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HomeMy WebLinkAbout11762-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-22883 Date MARCH 1, 1994 THIS CERTIFIES that the building Location of Propert~ 630 FLEETWOOD ROAD House NO. County Tax Map NO. 1000 Section 137 Subdivision ALTERATION CUTCHOGUE, N.Y. Street Block 5 Lot Filed Map No. Lot No. Hamlet 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 1, 1982 pursuant to which Building Permit No. 17762-Z dated JUNE 30, 1982 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 ALTERATIONS TO CONVERT EXISTING PORCH TO HABITABLE AREA & TO CONVERT DWELLING TO YEAR ROUND OCCUPANCY. The certificate is issued to ELIZABETH J. LANGHANS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-571948 -August 2, 1982 PLUMBERS CERTIFICATION DATED N/A NOTE: THIS UPDATED CO Z-11143 DATED AUG. 18, 1982 Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ~o. Zt I THIS CERTIFIES that the building ................................................ 'Po Location of Property ~ F/-/~ b .-/'..~. 9.~.b' ~ County Tax Map No. 1000 Section .... l..~. 7..Block ......... ~5....Lot...~ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fled in this office dated p-t/4 ¥ ] 19 .~. .~-pursuant to which Building Permit No. [.tTbE 7.. dated ........... ~.?..~{ ~ ..... .~j .t~.. 19 .~..,~as 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 Iowneo I~) of the aforesaid Suffolk County Department of Health Approval ........... '~ .............................. ~5719~0 ' , UNDERWRITERS CERTIFICATENO ................................................. Building Inspector Rev, 11al TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N©. 11762 Z Permission is hereby granted to: ...~ ./z.....~...~.~...~/,~,. ................ ...... ~:....~./.,(....~,~.~..../.,~,..;-~... ...................... .,, ........................................... at premises located at ....... ~"S~' ...... ..~..~.~-~.~,~....~,..?.?.~.~.k. ............................. .....................................................................................................7 County Tax Map No. 1000 Section .../..~.~..~.. ....... Block ....~....~... ...... Lot No...~..~.].., ......... pursuant to application dated ....... ...~....~...~....../.. .......................... , 19~--~ and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ali property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If ~ Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in.writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swirmming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $i00.00 3.Copy of~f~ate of Occupancy - $5.00 over 5 years - $10.00 4. _~dated Ce~a-~e of Occupancy - $50.00 5.'-~f~---~pora-~ ~-~rtificate of Occupancy - Residential $1~.00~, Commercial $15.00 ........................ New Construction ........... Old Or Pre-existing Building~ ........... ~ .... Locatzon .of Property.. ~p~f ...... f.~.~?..~. ........ if~M. ~/ ~( C House No. Street 'Hamle~ .......... Onwer or Owners of Property...~h.~.~..~.Z,...~.~...~.a.~.~.~.~ ~.~. ....... County Tax Map No 1000, Section...L.~.7. .... Block...~.. ......... Lot.. '~ Subdivision .................. Filed Map Lot Permit No .............. · . Date Of Permit. . Applicant Health Dept. Approval ...................... · - -- Underwriters Approval ........... ... . ......... . Planning Board Approval ........................ Request for: Temporary Certificate ........... Fee Submitted: $ -- · .... .... .......... y ' " '" .............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... ~ · · New Building ............. Old or Pre-existing Building(X) ..