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Home My WebLink About14021-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... z. l 6..7.6.9. ...... Date ..... ?.u. gu. 9.~..6., ................ ,19 .8.6. THIS CERTIFIES that the building ... &d.d. $ .~3.qn. ................................... Location of Property 9q0 Old Shipyard Lane Southold, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section . .6.4 ......... Block . 4 . .Lot. 22 Subdivision..~/.q..~ p.u.n.d.e.r.s..g..s .~.s ..........Filed Map No ......... Lot No. 2.2~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated M a y 30, 19 .8.5. pursuant to which Building Permit No. 14021 z dated . .3. u..n?. ? ................. 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 one family dwelling as applied for. The certificate is issued to Ernest H. Prussner & Elizabeth M. Prussner ..................... ?o¥.'~;, ¥~;~'~6grld~'~ .................... of the aforesaid building. Suffolk County Department of Health Approval Iq//~ N756465 UNDERWRITERS CERTIFICATE NO .................................................. pector ............ Rev. 1/81 Z'O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . SOUTHOLD, H. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14021 Z Permission is hereby granted to: County Tax Mop No. 1000 Section ............... ..~...(~...~. Block ......~ ............ Lot No. ........................ Building Inspector. Fee $,. ' ond approved by the 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 This application must be filled in Wpewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. FinaJ 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. 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 2. Certificate of occupancy on pre-existing dwelling $1 5 o 00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.C. $5.00 5.Updated C.C./ $15.00 Date .......................... New C ohs t r uc t i on ......~/ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ?/. ¢. . Q.~ .Jg. . :~./. ~./. .,~o.¥.~. .~.~. . /, .¢)..4.2~' ..... .% ~' ~z2. 2¥~,~. ..z~ . ~. ¥~ ¥~ . ./ 4 ~. ?.. /. . . House No, Street Ham/et Owner or Owners of Property .~7-?..~.E-..~?,'./?.' ,../?.~'.~.~ .4~.¥.~...~f..~'~-.~./.~. ~..~,~. ~..~../~.,. ~'.~..~.~'.~/~ .,~/~-~ County Tax Map No. 1000 Section . .(~0..[ .......... Block (~4~...~ . Lot..~2. ............ Subdivision .?..~.~¥.~..~.,~.~.~'....~...S~.~. ?~..~..~. ...... Filed Map No ........... Lot No. ~. ~ ........ Permit No../.~Q'~./.~.. Date of Permit .% . . .Apphcant ............................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $... ~. ....................... Construction on above described building and permit meets all applicable codes and regu lations. Applicant..~./~/,. ~. ........................ Rev. 10-10,78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment az described belotv and introdaced by the applicant named on the ebove application nu tuber in the premises of t~nc~t !~I%k~sm~r~ 910 Old Shipyard ~gne. 8outhold, FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUO~ESCEN? DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: 1-G.F. CI. 1 '-b~mol~ Detec~oz' Panell~oarda: 1-1]ciz-. 125allltX~ S E R i~ Eii~' A.W, G, NO O COND, OF CC, COND, 110 C NO, OF HI-LEG OF HI-LEG NO OF NEUTRALS OF NEUTRAL 1/o }]OX [~2 I~el, N. Y, 1194~ MC, 1227 Per This certificate must not be altered in any manner; return to the office of the Board if in,~:orrect. Inspectors may be i~lentifled by their credentials. COPY FOR BUIlDiNG DEPARTMENT. THIS COPY OF CERTIFI£ATJ .~Y. ~,, MANNER, FI~LD ~]~SPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C. gDE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [. ]~Ji~ATION FRAMING [~ FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [/~] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: FINAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765~1802 Examined ~.~. ;~ ..... , 193..~. Approved· ..~ .'7 ...... 19~.~.. Permit No. 1.?.Q.~....