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Home My WebLink About13695-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ... O..n.e.. f..a.m.i.l.y.., .d.w.e.l..3_ .i.n.~ .. ..................... Location of Property ....N./.S...F.qq .v.g.h..S..t.r.e.qt..,, Laurel House No. Street Hamlet County Tax Map No. 1000 Section . . .1.2.6. ...... Block . ...0.7 .......... Lot ... P/.q . .2 .5 ....... Subdivision .G.e. 9.r.~e., .T.u.t.h..i .1.l..&.. 9.t.h.e..r.s...Filed Map No ......... Lot No ..... .5 .9 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated Feb, 1 ..................... ,198.5,. pursuant to which Building Permit No ..... 1.36 9.5.~ .......... dated ......... Feb...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 ......... ..... 5.n. .. ................................................... The certificate is issued to ......... .R.0.B.E..R.T..J..0 .H.N.S.E.N. ................................. (owner,~Y~&~t~r~,~ of the aforesaid building. Suffolk County Department of Health Approval ........... 1.4. = $ 0.-2.5 ~ ..................... UNDERWRITERS CERTIFICATE NO .................. /).N. T 9 J .2.5.5. ...................... Plumbers Certificate 7/31/85 Building Inspector Rev. 1/81 l~O~ NO. 11 TOWN OF $OUTltOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TI-II: WORK AUTHORIZED) NB 13695 Z Permission is hereby granted to: . Coun~ Ta~ap No . 1000 Section ............... pursuant to application dated ........................................................ , 19 ........ , and approv~ by t~e Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions \ c_~ C~ / ~ e r'e OR in and'su A. This application must be filled in typ w It r k, bmitted in duplicate 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. 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 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 $1 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ., ,Y~..~-%. ..... Old or Pre-existing Building ............ Vacant Land ............. Housa No. -- .......................................... Street Hamlet Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~. ~/~..'.Z-Date of Permit , '.~.-.~: ,~';S'..Applicant... ~. ,~Z.~.~.~, $.'~/;I .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ · . Underwriters Approval arming Board Approval ........... Request for Temporary Certificate ..................... Final Certificate ...~/. ............ Fee Submitted $ ...... ,~'~, ~ .o. ,...o. ........... ., ,,,.,~-~ // Co.st tion o. Applicant..~/~/...~m~...u'~.../..~/~-. ~..; ............... THE ~NEW YORK BOARD OF FIRE UNDERWRITERS [00[0'7]. BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO38 ~-,~ au:~y ~s,~9~ A,,,,~ic,,io,,No.o,~Slfe 3~4~4~/~S N 701255 THIS CERTIFIES THAT Robert Johnsen, 4th St., w/s Bray Ave., Mattituck, N.Y. / was examined on ~ly 1 ~ t ~ 9 ~ 5 and found to be in con~pliance with the requirernents of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT V^pO~ 11 26 16 11 DRYERS FORNACR MOTORS EUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS: Motors~ 1-1 H.P. G.F.C.I.- 1 Smoke Detector- 1 I c E CC. COND OF HI-LEG OF NEUTRAL 2/0 2/0 G & S Electric Box 215 Southold, N.Y.