-..~. __ =/Vacant Land ...... Location of Property Hou~ No. t~eet Hamlet Owner or Owners of Property ~/~~~ ~'~ County Tax Map No. 1000 Section ... K~. ..... Block .~'.~ ...... Lot.. ~& ~ ..... Subdivision ................................. Filed Map No...: ....... Lot No .............. Permit No./../~...~..~..~'. Date of Permit .~..~i~....~.~.A~pplicant . ~.~'.~.~..~..'~..~.~ .-~.J('..~.~f. ~. ..... Health Dept. Approval ........... ~ ......... Labor Dept. Approval ... ~ ............... ,. · Underwriters Approval../~'....~.../. 2~..~. ........ Planning Board Approval - . ..... ,'., Request for Temp~ry Certificate ..................... Final Certificate ... ~ .......... - Fee Submitted ~..~..'-'-~. .................. Construction on above described buildin,c Rev. 10-10-78 Applicant 10003¢. THE NEW YORK BOARD OF FI~E UNDERWRITERS BUREAU OW ELECTRiCItY ', ~-~ 86 JOHN STREET, NEW YORK, ~.].~].~3W~Y~)J~I~ 1OO~8~ ~.~ ~ ~, ~9~z ~,~..o~,~o.o.~ N 57~948 THIS CERTIFIES THAT~ ; : onl theelectr~q~t.~be~q~b~pli~~o~eapp~tc~tto~umb~tntheprem~seaof FIXTURE OUTLETS ~ECEPTACLGS SWITCHES 33 lB 16 FI. ~ Section Block Lot and found to be in co,~pli~nce wi~h the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTOR~ ~ FUTURE APPLIANCE FEEDERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V NO, O~ CC. CONe,o~A-W.G :~ OTHEE~.~E~ATJ[~)C~ Hea. t:era:2-2.5, 4-2.0, 3-1.5, 1-G.F.I., 1-~ Detec~r~ ~ T.~ght~1440 I C OF HI-LEG NO. OF NEUTRALS A. WG OF NEUTRAL 2/0 73 Gillette Ave., ~ay~o]YcF N.Y. 11705 This certificate must not be altered in any manner; t~, the IAc:567E NAGER ., credentials. % O FIfLD INSPECTI N 1. FOUNDATION ( FOUNDATION 2. ROUGH FRAME & PLUMB INSULATION PER STATE ENERGY CeDE FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTiqOLD, N.Y. ~1971 TEL.: 765-1802 //~ / (Bt~ldin~ ~spector) APPLICATIO~J FOR BUILDING PER~IT Application No ....... Date . .l~gy..1.,. ~ 9.~2 .... 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordiug to %chedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas, and giviug a detailed description of layout of property must be drawn on the dia~am which is part oP'this ap cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc:aI of' this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such pen shall be kept on the premises available for inspection throughout the work. e. No building shal/ be occupied or used in whole or in part for any purpose whatever until a Certificate of Oecupm shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance of a Building Permit pursuant to Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or ,alterations, or for removal or demolition, as herein descfib Thc applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) · 9t! Ohester Road~ S~yville~.1178¢ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nmne of owner of premises E.~.izabeth J. Lan. gh,a.n.s (and. 9.t.h.e.r..s) (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'sLicens~ No ................. ........~ , t Ek:ctr c a ~ s License ~o ..... C. .... O£her Trade's LJcehse No ...................... 1. Location of land on which proposed work will be done ....................................... ' - .. ~5.50. Fl.aetw~.o.4. DrJ. v.~ ,. 9.u, tg~pgu, e. ,. Y.Y. ............................................... House Number Street Hamlet County Tax Map No. 1000 Section A37 .............. Block . .4. .8~. 5 ........... Lot .1.8..~. 3. ........ ~ -' "<'~-- (See enclosed survey) .,,? Subdivis:imi '.. ;... ~ ...... , ............................ Filed Map No ............... Lot ............. ...... ..,~; ,: . , (Name) 2,, State ex}sting use and'occupancy of premises and intended usQ and occupancy of proposed construction: a. Existing use and occupancy .. ~..~Q~B. =m .~. 9.~. ................................. I am in-the process of buying out .the other .. b. Intended use ~d occu~anc~ q~er and.'~y~ .there all ~ear around. ~, Ill 2. Nature c~ ,,o"t ................. (check whit!, applicable): New Building ...... Addition Alteration Repair X.~ Removal D~molition Other Work . The house is to be insulated, new windows and installed heat (De~cri~o~ ,updated pl~bing) (to bc paid on filing this application) S, If d~;:cBL~g, hum bet of dwelli:~g units ...... ~ ......... Number of dwelling units on each floor, .~ ........... If garage numberofcars $. ,If basiness, con:mercial or mixed occupancy, spec~y fiature and extent of each type of use .No .............. 7..Dimensions of existing stntct~rcs, if any: Front .... ~g ........ Rear .... ~ ........ Depth ~... ~eight ~ Nt : ~ber et Storms ~ '" Dimensions of same structure ,with alterat ohs or additions: Front ~INO. ~ t, ~ear ............. Depth .................. = ....l{ei~:t ...................... Number of Stories .............. ~. Dimensions of entire new construct on: Front ............... Rear ............... Depth ....... Hc:oht .............. Number of Stories ............................... ' 9. Siz~oflot:Front .~00,~O~ ..;.... . Rear .1. OO ................. Depth ~OO,.~,~OO...1.Q ..... 10. Date dfPurcha$e ~uly 26, ~ D~'.,, ~. ,Name of Fore, er Owner ~,~.$~.~0 ..... H Zone or usc district in which premises arc situated '' ~ 2.Does proposed construction violate any zoning law, ordLaance or regulation: ............................... t~. Will Iot be regraded . .~Q... :.... .................. Will excess ['ill bo removed from premises: Yea N {4. Name of O~vn~r of premiics ~, .L~sha~ ...... Addrcss~l. 0~$O~..~d... Phonc No. 589~Z1. Q~ ..... Name of -%rchitect Address~O Phone No Name, of ContractorR~O~ .$,. fl.~$$Z ...... Address~aypoz~. · ~ · ~. .... .. Phone No. 472~Z~61 ..... PLOT DIAGRAM Locate c}ear4' ~d distincHy MI at 'ldings, whether exis:ing or proposed, and, indicate MI set-back d~nsions pcopcrty Hues. Give street and block number or description according to deed, and show street names and indicate xvhcth( ;nter~or or corner lot. ~'FATE OF NEW YORK, COUNq'Y OF. SIZl~./?O~5~c. . . . ' S.S ...... ~:l..Lzabe.t~. O' .. 5~a,~ghi~D,~ ................. beiug dt,ly sworn deposes and says that he is the appliem= (Nanie of individual signing contract) $ .............%. .%. ., ........... . ........................... ( gent, corporat~ officer, etc.) o'f said bwner or own'e~, m~d is dMly authorized to perform or have performed th~ said work and to m~e and fil~ application; t~mt all statements coOtained in this appl cat on am true to the best of his knowledge and belief, and.tt ~ork ~11 ??erformet~.in thc n, an~er set forth h~ the application filed ti,ercwith. ':'"""~ W~/TER F LH~ '~ ''~ ~orn to etore lng tlll~ ~ ~ ' ~ NOTARY ~BLIC in the S~te of ~w York .....~ * ~ ResMing m Suffolk County ..... ........ , ~ota Publ'Xkk ~% ~,. ~ , ~ '~, x. ~ / C0mnussmn Expires March ~0, 1984 /::'?-. &W.i'F 7-P/C) ........... . ..... ' ~ % ~ ~ , r~ m '~ ,.-..; ' ;'.,' . '. ~ c~ 167 ~lo~ i ~DUCATION ~W ' '* -- k (~ ~ ~ ' I ~ / ,,, ,~ ,~ DAT .... . ........ ~ ..... FEE~ .DE,P. ~ ~ ~E~N~TT,~E . ' ' · ' ' ' ' ' P 'REQUIRE~- ~ ' 2. ~0UGH ' F~t*~m ~ '~"- , 3 INSUL^T/ON MUST 4, FII~AL: - ~ON'STP. UCTJON, BE CoMpLETE FOP- C.O. - ' ' " ALL coNSTRU.CTION SHALL MEET ' THE REQUIRE~AENTS' OF THE N,Y:', ', STATE coNSTRUCTiON & ENERGY S NOT RESPON$1B~'E~ FOR CODE, CONSTRUCTION ERROR~.