HomeMy WebLinkAbout12968-zFORM NO. 4
TOWN OF 5OUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z-16471 December II, 1987
No .................. Date ................................ ·
Construct Addition
THIS CERTIFIES that the building ................................................
1120 Broadwaters Road Cutchogue, New York
Location of Property ...............................................................
House No. Street Ham/et
9 O2
County Tax Map No. 1000 Section l 04 .Block ............... Lot
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
March 26, 1986 12968 Z
...................... pursuant to which Building Permit No ......................
dated ....~,a... · ....................r ch 30, I 984 , 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 .........
CONSTRUCT ADDITION TO EXISTING ol~g FAMILY DWELLING
EUGENE & MARY JANE BOLTER
The certificate is issued to ..................... ?o'~ob),YeTefeT~fe~;~ .....................
of the aforesaid building.
~/A
Suffolk County Department of Health Approval ..........................................
N844933
UNDERWRITERS CERTIFICATE NO ..................................................
N/A
PLUMBERS CERTIFICATION DATED:
Rev. 1/81
FO~.M' NO. ~
TOWN OF $OUTHOLO
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? 12968 Z
Permission is hereby granted to: , ~ ~ , ~ fi)
....... ...~.....~.~..~ ...... 2L~.~.~..~ ..........
..............................
/,~ , . ................. ~..~ ................... ~ ............ r'~ ............ ,, '- '~ ,
,o
.................... ~ .......... ..~ ·
at premises located at ..~.~ ~ ~, ~~ .-.~-...' .~~...~..
cou.,~ Tox Mop No ,ooo Se~,,on ....~ o ~ B,o~,~ ~ ..... ~t No. ~ ....~,..
pursuant to opplication doted ...... ..~....~ ................... , 19. ., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
flLDG. DEFt.
TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in typewriter OR ink. and submitted ~a IJ===~a=~ 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 unu~al
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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate suave,/ of pm3perty showing all property lines, streets, buildings and unusua~ 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.
C. Fees: . '
1. Certificate oi occupancy New I)welt[ng.$25.00, Acce.~.~ory ~$10.00
2. Certificate of occupancy on pre-existing dwelling ~ 50.00
3. Copy of certiflcate of occupancy $ 5.'00~ over 5 years 810.00
4.Vacant Land C.O. $ 20.00 ~'~'?/'~'~/://~°~-/~
5.Updated C.O. $ 50.00 Da~e ................
6. Alteration $25.00
Newtons [~uc[ton Old or pre-existing Building ~ Vacant Land
Location of Property .... · .................... '. ·" ............
o~ o, o~=. o, ,ro~,ty ~¢~J~¢.. ~.. ~.. ~ ~ ................. ·
co~ty r~ ~ ~o. ~ooo s=~,o~ .l~ ......... ~o~ .. ~ ........... co~...~ ...... '.
............. .... ........ .................................
Health De~t. ~ppro~al . .~ ............... kaBor Oept. ~pproval . ~ ................
Hnde~rit~r~ ~Oroval..~} ............... Pbnnin~ Board ~pOroual ...................
~eque~t ~or Tem~ora~ Certificate ..................... Final Certificate ..........
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
II,v,
BUILDING INSPECT"' S OFFICE
TOWN OF $OUTHOLD
TOWN HALL, SOUTHOLD, N. Y. 11971
765-1802
Deceraber 11, 1987
AWJ Construction Corp.
Depot Lane
Cutchogue, New York 11935
Dear Mro Jacobs:
We return herewith your Check #1283 in the
amount of $5.00 dated Sept. I, 1984.
You submitted this check for Building
~ernit #12968 Z for Eugene & Mary Jane
Cert{ficate of Occupancy.
Mrs. Bolter applied for the CO and it was
issued to her today.
Thank You.
SOUTHOLD TOWN BUILDING DEPT.
Georgia Rudder
Secretary
AWJ CONSTRUCTION CORP. 1 2 $ 3
DEPOT I.^NE
CUYCHOGUE, NY 11935
FORM NO. 6
TOWN OF SOUTHOLD
Building 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 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 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.
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 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:
1.
Certificate of occupancy $5.00
Certificate of occupancy on pre-existing dwelling
2.
