The URL can be used to link to this page

Home My WebLink About13557-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.!.6.0.0.3. .......... Date. Ju~-? 30, 1987 THIS CERTIFIES that the building Addil:ions & alterations Location of Property ... 6. 2. .5..P.v.t. :..R.d. :. ?. 1.. S..t .e.p.h.e..n .s,o.n.s...Rtl.: ....... .0 .r.~ e. n. t House No. Street Ham/et County Tax Map No. 1000 Section . 9.1.7. ....... Block ...0.1 ........... Lot .... 0.0. 8. .......... S ... Map of the Cedars ........ LotNo ubdlwmon ............................... Filed Map No. 421 conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. 25, 1984 , pursuant to which Building Permit No. 13557.Z dated N.o.v.:..2.0. ,. ! .9 .8.4 ................ 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 ......... ... ,~.d.d.i ~ ip.n.s., .a.n.d...a.l.t.e.r..a.t j.o.n...t:9. ,e.x..i.s.t.!n. g' .o.n.e...f.a.m.t..1 y..d.w..e.l.l.~.n..g.. ......... The certificate is issued to GRACE B. LOMAS ..................... ?o¥,,'o;, '~ '~'~×xx .................. of the aforesaid building. Suffolk County Department of Health Approval ........ ~./.~. .............................. UNDERWRITERS CERTIFICATE NO ................ .P.e.n..d .5_.n.~ ...7/. I. 3. ./.8.7 ............... PLUMBERS CERTIFICATION DATED: MIKE JACOBI 8/10/87 Building Inspector Rev. 1/81 FO~:xe NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Nfl 13557~ Z Permission is hereby granted to: ...... ~..,.2../~.......~.....~~_:: ......... ..... z~. ..J. /~. ~.~z.~.. . Z ~.~.~. .......... .... ,o....~~~.~._~/ ..... ,. ~..~..~~...~~~ ...~....~~...~~..~ ............ ~...~o~ ....... .,,~,,,~ ,=,~,,'.~.~ ...... ~_..~.~..z.....C~~~.~: ....................................................................................................................... ~~=~..~ pursuant to application dated .....~......~... ......... ..~....~.. ........................ , ' .~....~., and approved by the Building Inspector. Fee $...~..~......~ .~... Bul ding Inspector 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 A. This application must be filled in typewriter OR ink, and submitted ~ 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. 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 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 requ ired to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS' $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3, Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20 00 5.Updated C.O. $ 50.00 Date .. . .../..~.~, ........ v/ NewC°nstructio~-~,.,. OIdorPre-.existinqBuiJding ,..~. ..... 4/.4 Hou No. /q_ " :treet ........... I Owner or Owners of Property . ,~,.& ~'-.9. ,~T-.... ~, ,-'.. Z,~,, ,~1,, ~,: ............. : ........ County Tax Map No 1000 Sect on ~ '~ Bock . ./ ' ,, · .... f .... ;; ................ LOt...~. ............ 11 F,,edMapNo otNo Perm tNo ~..~?.?Z"~ate of Perm t ./~.~.~..~F~p~ ,cant .. :.~,:~.'~.'. ~.'.~. i'~_iii Health Dept. Approval ........................ Labor Dept. Approval .................. ; ..... Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempo~a~fl Certificate ..................... Final Certificate ....................... Fee Submitted $//~Y/..~...~.~: ~ .............. Construction on above described building and permit meets..a, II a~licable codes and regulations. Applica ..................... Rev, 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N,Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Per,nit No. /3 ~"~,~f" Owner ; (please V~-int ) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /~- day of, 19E7 Notary Public, County HELEN K DF rOE NOTARY F'Utjx! ,~- ', , L',?; york Notary Public FIELD INSPECTION FOUNDATION 1st) FOUNDATION 2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY ~ODE FINAL COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS t BUREAU OF ELECTRICITY 0t31~ 85 JOHN STREET, NEW YORK, NETM YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described belotv and introduced by the applicar*t named on the above application number in the premises of ,?ohn I,oma~ O~.d HaJ~n ~oad ,So~thhold Orient in theJ~ollowing location; ~ Basement [] Ist FI. [] 2nd FI. Section Block Lot t~s exatnined on o"lJL~ 1L~ , 1987 × af~5~l found to be in compliance u'ith the reqnlretnent,s of th s Board. FIXTURE FIXTURES RANGES OUTLETS SWITCHES OVENS ERS 84 86 76 84 DRYERS FLUORESCENT FUTURE APPLIANCE FEEDERS SPECIALKEC'P1 TIME CLOCKS MULTI-OUFLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E NO O~,~C~CONV OTHER APPARATUS: r 8" -0'--.2 Li~es I C E A w G, NO OF HI-LEG A W G OF CC, CONO OF HI-LEG AW.G OF NEUTRAL ?ody Pumillo Lane Hettituck r~,¥, 11952 Lie#2300~-E GENERAL MANAGER ~ot be altered in any manner; return to the office of the Boar-~ :~ ...... Per l'~ ~-~'m~w'"~r"TeTT~a~'~a"~T~'7~e~w~r~r~eTT~Jrr'er~'~CO'~y ................. ~Z~~~]'~qrrec~' *nspectors may oe identified by their credentials. r~ ~u~ pu,LulHu DEPARTMENT. THIS COPY OF CER?FIC~TE~MU T NOT BE 4LTERED~iN A~ ~NNER BUILDING DEPT. INSPECTI ~ON ' [/FOUNDATION XST [ ] ROUGH PLBG. [~/]/FOUNDATION, 2ND [ ]INSULATION [ ] FRAMING [ ] FINAL INspECTOR TOWN OF SOUTHOLD OFFICF. OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 ThJs i.q [o advise you that the job under building permit no. ~35~ ~ssued to John Lomas i>n .l122QIB~ .... for Addition is completed and a flaal inspection bas ( ) has not ( x ) 'been done, An Underwriters Certificate is needed D~ order re complete thin file, it is necessary that ;t Certificate of Occupancy be issued. Please fill out the enclosed form, retarn same to the above office ~ith a check for $25.00 payable to the Town of Sonthold. Please indicate to l./hom the Certificate of Occupancy is Co be mailed, and arrange with this office for an inspection date Occupancy or u,qe ii, unlawful without a Certificate of Occupancy. t'len~e help us to clear up thi~ matter ao tha~ legal action does so[ have to be taken, 'l'hntlk y¢)~ for yot~r prompt agtentiono Victor Lessard Executive Adminfstrator encl . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 .& (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 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 inspections. ~/i /~' /] _ (Signature of applicant, or name, if a corporation) . . Y. /. . . . (M~iling afldress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ £ P..~ .-t-...r. c~..c,~..0. }, .................................................................... Name of owner of premises.. ~U~...~... ~ ./q.'~7 ..... (~'~.]¢ O ..... .~. .~. .~'~. ~rZ ......................... (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 ........ ?t .~ .............. Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone..~.~..~...?.~....~....,/..~..f-.c~.. ......... . . .l . . .-. . . . /4 . ?m 'r' ...................... House Number Street U 1 ~ty Tax Map No. 1000 Section ....... /.~. ...... Block .... /. ............. Lot....~. .............. Subdivision.. ~.~./.-.4. i)...0.'~...~.~...~*.E~(Jc4/~.~'~.. Filed Map No...2_~..~./ ...... Lot ............... (Name) 2. State existing use and occupancy of premlses and intended use and occupancy of proposed construction: a. Existing use and occupancy ~/3'7 ~ /~. D c4~.,.~. ].1 'gl a ~ ~ ........ f. ...... .. ....... /. 0 ~.. ....... . .................... b. Intended use and occupancy ......... ,~'..~.Df2 .~ .~... ~..~..-~./d'~.....~,.//~.~-~~/.~.'. 3. Nature'ofwork (check which applicable): New Building .......... Addition. ~. ..... Alteration Repair . ............. Removal ........ Demolition . ................... Other Work ............... 4. Estimated Cost ..... /.~..~.,,?.!O..O..~.¢.~. ~... .......... Fee ..... ~ ....... ~ .....1 .......... .' (to be paid on f/ling t is app ication) 5. If dwelling, number of dwelling ~ni~ ............... Number of dwelling units on each floor.., i ............ If garage, number of cars ..... i' '/' ............................................................... 6. If business, commercial or mixed occupancy, spe~fy natur~ and extent of each type of use ..................... ' · ' · 7. Dnnenslons of existing structures, if any: Front ,~.~. . . Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front 3..~. ~ .... p.]~ ~7 Rear ............ ...... Depth .................... ~.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ~ ¢. ~...]~ [~/0~ Rear ............... Depth ............... Height ............... Nun)her of Stones ............ '...; ..... ;, ............ Size of lot: Front .... [z~..0...! ........... Rear.../.q..O..'. .... i i i i i i i '~)'e;il~' i i~i Date of Purchase ........... i .................. Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed constructiort yioiate any zoning law, ordinance or regulation: . ./J,f..~ ........................ Will lot be regraded ..... .~....~ ........ ,..., ...... Will excess fill be removed from premises: Yes flqo Name Of Owner of premises/¢. ~/'.~!. ,.M./-& ~T~.~ ~. ~( ¢'~f~JAddress . .O. 1-. }.~ .,q..~/&~. Phone No. ,7~. ,J...'-¢~-.~.ltr · .~ Name of Architect '~).O n.~.l d..?.4;,..~ ~ ~. ~t.5 ..... Address AV~ .~ J.~ o.q ~.~, l,~. Phone No. ~. D.-r .~./.]... Name of Contractor .t~ r i [, a.aO.. ~,/o../~/~&/~ (L-T. Address . ~M,-~c,.['t 0 ~.~x ~ t..~Phone No. ? ~ t,/_. &/~.~./.. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from or description according to deed, and show street names and indicate whether 10. 11. 12. 13. 14. property lines. Give street and block number interior or e. orner lot. STATE OF NEW YORK, COUNTY OF ................. , (Name of individual sig~ing contract) above named. He is the ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duIy authorized to perform or have performed the said work and to make and file this application; that all statements confained in this application are true to the best of his knowledge and belief; and that the work w~ll b~ performed in the manner set forth in the application filed therewith. Sworn to before me this ~ NOT:~,RY PUBLIC, Stale ol New York (Signature of applicant) ~o, 4707878, St~tolk llerm Expires ~V/ardl 30, 19~'~ N II Sx//,.L.L. PM- 4~ P.o. s-L~ If COpper mbL 9 .~ for water distributing syslem; piping shall be of types K or L only PLUMBER CERTIFICATIJON' ON LEAD CONTENT BEFORE CERT]FICATE OF OCCUPANCY SOLDE]~ uSED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1% LF_,AD. · E P.J-J 1[' \ ~, A~ ~ U~, ~1 4. FINAL - CONSTRU~,IqB BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION ERRORS. tt /fl ~O ,.) ~'f I-d F.e,L~ !~oF l I l l i L DONALD A. DENIS A.I.A., P.C. ARCHITECT t- 1 ' I .DONALD A. OENIS A.I.A., P.C. ARCHITECT ( IZ ',0 II t Q I® II LI It