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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.~¥. ...................