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Home My WebLink About11012-zNo Z-20689 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date AI~RIL 29, 1992 Block 9 Filed Map No. THIS CERTIFIES that the building Location of Property ~QUESTRIAN AYENUE House No. County Tax Map No. 1000 Section 9 Subdivision ADDITION FISH,RS ISLAND~ N.Y. .. Street Hamlet Lot 26.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECE14BER 29, 1990 pursuant to which Building Permit No. 11012-Z dated JANUARY 7~ 1981 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 AS APPLIE~ FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROYAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ORMSBY H. MATTHIEBSEN N-521194 - MAY 26, 1981 N/~ Building Inspector Rev. 1/81 FOEH NO~ ~ '~ · TOWN OF soUiTHOL TOW~ HALL sOu~HOLD, N., ~. BUILDIH~ P~ (THIS PERMIT MUST BE KEPT ON THE PRENISES UNTIL FOLL COMPLETION OF THE WORK AUTHORIZED) ~ ~ 19 11012 Z Dora ~ ~ · Permission is hereby granted to: : Tox M~ No. 3000 Section ....................... . Block ,~...' ............... ; ot N ........................ ~ ~ ~ ~19~' ond 0 roved b tho /~-- ' ' · Rev. :~.o~,.o,~o~ov4o~' ~ Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: 1o 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey of property showing all property lines, streets, building and unusual natur~al or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinmaing pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $100.00 Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .................... .. Construction...........~ Old Or Pre-existing Building ............. ocation of Property ~-~5 z~ ~ ~ ~ ~'~ House No. Street Hamlet h~wer or Owners of Property...~..~../.~.~/.~. Oo~'o o .~/?F ~ ~ Too/ ~ounty Tax Map No i000, Section ..... ~ ........ Block. o. ...Lot ~ubdivision .................................... Filed Map ............ Lot ...... . 'ermit No~.~..f./.O./.'C.~...Date Of Permit./.7%.?..-'.~?...~...Api~licant.~.J~/~ !ealtb Dept. Approval ....... -.~--- .......... · · Underwriters Approva .......... noing Board Approval eq.ust for: ee Submitted: I~,4X; .q3 ? 19---~ Temporaryy 5~ ~Certificate ........... Final~j~o~ l~-'/~' ~]/Cur ticate '~' ~' '/~ ...... PLICANT 1000648 THE NEW YORK BOARD OF FI RE UNDERWRITERS BUREAU OF ELECTRIOITY THIS CERTIFIES THAT ' only the e~ctrical equipment as described below and introduced by t~ applicant named on ~he able application number in the premises of in the followlng location; [] Basement wasexa,nlnedon M~y 19, 1981 FIXTURE OUTLETS IECEPTACLES SWITCHES 18 22 15 ~ 1st FI. FIXTURES FLUORESCENT 7 [] 2nd FI. 0%1~S~ Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS E OTHER APPARATUS: ~,I~ Hea~:er/~: 2-1.5 Kw ~totor/$~ 1-1/3 ~ P~ard/s: 1,-~34 c~. 200 a~s~ 2-G,F.I, ~c. E R V I C NO OF CC, COND. PER ,E 1 OF CC COND NO OF HI-LEG OF HI-LEG NO. OF NEUTRAl AWG OF NEUTRAL Gadd Ooncractiog> Co., Fishers Islm~d, N.Y, 06390 l~, 2~-*~ GE.ERAL M~NAGER This certificate must not be altered in any manner; return to the office of the Board if ~hco~rect. Inspectors may be identified by their credentia;~ COPY J ILDING THiS COPY OF NOT, BE ANY MANNER. F%ELDrINSPECTION FOUNDATION FOUNDATION 2, ROUGH FRAME & PLUMBING (2 d) INSULATION PER N.Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. / / Examined Disapproved a/c ,...~...~/7 ...... (Building Inspector) APPLICATION FOR BUILDING P£RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in 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 ofproperty must be drawn on the diagram which is part of this application. c. The work ~overed 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, os 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 inspections. (Signature of applicant, or n~me, if a corporation) (Address of applicant) builder. ..................................... ............................................. If applicant is a co~orate, signature of duly authorized officer. (Name and title of carpor~e officer) Plumber's License No. Electrician's License No. Other Trade's License No ............................................... Location of land on which proposed wo~,will be dgne. Mep No.: ....................................... Lot No ................ // Municipality State existing use and occupancy of prem~ and intended use and occupancy of proposed construction: a. Exstng use and occupancy ......... b. Intended use and occupancy .......... ..~....~... ~..~./ff.{~m.~.. ............... property lines. Give street and block number whether interior or corner lot. 3. Nature of work (check which applicable): New Building ,.,! .............. Addition .....~... ......... Alteration .................. Repair .................. Removal .................. Demolition ........ ' ......... L. Other Work ................................................ ..... (Description) 4. Estimated Cost ........... y..~......! ..................................... F e ............. ~..5~..0..0. ................................................................. (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 c~rs ......i ............... Z .................................................................................................... ~ ............... 6. If business, commercial or mixed occupancy, specify nature and extent of ~,ach type of use ...... ..~..~..~....;,. ......... 7. Dimensions of e~isting structures, if any: Front ....~ ................ Rear ...... ~ .................... Depth .......~ .......... Height ...~.~ ............. Number of Stories ....... .~ .................................. ';'~'Y .............................. ~'~"7' ............. Dimensions of same structureiwith alterations or additions: Fronf ........ ~.}. ...................... Rear ....~. ..................... Depth .....~ ..................... Height ..~.~ ...............Number of Stories ....~ ...................... 8. Dimensions 0f entire new construction: Front .................................... Rear ............................ D~th ........................ Height .................. L Numb~r~of Stories ........................................... ~-.~ ......................................... ~ ........ /- ............... 9. S~ze of 1ot: Front .... ~ ........ , ...................................... Rear .......... .~ ................... ~.. Depth ................................ ]0. Date of Purchase ................. : ...................................... Name of Former ~ner ..~.~ ................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does~proposed construction viblate any zoning law, ordinance or regulation: .......... ~ ....................................... 13. Will I~ot be regraded ....~...] .............~ill excess fill be removed from premises: ( ) Yes ( ~ No ]4~ Name of Owne~ of premise~.~...~.~J~.~ ................... Address~F.~[~,.~.... Phone No ....................... -' Name of Archltect ............... ' ............................................... Address ............................. ~.. Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAG~M Locate clearly and distinctly al"l buildings, whether existing or proposed, and indicate all set-~ck dimensions from or description according to d~d, and show street names and indicate STATE OI~ NEW Y~RK, COUNTY (~ ...... ~ ~,4~. (.&r. ......... ~'~ A ' ,J(~,.IkJ !(,~i~i'3~ ~, .. be na duly sworn, deposes and says that he is the applicant (Name of individual signipQ contract) above named. ~,~ I .............. ........ ...................................... ! ....... i~ract~"a'~'~¥',";:'orporate 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 oil statements contained in this application are true to the best of his knowledge and belief; and that the v~ork will be performed in }he manner set forth in the application filed therewith. Sworn to b~fore me this ....... o, ....... ...... ' ................................ Notary Public, ............. -/;~'"'..v'"~' County (S, noture of ap cant) M,'~Y B. P~NKIEWICZ NU1AR¥ P[IBLIC, STATE I)F ~£W YORK Il(}, ',2-8267B~0 -- 8t]Fi;OLl~ COUNT'/ ','(;~IMiSSION EXidRE$ MARCH .31],! 19~9.~.~