688 Qualified in Suffolk County Term Expires March 30, 19 EIE~D I~BR~CTIOf FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~,ODE COMMENTS ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [] ROUGH PLBG. ~-~OUNDATION /ND [ ] INSULATION [ ] FRAMING FINAL REMARKS= DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 .... ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.~.~.Gvt' ~.a.~- to the Bnilding 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 issue a Building Permit to the applicant. Such permit sball 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 Southotd, 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 alt applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaw inspections. .[,.o. ~..~..~. g~;. ~4o.~,.~.~.. I r~.c. ............ (Signature of applicant, or name, if a corporation) / .¢..o.B.o.~...~.~.q....~..~..-.~ .e~ ~'7.,..bI~.Y.. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ~ ~ .~.~..~.~.~,..~..,,.,~.~.~ ~.*.-",W..o. g, .............................................. Name of owner of premises .[~ ok .~.~-..~....~4~... N. i.¢.$ ~, I~ .............................................. (as on the tax roll or latest deed) tf applicant is a corporation, signature of duly authorized officer. ....~.~. 6~.,.%...~.o..~.~.a, .... .t?l~.~-.~ ............ (Name and title of corporate officer) Builder s License No .......................... Plumber's License No...~..~.~..-.Z ..~.. ............ Electrician's License No.. ~ .~...7..'7/;~'. .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Other Trade's License No ...................... Location of land on which proposed work will be done..~..,rS. ~.~...O'./~../.~. ......... /.~ .~ ........... ~ }4 .L .... L~ ~ .............. p. & ~ ~ ~....~, >~... }louse Number Street Hamlet County Z~ ~p ~0. t000 S~ctio, ...~ ~¢ .......... mook..~ .............. rot P/0.24, 7. ........ S,bdivi,ion ~ ¢.~.~..6~.'%4e..Se ~.S~.~. 3... Filed Uap eo. 3. ~ ....... rot./6/ ......... (Name) a. Existing use and occupancy ..: ."7 ................................................................ b. Intended use and occupancy . .O...t>[..~. ~..~ .t~.t.¢.'-~...~..1~..t~'./,../.,¥Z44(~ .......................... 3. ~e-~'~Fk-~(~heck ~i{~ applicable): New Building . .Vfi. ...... Addition .......... Alteration .......... ~'fpair ~l~l~l' .i.}]~imbval ..: ...........D~molition ..............Other Work ............... .............. (to b~ paid on filin~ this ap~ication) 5. If dwelling, number of dwelling units ... ~ .......... Number of dwelling units on each floor ~ ..... ~ ;~.. ~.. If garage, number of ca~ .... /.. ~. ~ ~. ~ ......................................................... 6. If business, commercml or m~x6d occupancy, specify nature and extent of each type of use . ~ .................. 7. D~ensions of existing structures, if any: Front. ~. . Roar ..... Depth ............... Height ~ N~ber of Stories ~ D~ensions of same structure With alterations or additions: Front ~ ............. Rear ............ Dep~ . . ~ ..... .. HeiSt ..~ .................. Number, of S,tpries ............. ~ ......... 8. D~mensmns ofenhm new constmchon: Front. , . R~ar .... D~pth ~ Height ........... Number of Stories ............ t ....................... v .............. 10. Date of Purchase .... /~ ................... Name of Foyer Owner ~ ........................... 11 Zono or use district in which promises are situated 1Z Does proposed construction violate any zonint law, ordinanc~ or r~gulation: . .~ ....................... ~, PLOT DIAG~ Locato clearly ~d distinctly a! build~ts, wh~a~r e~istint or proposed, and. indicate al s~t-baok dimonsions from property ~n~s. Giw stm~t ~d blo~ number or desc~ption according to deed, and show stm~t n~es and indicat~ whether interior or corner lot. I STATE OF NEW YORK, ' S.S COUNTY OF ................. ..... [.~'a,a ~r.,~./,I ,~a .d,O~, ................. being duly sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) above named. He is the ..................... j .... (/~ .~..~...~t~...) ............................................ 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 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 mannSr set forth in the application filed therewith. Sworn to bsfore me this ....................................o? 19r..c. . Nota,, Public, .. iHELEN K. DE VOE '"' NOT,~RYI PUBLIC, State of New York . ...~,.. ....... ~ -...-~'~--.e~... ~ . ~ .-..~. ............ : .... ; No. 47078~8, Su folk Coun/~ _ (Signature of applicant) [ To',m ?×p~res M~ oh 30, 19~'5 t k,i l /! / / STATEME THE WAYER CONFORM TO SU~FOL~ ~EP~ , ~ SU~OL~ COUNT' )s~v~c~s - F~ CONSTRUCTION DATE: ,, H. ~. REF. APPROVED SINGLE FAM'~Ly S~FFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. , , THE WATER SUPPLY AND SEWAGE DISPOSAL CONFORM TO THE STANDARDS OF THE .... SUFFOLK C~O_~EPT. GkET~ALTH SERVICES. CONSTt~UCTION ONLY SINGLE FAMILY DW~LLiNu~ H.S.R~, SUFFOLK CO. TAX MAP DE;TON I~I~T, ~i~CT. BLOC- K PCL. g.o.O 3 ~ADOLE --- -., , , ¢ 4~, .~,r, TEST HOLE STAMP , ..... ,,- SEAL RODERICK VAN TUYL, P.C. LAND SURYE¥O~S GREENPORT NEW YORK '~" ' SUFFOLK CO. HEALTH DEPT. APPROVAL H.$. NO. ~zl-,SO.Za.4. ~ ~. ~ ' '~" STATEMENT OF INTENT -~ . /~ ~.~ THE WATER SU~LY AND SEWAGE DI~SAL t~.~v~ OF~/~, rx-,O~ D.r'~f~ SUFFOLK CO. DEPT. OF HEALTH ~RVICES. -O ';~ / /~ ~ SUFFOLK COUNTY DEPT. OF HEALTH SE.V~C~s - FO. A...OVAL OF '<~ / / ~ ~/ , CONSTRU~IONONLY H. / APPROVED:. ~ - gUFFOLK CO. TAX MAP DESIGNATION: (l~l ~ '' ' DIST. ~CT. BLOCK PCL- ~ .~,,:~ ~,. [. ~,,~[~,, ~o. t~, ~o.~.. ~, b.. ow.~ ADDRESS: . '¢ , SEAL MAp ~O, ~DA~ ', GREE~RT NEW YORK