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HomeMy WebLinkAbout12446-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16088 Date August 21, 1987 . THIS CERTIFIES that the building .... qN..g..F.A.M..I.L.Y..D..W.E.L.L.I..N.G ...................... Location~¢P~n~r~,, 5615 Soundview Avenue Southold, New York ..... h3 s' 'tv'o: ....................... 's'do3i ....................... County Tax Map No. 1000 Section 058 . .Block 01 .Lot 002 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..~u.n.? 7, 1983 pursuant to which Building Permit No. 1244.6 Z dated...........July 27 ...., I..98 .... 3 . ...... 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 ......... ONE FAMILY DWELLING The certificate is issued to TIMOTHY S. GRAY ..................... /,,¥,,'d-, 'ro xo x .................... of the aforesaid building. Suffolk County Department of Health Approval 1 3- S o- I 0 9 UNDERWRITERS CERTIFICATE NO. N 6 3 7 0 6 0 PLUMBERS CERTIFICATION DATED: February I I, 1987 '~il~Inspector Rev. 1/81 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) Permission is hereby granted to: ........ ........ ...... ~..~.~ ...... ~.......~.aZ~....~,.~<, to ........ C~c~.~.~. ~.~..~ZL...c~z~...~......~,~/~. ~./_...~....... ~(//..~Z.~./.~..~ ..................... at premises I~ated at ...... ~ ......... ~~.~/~..~.~: ............................. ............................................................................................................. Coun~ Tax Map No. 1000 Section ...~0 ...... Bilk ....~.L .......... Lot No...~.~. ..... Building Inspector. Fee *..~.:.~.......i::. .... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N,Y, 11971 765- 1802 BLDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~. lamam~a~ 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 end 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. §. Submit Planning Board approval of completed site plan requirements whgre 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: ~'~ 5 .~ ' 1. Certificate of occupancy New Dwellino~.~---~. Acce.~sory '$t0.00 Bus'.ness $50.00 2. Certificate of occupancy on pre-existing dwe ~lTi'~g $ 50.00 3. Copy of certiflcate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.U~dated C.O. $ 50.00 Date .......................... 6. ~lteration $25.00 NewCon= %ruc%ion ..... Old or Pre-ex isting Building ......... Vacant Land .......... Location of Property ............., , . , ' .................... /~ouse No. Street Hamlet Owner or Owners of Property ..... .c~. ~th .~ ...L3. ¥.~..~ ..... . .......................... County Tax Map No, 1000 Section ............... Block ............... Lot .............. Subdivision ........... ~, ,o, ,~,~., ................ Filed Map No ........... Lot No .............. Permit No. [ ~.~/q¢'7- Date of Perm!t $ .Appticant "~' Health Dept. Approval .. [~.."..5..o.T.~.o.~. ......... Labor Dept. Approval .. .... ~ ............... Underwriters Approval ~ (~.~7. g..~.~.. Planning Board Approval ..-'~.... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............. Fee Submitted $.....~..~..~'..o? .................. Construction on above described building end permit meets all applicable codes and regulations. Applicant ..... 1, . - ........................... Rev, 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. [~ Owner -~t~o~ ,S. Gr~ (please printy Plumber Henry J Smith & Son: Ina. (~lease print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (p er's signature) Sworn to before me this '__~\~Dday of' ~, Notary Public ,~~County Notar~- Pub~io/ '..THE 'NEW ~YORK BOARD OF FIRE 'UNDERWRITERS ' SERVICE El~ctric Room 'Heaters ~ 1 +'2 '0 .KW, _1 fl. 5 -KW, -2~1.0 KW~ :' 2-~;-75 _XW~ ;B: ;5 .