HomeMy WebLinkAbout12751-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Of Occupancy
No..g.1.2.6..8.8 .......... Date Aug. 10 19.8.4.
THIS CERTIFIES that the building .... hJ.e..w..O.n.e.. F.a.m..i.1Z .D..w.e.l. lj: .rig .................
Location of Property 170 . .Dg.%ph..i.n?..D..r.i.v.e. .............. .G.r.~..e.np.o.r..t ......
h3~sb Ho: ....... street Hamlet
County Tax Map No. 1000 Section . . . .0 .5.6 ...... Block .... 0 7 ......... Lot ... 0..0 .6 ...........
Subdivision . .S. qu..e.hP.l. 4..8.h. qr. 9P ............ Filed Map No...3..8 .5.3. ,Lot No. , .1.5 ..........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....O.c.'q.q .b.e?. .... .2.8..., 19 .8.3. pursuant to which Building Permit No....1.2.7.5.1. g. ............
dated . . . .Ng.v.e.m..b.e.r. ....... 2. 9 ...... 19 .8.3. , 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 .........
...... a.. ?.r?.a..e.e..o.n..e:-?.q~.i.:L~, .p.w,e.~3. $.n9 ........................................
The certificate is issued to ......... C.H. &R.L.E.$..& .A..L.I.C.E..T.E~A. .........................
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval . .1,3.'rS..O7.1,9. 0. · .6./.2. .0 [.8.4.
UNDERWRITERS CERTIFICATE NO....N.6.4..8 .1.4.5. ......................................
Building Inspector
Rev. 1/81
FOEM NO. 2
TO~N O~ $O~THOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
12751 Z Date .... ~..~ ..L~.. .... .c~.. ...6. . .. :. .. . .., ! 9..~...~
Permission is hereby granted to: ~,
.....~..~.~.......b....n....~ ............................................
......... ~. .................... ;~.~ ......... .V....L..~-~
,0 ..
County Tax Map No. 1000 Section ..... .?..,,~,,.~. ...... Block ...... i..~ ............ Lot No ........ b ............
pursuant to application doted .J~).. ..~;,~..~.' ..~.~.......~...~. ................ , 19..~...~ and approved by the
Building Inspector,
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
$;=uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitte~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.
C, Fees:
1. Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling land use --?re-E×is tin~ C.O. $15.00
3. Copy of certificate of occupancy $1.00 Vacant land C.O. $ 5.00
New Building .... .~ ...... Old or Pre-exi~ing Building ............ Vacant Land .............
Hou~ No. Street
Owner or Owners of Property . ~ ~ .~...~. ~ ~ .....................
County Tax Map No. 1000 Section . ~ ......... BlocE .......... Lot ..........
Permit No./. ~7 ~/~ Date of Permit ~.Ap ant ............ ~ ; .......
~ .... ). ~.O ........ Labor Dept. Approval ........................
Health Dept. Approval .~ O ~
Unde~riters Approval ................ Planning Board Approval ......................
Request for Tempor~ertificate ..................... Final Certificate...~~ ~.-~ ~
Fee Submitted $ .............
Construction on above de,ribed building sn~~s a~and regulations.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
TEMPORARY
Cerfi[icale O[ Occupancy
No..Z12.57.4 .-TF24P... Date .... Jur~a .~¢ .................... ,19 .8.4.
THIS CERTIFIES that the buildine--new dwelling
Location of Property ...17.0 . Dolphine Drive ,G. reenport
County Tax Map No. 1000 Section ...0.5.6. ...... Block .. 9.7 ........... Lot .... 0 06
Subdivision... $.o.u~h.o.l.~.. $.h. o. .r .e .s ......... Filed Map No. 3 85 3 .Lot No. 15
conforms substantially to the Application for Building Permit heretofore filed in this office dated
October 2 8 19 .8 .3. pursuant to which Building Permit No. 12 7 5.1 Z
dated .... N..oy.e.m.b..e.r..2. 0, ...........19 8. 3.., was issued, and conforms to all o f the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.~ private one-family dwellin5.
The certificate isissued to CHARLES & ALICE TESTA
of the aforesaid building.
Suffolk County Department of Health Approval . .1.3.-xs. 97.1.%Q ,. 5./.2. 0../.8.{ ,...~.o.b.~.:..~........Vill.a ,. P.E.
UNDERWRITERS CERTIFICATE NO ......... .lq..6. 4 ~ .1.4.5. ...............................
Rev. 1/81
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Bu tiding Department
Town Hall
~outhold, N,Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted~aC~e~e-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 fi'om Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences arid 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 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/ land
3. Copy of certificate of occupancy $1.00
use--,?re-ExJ, sting C,O. $15.00
Vacant land C,O. $ 5,00
New Building .. [~'~..'~ ,~ .... Old or Pre-existing Building .NP ....... Vacant Land
.......... ..... ..... ...... ............
~ou~ No. St~et
Owner or Owners of Property , ~ -5
'" ·
Subd~vmlon ~ ~ ................................ ~ Filed Map No ..... Lot No, . ) ...... ~ ....
Permit No. Date of Permit pp cant
Health Dept. Approval ........................ Labor Dept, Approval ........................
