HomeMy WebLinkAbout10536-zFORM NO. 4
TOWN OF 80UTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
8outhoid, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18049
Date MAY 23~ 1989
THIS CERTIFIES that the building
Location of Property 275 PINEWOOD ROAD
House No.
County Tax Map No. 1000 Section 110
Subdivision
ADDITION
CUTCHOGUE~ NEW YORK
Street Hamlet
Block 3 Lot 3
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 31, 1979 pursuant to which
Building Permit No. 10536-Z dated JANUARY 7~ 1980
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 CLEMENCE L. & J--F~N A. CAMERON
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
H 006381 - NOVEMBER 10r 1988
Building Inspector
Rev. 1/81
TOWN OF sOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, ~1. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 10536 Z
Date ...... Z ........... 19
Permission is hereby granted to'/.//f /
........ ~.~.~.~..c.~L~t ......~.,~,~.~..~..~z~
........
..~Zz~ ....................... ~,,~ ............................. ,.~ .....................................................
,, ~,,,, .,~,,~ ~, .~ ~ y,~.....ZL~....~.~.....&o ~a.~ ..........................................
pursuant to application date~,...~..4~-,~-~...X5 ..............,~'/ ...., 1~....~ and approved by the
Building Inspector.
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hail
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and subr~itted 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 buddings, 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.
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.
C, Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date . ./~.~ ~,~ ~ ..
New Boilding ............. Old or Pre-existin§ Building(X) ........ ~ ~Vacant Land ............
Location of Property . ~t~. .~.~-~.~. ~., ......... . ..........
House No. Street Ham/et
County Tax Map No. 1000 Section . ./'. ,/~, ......... Block ... ~. ......... Lot .... ~.. ..........
Subdlwsion ........ ~ ...................... Filed Map No .... ~ .... Lot No .... .'~. ........
Health Dept. Approval ........................ Labor Dept. Approval .........................
Underwriters Approval ........................ Planning Board Approval .............. ' ....~ ,.,
Request for Temporary Certificate ..................... Final Certificate ........ - ......... *
Fee Submitted $...~...~.~ .... ~ ................
Construction on above described building and permit~meets all app~cable~codes and regulations.
~ejE~¢'k_ Ap p hcant ~' ~ .........
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-
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 topographm features.
2, Final approval of Health Dept. of water supply and sewerage disposal-iS-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.
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.
C. Fees:
1. Certificate of occupancy $5.00
2, Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy Of certificate of occupancy $1.00
Data
Naw Building ............. Old or Pre-axisting Building(Z)., ...... ~/Vacant Land ............
Locat,on --. .
No.
Owner or Owners of Property ~~ ~ ~ ~,.~~ ~ ........
County lax ~ap ~o. 1000 Section .../g~ .......alock ... ~ ......... Cot...~ ..........
Subdlvis[on ......... ~ ....................... Filed ~a¢ ~o... ~ ...... kot ~o.. ~. .........
Permit ~o. ~.. Date of ~ermit .~.A~'icant ~*~.~~ .~ ....
Healt~ ~e~t. Ap~ro~a~ ........................ k~bor DeOt. Approval ...................... ,..
Underwriters Approval Planning Board Approval '
Request for Temporary Certificate .... ~.,: ............... Final Certificate ................. *
F e Submitted $ ..........................
Construction on above described building and permit~mee[s all app~i,cable~co,des and regulations.
Rev lO-10.7a
FIELD
I.
FOUNDATION ( I st )
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.Y.
STATE ENERGY
co E
FINAL
ADDITIONAL COMMENT~:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
8006378 ~UR~AU O~ ELECTRICITY
[~ 88 JOHN STREET, NEW YORK, NEW YORK 10038
D,,~ NOVEMBER t0 · 1988 Applic.,io, No. o,/ile 57259788/88 H 006381
~LEMENCE L. CAMERON, RR1,275 PINEWOOD ROAD, CUTCHOGUE, N.Y.
in thefotlowlng h,cation: [] Be~sement [] Ist FI. [] £nd FI. Section Block Lot
w~s examined on NOVEMBER O~ , 198~ and found to be in cotlipllance ,~'ith the requirements of thls Board.
FIXTURE I FIXTURES
DRYERS I FuRNAcE MOTORS t ~UTURE APPLIANCE FEEDERS
SERVICE DISCONNECT NO. O S
*NO VISUAL DEFECTS: "An electrical
survey has been made of the exposed
electrical equipment in the
premises indicated." "No obvious
unsatisfactory condition was found.
RANGES
SPECIAL REC'PT,
V I C
A W G NO O; HI-LEG A Y4 G
OF CC COND OF HI LEG
EXHAUST FANS
DIMMERS
This certificate must not be altered in any manner, return ,o the off~ce of the Board if incorrect. Inspectors may be /dent,fled by~eir ~re~i/ntials. ~
December 3~, 1779
'~ovm of ~authol~
Huil ding
?own }lel]
Southolc4 ~.Y. 11977
~¢lozed h(,~rowith i:~ a chock for fifteen lbllars and our ~cumonts in
ap,~licatton for o building ?oPf~:it for a kitchen extoBsio~ to
located on ~-~7~ ['ine %%~ood Ro~%d~ Cutcho~ue~ N.Y. ~1935.
'fho~,e doc~i~ont~: co,~t,~'~ise throe co~>ies e~]ch of ~*e
have pre,ored these ~olans odd ~sade these calculations under my ~3.Y.
P~ofession&~l F,n~ lnoer$ License /'36781 which is current.
