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/.>
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