~,-: -.::.:- :: :. FIELD I~S PE~TI ON FOUNDATION (1st) COMMENT~ -' ~' FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: 1001071 -THE vat* March 16, THIS CERTIFIES THAT NEW YORK BOARD OF FI'RE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 1984 ~,plicatio, No.o,/ite 236232-83 N 637060 only the electrical equip,nent as described belair and introduced by the applicant narged on the above application number in the premises of Tim Grey, 8oundview Ave, N/~,first Dirt Rd. W/Of Camp, Southold, in the followin8 location; [] Basement [~ 1st FI. ~as~,,~in~do,~ March 12, 1984 FIXTURE OUTLETS 26 ~ECEPTACLES SWITCHES 26 2.4 DRYERS FURNACE MOTORS 3rd Fl. ~ ~nd ri. Section Block and found to be in compliance with the requirements of this Board. FIXTURES RANGES 26 FUTURE APPLIANCE FEEDERS Lot TIME CLOCKS OVENS EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS~ 1-4.5 KW. Hot Wa~er Hea~er 1-G.F.C.I. 1-Smoke Detector Electric Room Heaters:l~2~0 S E R V OF CC CONO 1-1.5 KW, ! C NO OF HI-LEG 1 2/0 2-1.0 KW, 2-.75 KW, 3-.5 KW. G & S Elect. P. Oo BOX 215 Southold, N.Y., 11971 LIC.~578 Ihis certificate most not ~e altered in any manner; return to the office of fhe Board if inco?rect. OF may be identified IN .ANy MANNER. TOWN OF $OUTHOLD OFFICF, OF BUILDING INSPECTOR P.O. BOX 728 TOWN ItALL SOUTtIOLD, N.Y, 11971 TEL. 765-1802 This is to advise you that the job under building permi~ no.l~g46Z___ isnued to T, O, Gray on _~./27/flt___ for N~_Dwelling ia completed a fi,,a] 'inspection i]as ( ) has .... not (X)'"'been done. and In order to complete this file, it is necessary that ;~ Certificat. e of Occupaucy be issued. P~ease fill out the enclosed form, return same to the above office with a check for $25.00 payable to tile Town of Southold. Please indicate to Whom tile Certificate of Occupancy is to be mailed, and arrange with this office for an ~nspeetlon date Occupancy or uae is unlawful without a Certificate of Occ,pancy. l'leane, help tls to clear up this matter so that legal action does asr have to be take~. Thank you for yo,r prompt attention. Very truly _yo_~, Victor Lesaard Executive Administrator VL:gar eric1. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [~ FRAMING [ ] FINAL REMARKS: INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~}--ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ._f---~ -] FINAL REMARKS:/, .~.~'~ / ~..~.~.-~/.-~, .-,-',-z//.~. DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]~ INS~JI~.ATION FRAMING [//]*'FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING TOWN OF SOUTHOLDt,~t~'~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No./d.55'..~.~. ........ Disapproved a/c ............................. '7~' ' ~ \/ ~(Building Inspector) APPLICATION FOR BUILDING PERMIT Date ....... ~..--.~. .......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 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 reguhtions: and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of al~licant, R.P.. .,. ~o..C.,r,[*. ' ' .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. O~t&e.~ ......................................................... P. uSclc. .g. , .................................................. .CoY_ (as on the tax roll or latest deed) Name of owner premises If iii~plicant is a corporation, signature of duly authorized officer. :z .... .......... ~' dq'a~d 2~ title of c0[porate of.ricer) Builder's License No. S6~--~[~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ' · ......... ' - ' ...... ' . .................... ......... $5o~o~.%.e... A~. House Number Street Hamlet County Tax Map No. I000 Section ..... ~.~ .......... Block ..... I ............. Lot..~%,. ........ .... Subdivision ............... ~o. Qg- ................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~.Oe. otr¥~ ....................................................... b. Intended use and occupancy ..... .fi. es.t.d-.encg. .... .n.~ ................................... 3. Nature of work (check which applicable): New Building ... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ............. ~..