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Home My WebLink About13679-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z 16360 Date November 2, 1987 THIS CERTIFIES that the building ..... O..n.c.. f..a .m.i.l.y. dw e 11 i n g. Locati nofPro err 1770 Jacobs Lane Southold House NO. Street ' 'l~n/e~ County Tax Map No. 1000 Section 079 .Block 07 ...... Lot 29 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Nqv. 27, 1984 pursuant to which Building Permit No ]3679Z dated J an. 18, I 985 was issued, and Conforms to all of the requirements of the applicable provisions of tile law. The occupancy for which this certificate is issued is ......... .... O.n..e..f.a.m, .i .1.y..d, .w.e.1.]..i, .n.g.,..d, .e .c.k.s..?.nfl..g..a.r.a.g.e...a.t.t.a..c .h.e.d...b.y..d.e, .c.k.,. ,s, ,u.n. ,r,o..o.m. The certificate is issued to LENORE & WALTER ADAMSON {o .,nor,/KEd& ~d~Y~i~I X of the aforesaid building. Suffolk County Department of Health Approval ........ 1. 4. 7 .S .0.-. 2. .6 .5..0. c..t :..3. 0. :..1.9. 8..7 ....... UNDERWRITERS CERTIFICATE NO ................ N. 7,.TJ.0.83 Sept. 25, 1986 PLUMBERS CERTIFICATION DATED: Henry P. Smith Sept. 14, 1987 Rev. 1/81 1~0~ NO. ~ TOWN 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) 199 13679 Z Dot~....Z.~ ................. , I~.~....~-- Permission is hereby granted to: County Tax Map No. 1000 Section ....(~..Z~... ...... Block ...~.../~... .......... Lot No. ~..~...~... ......... pursuant to application dated .......~' ~' ~....~' .~... ................. , 19..~..~..,"~ and approved by the Building Inspector. Rev. 6/30/80 FIELD INSPECTION FOUNDATION (3st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY ADDITIONAL COMMt TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECrOR P.O. BOX 728 TOWN IIALL SOUTIIOI,D. N.Y. 11971 October 22, 1987 TEL. 765-1802 Mr. Waiter Adamson North Bay View Road Southold, New York 11971 Whom Thi£; blay Concern, We are unable to complete your Certificate of Occupanc~y becau:;,~. .of thc following reasons. /~/ An application for Certificate of Occupancy is not on file. /]? No Underwriters Certificate on file. /~/ T]lu check is(ouLdated/not on file.) J~_;'/ No Health Dcpt, Approval on file.7~ /~/ No final inspection has been made° office on this matter. ILl e/'l.';O C()rlto. Ct; Thank you for your cooperation. Building Permit ~ .[_ ~. ~_ ~[~ ~ Z Bui ].ding Dept. ***/~]/ No Plumber ~older Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) or use is unlawful without a Clear up this matter as soon of Occupancy. so that legal act ica docs not have to be T}lallk yon for yotlr prompt attention. Certificate as possible taken. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1 BO2 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ~of the following reasons. /Z/ An application for Certificate of Occupancy is not on file. /5/-' No Underwriters Certificate on file. /--/ The check is(outdated/not on file.) /? No Health Dept. Approval on /5/ No final inspection has been made. Pleas~ contact our office on this matter. Thank you for your cooperation. Building Permit # _[_ ~_ ~_ 7 ~- Z Building Dept. ~ ' _~~~ficate on fi~e. /~J~rmit s in vo 1 v i ng p----~n~q~_, b e~i ng issued after April 1,1984 ) Occupancy or use is unlawful without a Certificate of Occupancy. Clear up this ma~ter as soon as possible so that legal action does not have to be taken. Thank you for your prompt attention. THE NEW YORK BOARD OF FIRE UNDERWRITERS lO00~,~ BUREAU OF ELECTRICITY ~ E5 JOHN STREET. NEW YORK, NEW yORK 10038 THIS CERTIFIES THAT only the electrical ~uipment ~ ~scribed be~w a~ int~duc~ by tl~ applicant ~med on the a~ve application number in the premises of W~l~er Adamson, Jacobs Lane, ~. Bayv~ew Rd., Southold~ ~.Y. in the /otlowi.