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HomeMy WebLinkAbout12989-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14314 ~ Date April 11 .................................................. 1986. THIS CERTIFIES that the building ..... .O.qe...~.a.m.i..ly..d.w..e .1.1.i.n. ~ .................... Location of Property ....6.7. 9..N.q~. T.HF.I.E..L.D..~.P.: .......... ~..O.U?.~O..L? ................... House No. Street Ham/et County Tax Map No. 1.000 Section . . .0.~.9. ...... Block ...... ~. ........ Lot ..... 5. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated [qa2'.cl~. 3.1~ ........... , 1984. pursuant to which Building Permit No...q.2.~ .SQ.g ............. dated .... & p. ? .5_.iL.. 9. ................198. 6.., 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.ne. fa,m± 3_y..dwoJ..ZJ. ng .......................................................... The certificate is issued to ........ WK?~i~ E. A... 4.OR~ ~ 9lq ................................. (owner,~)~r~/~ ~t) of the aforesaid building. Suffolk County Department of Health Approval ...... q. 6. 7.S.0. ~ .6 .9 ........................... UNDERWRITERS CERTIFICATE NO .............. N69.7.a83 ............................ PLUMBERS CERTIFICATION March 4, 1986 Building Inspector Rev. 1/81 FOBM NO. e, TOWN OF SOUTHO/D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 12989 Z Date ...... ' .o.~.. .............. , Permission is hereby granted to: .... .............. i~ . , 1l~7 c/ o .~.~.~.~...G.~ ........ ~.~ ....................... ...... at premises located ot ....,,[?,..~..~. ........ ..~,,.~,~,.,LJ.....~.:......~k~/,,.~.~.. ................... County Tax Map No. 1000 Section ...... ..0.,..~,..,~, ...... Block ....... .~ .......... Lot No....,.~.,,'~,. ............. ~u,suo,, ,o o~,,~o,,o, ~,ed ..... h.l.~.~......~.... .................. , ,,.t..l.., ond op,,ov~ by ,h. Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bui~din9 Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ia II1~ 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 property showing all property lines, stre~$s, 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. Fees: q "~ h 1. Certificate of occupancy ~-.$5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date .. ~'~.//.~[ ~.~. New Building ~ Old or Pre-existing Building Vacant Land Location of Property., .~?.~)...?.0/~,~.'~..7~<~', .~.~./,,~?C~. ~, .... /, .~.427, ', ,~H, ,~/~'f' ........................ House No. Street l-lam/et Owner or Owners of Property ....~.~..~.~..~ .... A-...-~o .~v~,~p. cQ ............................. County Tax Map No. 1000 Section .......... Block .. '-~ Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ......... Date of Permit £..~.,. .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. described building and peri, it meets all apl~licab~odes and regulations. Construction on above / THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 BUREAU OF ELECTRICITy ~-1~ 85 JOHN STREET, NEW YORK, NEW YORK '1OO3~ Oat~ June 20, 1985. Appm. atio,~ ~/o. o,/ite 298368/84 T.,S CERT,~.ES T.