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HomeMy WebLinkAbout13236-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY NOZ13628 DateMa~ 20, 1997 THIS CERTIFIES that the building one-family dwelling Location of Property 5530 Pe~uash Awe. House No. Street County Tax Map NO. 1000 Section 110 Block 5 subdivision x Filed Map No. x Cutcho~ue Hamlet Lot 34 Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated June 20, 1984 pursuant to which Building Permit No. 13236z dated June 20, 1984 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued isNew one-family dwellin~ with attached screen ~orch and deck The certificate is issued to Richard Anderson (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 14-SO-142 UNDERWRITERS CERTIFICATE NO. N691755 PLUMSERS CERTIFICATION DATED //B~ding inspector Rev. 1/81 FORM 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) N? 13236 Z Permission is hereby granted to: ~.....: ....... : ............. .,. ................. .~.........I .............. ..... ~,~ ....... ~k~...~....~..%.~.:.(~.:.~....;~...~] ................................................................... ot premises located at ....~....~...'..~....0. ...... ~.~..~....~ ......... .~..~ ................. County Tax Map No. 1000 Section ....... .I.L~. ......... Block ........ ~ .........Lot No.......~'...~. ............. .....................~ ~/. .............. 19.~..~.., and approved by the pursuant to application dated . ~,/..~ ........ , Building Inspector. - B~lding Inspector Rev. 6/30/80 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, NaY. Certificate Of Occupancy No ...... ~.1,3.6.28 ..... Date .......... .~.uly. 3. l .............. 198.5. THIS CERTIFIES that the building ..... one-family dwelling. Location of Property 5530 Pequash Ave. Cutchogue House No. Street Ham/et County Tax Map No. 1000 Section 1 1 0 .Block 5 .... Lot 3 4 Subdivision.. x x. x ............................. Filed Map No ........ Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 1 1 ..................... ,19 B.4. pursuant to which Building Permit No... 132~3.~ ............ dated ............,,,,.,,,,.....,.June 20 19 ~.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 ......... The certificate is issued to RICHARD ANDERSON ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ............ 1 t4 - $ O- 1 t~ 2 UNDERWRITERS CERTIFICATE NO. N 6 91 ? 55 Building Inspector Rev. 1/81 FORM NO. ¢ TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buiidin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... Z33.6a$ ..... Date ........... ~USy..1. I .............. 198.5. THIS CERTIFIES that tile build~g one-family dwel ling. Location of Property 5530 ?equash Ave. Cutchogue House No. Street Hamlet County Tax Map No. 1000 Section 1 1 0 . .Block 5 .Lot 3 4 Subdivision ........ x Filed Map No. x .Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated June 1 I , ..................... ,19 15.4. pursuant to wkich Building Permit No... 132,3.6Z ........ :~.. dated................June .... 20.... .... 19 {35. , 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 ......... New one-family dwelling. RICHARD ANDERSON The certificate is issued to ..................... ?oll, n'o;,'t~s~¥?e~}~ ...................... of the aforesaid building. Suffolk County Department of Health Approval 14 - S O- 142 N691755 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 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 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. 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. 1, Certificate of occupancy $5,00 [j QO_z~c~ ~_~:f~ ~°.O. - ~ ~', ~O 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1,00 New Building ...~;~ ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................. ~,q [, ,,,p.o,~?.¢~¢ ........................... House No, Street Hamlet Owner or Owners of Property .LU, C~.~.-?~. ~,~,~ ~7'~.O.T~ ........................................ County Tax Map No, 1000 Section ...I]Q ......... Block ,, ~ ............ Lot ...... ,~¢. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. %~.~36. ;K. Date of Permit 6/2.Q/'.~..Applicant Health Dept, Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate . J~ Fee Submitted $ .~,,0,0,,, ,~/, ,~,', 1 ~ ,~..~.~, ..... Const, ruction on above de~ribe, buildi~~2Z~cable codes and ,egu lat,on,. 76S.18~ BUILDING DEPT. ,: iNSPECTiON~~ ~ FOUNDATION ZST [ ] ROUGH pLBG, [*~FOUNDATION :~ND [ ] INSULATION FRAMING REMARKS: ,, [ ] FINAL DATE INSPECTOR FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH (1st) (2nd) FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ; ADDITIONAL COMMENTS 1001oea THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 8s JOHN STREET, .EW YORK. NEW YORK ~003~ o.te ~ 14, 1~5 307~8/~ ~"""~""~" ~* ~"~'~ N 691755 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the able application number in the premises of Rich~d ~der~n~ P~u~ A~ C~tc~gue, ~ inthefollowinglocation; x~,.