~ t,,caao.; [~ Ba.,~me.t [~ I~t ri. trots examined on ~ e~3 ~ ember 19 ~ 19 ~ ~) and found to be itt compllanee with the r~qt~ire.tents qf this Board. ~1 57 57 31 --ORYERS I SURNACE N~,OTORS I FUTURE A~q~LtAHCE t:$EOERS SERVICE DI~ONNECT I NO. OF / S ~ METER ~ ~ ~1 200 cb ' X RANGES 1 30 IcOOmHo OEC~S I OVENS IOISH WASHERS 1 v I AWG OF CC CONO 2/0 Hotors-l-lH.P., ]-3/4H.P. Panelboard$;1-2(cir.)100amps~ ~.F.C,~.~ S, Smoke Detectors~ Lot EXHAUST I~ANS DIMMERS c E NO OF HhLE A W G, OF HI.LEG NO OF]LNEUTRALS Paul Burns Town Harbor Lane Southold, N.Y., ]197], GENERAL MANAGER 11 This certificate must notbe altered in any manner; return to the office of the Board if incqrrect, JnspectO~rs may be: identified by their credentials. COPY FOR BU~ LO NO DEPARTMENT. TH S COPY OF CERTIF CAT~ ~uS? NOT BE AL~TERED IN~ ANY MANNER. HENRY J. SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD, N,Y. 11971 (516) 765--3690 Inc. CERTIFICATION Date__S_e~te_~mber 14, 1987 Building Permit No. 13679 Z Owner Walter Adamson Plumber Henry J. Smith & Son,__In_c- I system certify that the solder used in the water supply contains less than 2/10 of 1~ lead. Sworn to before me this _]/._th_day of ~S~I~jb~_r___, 19 87 Notary Public, Suffolk County f'~OTA,~Y PUBLIG, ~tate ~f Nmv Yo~ ~;~di~E,m Sufi~k County O~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no. _~679Z_ issued to Lenore Adamson on ~ for New Dw~llin~ & Garaae is completed a final inspection has ( ) has ~ot ( X ) been done. and In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $35.00 payable to the Town of Southold. Please indicate .to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Please help us to clear up this matter so that legal action does not have to be taken. Thank you for your prompt attention. Ver! t r u 1 y~,ur~ Victor Lessard Executive Administrator VL:gar TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no, 13679Z issued to Lenore Adam~o~ on 1/18/85 for _ New Dwellin9 & Garage is completed and a final inspection has ( ) has not ( X ) been done.~ In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $35.00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Please help us to clear up this matter so that legal action does not have to be taken. Thank.you for your prompt attention. Very truly you~_~ ~ Victor Lessard Executive Administrator VL:gar /36?? 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH pLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~INAL REMARKS: / / FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 .~ TEL: 765-1803 '~.~,~?~.~Z ...................... // _,'~ ('-7 .... ' .............. ..... . ..... (Building Inspector) ~PPLIC~TIO~ FO~ BHI~I~G PERMIT Date ./~. ~.~ ...... ,19~ INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building lnspector, 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 tins 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 necessary inspec/,i_ons. ~ ~' j;8]gnat,ure of applicant, or name, if a corporation) qMailing address of applicant) / ~'?/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .X,ff..'~.~./?. d'.:....~..frO.. ~..~. ?.z~../¢....~...~. ~..~..~..~.]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 .......................... Plumber's License No. ~&..z~..~ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work wiltbe done. ........... /.:.z.o.... . ..z..... .....i_ii? iiiiiiiiiiiiiiiiiiiiiiiiiill House Nmnber Street Hamlet County Tax Map No. 1000 Section .... ~)../../5. ...... Block .... ff.. ........... Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of p~remises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ ....................... ~ ......................... b. Intended use and occupancy . Z~/'~t.....~¢~P~-. ~...~. ~ .d,-~. ,~ ................................ 3. Natur~ of work (check which applicable): New Building Addition. Alteration Repair Removal Demolition Other Work J ~ ~ (DeScription) 4. Estimated Cost .... ~"..~.. ~..d..~. .................. Fee ~..~.//..~.~. ........................... '~ (to b~ paid on filing this application) 5. If dwelling, number of dwelling units ..... t/. ...... Number of dwelling u~its on each floor .......... If garage, number of cars ........................................... , ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear ...... i ........ Depth ..... . ........ Height Number of Stories ............. Dimensions of same structure with alterations or additions: Front ........... ! ...... Rear ................. Depth ...................... Height ...................... Number ~f Stories ..................... 8 Dimensions f ti new construction Fro R : Depth ' . o en re : nt ............... ear ....... I ...................... Height Number of Stories 9. Sizeoflot: Front ...................... Rear ...................... i Depth .................. .. . 10 Date of Purchase Name of Former Owner ' 11. Zone or use district in which premises are situated ........................ ! ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ............................. 13. Will lot be regraded ......................... ' ' ' X/es No .... Will excess fill be removed from prermses: 14. Name of Owner of premises ~..~?~ .... Address .............. i .....Phone Nof]XP.....~..~...~.,.. Name of Architect ........................... Address .............. i .....Phone No ................ Name of Contractor .......................... Address .............. I. Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, ihdicate 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, COUNTY OF ......... S.S ................................................. being duly sworn, dep )scs and says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................... (Contractor, agent, corporate officer, etc :) of said owner or owners, and is duly authorized to perform or have performed the ~ald work and to make and fi!,.e 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 ""' HEL[!N ~/. {DE VOE ........ NOTARY PUBI lC. S~ato of Ne~v Yo~k , No, 4?07375, $1~fto~ · /., .-c~':-..-. :rr ........... i. · (Signature of applicant) _J'=Y~E~- ~j. SUFFOLK ¢O. HEALTH DEPT. APPROVAL '" THE WATER ~LY AND ~WAGE Dt~SAL ~ . ~ SYSTEMS FOR THIS .ES,DENCE W,LL '~ ~ . CONFORM TO THE STANDARDS OF THE J ~ ~ ~ .Se 'l SUFFOLK~..~PT. ~ALTH SERVICES. ~ ' ~ ,:~ ,~ SUFFOLK COUNTY DEPT. OF HEALTH LICEN~D LAND SURVEYORS GREEN~RT NEW ........... ~"' ' '~' '" " SUFFOLK ¢O. HEALTH DE~T. APPRO,,AL .,,,~UFF'0LK COUNTYgEPARTMENT~0~ H~I~H SERVtC~ [ i~ ' , SINGLE FAMII;3' BWELUNG ONLY The sewage a'isiJosa~ and W~iter ~upply,facil ties for th s STATEMENT OF INTENT location have been inspected byth s Department and/or ether age~ci~L~d,fou~ to ~..~i~Jis~ac~/. , THE WATER SUPPLY AND SEWAGE DISPOSAL .~]~,~¢.,~,- ~ t,.~'~ ~.,g, SYSTEMS FOR THIS RESIDENCE WILL SUFFOLK CO. DEPT. OF HEALTH SERVICES. (st , APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH ' J '~ Ja~-~- '~ SERVICES -- FOR APPROVAL OF ~ ~,~ , ' , APPROVED: ~,' ~i [ SUFFOLK CO. TAX MAP DESIGNATION: , ,., I~~ ~j] ..... i~;'~Vf ~'~ ' TEST H~E MP L IC~D LAND SURVEYORS ~EEN~T N~ Y~K "~