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Home My WebLink About14680-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17623 Date DEC. 21~ 1988 THIS CERTIFIES that the building. Location of Property 13805 MAIN ROAD House No. County Tax Map No. 1000 Section Subdivision ADDITION Street Block 03 Lot 30 Filed Map No. Lot No. MATTITUCK Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCE 19, 1986 pursuant to which Building Permit No. 14680Z dated MARCH 20~ 1986 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 AS APPLIED FOR. The certificate is issued to DE FRIEST FUNERAL HOMES INC. (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N806646 4/30/87 H001987 4/15/88 PLUMBERS CERTIFICATION DATEDN/A ' Bulldlng Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 . A , -~ Date. v~ .~..~..?.' / .... New Building ....... Old or Pre-existing Building ...~,~. .... Vacant L~nd ............. Location of Property../.~. · .~...~. ...... .~...~..~....~' · '~'~'~ House No. Street Hamlet Owner or Owners of Property . ~ .~.~ .~. ~~ ........ 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~o~lrmi~ ,~/~aP,~: ~s and regulations. Applicant .... ?..L~,., .-~...K ."'/./.~.... ,~'~7;~-~. ................ Rev. 10-10-78 · ORM NO. B 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) N.o 14680 Z Permission is hereby granted to: ...... ......................... at premises located at ..~/..~,,~..~.......~. .......... ...~....q)-~.......~ ............ ~~ ............. County Tax Mop No. 1000 Section ........................ Block ...................... Lot No ......................... pursuant ,o application dated ..... ...~C.,~...../..~. ............... , 19..~..../~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 THE NEW' YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ~,, ~,19. E, Jo.~ ST, ET. ,EW 001987 ~e ~ppllca~io. No. on fil~ THIS CE~IFIES THAT ~ examin~ on and found to be in compliance u'ith the r~ulrements of th~ ~rd. fiXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 3 3 3 DRYERS FURNACE MOTORS RJTU~I S · B C DEFRIEST FUNERAL HOMES MAIN ROAD SOOTHO5D, NY, 11971 This certificate must not b~ 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 MU~T blOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000174 aUREAU OF ELECTRICITY ~g 85 JOHN STREET, NEW YORK. NEW YORK 10038 ~t. .,.,a 30. ~987 App,,~.,,o.~o.o./i,. 4~o~/~7 N 806646 THIS CE~IFIES THAT in t~ followin~ hwutio.; ~ B~nt ~ I,t FI. ~ ~nd ~. ,~ction BI~ Lot um examin~ on and found to be in compliance u'ith t he r~uirement* qf this Board. flXTUR~ RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FL~ORESCEHT DRYERS RJRNACE MOTORS FUTURE AFEMANCE FEEDERS TI/V~CLO~KS UNITHEATERS MULTI-OUTIICT DIMMERS SYSTEMS NO. Of FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: *l~,acall l-lOOa~l~ pauel HO. OF CC, COND. A, W. G. P~R ,~ OF CC, COND, Ii,co ~i.~ct: Corp. (CIilr ~2b WLIJ. ow Poi.ut ll. oa~ Sour. hold, NY 11791 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. iPARTMENT. THIS COPY OF CERTIFICATE MUST NOT MANNER. FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE COMMENTS FINAL ADDITIONAL COMMENTS: 7GS-X802 BUILDING DEPT. INSPECTION DATE INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 ~ TEL.: 765-1803 Examined :{..~...O~....&.o..., 19 Approved . .~...O-d~..&-..o .... 19~.~. Permit No. ).~../~..~.0..%. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 3 t Date .................... 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 necessary inspections. J/L (Signature of applicant, or name, if a corporation) (NIailing addregs of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ..................................................................... Name of owner of premises .... D.~.. '..~..~. ! ~.{ · .~'......~--~'~. ~ .~../"/~..~... ~...ff~...~.....~. · · .(-~. ........... (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 ...... .~..k/'. ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... -~ Location of land on which proposed work will be done ..... ~..~/..~.. ]..~.... ~/~ 0/~ . .~-.. ................... .................................................... i;' ./z,... ....... House Number Street Hamlet ~'/ 0:3 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 ....... . .-'~. ~./fl0, e./.~..~.. ~-.. ..... ~.~...~ ..'~ ....................... b. Intended use and occupancy ................ 3./f~-..~/~'~ · .'~:_.. · · . . . ............................... 3. Nature ofwork (check which applicable): New Building Addition .......... Alteration .......... Repair ......... ~.. Removal .............. Demolition .............. Other Work ............... ' ~ //~a~ (Description) 4. Estimated Cost ...l~....Z//,ff-~..[fJ4~..., .................... 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..r~, ....... -t'~.J. Rear .............. Depth ............... Height ............... Number of Stories .. ,~.~ .~? .... .~. ~--t~ .h. ~. ................................. Dimensions of same structure with alterations or additior~; Front ................. Rear .................. Depth ...................... Height ...~.~_..-~. ~. ~.~. ]~o~.. Number of Stories ...................... ~-4t. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size oflot: Front ..~..~.~....~.~ 10. Date of Purchase : :: .~..~.~../(. Rear ...................... Depth ...................... ........ Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated.. 12. D~espr~p~sedconstructionviolateanyz~ning~aw~~rdinance.~r.regu~ati~n:......../~(...C/.'''''''''''''''''''''--''---------''' "'"'"~'~"''"'"'''"'"'"'" 13. Will lot be regraded ............... ,. ............. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises~_~ . .,~.~[~'L .fi-.e'_~/J~.~Tfddress ,~e, t*7~].~L, ..... Phone No...7~ 3.~.. · . .......... /~ . .~...:. Address ............ Phone No. Name of Contractor-- ~']z.V.?. ]~.. ~'.~.q-llq. ........ Address ~.(~ .~E.X~.~ .~..-JT~.... Phone No. i ~.' ~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate 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, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) hbove named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and f'de 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 1.~. ...... day of.. Nota. Public,. .... Coun. ... ....... ~'~ l~--l~ ~ ~(Signature~ of applicant) HouS~ 705-1802 H ~S' . ~ ' 1 PO Cu~' ' ~N~;~ J~ ~' '~?~,]S~m~cT~ON "~' MUST A:.J -" , ' OF THE 5-r~ tONS ~ RUC~ION & ~NERGY --1 ,Ax Z C, x4