HomeMy WebLinkAbout13540-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
UPDATED C.O.
No. z17136 Date July 29, 1988
THIS CERTIFIES that the building .... 0. r}..e..f.a.m. ~.l.y..d.¥.e.Z.l.~..n.g ......................
Location of Property 380 The Greenway East Marion
IJl[~s'e HO: ........................................................ Street Hamlet
County Tax Map No. 1000 Section . .3.0. ........ Block .... 2. .......... Lot 47
Pebble Beach Farms
Subdivision ............................... Filed Map No..6.2.6..6...Lot No. !9.7 ..........
conforms substantially to the Application for Building Pernfit heretofore filed in this office dated
October 12, 1984 pursuant to which Building Permit No. 13540Z
dated ~ 9Y.e.m.b. e..r..I'.6.,..1.9.8.4. ........ was issued, and conforms to all of the requirements
of the applicable provisions of the law. The o,ccupancy fo[: wbicl,t this certificate is issuedis .,.
Private one-family dwelling wztH two t. 21 aec~s ~ garage wnzcn''i's ....
attached to one of the decks which is attached to the privat~ one-
family dwelling.
Tile certificate is issued to LEONARD & BETTY WALTERS
..................... ......................
of the aforesaid building.
Suffolk County Department of Health Approval ...... 1.4.'7S. 97.2.0.9. ..........................
N691471
UNDERWRITERS CERTIFICATE NO ..................................................
PLUMBERS CERTIFICATION DATED:
Original C.0. #ZI3558 6/25/85
K & K PLUMBING 5/24/85
Bnilding Inspector
Rev. 1ia1
TO%VN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
Ct'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No 13540 Z
Permission is hereby granted to:
..Z~..2~._~.. ~'..~.-~..,Z~.c~
...~0...~..../~.. ........ 4~Z ..........................
.... ~/~.-~.~.,~...~..:.~......~../.~...~
...~...,~..~..c~.~..:.~ .~,~..~.... ............................................................................
at ~remises located at -~(~ ~*/-/~ ~~/~/~f~-~-~ ~
co,,.~ Tax ~ap No. ~000 Sec.o...0..~.0.. ....... ,,ack ....~..g. ...... 'o, ~a. '~"Z" ........
~.uon, ,o opp,,~a,,o, dat,~ ...~.....Z~. ............................ . ,,2..~ and opp~ ~ ,he
Building Inspector.
Rev. 6/30/80
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building one-family dwelli:ag w/deck & Attached garage.
Location of Property 380 The Greenway East Marion
House No. Street Hamlet
County Tax Map No. 1000 Section 30 .Block 2 .Lot z~7
Subdivision....P,e.b.b. 1..e..B.e.a. ,c.h. ?.a..r?.s. ...... Filed Map No. 6266 .Lot No. ? 07
conforms substantially to the Application for Building Permit heretofore filed in this office dated
October d 2 198.~-.. pursuant to which Building Permit No. q 35~0Z
dated .... N..o..xr.e.m.b.e..r..q.6. ........... 19~.~., 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 .........
.., .~..~y?.~.e., .o.n.e.r .&a~.~. 7. ~Ve..~!i~.~' .wZ~.~..e.k' .5..a.~a. e..h.e.~., .~.a.r.a.~?: ..............
The certificate is issued to ......... LEONARD & BETTY WALTERS
(owner,~
of the aforesaid building.
Suffolk County Department of Health Approval Ig-SO.-2.09
N69q#7i
UNDERWRITERS CERTIFICATE NO .................................................
Building Inspector
Rev. 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
~{outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
in duplicate ~
A. This application must be filled in typewriter OR ink, and submitted, 'V, :~o' ~.he Building l nspec~-
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. Commemial 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 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.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.00
3. Copy of ce~iafi~c~e~f. ~c. cupancY5. 0051.00
~ew Buildin~ ............. Old or ~re-existin~ Buildin~ ........ ~fi. Vacant Land ...... ~ .....
Location of Property j~..~.~. ~~
co..,~ ~a~ ~,~o. ~000 S~,,~o. .... ~ ....... ~,oc~ ... ~ .......... ~o, . . ~ .........
.... ........... .....
,~a~, D~,~. ~o~ .~.~.:.~. ~ ~.~ ........ ~or D,~. ~,~o~a~ ........................
Unde~riters Approval ........... Plannin oard Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $,~, ......................