^T N 697283 only the electrical equipment as described below and introduced by the elppllcant named on the above application number itt the premises of Wayne John~on~ S/S Northfield -Lane, 500' E/O Dayton Road~ Sou~hOld~ N.Y. in the yollowing location; [] Basentent [] 1st FI. ~ 2nd Ft. Sectio,t Block Lot was examined on Jurte17, 1985 and found to be itt compliance with the require,nents of this Board. FIXTURE ~ FIXTURES OUTLETS SWITCHES RANGES COOKING DECKS OVENS EXHAUST FANS FLUORESCENT VApo~ 23 30 19 23 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: Foto~s: 1-1hp 1-G.F.C.I. 3-Smoke Detector Track Lighting 8' 0" 6 Lites. S E R V NO, OF CC COND PER ~' OF CC, COND. 1 2/0 NO OF HI-LEG C E I A, W. G, j NO, OF NEUTRALS O~ NEUTraL OF HI-LEO A. W G. I 2/0 Buland Electric Co. P. o. Box 143 ~attituck, N.Y. 11952 L$c. 2~2 PeL This certificate must not be altered in ~ny manner; re~urn to the office of the Board if ~ncor~ect. Inspector may be by their als. HENRY J. SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD, N,Y. 11971 (516) 765--3690 Inc. CERTIFICATION Date March /,..z__.1_9_80___ Building Permit No.__~2~ ...... Plumber Hen~ J. Smith & Sonz Inc. Southold I certify that the solder used in the water supply system contains less than 2/10 of 12 lead. Sworn to before me this _~h_day of -~h ..... , 19 86 Notary ~ubli c Notary Public~ Suffolk County State of New York, Commission ~xpires March 30, 1987 FIELD INS?ECTION COMMENTS FOUNDATION { lst) FOUNDRTIOt! 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: 7GS.180~ BUILDING DEPT. INSPECTION [] FOUNDATION XST [~ ] ROUGH PLBG. [ ] FOUNDATION 2ND ['"~INSULATiON [ ] FRAMING REMARKS:, [ ] FINAL DAYE,, INSPECTOR DEPARTMENTOFH£ALTHS£RVIC£S COUNTY OF SUFFOLK ~ETER F. COHALAN ~UFFOLK COUNT~ EXECUTIVE FACT SHEET LEAD IN DRINKING WATER SUPPLIES DAVID HARRIS, M.D., M.P.H. Sources of Lead Concentrations in Drinking Water Systems Use of lead solder in new plumbing or in plumbing modifications to existing water supply piping. Lead is not a naturally occurring element in Long Island groundwater. Occurrences Lead is present in drinking water as a product of corrosion. The natural corrosiveness of Long Island groundwaters contributes to this process. Most public water supplies in Suffolk provide chemical treatment to increase the water's natural pH, and minimize corrosion products, but no amount of treatment can produce a totally non-corrosive water. Studies indicate that after prolonged periods of water non-use, lead concentrations can be found in excess of Drinking Water Standards. This problem appears to be limited to newly installed internal water piping systems, or recently modified systems, in which lead-based solder is used. Lead is rarely detected in routine water supply surveillance. This fact is seen as indicating that, at a particular location plumbed with lead solder, this problem will diminish with time. The New York State Health Department concurs with this evaluation. Health Considerations Lead is a compound which is accumulated in the body. Human intake can be expected to occur through many environmental sources, including water. Recommended Action In order to minimize lead occurences, the following steps are recommended: Particularly in new or recently modified plumbing systems, users should be encouraged to flush the water line for a period of at least two minutes prior to consumptive water use. This is particularly necessary after prolonged water non-use, such as the overnight period. ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....~.(-r...~..., 19~.~. Approved...~¢& . . .c~..., 19~.q. Permit No../~ .~.~ .~.RT.-.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 beforeissuance 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 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 co~nply with all applicable laws, ordinances, building code, housing code~ and regulations, and to admit authorized inspectors on premises and in building for necessary inspect.,i9ns. .o f ) .