~;i Disapproved h/c .................................... '~ (Building Inspector) 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 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 necessa~linspections. .. o,.. t .... (Signature of applicant, or name, if a corporation) · ? .,4.,.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ................. Name of owner of premises .~.~..k:~...~ .~. i . .e.~.--~. ·O. ~ .~. ?. · .~. ............. ............................. (as on the tax roll or latest deed) If ~ant is a co~ol~ali_°nk~nature o~ duly aut~°rized Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~..t~.~.....~..~..~y~ House Number Street . Hamlet County Tax Map No. 1000 Section ... ' ............ .~..~...~. ff.--..~..q~. · ~'2---~ '~. Block .. Lot ................... Subdivision...~...~..0~.....~. ..... .~..~T./~W-~ ..... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancv of proposed construction: a. Ex~sting' use and occupancy .... ..~.\-- .Q.O~x.e ..... .~.O¥ .17~..~.\.,-.~' .... ~.~[~ ,' ~. :~ .................... b. Intended use and occupancy ....... .~...~..l~...~..../( ~.~/. ?k.).~/~ ..... ,~. ~i~..~,,~{~a. ....... 10. 11. 12. 13. 14. 3. Nature of wo eck which, pphcable): New Building ......... Addition Alteration Rel~ir ....... .~ ...... Removal .............. Demohtlon ............. Other Work ............... .~/.~...~ 'I ~-.~ -4g ] .~..~.~. .....(Description) 4. Estimated Cost ............................. Fee... ' ........................... ~ *~ (to be paid on filing this application) 5. If dwelling, numbar of dwellin~ units ..... /. ......... Number of dwalling units on each floor ................ If garage number of cars ...~ . 6. If business, commercial or mixed occupancy, specify nature and,extent of each type of use ......... , ............ Height ............... Number of Stories... ~. .......................................' - Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ;... Height ...................... Nu r of Stories ...................... Dimensions of entire new construction: Front .....~.l, ........ Rear ..... { ......... Depth .....7.f~.. ~ ..... Height ............... Number of Stories ........................................................ Size of lot: Front .......... . ............ Rear ...................... Depth ...................... Date of Purchase , Name of Former Owner Zone or use district in which premises are situated... ~.(~-" Does proposed construction viglate any zoning law, ordinance or regulation: . ~ ....................... Will lot be regraded ...... ~.., .................... Will excess fill be removed from premises: Yes Name of Owner of premises~./F, Jf~.. ~-qS~..~Address ................... Phone No.Q~.h'. 71 ?fi.9 ..... Name of Architect .: t ...... ' ................... Address ................... Phone No... ~ ........ ~ .... Name of Contractor ~-~..~'~..~)...,..~q~. ,O...5~. ..... Address (~-X~.C.~ ...... Phone No. ~.cl~ .'~..~...~.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, C ~'~ OU, N:rY OF ................ -~-----~L~ .~... .... ~.~.~ ~ ................. being duly sworn, deposes and says that he is the applicant (~ame of individual s~ging contract) above named. He is the ............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dOly authorized to perfom or have performed the said work and to m~e and file this application; that all statements conialned ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~er set forth in the application filed therewith. Sworn to before e this N ~~Id~Y~[ (Signature of applicant) APPROVED AS HOTED NOTIFY BUILDING DEPARTMENT A OCClJ~ANCY OR USE IS UHLAWFUL "~65-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS; 1, FOUNDATION - TWO REQUIRED FOR pOURED CONCRETE '). ROUGH - FPJkMING & pLUMBING 5. INSULATION 4, FINAL - CON'STRUCTION MUST ~3E COMPLETE FOR C. O. ~L~. CONSTRUCTION SHALL MEET "l'N~ REQUIREMENTS OF THE- N.Y. ~j~',~T"E CONSTRUCTION & ENERGY ~;OOES. NOT RESPONSIBLE FOR ~-~:~[G'~I OR CONSTRUCTION ERRORS. ~ITH0tJT C[RT'IFICAT~~:'~--' ""~ copper tubing is used · for water distributing system; piping shah be of ~pes K or L only OF OCCUPAN,C¥ 'SOLDER USED IN' WATER SUPPLY SYSTEM CANN02' ,~ZCEEZ~ ~/~o o.f ,z~ ~'~.~TIFZCATE OF OCCUPANCY