Construction on above described build~g a~er~ets all applicable~s~nd regulation,
¢,¢ ,~ ~1 ~ Appl ...........
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
~uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANC
Instructions
in duplic
This application must be filled in typewriter OR ink, and submitted, 'V,
tor with the following; for new buildings or new use: "
BLDG. DEPT.
....... ~OWN OF SOUTHOLO
I. 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--(So9 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:
I. 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 preoare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre~existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
New Building ..... . .tS~...... Old or Pre-existing Building ....... ~ Vacant Land ...... .~ .....
County Tax M/~o. 1000~ ction .... ;~..~. ....... Block ...~ .......... Lot..~ .~.Z .........
Subdivision ; .... Filed Map No ........... Lot No...,,~./~. .....
Health gept Approval tH - ~ - , .~.;,O o~ App
..................... Labor Dept. royal ........................
Underwriters Approval ,~.~..V~(.V-~..~,., ..~ .......... Planning Board Approval ......................
Re uest for Tem a \ '~
q por ry Certificate ..................... Final Certificate .......................
Fee Submitted $ .._~2. .........................
Construction on above described building and.p~rm,~ets all applicablepqdespnd regulations,
State of New York)
ss.:
County of Suffolk)
BLDG. DEPT.
3"OWN OF SOUT,HOLD
William H. Price, Jr., being duly sworn, deposes and says:
1. I.am the attorney for Leonard and Betty Walters and am personally fa-
miliar with the facts hereinafter set forth. I make this affidavit knowing
that the Building Department of the Town of Southold relies upon the truth
of the statements contained herein.
2. My clients are the owners of certain improved real property located at
380 The Greenway, East Marion, New York, designated on the Suffolk County
Tax Map as District 1000 Section 30 Block 2 Lot 47.
3. That in respect to the one-family dwelling with other structures lo-
cated at said premises a Certificate of Occupancy No. Z13558 was issued by
the Building Department of the Town of Southold on June 25, 1985.
4. My clients have contracted to sell the premises and the purchasers
thereunder or their lender is requesting that the certificate of occupancy
be made more specific. The certificate of occupancy currently describes
the approved structures as "PriYate one-family dwelling ~/ deck & attached
garage". The requested amendment would read "Privat~ one-'family dwelling
with two (2) decks & garage which is attached to one'of the decks which is
attached to the private one-family dwelling".
5. On July 27, 1988, I did go to the premises and, in fact, there is a
deck in the back yard attached to the house and there is a deck in the
front yard which is attached to the house and to the garage.
Sworn to before me this 28th
day of July, 1988
Notary Public /
URtE F- GP, AEB
~k~.~,. State o! New York
~k~t~'Y ,~,,~,~. SuftO~k County
NO.~z'"'"' per 30 1988
T~ ~ires Septem '
.Luul~ THE NEW YORK BOARD OF FIRE UNDERWRITERS
SUREAU OF ELECTRICITY
~ o.L 8~ JOHN BTREET, NEW YORK, NEW YORK 1003~
THIS CERTIFIES THAT
only the elec tricel equipment as described below and i~troduced by, the applicant named on the able application number in the premises of
in the followlng location; ~ Basemer~t ~ 1st FI. ~ 2nd FL Sect~o~ Block Lot 10'1
was examined on ~,~ ~ ~ and found to be in compliance with the requirements of this Board.
FIXTURE
OUTLETS SWffCHES
JO
DRYERS
I ~ FIXTURES
INCANDESCENT FLUORESCENT
RANGES OVENS DISH WASHERS EXHAUST FANS
OTHER APPARATUS:
;~lm;orb 1-~/~ 11t*
Zd-t-O" t0 li"~es T~ac~ ~ti~5
$ E R
OF CC. COND
C
NO O~ HI-tLC
A. WG
OF HI-LEG
1
A W, G
OF NEUTRAL
4/0
G- ~ ~ Electric
.[~Lc 5?5 E
OENI:RAI,~ANA~E~
Per 11
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
.... CP"hF°." SM'O "? OEe~"TME"~ T" S~CO~ P~C~"T F~,C~W~,~q~T ~OT ~E~T~eEO '~" ^"V MA""E"
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No.