3. Copy of certificate of occupancy $1.00
land use $/5-/$5.00
Date
New Building ............. Old or Pre-existing Building . .~. ......... Vacant Land .............
Location of Property ..(!..~.....~ ~...~...~ i
Owner or Owners of Property .~:..~~/E- ~'
County Tax Map No. 1000 Section ( ~ ¢ Block 7 Lot. 6 ~
Subdivision ......................... ./ ....... Filed Map No ........... Lot No ..............
PermitNo ........... ate of Permit .~/~.~.~..~.~. Applicant ~/'..~..~.'~'7 ~ ~.~.
..... ......
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $...?...'.~... ..................
Construction on above described building an/~/~s al~.
Applicant...~..~
Rev, 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
10003/['3 BURE[AO OF E~ECTRIC~Y
~ ~ 85 JOHN STREET, NEW YORK, NEW YORK I00~8
Date
THI~ CERTIFIES THAT
only the el~trical equipment ~ ~scrlbed below and int~uced by t~ applicant ~med on the a~e application number in the premises of
~y Jaue Bol~on~ ~roadwater Rd., Nassau P~. ~d,, Cu~ogue, N.Y.
in ~efo~o~in~ ~.c.~io.; ~ Basement ~ ;s~ FI. ~ ~nd FL Se~ion Bl~A Lot
~se~a,.i.edo. Nove~er 19, 1987 andfoundtobelncoo,plianceu'iththereq"ire"'entsgfthisBoard.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
3 2~
DIMMERS
DRYERS SYSTEMS
NO. OF FEET
OTHER APPARATUS=
~A~ L IGHTI~G
lites
E R V I C
NO OFp~CC~COND.
NO OF HI-LEG
NO OF NEUTRALS
j~' 7 - .CO~P¥ FO~ BUILDIN8 DEPARTMENT. THIS COPY OF C~R~.I~]~A~ ,ER~D IN ANY ~.
TOWN OF SOUTIIOLD
OFFICE OF BUII,DING INSPECTOR
P.O. BOX 728
TOWN ttALL
SOUTIIOLD, N.Y. 11971
October 22, 1987
TEt,. 765-1802
Mary ,lane Bolter
90 Fourth Street
Garden City, New York [1530
To Whom This May Concern~
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
_. PI .- on for Certificate of Occupancy
is not on fileo
~// ,'4o UndQ w/~.iters Certificate !All_f__ij~
/,_-_~/ Thc check is~c~/~md~xmmxX~}mm) Returned herewith. P].ease
submit new cheek - $25.00.
/.-_/ No Henlth Dept. Approval on file.
No final in~;[>ection has been made.
NOTE:
P.le,~se cont:act our office on this matter.
Thank you for your cooperation.
Building Permit t~ J_ j~ i ~_ ~_ Z
Duilding Dc[it.
***/~/ No Plumber solder Certificate on file..
( all permits involving plumbing being
issued after April 1~1984 )
Occupancy or usc is unlawful without a Certificate
o[ Occupancy. Clear up this matter as soon as possible
so that legal action dnes not have £'o be taken.
Thatlk you for your prompt attention.
Building Permit expired September 1986. This is your third notification. Please
submit the proper papers to this office by November g~ 1987 or an Order to Remedy
Violation will be issued.
FI~L'D ~NSPECTION
FOUNDATION
{1st)
COMMENTS
FOUNDATION
ROUGH FRAME &
PLUMBING
(2nd)
INSULATION PER N.
STATE ENERGY
C,ODE
FINAL
ADDITIONAL COMMENTS:
TOWN OF SOUTtlOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
We are unable to c
of Occupancy because ,of
/~/ An application
is not on file.
~- No Underwriters Cer
/5/ The check is(outdat~
/Z/ No Bealth Dept. Appz
/~/ No final inspection
Please contact our o:
Thank you for your cooper~ _
Building Permit
Building Dept.
***~_-- No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
This is to advise you that the job under building
permit no. _12968~Z issued to Eugene'Bolter
on _3~30~8~__ for Addition is completed and
a final znspection has ( ) has not ( x ) been done.
An Underwriters Certificate is needed
In order to complete this file, it is necessary that
n Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a check
for $25.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an inspection (late
Occupancy or nsc is nnlawful without a Certificate of
Occupancy. Please help ns to clear up this mstter so that
legal action docs not have to be taken.