Unde~riters Approval ........................ Planning Board Approval ......................
Request for Tomporary Certificate ...... ~ ............ Final Certificate ...... ~ ..............
Fee Submitted $ .............................
' 'm ik~e
Construction on above de~rlbed bulldm~ and per ts~ll applicabl~codes apd regulations.
Applicant .., ......................
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
in the foliowing location; ~ Basement ~ Ist Fi, ~ 2nd FI. Section Bilk ~t
w~ exami~d on ~ ~ ~ ~ a~ found to be in compliance with the requirements of this Board.
fiXTURE I FIXTURES RANGES OVENS DiSH WASHERS EXHAUST
OUTLETS SWITCHES FLUORE$C~NT
15 18
DRYERS
OTHER APPARATUS:
?amelbo,%rds: !-12c~r.
l-4.SkWo Ho~ Wate~-
!~.F,C.I. i~ Detectoz~.
E R V I C
Ricl~rd Reiyer
P, O. ~x $7J
L~urel, N.Y, i1E~S
2148
This certificate must not be altered in any m~nner; return to the office of the Board if incorrect, ors
GL~NERAL MANAGER
Per_ ~
,be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FIELD INSFECTION COMMENTS
FOUNDATION (~st)
FOUNDATION
2.
(2nd)
ROUGH FRAME
FLUMBING
INSULATION FERN. Y.
STATE ENERGY
~ODE
FINAL
ADDITIONAL COMMENTS:
Charles Testa
P.O. Box 678
Green~ort,
~77-2882
October 26, 1983
Bank of New York
Greenmort, N.Y. 119~
Gentlemen:
Since I am going to be the General Contractor for mv
own home which is to be built on DolDhin Drive, Southold,
(Southold Shores), I would like to submit a short
resume of my ~revious back,round in the bu~ldin~ business.
Due to the fact my father was a contractor in both New
York and Miami, I was ra~.~ed in the buildine trade; as
a result, I am most familiar witb all facets of the business,
es~eelall¥ escavation and cement work.
I have also worked considerably with sheet rock, carpentry
and landscaping. Although, I have not been in the trade
full time for some years, I have done a great deal of work
in my previous home~ such as remodelinR and extentions ,etc.
I have also worked for other individuals which ran~ed from
complete remodelinm of a terminal in John F. Kennedy Airmort
for Caoital Air Lines, and also assistinR in the construction
of Mr. Leonard Walters home on Tarpon Drive, Southold, N.Y.
Should you r. equire additional information regarding my
exoerlence~ please feel free to call me at the above number.
,relv,
Charles Testa
enclosure
Examined .D .~1'. mkk . .3'p...., 19 ~
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved ./~.d'W~[~-kh. ¢.O., 19 3.~ Permit No. ~
Received .......... ,19...
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~x~ 0(~)~ 19~.. ¢
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter 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 tbJs 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, bui/d~g code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necess~,~~.
(Signature of applicant, or name, if a corporation)
lq, 0 : .r3. 0.4 ! g .P. a g T. . a / /
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... .........................................
Name of owner of premises . .~. k~ .~ .~-~-~...+'. ~').~.I.Q-~..~.~..~.-7~..~.~. ...................................
(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..~....~..I.~.¢?. ...........
Electrician's License No ~c ~-q ~ ~ 1~ - C~...-?~. 4 "~co ' ,,
..... %
Other Trade's License No ....... ~. ~L~ ~, ~.~
I. Location of land on which proposed work will be done.., k~7....i. ~...~.(~..I. ~9.(~/*~G*. ~..
'~ ~.. ~ :)r.~> 3.~. ~,,1~' .... ~O~ffS~ ~ ......................]
.......... :2. 4...
County Tax Map No. 1000 Section . ~ .c~ ~. Block ....................
Subdivision .~.~ ~O~¢.. ~.~ ............... 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 ........ ~'~...~.~.: ...................................
' ~ . . ~ ..................
b. Intended use and occupancy ...~ ~,~ .~. ~ ~.~.%~....~lV~...~(¢.
3. Nature' of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
~0~) ~ (Description)
4. l?,stimated Cost ......... ~{~/" 'I ......................... Fee...~..~).c~ 0.
(to be paid on filing this application)
5. If dwelling, number of dwelling hAltS ..... ./ ......... Number of dwelling units on each floor ..... ~ ..........
If garage, hum bet o f cars ..... '.....~ .............................................................
6. If busi¢ess, commercial or mixed occupancy, specify nature and extent of each type of use ...O .................
7. Dimensions of existing structurds, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ............ Rear ........
Depth .................... i.. Height ..................... Number~f Stories ............ t .........
8. Dimensions of entire new constrUction: Front ..... ~.0.~. ..... i Rear../~ D .......... Depth . .~.
Height .... .3-.*'4. ~. ....... Nuinber of Stories '
10. Date of Purchase
........... : .................. Name of Former Owner .............................