Owner ~ ~/~/~D
(please p~ri~{) ' --
Plumber ~ /~
(pi-ease' print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber' s signature)
Sworn to before me this
~y day of ~.· . ,
Notary Public ,~County
iBC'it ry' L. WALTIER~
I~OTARy Pt/BLC, State of t/e~ York
~1o. 5,~-4147350, Suffolk
~ F. xplr~ Uar~ ~0,
The sewage direful a~l wster aul~l~l¥
facilities for ~bJ.~ looation ~ve been
inspected b~ this do~rtm~ut ~ found
Services
FIELD IN~FECS*ION COMMENTS
FOUNDATION ( 1 st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
QODE
FINAL
ADDITIONAL COMMENTS:
(516) 298-4817
North Fork Drywall & Insulation Co.
P.O. Box 1230
Mattituck, N.Y. 11952
~.~ I
SWORN TO BEFORE ME THIS 13th day of
MAY 1985
76S-1802 ·,
BUILDING DEPT.
NSPECTION
FOUNDATION IST
FOUNDATION 2ND [ ] INSULATION
[~RAMING [ ] FINAL
RE:MARKS= 0/~/
DATE
INSPECTOR ~/~
765-1802
BUILDING DEPT.
INSPECTION
[ '1 FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[]FRAMING
/[~/~ FINAL /,
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Received ........... ,19...
Date.. ~.../-~.. ..... 19gY
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. ' '
e. 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. blo 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 Courtly, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolitinn, as herein described.
The applicant agrees to comply with all applicable laws, ordfnances, building eogl~, housing code, and regulatigj3s, and to
admit authorized inspectors on premises and in building for necessary .... inspecti~./~d~ '~WY~- _ ..~.~_~.~'"~"" ..........
(~tu~eof applicant, or name, if a corporation)
' . - (Mailing address of app~ant) /
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..... D:... ./:(. .-% .................................................... -: ........
Name of owner of premises . ~..~6~..0..~.~Z~. ,ff....J-..f~..'~..~2fl..~ ~ ..................................
(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 ............ '..: ...........
Other Tmdc's
I. Location o~land on which proposed work will bc do~c .......... ~ ......................................
House Number -- Street
Subdivision . . q~ ......... Filed Map No ............... Lot ..........
/ (Name) : ....
2. State existing use and occupBncy of premises and intended use and occupancy of proposed construction:
~, ~x~stin~ use and occu?ancy ..........................
. ~.. nten e us cupanc ................. ,~ ......................... ~.,.
3. Nature of work (check which apphcable): New Building ....... Ad&hen . ~, ........ Alteration .; ........
Repair ........ ' ...... Removal; .............. Dgmolition .............. Other Work ...............
~ .~..~.~. ~ (Description)
4. Estimated Cost ...... ~ ~~.)~tJ~0:~O. · ................... Fee ........................
(to be!paid on filing this application)
/. Iii
5. If dwelling, number of dwelling units ............ Number of dwe ng units on each floor ................
If garage number of cars '
6 If business commercial or mixed occupancy specify nature and extent of each type of use
7 Dimensions of existing structures if any: Front Rear ' Depth
Height Number of Stories
Dimensions of same strUcture with alterations or additions: Front ~ Rear
Depth ...................... Height ........... ~ .......... Number ~f, ,~ories .......... ac. ,~ ......
a. DimensionsofentirenewconstrUction:Front ..... ~t~.'~.: .Rear.. ~....Depth....~E..... ....
Height ............... Numbet' of Stories,..,~..~..~..~ ..... ' ' '
.....-.........
9. Sizeoflot: Front ......... 2?/. ........ " "', .... / ............i ....... , ~ ....
10. Date of Purchase ../~.~./~ .................. Name of Former Owner i ...........................
1 1. Zone or use district in which premises are situated 7~ ...................................................
12. Does proposed construction ~'iolate any zoning law, ordinance or regulation: ~ ........................
13. Will lot be regraded ............................ Will excess fill be removed from premises: ~ No
14. Name of Owner o remises . · . reds .............. ; ....Phone No.. .':' .....
Name of Architect ........................... Address ......... ~ .... i .... Phone No ..............
Name of Contractor ~.~>,a.~,~g~... ~/.~Fe~-4- ..... Address ...... ~¢2:.-~.~..~... Phone No. 7.~' ~.. ~..~..~.
PLOT DIAGRAM
Locate. clearly and distinctly all buildings, whether existing or proposed, and. ifidicate all set-back dimensions from
~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
./
COUNT F ...... ~'~ ~- . q ;~.~d,~'e,~,,~ ~,,~ ~/
.........
(Name of individual signing contract) ,
above named·
tte is the ........................................ ' .............................
