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Home My WebLink About13992-zFORM NO. 4 TOWN OF 50UTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z24353 Date April 22 ................................................. , 19.86.. THIS CERTIFIES that the building ....... A..d.d.~ ~. $ .o.n ................................ Location of Property ...... .1.6.9.~..~BI~.YARD L.ANE EAST MARION Ho.se No. ' ..............'S't/e$i ....................... h$/ iel County Tax Map No. 1000 Section . .3.8. ........ Block ..... 0. I. ........Lot ...0.1. 8. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemfit heretofore filed in this office dated ·..~ .a y..2. 0. ........... ,19,8.5. pursuant to which Building Permit No... 1. 3. .9.9.2.~. ............ dated . .J.u. n, .e..3. ................... 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 ......... Addition to existing two family dwelling. The certificate is issued to .. 3. T $ F ~I.E.~. W.... S. I:t y.B.U, ixJ..~ 9 .................................. [owner, ~f~X ~]f~o~J of the aforesaid building. Suffolk County Department of Health Approval ........ .N./.A. .............................. UNDERWRITERS CERTIFICATE NO ................. N. 7. 3. 7 ~.~6. ......................... PLUMBERS CERTIFICATE Feb. 17~ 1986 Building Inspector Rev. 1/81 FO~ NO. 0 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) 13992 Z Permission is hereby granted to: ....... ........... .~ .o...x. ~o..~-' ..... ..~..~' ~.~' .......... ~.:~, ...... ~ ~.~.~.~, ...~.~~..,.~......~ ~¢~/,~, ....... ~....~ ............................... ~ ..................... ~ ........ ot premises located at ..~..~..~'...%~.......~..~....c~.~..~...~..,..~....a~,......~.....~.~... County Tax Map No. 1000 Section ..... ...(~....'~.....~. ...... Block ...... ...~...[ ........ Lot No ........~..I..~. ....... pursuant to application dated ....... .......~.........~.....~...~. ................ , 19.~, and approved by the Building Inspector. Fee $..9~. .................. Building Inspector 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 244 ~ ~ A. This application must be filled in typewriter OR ink, and submitted el~ 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 approvat 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 $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ~/~f ~ New Building ............. Old or Pre-existing Building .... ~ ...... Vacant Land ............. Location of Property . .//.~'f..~. .... . .~.~../.~L.~...~.~....zt'-.~.~..~/~-~j.~ ............. .L~('.~.~?-..../~...~../?.~.~ House No. Street Hamlet Owner or Owners of Property ~/9/7t'~'-/ ~' ...~?./~../(.~.&..~./..~.~.. ......... County Tax Map No. 1000 Section ...~..~. ........ Block ..... .~,/, ....... Lot .,,~...~/~.. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .......... Date of Permit pplicant ................... .o. ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ,,, .~. ................. Fee Submitted $ ..... /~.~...~. ~ ................ Construction on above described bu lid lng an~.,~r/~J~ app~a/b~...~and regu lations. uti. BLDG, DEPT. Tow oF soU OLO TOWN OF SOUTHOLD Office of Building Inspector TOWD Hall Southold, N~/ 11.971 ATTN: Mr. Curtis Horton Stephen W. Shybunko 1695 Shipyard Lane PoO. Box 805 East Mar{on, NY 11939 January 21, 1986 RE: Building Permit ~13992Z Dear Sirs: This is to confirm that prior to any restoration work being performed on the subject property, it was a pre-ex{sting two-family dwelling. If you require any further ~.nformation, please contact the undersigned. Thank you. (.~16) 466-95~'~ SWORN AND SUBSCRIBED TO BEFORE ME ON THIS 21ST DAY OF JANUARY 1986 AT GREAT NECK, NASSAU COUbYfY,N.Y. NO J~RY PUL;LIC, %Jc?e of New Yo~k No. d582300 Qu~Jified in ~ussm~ Counly Cot~mJssion Expires March 30, i98~ ~' THE NEW YORK BOARD OF FIRE UNDERWRITERS ].00107,~ BUREAU OF ELECTRICITY ~' ,~'C~, G~ l~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,.~ ,..,~.,~. ~o.~..~,~ ~/~ N737986 THIS CERTIFIES THAT inthe~olIowinglocatlo.; ~ BaseR~nt.~,lstm. ~ 2nd bi, Section Block Lot was exatnlned on ~)~g~ ~ ~ 3.~ a~d fou~d to be in co.~pllance with the requirements of tkis Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS IRNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: NO OF CC COHO. A W, G pER ,~ OF CC COND. Box ~15 ~.,ut:hold, N,¥. 