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HomeMy WebLinkAbout12496-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z14759 August 5, 86 Date ................................. 19... THIS CERTIFIES that the building..~ qt ¢.i.t.i. 9~ ..................................... Location of Property 4130 Feconic Bay Blvd. Laurel, N.Y. House No. Street Hamlet 128 04 024 County Tax Map No. ]000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .J.u..t.y..1.1.: ........... 198..3. pursuant to which Building Permit No. z q 2496z dated . .it.u.g..u.s.t.. 2. .3., ............... 198. 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 ......... Addition to existing one family dwelling The certificate is issued to ............. .F.r.e.d..e.r.i.c.k...&..Charlotte Wallerius (owner, T~Y, Wo~ of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N 7 5 9. 3. 2 Rev. 1/81 FO~ NO. 2 TOWN OF SOUTHOLD BUILDING D~:PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING t'EIU~IT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12496 Z Permission is hereby granted to: ................................... .. ~..,~.~,~.~...,~../~..~....~.....c;t.7..~.~ / to ...... ~.~...~z.~..~..c~.......~C~..~ZO~....~ ...... ~-~,~.~.....~/~,~///,~ County Tax Mop No. 1000 Section .../.~.Z ......... Block ....~....~.. ........... Lot No..~.~...~... ........ pursuant to application dated ..... .~.~...~...~... ......... ./'/, ................ , 19.2~, ond approved by the Building Inspector. Fee $..~..~... ........... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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 featu res. 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. Commercia~ buildings, Industria~ 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 survev 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1,00 4.Vacant Land C.O. $5.00 $15.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ,'?~,/.~, House No. i Street , Hamle~ Owner or Owners of P roper ' ... ?..~.'/~.f.~.'~//./.~. .................... County Tax Map No. 1000 Section /"~¢6' Block 0 ~ Lot. . ~ .;~z~.' ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~. ~. ?.~... Date of Permit ~/./¢~.~..Applicant ~..~.~3~.,. ~..~'. ~.~.~¢44~ ,~ ............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .......,;,~ ............ '~/ Request for Temporaw Certificate... ~ ................. Final Certificate ....................... Fee Submitted $.. ~-: ........................ Construction on above described bui,lding and permit meets all applicable codes and regulations. Applicant..~..-~.~.¢~ .'~:. . _,-,-,-,-,~.~ ................ Rev. 10-10,78 ]:~I~ ¥OP~( STATE' DEPAPfMENT OF ENVIP/)N~NTAL CONSBIlVATION Regulatory Affairs Unit Bldg. ~0, SU~Y--Room Stony ~a~- ~ ~' 11794 ~, ,. '016) b1--7900 l qe'3 Bar A review has been aade of your proposal to: New York State ~part~at of Environmental Conservation has found the parcel ~' project to be: .... Greater than 300' from inventoried tidal wetlands. grea~r than 100~ in l~ngth constructed prior ~0'SeP~e~er fi0, 1~%77~''' ..... Landward of 10' contour ~levaCion above ~an sea level a a gradual, nat~ ural ~lope. ..... Landward of toposraphtcal crest of bluff, cliff or dm~ in ex~ms of 10 feet in elavaion above mean sea level. .. ~erefore, no pe~t under Article 2~ (Tidal Wetlando of the En~ron~ntal "-- Conservation Law) is required aC this ~im~ sinc~ ~he current proposal is beyond Sta~ ~nda~ed ]'~rtsdicCion pursuit to chis act, H~ever, any additional york or ~difications to the project ~y ~aq~re a pemlt. It is your responsibility to notify this office, in writing, If such additional ~rk of ~difications are c~te~ lated. Very truly yours, Regulatory Affairs DJL:RNT:cz FIELD1. INSPECTIONs, · . DATE ~J~I.