(Contractor, agent, corporate officer, etcl)
of said owner or owners, and is duly authorized to perform or have performed the !said work and to make and ~e 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 manner set forth in the application filed therewith·
Sworn to before me this
· ·. ~ ~t0~('~.f~ ~t0t~.day of. · ~ .....
~ g~'4147350, Suffolk CounJ~ ,**~*:-. -~ ~ .//., ~
Not aryl~ub~c*,# r.~ ~. ~ ~-~..'~,Z...
TH.C--
~ FOR APPROV~L OF CONSTR~JCTION OF
. . Singl~ Family Residence Only
/~ ~. t~%X r~,,..,
State of New York)
ss.:
County of Suffolk)
William H. Price, Jr., being duly sworn, deposes and says:
1. I am the attorney for Leonard and Betty Walters and am personally fa-
miliar with the facts hereinafter set forth. I make this affidavit knowing
that the Building Department of the Town of Southold relies upon the truth
of the statements contained herein.
2. My clients are the owners of certain improved real property located at
380 The Greenway, East Marion, New York, designated on the Suffolk County
Tax Map as District 1000 Section 30 Block 2 Lot 47.
3. That in respect to the one-family dwelling with other structures lo-
cated at said premises a Certificate of Occupancy No. Z13558 was issued by
the Building Department of the Town of Southold on June 25, 1985.
4. My clients have contracted to sell the premises and the purchasers
thereunder or their lender is requesting that the certificate of occupancy
be made more specific. The certificate of OCCupancy currently describes
the approved structures as "Private one-family dwelling w/ deck & attached
garage". The requested amendment would read "Private one-family dwelling
with two (2) decks & garage which is attached to one of the decks which is
attached to the private one-family dwelling".
5. On July 27, 1988, I did go to the premises and, in fact, there is a
deck in the back yard attached to the house and there is a deck in the
front yard which is attached to the house and to the garage.
Sworn to before me this 28th
day of July, 1988
Notary Public
NOTIFY BUILDING
1, FOUNDATION - TWO REQUIRED
ALL CONSTRUCTION SHALL MEET
THE REQUI?EMENTS OF THE N,
'0
0
0
I
, . _ .............. -- ..................... d ~-Ummtlhoriled-m
or
i the', Nev~ York State EducatiOn
Copies, of this document not
beari~!g the enginee/s inked
~eal or embossed seal shall not
be~ comsidered valid copies.
¥~\0 .,~ oO , :
addition to this document is a
violation of section 7209 of
fhe New York State Educmtlon
Copies of' this document not
bemring the enginee/s inked
se~l or embossed seal sh~Jl not
be considered v~lJd copies
NOmESi
1. ALL-WOP/~ SHAL~ COMPLY WITH THE NEW ¥0EK STATE L~6IFORM lPIl~
P~VENTION AND BUILDIN~ CO~S,
2. ALL ,LINTELS SBO~I ARE }IINIMUM.
3. DOUBLE JACKS FOR ALL OPENINGS GREATER THAN 6 PEET,
4. D~UBLE FLOOP JOISTS UNDER PARTITIONS.
5. DOUBLE RAFTERS AT SKYLIGHTS AS APPLICABLE.
THE NEW YORK STATE ENERGY CODE SHALL BE COMPLIED WITH ON
BASIS OF PART 5 (ACCEPTED PRACTICE AND IN PARTICULAR A~ ~LLOWS:)
7. PROVIDE SEPARATE HEATING ZONES FOR FLf DE.
FIREPLACE DAb, PER SHALL HAV~ A LEAK BAT}~
OR BE FITTED WITH A GL;tiS DOOR & HE FIT"ED WITH AN, E~TERNAL
COMBUSTION AIR SOURCe.
NON-VENTfNU.
ALL ~HTIN~, ~OT w~TER, AND
WI~H Tlil~ NEW YORK ~AT~ CON~RVATI~N
. INSULATION SC~DIILE
0,40
r
additiom fo this document i~ a
425 %'~1
-i
Un.uthorized alteration or
mddltlon to th~s document ii ·
violation of section 7209 of
the New York State Educ~tlon
Cop~es of this document not
bearing the engineer's inked
~eal or embossed seal shal~ not
Un,uthorized alteration or
~ddition to this docUmeM ii
violation of section 7209 of
the New York State Edu¢,tioil
Copies of this document
bearing the engine,/s inked
se~l or e~lb~ssed se~l shall nat
be considered valid copies.