Thank ynu for year prompt attest{on.
Very truly yo~,
Victor Lessard
Executive Administrator
VL:gar
encl.
Examined. !f~ .0~. q~...'.d~...
Approved· ').~.fit+.~.'~..~.~..
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
.,
., 19dr!. Permit No../.~.cl .~ ~.~
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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.
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
Building Zone Ordinance 6f 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 regulation_s, and to
admit authorized inspectors on premises and in building for necessary in,~c,~,p/s,~ (~
..... fir_t, TM ........
(Signature ~of applican[,/or n(aryfe, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, arch, itect, engineer, general contractor, electrician, plumber or builder.
.................................... ..........................................
Name of owner of premises .. G'..G;~ .c..-~..~.--i .~.....~.a¢. 'k,~.. ~...~...~..~.~ · .'~'. .........................
(~lc~a-4he 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.. ~.(. ¢.~'. F .............
Electrician's License No.. 7J( 7~ (
Other Trade's License No ......................
1. Location of land on which proposed work will be done ...... .~..~.. ............... -..
........ l....:. ........... ......................
House Nmnber Street
County Tax Map No. 1000 Section .../. ?..(~. ......... Block ..... ~. ........... Lot...'.~. .............
Subdivision .... t..~.'~...~).~ .~/.' .~. ........... Filed Map No.../fi~. ~-..],.,q'.~.. Lot ..~. f,~ .......
· (NaJne)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~.. q~.'~d.</~7. .... ~~,,~_.~ ..............................
b. Intended use and occupancy ....
' ' ............... ,:,J~i b~ ~% ~y: .'.i~: i'~ ~ '~ ................................
/
3. Nature of work (check which applicable): New Building .. ......... Addition ...~... .... Alteration ..........
Repair .............. RemOval .............. Demolition .............. Other Work ...............
! ~..~q- (Description)
4. Estimated Cost ........................... Fee ~)~--:
(to be paid on filing this application)
· ' fd~
5. If dwelhng, number of dwelling[units ............... Number o elling units on each floor ................
If garage number of cars
6. If business, commercml or mlxe'd occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any Front... ~?, .......... Rear . ~. ~., ........ Depth..-~.~. ............
Height /(. ~...~ ........ Number of Stories
l)jmensions of same structure with alterations or additions Front . .3 ~ ............. Rear ~'. ~ ...............
Depth: ~50 ............... [.. Height.../..~. ............... Numb. e~j~f S~ories . f..~.~ .............
8. Dimensions of entire new construction: Front ......... , ..... Rear . :?~..~. ....... Deptl~.. ~.'.~ ..........
9. Size of lot Front .... J7 .~... i. . th ~./..O..~..~..OI ........
10. !)ate of Purchase .......... i .................. Name of Former Owner .............................
11. Zone or use district in which pr~mises are situated ....... ~q--.--.--.--.--.--~~ ............................
12. Dobs proposed construction viotate any zoning law, ordinance or regulation: ..... .,~.. ~..~ ...................
13. Will Io~ be regraded ...~a.~...a.. i...~ ................. Will excess fill be removed froln premises: Yes
14. Name of Owner of premises ~.~../?:..~...o?~.,. ...... Address .~*. ~. ~..~.. · .~r~l~l~Sne No. ~. ~. ~..'~.2 ? .o.~ .~'~..
Name of Architect ......... [ ................. Address ................... Phone No ................
Nmne of Contractor ~'/'~.Jt°tr-o~,~ Ad,4 ....I)L'I~ r- z;. n-,~'c* Phone No. ~,.~. ~..~.~'7'.~/~
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY.O,F ...........
~.~...~.~.~.. · .'~. ............... being duly sworn, deposes and says thee is the applicant
~ ~(Name of individual sign~ing contract) -
above named.~-a
~teisthe~~.~.~ .~g>..-~..... ..... .. . .................................................................
I (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dully 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~edge and belief; and that the
work will be performed in the manne'r set forth in the application filed therewith.
Sworn to before me this
........... .~..~.....~A~.....day o~ .... .~<?. ~..~:.~A~ .... 19.~¥.
...................