(1) A,~plicat[on for Building [~ermit (Festal No. I)
(2) P~o ~erty Survey
(D) ~3uil~ng ?l~n~ ~nd written descrlptl~ms
(4) Calcula[.ions of he~t trens~is~ion coefficient for eziotin[~ r'nd
p~.'oposod otructureg indicsti~g results of other home in~u].c,t~ng
i~;~r~row~onts in "Trade Off" for o~tra v~ndow area (~kyliiht~:)
in ~mo~:o~_:cd t~itchen.
Very truly
Cutchogue~ New York
'1
/FZ.oO
G. '7?)
I1UUIbfl A~UL;IAIE$~ INC.
CONSULTING ENGINEERS
(212) 490-38g0
PROJECL_
SUBJECT__.
6.'4//7-
ou~, C~vdL
420 LEXINGTON AVE°
NEW YORK, NEW YORK 10017
CABLE: VANENGER, N.Yo
SHEET NO .... OF__
,JOB NO .....
MADE BY.
CHKD. BY~ ~ATE__
??
T=T', V~AL
CONSULTING ENGINEERS NEW YORK, NEW YORK 10017
.' (212) 4g0-3890 CABLE: VANBNGER, N.Y. SHEET NO ..... OF
PROJECT JOB NO
SUBJECT. _ .... MADE BY __DATE
CHKD. BY___ DATE
Barney A. Evans
CHIEF DEPUTY COMMISSIONER
COUNTY OF SUFFOLK
DEPARTMENT OF PUBLIC WORKS
r M KAMM I~RER, COMMISSIONER
YAPHANK, NEW YORK, 11980
YAPHANK 4-3451 - 3452
June 16, 1972
In[and HomesE Inc.
q32 Middle Co~nt~y Road
Selden, New Yo~k 11784
Town of $outholdv/
7SS-1802
BUILDING DEPT.
NSPECTIO,
FOUNDATION 1ST [ ] ROUG, PLBG.
.ou oJ ,o
/
FRAMING [,/] FINAL
REMARKS:~ ~/~~.~ :
DATE
ExaminedJ~...7 ....
Approved ~7~....~. .....
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
., 19 .~.
., 19r.~.. Permit No.
........... :.-7~'~ · ~ .............. z' . .......
(Building Inspector)
APPLICATION FOR BUILDING
Application No. f.~..~..~.~.4 .......
INSTRUCTIONS
a. This application must be completely filled in by typewriter or m 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 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 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 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 buildings for necessary h~spections.
(Mailing address of applica
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of/premises ffZ~.~,6'/~77.~/C~'7~,..(..~..~.'-~/~..~.*.---~:'-'-~'-~g-~.'~.'~'O~,).. ~ ................... (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 .... . ./~.~././(. ~... ............
Electrician's License No..
Other Trade's License No ......................
1. Location of land on which proposed work will be done .................................................
· .... ....................
House Number Street FIamlet
County TaxMap No. 1000 Section ...~//.~. ......... Block (272C Lot OOSr
Snbdiwsion .................................... 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 . .~-~d~r.~'~.d/~, .................. : .................................
b. Intended use and occupancy .,m____--~__r.~/,~.~.lS~./.4/.ff~....~,~,~/.././.~(~7../~:.' '~ .............................
/
$, NatureI of work (check which ap,plicable): New Building .......... Additiong. ........ Alteration ..........
Repair .............. Remgval .............. Demolition .............. Other Work ...... ~ ........
~' i (Description)
4. Estimated Cost f6*..O.~.:
(to be paid on filing this application)
5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................
If garage, number of cars ..... . ...................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of ea%h type of use
7. Dimensions of exisfing structures, if any: Front...~.O.' ........ Rear . ~: ........
Heighf ... ~..~.' ........ Number of Stories ...... .~ ................................................
Dimansions of same structure w~th alterations or additions: Front .... ~ ~. ......... Rear . .~.~ .............
Depthl ...... ~.(~.' .......... I.. Height .... 2~ '. ............. Number of Stories...~- ..................
8. Dimensions of entire new construction: Front ............... Rear ... 1Z .,~ ....... Depth . .~. ~. ..........
/.2. N lb
Height ..... ' ..... um er of Stories . ./. ........................................
9. Size of lot: Front .... ./~ ......... Rear .... F.~.f ........... Depth .... ~.~ .............
10. Date of Purchase ./.~..~r'*4.~:~d~..~.~.~. ......... Name of Former Owner ............... ,~e~r'.~'~.~'~l..
....... tuated
11. Zone or use district in which premises are s~ .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~ ............................
13. Will lot be regraded ....... ~ ................. Will excess fill be removed from premises: Yes
14. Name 'of Owner of premises~..~;~t..~...~, ~j~.~r~,.O~AddressZ~.~,~t~.~et~#~t.~.. Phone No..~r-r..~.~ ....
Name of Architect . .~.~. ~..~...~, ,~. ~. :~-'J~'~Address . .~.~..~¢~.zp ~. 4~.... Phone No ................
Name of Contractor ~'~,,,5~.,~r.'.~4' ........... Address ....... Pho e ....
PLOT DIAGRAM
Locate iclearly and distinctly al1 buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK._
COUNTY OF...~. ~.~../~..~, .~ .... S.S
..... ff~e./Q. ~,~. ~.~... ~.:..~../~.0~) ~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
abow~, named.
He is the . ~ ................... ' ....................................................................
I (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dhly authorized to perform or have performed the said work and to make and file this
application; that all statements con~ained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the mannpr set forth in the application filed therewith.
Sworn to before me this
;.. .,77:.,. .,./ ..... d. ..... ..........
' ~ LINDA F, KO?VA'
~o. s~[;i~;?~ vor~ ~ .~ (Signatur~b'~ applicant)
I I
11
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