119~£ Li~, 57~E This certificate must not be altered in any manner; return to the office of the Board if COPV~FOR S~U [DINe OEPAR~r~T~ ~HIS CoPVO~ GENEI~AL MANAGER may be identified by TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 TOWN OF SO~T~OLL3 (please print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's s~nature) Sworn to before me this Notary Public, Notary Public County ROBERT ~. $'~'IEIBEI~ NOTARY PUBLIC, Stata of Nevi No. 3~-R~.73~,0.0, Na~ Cotig~Af lr~rm F.,~piros N~'r3 30, 1~' F1E~p IN~PECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~O~E FINAL rADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined..~.~ .~ .... , 19~.)/. Approved . .~...t~;<%....~....', 19~..~. Permit No. }..~. ?.? .~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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, bu~df~h~using c.~le/j.~lld rflBllations, and to admit authorized inspectors on premises and in building for necessary i e ' ....... ................ (Sig4ffitt~ of applicant, o/r/flame, if a corporation) ..... (Mailing address of applicant) ,~/~ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ........... ~ .... ...~..'. ·.. · .~-~..F..~...~..~. .~. ................... (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 .................... Electrician's License No .................. Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ....... ............. . . . . . . .(. . .............. . , , //W/. ............ House Number Street Hamlet County Tax Map No. 1000 Section ....... ~<~ Block .~./ Lot. .~./..~. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... x~ .~...~..~. ?..~. ....... 'ti '~' ........................ "' '~",' .......... b. Intended use and occupancy ..........~....~....~.. .... .?~. l.. ~.~..4~.r ~x~ ..................... · .......... 3. Nature of work (check which applicable): New' Building ..... ' ..... Addition. i ........ Alteration .,~ ...... Repair .............. Removal ,., ............ Demolition .......... i. · · Other Work .............. 5. If dwelling, number of dwelling units ......... ].. ..~_~ (~Description) (to b~ paid on filing this application) ·.. Number of dwelling units on each floor ............... If garage, number of cars ............. ~ .... 6. If busmess, commercial or mixed occupancy, specify nature and extent of each type of use .......... 7. Dimensions of existing structures, ifany' Front .~,.~J . Rear ...~'~ ...... De'-th ~? . i.' .... Height ....... /~. ( .... Number of Siories. ii I ~] i~. '.~-.' ] i ' r... . i Dimensions of sam. e structure with alterations or addition~: Front ..... 7,-.~... i" ..... Rear... ~..'{'... ........ Depth ........ ~ ........... Height ...................... Number of Stories .. J. ................. 8. Dimensions of entire new construction: Front . . ~./. . Rear . 2 ~./. .. Depth ./.~,~. ~ .... Height .... /'O. r. ....... Number of Stories ............. ./ ............. : ........................... 9. Size of lot: Front ... ~",~. .............. R ar .... ~'.~. .............. :Depth ....~. {~.~. .... . ....... 10. Date of Purchase ..... .~//~'t/..I.~'..! [ .~R~. .... ~... Name of Former Owner [....-,J,~./~.'..t~ .~.¥~.. .... 11. Zone or use district in which premises are situated ..... /4g~.Fp~.,~ ! 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ...................... 13. Will lot be regraded ............ v&.~. ........... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~,~.. -b~P/~.$t~..J<.o. ...... Address ~O~.~>.~?...~'~.-...~..o?fi.. Phone No./l~. ~..~.~.': .~'~.. Name of Architect 'ii¢i i~ i~,~ i i i i'' Address .............. ~i .... Phone No ............... Name of Contractor .. Address .............. t ....Phone No .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. ifidicate 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 :. ...... .~.. ~..~.~.F../~..~..O. ........... being duly sworn, dePOses ~d 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 owne~, ~d is duly autho~zed to perfo~ or have perfo~ed the shid work and to m~e a~d file ~is application; that ~1 statements contained ~ this application are true to the best ofhi~ ~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ............ ~. ..... ~.day of ...... q .............. , 19~$. , . N~ARY PUBLIC Slate of NewY~ . , - ~uotl{l*~ i~ No~- .~gS~ ~ ~zgnatum o~ appJic~t) t d802 9 AM To ~ PM FOR THE ~ I, FOUNr''~'~ I.,, coNCRETE FO~ F~,~,M!N~ ~ pLUMBING N~IJ~A:I., ---,.,~'-foN MuST FtNx'L. - ~'-'~ C 0 Bc ( . ..- ~, S'-ALL MEET ALL C THE I" ' & ENERGY STAT~ N~i- RESPONSIBLE FOR ..... DESIGN OR coNSTRUCTION <5. L,o T~ N )TiFV =" .~iLTmiNG DEPARTMENT AT 7d~ 18c~' 9 AM TO /t PM FOR THE 1, EOU~Am~N - TWO REQUIRED ~,,, ROIJG~ -FRAMING ~ PLUMBING 4. F!kt'~ C~'c-~,:~'~']qN FAUST ~'-~E Rr~" '?rk'rNT5 OF TH5 N.Y. ~A-~ ~NcTRt)CTION & EN=RGY COD~S h?T REo, O,~5,B . e~tON OR CONSTRUgT~N ERROr;S,