~COMMENTS~"/~ FOUNDATION (1st) PLUMBING - INSULATION PER N. Y. STATE ENERGY ~DDITIO~B COHHENTS: ~ooo~o3 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~URE:AU OF ~[LECTRIC.,IT¥ [~ 8S JOHN STREET, NEW YORK, NEW YORK 10038 oat~.m~y ~.?, ~ ~.~.,,o.~o.o./.~ ' ~/~' N 7593~4 THIS CERTIFIES THAT o~ly the ~lectrical equipment ~ &scrib~ be~w a~ introduced by t~ applicant ~med on the a~v~ application number in the premises of in thefotlowlng location; ~ B~seme~l ~ Ist FI. ~ 2nd FL Section Bilk Lot ~sexa~ninedon J~ ~0~ FIXTURE FIXTURES RANGES COOKING DECKS ] OVENS OUTLETS £WITCHES FLUORESCENT DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: 1-G.F.I, ~noke Der ec~rs Track I~ghting 7' O" 3 Izttc~-I p~l~rds: 1-~ir, 200~ I R V I C NO. OF CC, COHD. A.w.G. PER ~ OF CC. COND. 1 2/0 NO. OF HI-LEG AW, G, OF HbLEG 1 OF NEUTRAL 2/0 IDE ~lectric 33 Eckern I~ Drive Smithtown~ N.Y, 11787 LiC. 22~8 E GEN'RAL MAN/AGaR This certificate must not be altered in any manner; return to the office of the Board COPY B~ILDING DEPARTMEHT. THIS COPY OF CERTiFJ~AT~ .,,' ~US~ NQT BE.,~ERED '~ ANY/v~NNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~. ~.~ ~.!., 19 .~.d Disapproved a/c . "Z ..... ;/' '~'/' ...... ~ .' ~ '_~.~ APPLICATION FOR BUILDING PERMIT Application No..../d .~..~.~. ....... filding Inspector) 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. . ........ ........ (Signature of applicant, or name, if a corporation) .. !.. .%Y.-. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ~general contractor, electrician, plumber or builder. O Name of owner of premises.....'~...I)..~I..OC...~Tr. ~..~...2fi?...T~..~,....~j..~.../_t.-.'~,. t.~..~. .............. (as on the tax roll or latest deed) If al: qicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~f>..I ................... Plumber's License No.../.~7~.0... ~-~-~-~-~-~-~-~-~-~... Electrician's License No. '~ ' '~ et Other Trade's License No ...................... Location of land on which proposed work will be done....4.~. '.~..O.. ~...~E~...O.t..~-...]~...x~.. i .1~....ff~. .............. House Number Street Hamlet County Tax Map No. 1000 Section ... !/.~..~. .......... Block ...47.. ............ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: I a. Existing use and occupancy ................ · .~ .Is~. · · .Lk4. · .kP'.-:) ................................. b. Intended use and occt~pancy Locate clearly and distinctly all property lihes. Give street and block interior or Corner lot. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .~. ........ Repair~ .............. RemOval .............. Demolition .............. Other Work ............... m~ ~(~r) ~ ~ ~,~re6X ~'F Tile T~~9(to be paid on filing this application) 5. If dwelling, number of dwelling ¢nits .... ( .......... Number of dwelling units on each floor... ~ ............ ' number of cars ~. [ If garage ................................................ 