~ (Signatured6f applicant, o/f/name, if a corporation) .... (Mailing address of applicant) t ~? ? o State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises .... ......................................... (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 .......................... Plumber's License No ......................... Electrician's LicenseNo ....................... Other ~rade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section 'O 7 ~ Block 3 ' Lot '~ Subdivision ..................................... Filed Map No ....... : ....... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy X) o~o_~x 3L I.~.t~c~ b. Intended use and occupancy ..... .~Y.~.iL-~... ~..~..'t (vk... F.e.~.t.~..ect..c*,?_ ......... -. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .~ ............. Removal .............. Demolition .............. Other Work ............. ~-. ! (Description) 4 Estimated Cost .~. ~ .~.~ Fee ~l ~'. (to be paid on filing this application) 5. If dwelling, number of dwelling iunits .... '......./ Number of dwelling units on each floor ................ If garage number of cars i 6 lfb a fly d t of htype f -- · usiness, commercial or mixe occupancy, spec nature an exten eac o use ................. 7. Dimensions of existing structures, if any: Front .... ~ ......... Rear ........ ~- ..... Depth -- . .... lteight Number of Stories Dimensions of same structure w!th alterations or additions: Front -- · ....... Rear .................. Depth ............ V- ...... :.. Height ................ -~ ..... Number of Stories .... ~/. ................ 8. Dimensions of entire new construction: Front ... /.~2:~.~.~. .... Rear ~ ~, n~,~, ~& ('C~,or.r tteight ............... Nuinber of Stories ii ................ ~w- ..... '. ....... v' · o~ze of lot Front Rear ...... ............ ........................ Depth .., .................... Date of Purchase ....~(C~.~... i/.~{ .°~. ............. mam.e of Former Owner .... ~ff?./. ~.e~...%. .............. Zone or use district in which pr~mises are situated .~.~..a~f..~.. ~. ......... Does proposed construction violate any zoning law, ordinance or regulation: . f~.~. ........................... Will lot be regraded .. ?.~.%~.,: .. .................. Will excess fill be removed from premises: Yes Name of Owner of premises . ~&/~.-~.~'. ~,..~.~,~ ..~. Address A~4.~.~f.,4/~.rf.~.~'. . . Phone No. 7 5,/-7 ~/.~. Name of Architect . JC~'.~¢t".~...~.~ (.~5.~&. ........ Address ......... .~ .~.r~.' .7~. Phone No. i ~-i&i~ Yi~&.' Name of Contractor . ~l c! ......................... Address ................... Phone No ........ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all.: buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block!number or description according to deed, and show street names and indicate whether interior or corner lot.i. STATE OF NEW YO~J;K, COUNTY OF..2j~,;P~./f.( ........ '~'(Name of individual sign above named. ·. · · · · · · · · ·. · · ·....~ ~/Z'/ being duly sworn, deposes and says that he is the applicant mg contract) He is the .......................................................................................... (Contractor, agent, corporate officer, etc.) of sakl owner or owners, and is dui ~ authorized to perform or have performed the said work and to make and file this application; that all statements cont~ ined 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 .............. .'" .~,. ~..m..day of:~ .......... 19 .,.cP?~" ! i N01^R'~N Pt/t~[10, ,State, o[ New ¥ort* " ,i ................ -Y ~ ' ~"~" ....... (S~gnature" ...... or2 appl~canD' ' '"" ' ' ~ / / / I I / / '/ / / t II O� lz:,,QOl'0E,PTY .'3/TU4TB AT ; VACANr `�✓ 1986 r7rv�5r<AV4. -<VSc L Gu4Tra Q w $ �pT OF + .•9CnAG ¢O — —< -— = Gx/-vr ,2 covToiz /„/� ✓�JNU.AR''Y /`ld4 —4 -- = a,QnRn6eo caYrt��'r L --j--- Ng�'�(TH S y NOR 41e W^ 4At C"VV^17Y TAA MAP OCSIalvA r/ON f � c:VST. /@OO SAC, 079 BLK. B LOT 5 _ —?-- q`ry o PAV'r q . /, EL�✓.4TlON3 .PW W&A- TO Th'E NAr1O.V.4Z. --h�_ - __.A6Pr!/3GT c,�purlc,qvteA'WOV1 >JKO O-� h'' i' _ -g•--�� � �_j ' AUNTY �K . le A74 OBLJ vo Tf/E uRFOGK 4 OdSOT. OF Pcl1?G/C WORKS. _. Q ,a1QvpG'i�TY G/CS .'N ZON/Nu DiST4lCT =\\ Z'/" •.' � , `yam �ialoaNce A . . .S. fa!'OPL'LTY Lls6 /N FLelfaO S'A1A.4O Love A4 - _-.----. _— \ � �'�� \�` \�•.'f'---j-;- �y_ (d1LK 6) U/d idO /{6 SHOi�.�. OA/ CO.vJM6/1,1/rY P4N64 4+ NO AMWA-!/T ,WVVC.0 -4k'771=4-B Z4;.SPC5HW4TB4' OF TKi Q.VV% ON MEKTdL CON.'48.?V10Ti v L4w /S '` I \ �,� YY 1 ,Q�Qs✓ilt0. 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L/C No.�w/'1'B �� N� i$ ,QQ• ''.. t.346 ?*Ar C. **"MY N.Y T.. G/C. M--44P IZ3 Fp LAND ICI 'k ��T✓.4T� AT t'�sfc.gwr� _ t986 .�'C�4G� : /"=40• — —4 -- -- _ �x/srnv� coNro��t �+ �l SERL/►OF &f.4NCJ.geY /984 D,��Pos�r� ccavTovt �'/Lc� - ��� CES NORTH _ - SUFfOG h �Ol�NTY TAX A^AP L7CS/GNq T/O/V -_ -- i o1sT. /000 sic, 079 5 f3�/'r /, ELEtiAT/J�vS ,QFFEQ TO THE N.4T/ONQL f-h�' ASPt/a�-' �•�� - �� _ vEdOETiC 4 to-�c:a o q ru,�� of /9Z 9. - ! ENC.4 A9A el< .0y THE CO�J.V 7-r- UG'PT, OF r�uQ:/G iti'O.QK S. ^J -! I-� �' • c�— Q, PRt>.,OeW rY L/ES ,')V tOrv/A/c's 0,STQ/CT Rs s/n�rvice A is As' 3. �G7CCF'C`!'TY L/C5 iN FLOOC� yaz4•¢c� Zo.v� A4 _- �` AS SHOJti.v 0A/ CaMMUN/T Y P.4N04 — �vun-saE.P 1 \ tv �. VO .-"RM/T✓A/OG�Q �4oC'T/CGG- 24 F?ESNKrATE4' IVErGGtir?�� t N It Y r— OF THE EN�.�Oti tiyEti'TdL ON:sEQvDTiO.v L4t�/ /S '\ O N \ \ REQu�CEJ. AS LETTER 04TEO c'o/23'62. j V �\\� ' �, __ NO PE,rCM/T :JNUd,Q ARTic:LE "5 r'T/OAS vV�TLQN05'J 1^ l' "l� Of' CON 4T ff e a. w�L� .w�sa���ra,�, / TE.vI L��t Tic i P✓c7'•ia"4'�. O 7. HC't-/.1C LCYL�T r V �rsrwtii L T4kF-_l�. O j I q �) ,OLK OOUNTY HEALTH DEPARTMENT AR Aa'L M C� 8 19$6' _ �' H. D. FvaF. 1 s e sewn h EX:ST/n�G Geao� v TOpu :\� ( �4- 1-1.e.r slinjaly -c-Ev. S.?r n O � - aoti , r `s -C , � s y ..: -�'.c-, cave been ToP ;,oic. i.o pec e3 pa.i'.LA;nL and found �� i c.r. ' be S8tisfa�t r 0 . oi�s�iT sE / �_� C3iief of General Engineering Y (� Services -- WA Y/VE A, ✓OfrNSOrV' I //o ���07(i 5 /4 NglNke NEST PD. 57"0/vY" r-- TES T Ho .4E101-c/reo�Y LINO off A. sron - - - I.Of NEW W. C45)MAf Y e, E 4;VVIVe 4e 5O/V �N'G/w�E'RS � �SUQ✓L�YO�c'S � ` ' � R��G�RT iti/, BQJwti N.Y.S. L/C Nam•lZO1/28 <i •. � O ..'HE 7 E NY. L. .e C. KEL3G�Y . f. /C. ,Vw,:�z3 ��� �� D J� SFD LA N D '�� It copper ,Uui„g 1� OCCO""ANCY OR for water distributing rDATE: y 8q 'B P. # ) a4 P q� 1 I system; piping shall be f�\VJ L..LINl1 OS� 7'' ���� M FO0. of types K or L only PEE /Od•9�- BY : U ,G ./- • - NOTIFY BUII_OING DEPARTMENT AT +;''`��` ' !:���•� C 1\11 ICI71 6.Tp. 765-1802 9 AM TO e PM FOR THE �'� FOLLOWING INSPECTIONS: 1. FO - TWO REQUIRED OF OCCUPANCY FORR POURED POURED CONCRETE 2. ROUGH - FRAMINr., n. PLUMBING 3. INSULAT!MI - - - - --- --- - 4. FINAL - CnpYSTNI 1�N MUST BE C^PAP rTF FOR C 0. ALL CONSTRUCTION SHALL MEET ///•••��� �y ,LjL-� �j��I,. __ THE REOUIRFMENTS OF THE KY � / � O NUC2TI�IFIELC� LAhIE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ` � ! DESIGN OR CONSTRUCTION. ERRORS, -- _ - 4 II viellf J WI � 4 vYsWT '140J gzf, —F-- T�Im1�UFsta�•Y. 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