~, (~aseao~ttt ~ lst Fl* was examined on ~i~D,y ~ ~ ~00 FIXTURE OUTLETS RECEPTACLES SWITCHES DRYERS FURNACE MOTORS ~ 2nd FI. Section Block Lot and found to be in compliance with the r~, quirements of this Board. FIXTURES RANGES FLUORESCENT OVENS DISH WASHERS EXHAUST FANS APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: ~oto~s 1-GFI, ~-Smoke Der. 8'~t' ~ ~es 'l~k Ltght~lg S E R 'V I ' C E NO, OFpERCC,,8,COND OF AccW'coNDG' ~NO' OF H I-LE~ :l. 1/o A, W G NO, OF NEUT?ALS A. W, G, OF HI-LEG OF NEUTRAL 3/0 Gary Doroski 4E5 Monsell Lane Cutchogue. AS' 11935 Lic Z~l E Per This certificate must not be altered in any manner; return to the office of the Board if incorrect Inspectors may be identified COPY MANI~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date July 11, 1985 Building Permit No. 13236 Owner Anderson (please print) Plumber Mattituck Plbg. & Htg. (please print) Corp. I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /~? aay of J~zF Notary Public, (plumber's signatur )~ . County o~N P' BRI$OIYI NO~,~,Y V~.~. 4732613 , Ma,ch ~0, 19 ~ FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ..~+~. ~ ..... 19g ?. Permit No. )..~..~..~. · .~. Disapproved a/c ........................... ' .......... ..... ~ ................. .D.~ ..j~...~...o~..' ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... Date ................... 19 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 ,~eui~ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or gulhtions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The ~lSplicant 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. · .~ ~¢~. ~.,~.~... ~. r, ~..,..-... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ge~ne~al contraqtor, electrician, plumber or builder. ............... .G e~..~e.~..¢,..... ?~...-x~...~:.~ ............ . ........................... ....... .....SO. I ........................... ~ /1 (as on the tax roll or latest deed) If.. ~~~.._~app 'can is po ' r of duly ............ authorized officer. (Name~r~d title of corporate~off~cer) Builder's License No.. ~ ~. '." .'7.~.[.~....~.'...--~...S .~ S ~ Plumber's License No ........ ~. ~. ........... Electrician's License No ...... ..~ .~[' ............ Other Trade's License No .... ~ [~-~. ............ 1. Location of land on which proposea work wili be done. . . .'.~'. . .~ .... ~-l~...< .................... ~s~.ip..e.q~s.~..../~..,:,., ..... .'7..~..00.' .... .s/~ ..... 6ov..~.,,.,'.~.. d'.~.~.s '~& ...... House N~mber Street Hamlet County Tax Map No. 1000 Section ..... i.~ .0 ......... Block .... ~.. .......... Lot .... 3..~.~' ......... Subdivision.; ]' i... i ~ ............. ~ ........ Filed Map No. . :-; .......... ~-Lot .-.... 7. ..... ~-.. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy., l...~. ~2¥[.~...'.~.~.~.{.'~{4~..{',~.:.'.~..~. X ~,, .¥?. b. Intended use and occupancy ..... ~ .~.' .~.' ..... ~...~J~..."~. S¥¢~.~o~ ....................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair ............... Rem6val .............. Demolition .............. Other Work ............... I ~ (Description) Estimated Cost... Fee ...... (to be paid on filing this application) If dwelling, number of dwelling ,Units ..... I ......... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or mixe~ occupancy, specify nature aCd extent of each type of use ............. ~ ..... rhmenmons of ex~at~ng structures, ~f any: Front . Height .... .~ .~. ....... Nu ~ber of Stories.. ......... !..e~.Jc%/ ................................ Dimensions of same structure ~ith alterations or additions: Front4 ............... ii 'Rear... ii ...... i .... Depth .. ................... i.. Height ...................... Number of Stories .............. ~ ....... Dimensions of entire new construction' Front . Height ...~, .7 ........ Number~of Stories ....................................................... Size of lot: Front ...... [ ~ ,O, . Rear ........ %.(~..C~. ) ........ Depth ... ~,~f)...~) ........... ~ate of Purchase ........... [ .................. Name of F. ormer.Owner ............................. Zone or use district in which premises are situated . Does proposed construction violate any zoning law, ordinance or regulation: ...... J~J I~ ...................... Will lot be regraded ....... h,~.(~. ................ Will ~xcess fib be removed from premises: Yes No Name of Owner of premises ...i ................. Address ................... Phone No ................ Name of Architect ! Address Phone No Name of Contractor ~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lir~es. Give street and block inumber or description according to deed, and show street names and indicate whether interior or 6orner lot. , STATE OF NEW YORK, iS.S COUNTY OF ................. ...... .~.13 .~.~.hg.¢'.. ~Z~.-~ .'~.~r,, [ ~¢. ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~He is the ... ~.~ i (Contractor,.agent~ corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file 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 manne~ set forth in the application filed therewith. Sworn to before me this ......... ................ · ,19 ~..~/ Nota~ Public ........ t'. 7....'TT?'rC'-ff...H[L[.N }~. ~[ Va[ ................ county i NOTARY PUBLIC, State ol New Yor~ ........ ........ lem [Xplres Mairch ~0, 19/.> P/>) >1 .-.1 1 2XlD ':"7:! II U ' I /'Z L &// //1'/ j C~ I /KY, .b .,'" ;0!- ':5 4 I, ! I - ................................................... e¢!eJC.?~ r~ t < ~ fzO ''1 !I C'~ I ' i j J ,.,~,, If! ::. ~ ~ ':'~ o,~. ..~ ~ ~ :Z ' ........ ~ ."t1:"-:'-"'~ ........ ~,~ ...... "] ............. ~ __:.__ ......... .... . _ = ~ .... ~ "x .."" / I I "-~ I ~ i >6, . · .} x. 'x 7_1 ..................... :\ 'xx '\ \ 'x -"1 / / I t 5',> ...................................................... ::::':i ~? :2:27:,2':?,g7:;':,.': ~.::::.:,:..L2"-.:2:"j::2:~,2 U 2 '.:".,.'::.: ~;-,;: ;:':7:':~:.":.::~ ;. ;',::2::: ~.t: '2:'~,:" ' '.' ': -,:. ,2:' ~: ': r. r. 11 iI 1 / i ,/ II (~ ttt il Ji ,1 I II ,! ill .......