6. If business commercial or mixed occupancy, specff~ natur~ and extent of each type of use ............. 7. Dmenmons ofexmt~ng stmcturels, ~fany Front...~. ...... Rear .. ~ [ ...... Depth .~ ~ ...... Height~ ... Number of Stories.. ~ ..... ' ' ' ' D~en~ipns of same structure wlth alterations o~i~i~s ~ro~['' 8. D~en~ions of entire new construction: Front .~.1 ...... Height~ ~ t~~. ......... ~mber of Stories . . ~ .......... ~ ......................................... 9. Size o~lot: Front~...[~ ........... Rear... 1~ .............. nepth .. ~ ........... 10. Date of Purchase , .................of Fomer 11. Zone qr use district ~n' ~hich~r.':mises are situated... ~5{ ~M~ ................ A ................... 12. Does proposed construction vio ate any zoning law, ordinance or regulation: ...................... ~ ........ 13. Will lo~ be regraded . ~..~ ...z .... ., ~ ......... Will excess fill be remOved from premises: ~s No 14. N~e ~f Owner of ~emises ~ ~ ~°*Address ~ N~e ~f ~chitect/~ :1 ~ .~..~. Address PLOT DIAG~M bu~d~gs, whether existing or proposed, ~d, indicate M1 set-back d~ensions from number or desc~ption accord~g to deed, ~d show street nines and indicate whether STATE OF NEW Y, CrRK , i~ ~ ' ' (Name ofindividuC~I sigmng contract) above named. being duly'sworn, deposes and says that he is the applicant (Signature of applicant) He is the ... ....... ~'~-*~'l .................................................. : ................ (Contractor, agent, corporate officer, etc.) of s,aid owder or owners, and is dul~ auth. orized to perform or have performed the said work and to make and file this apphcation ;':that all statements contained m this application are true to the best of his knowledge and belief; and that the wbrk will b~ performed in the manne~ set forth in the application filed therewith. Sworn to before me this day of . , 19~ ' ! I Ne. ~-81~5850, Suffolk COW~/ ~'~o× OUT....-' r N ./ , f P If copper lubing is usec for water distributing · sys em; piping shall be of types K or L only ~PPROVED AS INOTi FEE: ~ ~'~BY: ' ~' NOTIFY BUILDING DEPARTM 7650802 9 AM TO 4 PM F FOLLOWING INSPECTIONS; 1. FOUNDATION - TWO R FOR POURED CONCRETE 9. ROUGH - FRAMING & PL 3. INSULATION 4. FINAL - CONSTRUCTIOt BE COMPLETE FOR C, O. ALL CONSTRUCTION SHAL THE REQUIREMENTS OF TI STATE CONSTRUCTION & CODES, NOT RESPONSIB DESIGN OR CONSTRUCTION PLAN Ng. ~ 4'~,E, J~ OF~ SCALE: ~4% It- O~ DATE Ouc¥ I1 "THESE PLANS ARE FOR THE CONSTRUCTION Of A 51e;~LI- STRUCTURE ONLY. USE OF THESE PLANS FOR ANY TIONAL STRUCTURE WITHOUT THE WRITTEN APPROVAL OF T AT )R THE ~UIRED IMBING MUST MEET :N,Y, NERGY FOP, RRORS, ,5 /f col,per tubing i~ U.~ed · ~ , I MATTITUCK, N Y ~ L O. OL : t L, H S 'PLAN N~. H4Gq,5 ~ OF.~ SCALE: t/4'l-- 1~ DATE ' ~ /01/~ ~ "THESE PLANS ARE for THE CONSTRUCTION OF A SINGLE STRUCTURE ONLY. use OF THESE PLANS For ANY ADDI- TIONAL STRUCTURE WITHOUT THe WRITTEN APPROVAL OF THe ArCHITeCT, WILL THEREBY TRANSFEr All rESPONS- IBILITY FOR THEIR USE TO THE USER AND THE AUTHORITY ACCEPTING THEM." 00'12. < .06, ,', or.. ,¢ L PLAN N~. ~ 4-'¢~ fl ~ ~ OF,,.~ DRAWN By,'~ ~ ~ CHECKED SCALE: = ~' ~, 'DATE ~ 'THE~E PLANS ARE ~O~ THE CONSTRUCTION OF A SINGLE ST~MCTU~ ONLY. USE OF THESE PLANS FO~ ANY ADD[- TIONAL ~T~UCTU~E WITHOUT THE W~[TT~N APPROVAL OF TH[ AffiCH]T~CT, WILL THE~[BY TRANSF[ffi ALL ~ESPONS- IBILITY FOR THEIR USE TO THE USER AND THE AUTHgRITY ACCEPTING THEM."