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Home My WebLink About14466-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... ~:-.15.5.~ .... Date Decemb. e.r..23.: 19 8.6 Addition to existing dwelling. THIS CERTIFIES that tile building ................................................ : Locahon of Property ,C/~s~ ~]o .................. S o u t h o I d, . .N...Y.; ............ · 48920. Main Road ': .... ~/e~t' .......... Hamlet County Tax Map No. lO00Section . .070 BI k 07 L 009 .......... oc ............... ot ................. Subdivision ............................. .. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .v m.b .r 8. 85 hBuildingP 14466z N o e e , .. ., 19... pursuant to whic ermit No ...... dated .D.ecemb.er. I 1 ,. 85 ....................... 19..., was issued, and conforms to ail of the £equirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to existing one family dwelling. SHERLY DARRL ING The certificat~ is issued to ..................... /oWde;','Lg~TeYe~WX X .................. of the aforesaid building. N/A Suffolk County Department of Health Approval ..................................... .. ... N763045 uNDERWRITERS CERTIFICATE NO ............................................... ... Plumbers Certification dated August 29, 1986 Rev, 1/81 TOWN Of: $OOTHOLD BUILDING DEPART~t~NT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14466 Z Permission is hereby granted to: , ~..0...,...~.~.~......,'~..~,.1 ...... ,,(. .................. ..,.7~,~.~..r....,..u~:Z....,.~.l~.~..7 ~ c r~ ~-~-~.~ 'L o ~o .....C,~..~.~..'1= .~... ........ .'C....../;~.....:r~...,~>~.~ .................. .~z,~....~:.~.~...z,¥4...~ ............ .., /_.~., ..=~.~.~_ct.~......-~..m ........... ~..t~, ......... ...~~-c~.~.~ .......... o~ ~,,~ ~oco~ ~ .~.,~..~.~...0... .......... Mz.~a....~,.'~ ..................... ~ .......... County Tax Map No. I000 Section .C~)....~....(~.. ..... Block ..~....~. ........ Lot No..C~.-~.....c~ ........ ~,,,"-~ to ",~"~0"o, d,,t~ ....Mc~...V.....-......c~' ...................... , 1,4~5~,,~ o~,ov~ by Building Inspector. Building Insl~tor 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 A. This application must be filled in typewriter OR ink, and submitted m~ 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 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ......................... . New C on s t, r u c t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property . . .~. './'~. ~-/'~./-..~f ........................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ..... Date of Permit .......... Applicant .................................. 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 ~~1 ap~a~regulations. Applicant ./4 .~/'~ .'".'./4. -- ~4'. Z~,'~ .'.. .......................... Rev, 10-10-78 C0% 15333 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11911 TEL. 765-1802 CERTIFICATION Date Building Permit No. [~ ~ ~ ~ _(please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber '~/signatui~) Sworn to before me this Notary Public, County Notary Public /~ClSLAUS WINIAI~. Not~ry Publlc Ste~ of New ¥o~ No. 52-9703725 Suffolk County ~-~mm. E~llres M~mh ~0, 1~'-. ~RD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY '~ ~/,. 39'7819/86 N 763045 TH,S CEm,F'ES TH^~r u~s examin~ oa ~ 4 ~ ~9~ and found to be in contpliance with the requlrentent~ of thi~ ~ard. mv,~ ~.~T s E R v L_ ~ OTheR APPARATUS: Goodale Electrical Cont. Inc. 7355 Main Poad ~attituck, N.Y. 11952 Lic. 783E GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE iv~JST NOT BE ALTERED IN ANY MANNER, BUILDING DEPT. INSPE TIOH FOUNDATION ~,ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL 7rd.,1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION ZND 1' '1 INSULATION I' ] FRAMING [~)~ FINAL REMARKS: ~ ~ FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL e~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .-~-~. · · ...C.t ..... , 19~...~Permit No ........ Disapproved a/c ....... ~ ........ ,~r ...... :~' · ' APPLICATION FOR BUILDING PERMIT ]. Date~d · · .~..~ ....... 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 c~r 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 ttfis 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~Ode, housing code, and regulations, and to admit authorized inspectors on premises and in building (Sigt~ature of applicant, or name, if a corporation) ! (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~ .~..~..~..,...~... ~..A...$~..~-.. ;~..~. ~ ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 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 ... 7.O ........ Block ..... ........... Lot.. ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .. ~..t~,.~.~....."'~..... ~ ~:....[~'".a~..~q'~... ~.~. ~.?.~..~. .......... 3. Nature ~fwork (check which applicable):'- New Building ..... ' ..... Addition . · ./':~....~... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ....... t.~.,...~:.:~....~.., . .~,...a). ........... Fee .~....~9. o~-,~ · (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 cars ......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front...[.7. .......... Rear ..../? .......... Depth ./.'er. .......... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 0. Date of Purchase ............................. Name of Former Owner ............................. 