~ 11971 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectdrs may be identified by their credentials; (~OPY FOR RUILDING DEPARTMENT. THIS COPY OF CERTIFICATE i TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner Plumber (please ~rint ) '(please p~int) 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 //~_ ~/~/ 19 ~ Notary Public, ~~_ (plumber ' s/signature) ~/ Notary Publ~ County .,,~;~i~t T. T~RRY Notary Public., State of New York No, 52-0344963 Suffolk County c~,,~ Commission Expires March ~0, / ~~TE DIvISiON~ HOIJSING AND CO~MUFIITY RENEVCAL E;TAMP OF APPROVAL FOR A ~ODEL OR COMPONENT CHARLES J. URS~rAD1~ ............................. 11¥: ..................... Zig. 1~,-i f DWISION OF HOUSING AND COMMUNITY RENEWAl. 1. Insignia Serial Number____ 2. Name of Manufacturer 3. Plan Approval Nnmbe~ ..... 4, Model or Component Designation 5, /~lanufactureFs Serial Number___ 6, Date of Marlufacture Data for items 1.2, 3 and 4 to be inserted by the State of New York prior to issua.ce; items 5 and § to be inserted by the manufacturer, Fig, BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ]ROUGH PLBG. ~ FOUNDATION 2ND [ ] INsuLATi°N [ ] FRAMING £ ] FINAL REMARKS: COMMENTS EIELD I, NSPE~TION FOUNDATION FOUNDATION ( 2nd ) }IOUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ................. .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. , INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 tiffs 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, o~'Xemoval or d~emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu~/d'.m.g.,,~ode, housi~}~ code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins.~~ ~~ ......... ~. ...: ......... .. ...... (Sig~/atu;e of a pli -n , 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 .5. ........ K. . . .-. , 9. ........................................................... Name of owner o f premises ......... e .~..~'-.....~.c~ .~ Y3/.5¢.' 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) Builder's License No ..... .~. '?..r? ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section J ''~ ~'' Block (~5 .7. Lot .... ~.~.. &'~ ..... Subdivision. ~9(~..[. M [.~ [~..~ .~.~{? fL~; $ .... 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 ..... e'x' c a a { .Inten edusean occupancy .......... . .. .. · .... ~ ............... .. .. .... . ................., 3. Nature of work (check which applicable): New Building../~..~.~..... 'Addi ..... tion ...... Alteration .......... Repair Removal Demolition Other Work ~_!~O (Description) 5.0.. 4. Estimated Cost ......... .~.~?. .................. Fe¢.~...~'..~..., ..... i~' (to be[paid on filing this application) 5. If dwelling, number of dwelling units ..... ~. ........ Number of dwelling units on each floor. :~; ......... If garage, number of c~s . .~7'. ...................................... , ............................ 6. If business, commercial or mixed occupancy, spec~y nature and extent of each ty~e of use.~.':. ................ 7. D~ensions of existing st~ifany: Front .~.'.'":"y.-. ....... Rear :..77. ,~ ....... Depth ~ ..... ~ ........ Height~...~. Number of Stories . ~ ...................... ~ ............................ D~sl~_~~e stmc~re with alterations or additions: Front ............ , ..... Rear ......... ; ........ D~ ..................... HeiSt .......... ............ Number o~ Sto~es .............. 8. ~imensions of entire new constmction: Front. . ~ . Rear ~ i J . . Depth .~ Height Z ~ Number of Stories / ' 9. Size of lot Front ~ ~ . Rear... ~ Denth /~7~ .... 10. Date of Purchase .... '~ .... ~ ............... N~e of Foyer Owner . .~E :~ .... ~ ~. ....... 11. Zone or use district in which premises are situated ~. ~.~ ...... 12. Does proposed cofi~truction violate any zonin~ law ordinance or reoulation' '~ ........................ 13. Will lot be regraded .....~a ...... ~ ........... Will execs fill be rem cruises; 'Yes ' ' 14. N~e of Owner of premlses ~ ~9~ ~ I Address . . PhoneNa N~e of Architect ..... ~' Address " .. Phone No. N~e of Contractor ..... ~ ~ ' ' .................... Address Phone No. . PLOT DIAG~M Locate cle~ly ~d distinctly ~1 build~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from property imes. Give street and block number or description aceord~g to deed, ~d sho~ street n~es and indicate whether interior or corner lot. ]5o' STATE OF NEW YORK, S.S COUNT/Yg) F ................. .......... ~ ............ .~.~ .e'...~fl, .............. being duly (Name of individual signing contract) above named. sworn, deposes and says that he is the applicant He is the , (Contractor, agent, corporate officer, etc.): of said owner or owners, and is duly authorized to perform or have performed the slid work and to make a/id file this application; that all statements contained in this application are true to the best of hi~ 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 .......... /./~. .......... day of; ..... .~.~..~..~. ....... 19 ~.g7 Notary Public, ....J~ .... ~'...~..!~...~...~Ae-~...County ~' NO. 4707878, Suffolk Courtly ~ '' Tern, Expl[es [/,laich 30, 19~L-<, TEST FAMILY DWELLING ONLY/ i~3~pAR~I,,/,ENI[ OF H~LTH COUN1~ ApprOVAL OF CONSIRUCTION ONtY A~P~OVEO~ ~J~P ~1 )goo ~[tTtON ~_~C~ 07 LOT.~ ~ELLI~S WITHIN I00 FEET OF T~$ PROPERTY SURVEY FOR ROBERT J~HNSON LOTS 58~59,'GEORGE I. TUTHILL ~ OTHERS~SEC AT LAUREL TOWN O~F SOUTHOLD SUFFOLK COUNTY, NEW YORK SU~Y FOR ~L~ ~AMILY DWELLING ONLY ~;;~t cOUNtY o~.a.tm~t o~ .~tt. s~vmcEs ROBERT J~,HNSON LOTS 58~59~ OEOR~E I, TUTHILL 80THERS~SECI I" ~rowt O~ ~,.o. ~-~'~ruct~o~ o~t~ AT LAUEEL Oare o~u. ~N ~ SOUTHOLD SCALE: I"= HEALTH DEPARTMENT-DATA F~ APPRO~L TO C~STRUCT AND ~ HIS BEHALF ~ THE TITL[ C~P~Y, GOV~N- ~O~''~~O--I PURPOSE AND ARE NOT TO 'E USED TO ESTA'L,,H A~.eSS, ~00 ~o~U~' e~ ~Oq ~OS~NDER AVE~E I · ' YOONG a YOUNG ~T~oLd ;t' 9~ ~-//6~ RIVER~AO, NEW YORK SU BDIVISI~ MAP'FILED IN THE OFFICE OF THE OFSUFFOLKCOUNTYONJAN.IS,I929AS FILE N0.86, ~1 AND~AND SURVEYOR NY.S. UCENSE NO. 12845 AREA = 15pO0 ~f, ~ ~ I ~ HOWARD W. YOUNG, LAND SURVEYOR ~L~T~L(W),~ICTANK(ST)eCE~OLS(~)~N~E~ ~ ~ N.Y.S. LICENS/ N0.4589~ BRANDIS & SONS INC. 1046 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE~ ROBERT JnUNSn~ LOTS 58 & 59~W~- ~"GEORGE I. TUTHILL ~ OTH ERS~SEC[ I" JULY 22 1985 FOR APPROVAL OF CONSTRUCTION ONLY AT LAUREL DATE: JAN. IS, 985 ~N ~ SOUTHOLD SCALE: ~" ='~0' DATE HS REF, NO. ~SUFFOEK COUNTY, NE~ ~RK NO. 85-5 NGUA~AN~EES INOI~T[O NE~EON ~ALL RUN ~LY ~ HEAL~ DEPARTMENT-DATA F~ APPRO~L TO C~STRUCT Aao ~ a~S eEN*LF m ~aE T~TL[ C~e~Y, aOV~a- YOUNG YOUNG Yo. NOTE: ~=MONUMENT ~=STAKE 0=PIPE ALDEN W. YOUNG, PROFESSIONAL ENGINEER SUBDIVISI~ MAPFILED IN THE OFFICE OF THE CLERK AN~ LAND SURVEYOR N.Y.S. UCENSE N0.12845 OF SUFFOLK COUNTY ON JAN.15~I929 AS FILE NO. 86 I AREA = 15,000 tt HOWARD W-YOUNG, LAND SURVEYOR ~ ~ L~T~ ~ ~L(W),~IC TAHK(6T)a CE~6(~) ~N ~[~ N,~.S. LICENSE N0.45893