~ .............. Fee ................................... : (to be paid on filing this application) $.' If dwelling, number of dwelling 9nits ...... I ......... Number of dwelling units on each floor... ~. ............ If garage, number of cars ..... i ..... ~- ............................................................. 6. If business, commercial or mixe0 occupancy, specify nature and extent of each type of use . .C~{. ~..k.~ .e~..c~. .... 7. Dimensions of existing structure~, if any: Front ............... Rear ..... :...-Depth ............... Height ............... Num:ber of Stories ........... SO..~0~.'~..v~. ~.qrt U.~'~':*L .~.e,5 .................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... .. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... ~t~ ......... Rear '... ~4> ......... Depth .. ~?. .......... Height ............... Number of Stories ............ ~- ........................................... 9. Sizeoflot: Front ..... ~B.~, .......... Rear... ~-.q.q.0.*.9. ~ .......... Depth . .[~O,e, ............ 10. Date of Purchase '~..c~o~.~,..t~.O.~. 1.q82- ......... Nome of.Former Owner .~.c~o~-~ ¢.. ~ .MJ~.~{~eu 11. Zone or use district in which pr~mises are situated..l~.~.t.c~.~.c~¥'te,~[ ....................................." c .... di 12. Does proposed onstructmn wolate any zomnglaw, or nance or regulation: ................................ 13.' Will lot be regraded ......... ......... j .........Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~JJ.c[~.C-o~.~ ........ Addressti0~.o.o.l~.~x .~4...,~..~.q.~k~. Phone No. Name of Architect ..; ....... i ........-. ..... ,. lay ..... . Address ................ .... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all lbuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. : STATE OF NE~)RI~,~ c~ S S COUNTY OF ~'..... ......... ,~C~ .~, .'~tO~¥ ..................... being duty ~worn, deposes and says that he is the applicant i(Name of ~n&wdua' ~ ~ - - I sig[lng contract) above 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 file this application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the mannef set forth in the application filed therewith. Sworn to before me this ......... c~...~ ......... day ofi ..... ~ .... , 19~. ..... ..................... '~~,~.~[~. ~gy~fz"- -- (Signature of applicant) SUFFOLK COUNTY HEALTH DEPARTMENT ~ THE ~EWAGE DISPOSAl A~D WATER ~UPPLY FACILITIES F~ ~ ~.~' LOCATIO~ HAVE E.~E~ INSPECTED BY THiS DEPARTMENT ~,_~/ ' ' ~h'l'ef of Wastewater ~anagement Section SU~Y FOR AT SOU~HOLD DATE: ~N ~ $OUTHOLD SCALE: SUFFOLK COUNTY~ NEW ~RK NO. HE~ DEPARTMENT-DATA F~ APPRO~ TO C~STRUC T ANO ~ HIS ~LF ~ THE TITkE C~P~Y. GOV~"' ~/~ ~ ~ WITHIN I00 FEET OF T~S PROPERTY TO A~ITIONAL INSTITUTI~S OR SUBSEQUENT ,~ ~ ~ ~ ~ ~ ~ NrA~ ALDEN W, YOUNG, PROFESSIONAL ENGINEER ACRES ~ AND LAND SURVEYOR N.Y.S. UCENSE NO, 12845 ~ ~ HOWARD W. YOUNG~ LAND SURVEYOR ff ~ L~ ~ ~LIW), ~lC TANKI~TiM CE~OLS(~) ~N ~Rg~ ~ ~ N.Y,S. LICENSE N0.45893 [XCA,'VATIOH IHSPECTION REQUIRED "1¢ sl~ou~d l~e noted that since this property is located in an agricultural. oreo, the possibility exists that the water supp)y may contoln trace amounts of pesticides an.d/or nitrates. Special ano)ysls 7~,~,//,e' required,. SURVEY FOR SUFFOLK COUNTY FOR API'I~OV/~:, '"':~.,t CC~]STRUCTiC)N ONLY K. TNEI~ AI~, NO DWELLIN~R WITHIN I00 FEET OF TH~S PROPERTY AT $OUTHO£D TOWN ~ SUFFOLK COUNTY, NEW YORK "U"*UTNOmZEO ACTERAT, ON OR 'OOmO. SURVEy I~ A VIOI. ATIQN O~r SECTION T209 ~ THE TO A~ITIO~L INSTITUTI~S OR SUbSEqUENT DATE: dUNE /4,1983 SCALE: /"" ~OO' NO. 83 - $ ,~ 4 YOUNG 8 YC~I~GHd .,v..~^.,... YO.K ALDEN W. YOUNG, PROFESSIONAL ~a ~a su~vE~o~ ~.~.s. uc~jq~.N~NL~d~ HOWARD ~ YOU~G~ LAND N,Y.S, LICENSE N0.4589~ 14'© x /~ u" If- oper Ipb ng is used fo~' water distdlouting syslem; piping shall be oi typeslK or L only NOT[~ BUTLDIN 765-180~ 9 AM TO 4 PM FOR THE FOLLO~ING iNsPECTIONS: ~uNDATION - TWO REQU%~D FOR p~URED coNCR~K GF?AY APPF-'7OA C H