1. Zone or use district in which premises are situated ........ "~..'P.v.'v..~,~. ~-,9. ............... 2. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~..~.. ................ iiii 3. Will lot be regraded .......... .b,l.~ ....... ~ ...... Will excess fill be removed from premises: Yes i~ ~. Name of Owner of premises .:~..~-<a/ ~.~..t~.~.~. Address .q~.-~.. l.~.~,~ ,-n.a~hone No..7(,.~.. 7.t?.~,. '1 ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor "J~ol~-er.A~....n~...~..,9.~.-'7. .... Address '~...O.:. { .~.~...~.. ~A,'cr*.... Phone No.~'~'~..".~.-~! .7. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from 'operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. ATE OF NEW YORK, S.S )UNTY OF ................. ............................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) eve names. : is the ......................................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ,rk will be performed in the manner set forth in the application filed therewith. ,om to before me this ............ . ..... Y~_L' ............. : ......~"' / : '"'" -~ ,taryPublic, ...... ~.~...~:..~..AT~.'~ounty /~,/~ ~." .~..' ' ' :. ......... I~.1~ .~_.* ._~1>7 '/ (Signature of applicant) 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL °,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved~...C.t ...... 19~...~Permit No./~.~.' . ..... Disapproved a/c ....... ~ ........ /r ....... ,' · ' (Bu'fldSlg 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 ~r 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, buildingj~Ode, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~,c/t~s./J / .... .......... (Sigrfature of applicant, or name, if a corporation) ! .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~ .~'..~-r~...~... ~..~..~. ~ ........................................ (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 .................................................. ............... ..................... House Number Street Hamlet County Tax Map blO. 1000 Section ....~. 7~. ........ Block ..... .~. ........... Lot.. ~ ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature'0f work (check which applicable): New Building ' Addition ..... J..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost I."~...er::Ac~....~..~ ~r-) ~..~ (Description) ........................ Fee. ~ ~ (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 cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........... Dimensions of same structure With alterations or additions: F'r;;i'iiiiiiiiiiiiiiill 'l{;~r' iiiiiiiiiiiiiiiiii Depth ...................... Height ..................... Number of Stories ............... 8. Dimensions of entire new construction: Front ...[.7. .......... Rear ..../? .......... Depth ./.7 ........... Height ............... Number of Stories 9. Size of lot: Front ........................................................ ...................... Rear ...................... Depth ...... ................ 0. Date of Purchase ............................. Name of Former Owner ............................. 1. Zone or use district in which premises are situated ........ ~.. q,.s, .~..~X~.. ~ ~ ........... 2. Does proposed construction violate any zonint law, ordinance or re~ulati(-,' ~c3 .............. 3. NWflaml leOtofb;~graded ....... :~ ~I.o.'. :...d~0~.e;... Will exc_.es_}"fill b~'~n~}~t~ ~r'o~ 'p'r~i~e'sl ..... ~'~ ' ' ' '~ ~' N .. .ner of premises .......~O/.~)~ ........ Address .~..D..../.&.~5.c/.~.a~honeNo' .76.~7.t~.6.,1.' ame o~ Architect ..................... ;-~ ....Address ................... Phone No ......... NameofContractor'~.,~A~...n-*O ~-~,,~ Address~.'0- I~'b ~-t,~-e~., Ph N~2'~$~;~ ..... ................................ orle .............. t ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from 'operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. ATE OF NEW YORK, )UNTY OF ................. S.S ............................................... being duly sworn, deposes and says that tie is the applicant (Nmne of individual signing contract) ore nameu. is the (Contractor, agent, corporate officer, etc.) .... said owner or owners, and is duly guthorized to perform or have performed the said work and to make and file this plication; that ail statements contained in this application are true to the best of his knowledge and belief; and that the ,rk will be performed in the manner set forth in the application filed therewith. om to before me this .......... · ~ .'~-..: ...... day of ..... .~..&t.,-~.~ .......... 19.~,S.-' ~ ' '~ i."'~'~{'!~ l~let male~ ~ ~ ~t "'/.//./~rr.~.'../.-:.~.: :~ . . ~. ....................... ~ ' len~' l~'~r~l~ ~ 1.~e~~'7 ,/ (Signature of appllca~!t) -7E. ~0 If copper tubing is used fol' water distributing ~/~em,~ piping shall be %%. ~:ttrees K or L only ~PLUMBER CERTIFIt2ATIOIV ON LEAD CONTENT BEFOR~ CERTIFICATE OF OCCUPANCY SOLDER ~SD IN ~VATER SUPPLY SYSTEM CANNOT EXCEED £/iO of 1% LEAD. OCCU~Ai~CY OR 6~E IS ~IILAWFUL W~iIl~i C~T'IFECATE OF OCCUPANCY ~/~,P~RC)VED AS NOTED ~l~,i.~: ~Bmp' ~ NOTIFY BUfLDING DEPARTMENT AT 7~)~-1B02 9 AM TO 4 PM FOR THE FOLLOWING INSPECTrONS: 1, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE '~, ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL - cr')NSTRUCTION MUST BE C'"~,API rTE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS.