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Home My WebLink About13307-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. Z13390 Date April 25 1985 THIS CERTIFIES that the building Addition Location of Property ...1.1.6.5. ............ : .S.a.l.~..a.i.r.o...~.ay. ........... .~.a..L.t.i.~u..o.k. ..... House No. Street Ham/et County Tax Map No. 1000 Section .. 1..0.0 ....... Block . .0..1 ........... Lot.. 0..2.4 ............ Subdivision,, ,$.a~.~, ,~.~, .~.s..~.. ............. Filed Map No..4..6.8.2...Lot No..2.6. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... qu..ly .... ...... ,19.8.4. pursuant to which Building Permit No.., .1.3.3.0..7.Z ............ dated .... .5.u. 1. y ..... .3.0 ............ 19.8.4., 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 ......... The certificate is issued to ................ p.E.~..R~., .&...R.O.B.E.R.?..B.~.L.E..S ................... (owner,desse~er-termR~l- of the aforesaid building. Suffolk County Department of Health Approval ......... N. [.A. ............................. UNDERWRITERS CERTIFICATE NO ................. N..6 ~.7.9. 9 ~ ......................... Rev. 1/81 Building Inspector FOBM NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAt. L SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTil- FULL COMPLETION OF THE WORK AUTHORIZED) N? i3307 Z granted t ', ~ ~ . , Permission is hereby ...~~......:....~ .............................. ..... ......... . .....~~~......~.,~.~..~.~.~..~..,~ ~ ... ,o .~.....~...~..~....~.~~~ ~...~.~..,..~...~~,~.:.m~:~.~....L~~ ............ ot pmmis'es ,~o,ed at ..~.~..~.~:...~.~~....~....~~ ............. County Tox Map No. 1000 Section ...... J...../~... ......... Block .......... ~ ........... Lot No ........~...~. ............ pursuant to application doted ...... ...~....,.~....'~. .................... , 19.'~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Permission is hereby granted to: TOWN BUILDING ToWN HALL SOUTHOLD, J',l~. Y. 'BUiLDiNG ~P, ERMIT: (THIS PERMIT MUST BE KEPT ON THE PREMI$~ UNTIL F LL COMPLETION OF THE WORK AUTHORIZED) et pCemises located Cour~ty, ;To~< Map No. 1000 Section ..../,,~?.,,~,,..;...,. pu~sOant application dated ......... ~ ...~; Building Inspector. ~ i and ~pproved by the 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- ~q..r with the following; for new buildings or new use: Final survey of property with accurate location of all buildings, property lines, streets, and unusual ,~3~?tural or topographic features. ~. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). C.~ Approval of electrical installation from Board of Fire Underwriters. ~. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible f~r the building. ~'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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~,.~,~,'~ Date .... .~.. ~'.-...Q'..~..': .~..~ ...... New Building .... ;2.~.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./l (~ ~5. ~ .~5 /Jr ~'1.~- ~ ' '~ ~t/eet Owner or Owners of Property.. ............................... ~ ..... ................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ......................... Filed Map No ........... Lot No .............. Permit No. ~.~ .~Z ~. Date o~Permit [~; ~ ~.- ~ .Applicant... ~ Health Dept. Approval Labor Dept Approval Unde~riters Approval . . ~ .~ ~. ~.~ ).~ ...... Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~-.~ ~.~ ................ Construction on above described building and permit meets all applicable codes and regulations. ~1~ 2.~ ~ ~ ~_ Applicant .... ~ .~ .~....o_~.. ~c~.~ ~%q~ ..... ~ ....................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS t'tS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 ..t. March 26, 1984 A..,lcotio. No.o.l.e 240578-83 N 637998 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the abo~e application number in the premises of Robert Bales, Saltaire Way RR135-A, Mattituck, N.Y. io the followlng location; [] Basement [] Ist FI. [] 2nd FI. Section Block Lot was.x.,.inedo. March 19, 1984 and found to be in compliance with the requirements of this Board. FIXTURE ~ RXTURES OUTLETS SWITCHES FLUORESCENT RANGES OVENS DISH WASHERS FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMSCLOCKS MULTI*OUTLET SYSTEMS NO. OF F~ET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO. OF CC. COND. A.W.G HO.OF HI-LEG A-W-G. [NO. OFNEUTRAL$ PER ~ OF CC. COND. OF HI-LEG / OF NEUTRAL Robert Bales Saltaire Way RR135-A Mattituck, N.Y., 11952 This certificate must not be altered in any manner; return to the office of the Board if incorrect. be identified their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. NSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: 7GS.'1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PWG. [ ] FOUNDATION :~ND ~ INSULATION [ ] FRAMING [ ] FINAL -,'~ . , , f802 9 AM ..T ~ 4 PM ,FOR / , ,1 0UN.ATION, ~VKO REQ~ , f ....i'~' .. ' '~ ' ; ~, ' :DR POOEED~GONCRETE. ', ',', 'X , ; , i 2 OUGH - FRAMING ,& PLU;MB!NG - ,/ , ,, , ,3. NSULAT~ON , , . , - . '. ' ;,/ ,' ; ' 4 'FJNAL ~, COh~RJ,*TON MUST. . ¢, . .. : ,. ~L~ CONSTKqql I~N ~lqAbk.. MEET: , . , ' .,~NE' REQUIReMENTs OF. THE N.Y. ,.; '*' ' ' : ' 'STATE CONSTRU¢~IQ~: &':ENERGY' ~, ' ' , :~ES NOT R~R~NSIBLE ~OR , : DESIGN OR CONSTBOCTION ERRORS. U L ; , E t~ 1o ;i FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ Date .......... ~ ..~. ......... 19 .... To .../.~/~..?. ~..~.'..~. ~ ..... ~ · .x:T.~.~.../../.~-. ~. ~.. ~~ ~ PLEASE TAKE NOTICE that your application dated.. ~/~... ~, .... 19 ~. for pemit to construct,.. ~~~.. ~//Z~ .............. at Location of Property ... ~/.~ ..... ~~.. ~ ...... ~~~' } ~ House No, b't~et / Ham/et co~ty zox ~ ~o. ~ooo s,ctio~ ...Z~ ..... mo~ ...~./ ....... ~ot . ~ ~. ~. .... / RV 1/80 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1893 Approved ,.~b4~...~...., 19~.~.. Permit No]..~.~.O.'7.. ~ Disapproved a/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 necessary i~sp~ctions. ~_, b.~- t((o (~ .... ~.,i./>.~.~. ................. | · ~ (Signature of applicant, or name, if a corporation) %~ oxta~ o-~ .~.~./...).o. ~.. ~.~.~r.. ~o.6.~...).... (Mailing address of applicant) / /~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... t~-.~...~...'...~'..~37~..,..~.:...~.~ ..................... (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 ...... ~o.~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... I.(.(~.~ ....................... ¥'.~c-4~.~. ~. ~.%. House Number Street ......hamlet .......... County Tax Map No. 1000 Section .................. Block .......... ~. ~ ....... Lot ..... --.... ........ Su~,v~,on .... ~ I ~Ce. .~~S ..... ~il~a ~ ~o. . . ~0 ~ &. . ~o~..~C ......... (Name) 2. State existing use and occupancy of premises and intended use and o?upancy of proposed construction: a. Existing use and occupancy .......... ~ ....... , ....................................... b. Intended use and occupancy ........ ~ &.. ~ 3. Nature of work (check which applicable): Repair .............. RemoVal .... 4. Estimated Cost ......... /.~..~ .~. 5. If dwelling, number of dwelling units If garage, number of cars ...... , ....... 6. If business, commercial or mixed occupan 7. Dimensions of existing strncturesi if any: Height ............... Number of Sto! Dimensions of same structure with alteratii Depth.. .................... i' Height l 8. Dimensions of entire new construptinn: F~ _ Height ............... Number of Stc 9. Size of lot: Front. ........... ~ ....... 10. Date of Purchase ............ ' ..... 11. Zone or use d~stnct ~n winch premises are New Building ' . · Addition .......... Alteration .......... ......... Demolition ......... Other Work ............... ~, (Description) ................ Fee .... ~" (to be paid on filing th~s application) ......... Number of dwelling units on each floor ................ y specify nature and extent of each type of use font ............... Rear .............. Depth ............... ,ns or additions: Front ................. Rear ................. ...................... Number of Stories ..................... }nt ............... Rear ............... Depth .............. .. Rear ...................... Depth ..................... ......... Name of Former Owner ............................ [tuated ............ /'~AL.... ................................... 12. Does proposed construction violate any zo~ dng law, ordinance or regulation: .....~ ................ ~ ....... 13. Will lot be regraded .... /A.4~.. '~ ...... ~ .......... Will excess fill be removed from premises: (~e~ , 14. Name of Owner of premises .... i ...... i ........ Address .............. Phone No. ~.C/...~.-~..~,~,, .O.¥7/ hit ' Phon Name oflArc eot ........... ; ............... Address ................... e No ................ Nmue of Contractor .......... i ............... Address ................... Phone No ................ Locate clearly and distinctly all buildings, property lines. Give street and block number or interior or corner lot. ~ ~). PLOT DIAGRAM vhether existing or proposed, and, indicate all set-back dimensions from .escription according to deed, and show street names and indicate whether BY: ~.6. L. 7654802 9 AM TO 4 PM FOR THE ~OLLOWING INSPECTIONS: ~. FOUNDATION ~ TWO REQUIRED FOR POURED CONCRETE ' 2. ROUGH - FRAMING & PLUMBING ~. INSULATION 4. FINAL . ¢QN'STRt)CTION MUST BE C~MPI q'TE FOR C. O. ALL CONSTR~;CTION SF~AIJ_. MEET THE REOiff~FMFNTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRoR~, STATE OF NEW YORK, _ S S ' coum'Y OF ..... ' ..../~...a.-7.~.4...f~.....~..~...~ . .o~...~. 1 ....... ] .......... being duly sworn, deposes (Name of individual signing 4ontract)I and says that he is the applicant above named. : / · ./ ' He is the ........ ~ .[t~..~.~. ........................................................... , i (Contractor, agent, corporate officer, etc.) of said owner o'r owners, and is duly authorized [to perform or have performed the said work and to make and file this application; that all statements contained in this ~pplication are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in ~he application filed therewith. Sworn to before me this / ............ t2 ..~ ...... day of... Notary HEtEN K. DE rOE ~ NOTARY PUBLIC, State of New York i No, 4707878, Stiffolk County ~ le~l Exi)~es ~ch 30, {.9J~ (Signature of applicant) FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. · K .............................. Exommed ~ ............................... , 19..~... Applicotion No. //(/Y . . roved' ,(.. ~ /~z~ App ..~... ................../' lg~...f~.. Perm,t No ........... './.~../. ................... --,,u,g, p,~ (~"a:':-'~ F':";ns-"::tor) .............. INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate 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 street's or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 lhe 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ..................................... .7.......~.~ J....d~...~..S.~ ..... (Address of appl cant) ~7~'7 State whether applican~ is owner, lessee, aDenf, architect, enDineer, general contractor, electrician, plumber or builder. Name of owner, ofpremises .~O~¢,~ ~ . ~h~ O~K-a ~ If applicant is a corporate, signature of duly authorized officer. PERMIT INCLUDES APPROVAL (Name and title of corporate officer) TO REMOVE EXCESS FILL ,.,d.~'~ L,~..,. No. ~.C /~ ~OM ABOVE P~EM~SES ~ .................................................... REGRADING LOT Plumber's License No ................................................. DRIVEWAY C~STRUCTION CESSPOOL CONSTRUCTION Electrician's License No ............................................. CELLAR CONSTRUCTION OTHER Other Trade's License No ............................................... .... f~ct4~,~ ....... ~ ...................................... 1. Location of and on wh ch proposed work w be done MaD No ' z ' ' ~ /nt ~n st~t ond N,~b~ ..~.~.~..L....~.~....~:~.E..A ...... 3.~J.~a~;~.e....~.~ ........ ~.~:~/~ ........................... ~ I t6 ~ Municipali~ 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................ ~ ............... ~.~.~ ....... ~ .......................................................... b. Intended use and occupancy ............................... ........... ..~.~.., .......................................................... County Tax Map No. Dist. ~000 Section /OO, d)O Block (Z)/,OO Lot /o / / .,, _/... .. Nature of work (check which applicc Repair .................. Removal .......... If dwelling, number of dwelling uniti I~ garage, number of cars '"i"; ........... If business, commercial orj mixed Dimensions of existing structore$, if Dimensions of some structure with Dimensions of'entire new constructi Height .~....!..~.. .......... Number of Sro Size of lot: Front /CD,O..,oc >le): New Building,. ................. Addition ........ Alteration' . ................ ...... Demolition .................... Qther Work ............... ; ............................... , t ~ . ~. (Description) ' ............................................... :"': ........... · .............. U' "'"; ............................. (to be pad on fling ths applcahon) ........... ! ................ Number of dwelling units on each floor ..... , ...................... ccupancy, specify~ nature a'nd extent of each' type of use ....... ~[ ................... ~ / O' y: Front ...... ~...O. ................ Rear ........... ~.. ................. Depth ,..~, .............. aries ................. ~,, ................................................................................... ~erations or additions: Front .......... .~...(~. .................. Rear ..... '..~'....~.. ............... ......................... Number of StOries ......... ,]..~.1~ ~...~.~s~ ,-.~ ~ Front ........ J ........................... Rear ...... :../....~z.. ............. Depth. / ..~..' ........................ Rear .../....C2...O..:....q.~ ............... .L.. ,gepth ..~..o..../.;.%'~. ......... 10. Da~e of Purchase . ..~...~.~..i.....~.. ...... .~...~...~ .............. Name of Former Owner/~.,J~[I/~-~.....~..LO~..~. ...... l ............. 11. Zone or use district in which premiseI are s,tuated ....... .~..~..~..~..~..£.~..~.C.f~¢./. ................. :'. ...... ; ........ : ............................... 12. Does proposed construction violate alY zoning law, ordinance or ~egulation: .......... ~)'"~'""i ................................ 13. Will lot be regraded .....J~.~)C~. ........ 7'} Will e. xcess fill be removed ~rom premc~s: (~')/Yes , ( ) No 14. Name of Owner of premises .'~i.~...~..¢.~.~.j..i.~....~.J.¢.~....,...?..;i..'Addres~..~..!.~.q¢.r.[ ...... ~..~.~JPhone No. ?..~;%.3....o.~.. Name of Architect ........... ~.~_...I.~/~ ............................. ...... Addr,ess: ............................... ,'Ph°ne No ....................... Nome of Contractor ........... ; ............. Locate clearly and distinctly qll buildir property lines. Give street and block nun whether interior or corner Jot. STATE OF NEW('~ORiQ., ,// ~ c ¢ . (Name of individual signing col abpve named. ,; (Col of said owner or owners, and is duly outh~ this application; that all s%atements contai thor the work will be performed in the manl Sworn to before me this Notary PaNic, NO. .................................. Address ............. ~....' .............. Phon~ No ....................... gs, whether existing or proposed, and indicate all set-back dimensions from her or description according to deed, and show street names and indicate .......................... being duly sworn, deposes and says trocf) he is the applicam ~ractor, agent, corporate officer, etc.) ~rized to perform or halve performed the said work and to make and file ned in this application are true to the best of his knowledge end belief; and ~er set forth in the application flied therewith. (Signature of applicant) ANN NEVt~I[ Explre~ ~a(¢h 30,