O di ' hp ' ' d
11. Zone r use strict in wh~c remises are situate .............................................
12. Does proposed construction violate any zoning law ordinance or regulation: ..... /¥ b .................... ~.
13. Will lot be regraded . i .~qLh~..I ................... Will excess fill be removed from premises: _Yes
14. Name of Owner of premises .~'..~.~,.'v~.~,h~,.c~.-~,.. Address ,~.. ,0...r~o.X..[~.~.)~ ...... Phone No..~..~.0..~,..I~ ."p:...%~.
Name of Architect .......... · · ..__ ............. Address ................ ').. Phone No ...............
Nmne of Contractor.. ~.4,~.~q,~$. . \ :~.-~.. ....... Address .¢. .rY3. ........... Phone So. B.q
PLOT DIAGRAM
Locate ~learly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block rmmber or description according to deed, and show street names and indicate whether
interior or corner lot.
COUNTY ~ .... .
....... Cf~- ..~~ ..... being duly sworn, deposes and says that he is the applicant
, (Name of individual si~ing contract)
above named.
~~~t, corporate officer, etc.)
of said owner or owners, and is dul~ authorized to--or have performed the said work and to make and file 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 manne} set forth in the application filed therewith.
Sworn to before me this
............... day of ....
No ublic ........... ! C unty
~/ NS~t~RY__PUDLI_d.,_St~2~,.~.~Y,?II' / /' (Sighature of applicant)
,~'~[~ : ~t0'=. l~
RODERICK VAN TUYL, P,C.
LICENSED LAND SURVEYORS
GREEN~RT :%, NEW YORK
~UFFOLK
SERVICE
CONSTRUe
DATE:
H. S. REF. I
~PPROVE[
SUFFOL
DIST.
loOO
~WNERS A
DEED: L. I
'rEST H~
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO. iI~-
,~ 7 ,, ,.-~ ,m~ --T~C. z~ -,, .... .,~,,"'~]j THE WATER SUPPLY AND SEWAGE DIS~SAL
, '.~=.- ~STEMS FOR THIS RESIDENCE WILL
~L_._'~ ~-- ; .... ~ ;
~T CONFORM TO THE STANDARDS OF THE
~,:p~kxz~>~C.~t,,,~?,:~, ~ SUFFOLK CO, DEPT. OF HEALTH SERVICES.
~T/~O~ ['xj.~ APPLICANT
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES ~ FOR APPROVAL OF
CONST~UCT~O. ONLY
11t~e~ p~ ~ ~d ~*~ ~ APPROVED:
S ~7 thla d tSo~ he~e SUFFOLK CO, TAx AP DESIGNATI~:
DIST. SECT. BL~K
~c~ ~: ~0'= ~" ' ..... ," ' '
SEAL
RODERICK VAN TUYL, P.C.
LICENSED LAND SURVEYORS
GREENPORT NEW YORK
SUFFOLK CO. HEALTH DEPT. APPROVAL
h.S. NO.
STATEMENT OF INTENT
The WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS for This RESIDENCE WILL
CONFO~M~THE STANDARDS OF THE
SUFFOL~~T~A~ SERVICES.
SERVICES -- FOR APPROVAL OF
co~uc~,o~ o~ ~/~/~
APPROVED: _
TE~ HOLE STAMP
SEAL
1, ALL WORK SHALL COMPLY WITH
THE ~EW YORK STATE CONSTRUCTION CO~E,
2. THE NEW YORK STATE ENERGY CODE SHALL BE COMPLIED WITH ON THE BASIS
OF PART 5 (ACCEPTED PRACTICE AND IN PARTICULAR AS FOLLOWS:)
3, PROVIDE SEPARATE HEATING ZONES FOR FLO0~
ALL EQUIPMENT SHALL COMPLY WITH THE ENERGY CODE,
5,FIREPLACE DAMPER SHALL HAVE A LEAK RATE OF LESS THAN .20 CFM OR BE
FITTED WITH A GLASS DOOR,
6,THE KITCHEN EXHAUST FAN VENT SHALL BE FITTED WITH A DAMPER OR BE
NON-VENTING,
7, HOT WATER AND HEATING PIPES SHALL BE INSULATED TO R : q,6 MINIMUM,
8,ALL HEATING, HOT WATER AND ELECTRICAL EQUIPMENT SHALL COMPLY WITH THE
NEW YORK STATE ENERGY CONSERVATION CODE.
INSULATE PER SCHEDULE,
CEILING _ ez ,~ t~j
WALLS - ~, ~
FLOOR i2: ~i
SLAB EDGE - ~: s~
WINDOWS ~ ~-- o ~9
DN
UP
TOTAL
~ENT AT
'~5::1~0:2 9'rAM T0'.4 p~ FOR THE
,~; -~?~ ;, ~,~'~[;LO,~,~ NG N~~ECTIONS, '
, ; :~ ' J ~'~UN~ION - TWO REQUIRED
,;~,,~ :: , ArJ .~;"-m"~!o~ SHALL MEET
DP~,~N n~ CONSTRUCTION ERRORS.
If coppeIr tubing is used
/
J:,:L : ,-.t-' - - -Is~r, uut,nu
for
system; piping shall be
of types K or L only
occu r "oR,,
,:
Unauthorized alteration or
addition to this document is n
i
considered valid cop~es.'