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HomeMy WebLinkAbout13126-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date... June 2~ 1987 THIS CERTIFIES that the bulldog ..... ~.ily dwelling. Location of Property 1 4 5 0 Cedar Ave. Southo ld hi,~s~ 74oi ....................... 's'~/e~ ....................... County Tax Map No. 1000 Section .... .7.8. ..... Block ........ 8. ......Lot 18 Subdivision ............... X, ............... Filed Map No .... .X .... Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...M.a.y. 2.,.. 1. 9.8.4. ..... pursuant to which Building Permit No. 1312 6 Z dated ...... M..ay..1.5. ,..1.9.8..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 ......... ...... ~..o. aer ~.a.m.i..17..~w..e.l.~.i..rig. ?.i.¥.h..a.~..t.a.c.h.e.d...d.e.c.}: ......................... The certificate is issued to MICHAEL & KAREN ROTHMAN of the aforesaid building. Suffolk County Department of Health Approval ............... .1.3 7.S, .O. 7.1.7.7. ................ UNDERWRITERS CERTIFICATE NO ..................... N759495 PLUMBERS CERTIFICATION DATED: 4/28/87 Building Inspector Rev. 1/81 TOWN OF $ou'r~OLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13126 Z Permission is hereby granted to: ............... to ....c~.~.'~./.,~.~...~... ~..~..~... E.~.~z~.,~....~.~r..~c~ ............... at premises located at ...Z..~.....~.....~... ........ ,.~..~.~.Z~....~.~..~.., ........ ~.~..~......~....~.,~.- ~. County Tax Map No. 1000 Section ..~,Z .~... ....... Block .~.~... .......... Lot No..~.~...~... ......... ~)ursuan, ,o a~lJcoti~ d~ .... ~.~.~ ....................... , 19.~a~ ap,~ by ~, Buildl~ Insp~or. P~ $..~.~.~...~ [:~ .,l'l' IF:CLUDES APPROVAL ¥.::~ :"r' "hVE EXCESS FILL FROM h, BOV~ PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESS~OL CONS [RUCTION ~EL~R CONSTRUCTION OTHER Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Buildlng Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ~ltis application must bo filled in ..Wpewriter OR ink, and submitted ~a~ to the Building In,cc- or 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-iS-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 compllanco from thc 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 p3:operty showing all property lines, streets, bulldlngs 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. C. Fees: 1. Certificate of occupancy New I)wc. lllng.$25.O0. 'Accessory .~10.00 Bunines:~ $50.00 2. Certificat0 of occupancy on pre-existing dwelling $ 50. go 3. Copy of certificate of occupancy $ 5/00, over 5 yeare $10oOO 4.Vacant Land C.O. $ 20.00 5.Uodated C.O. $ 50.00 Date .......................... 6. ~lteration ~,.00 NewCons true,ion ...... Old or Pre.existing Building ............ Vacant Land ............. Location of Property ..................................................... House No. Street _ Ham/et' Owner or Owners of Property . ~ lC. ~ .~-~.~-r.'.'~.. K~ ~ ./~...'. '~.'49.~..~..~../~.: .~. · ............. County Tax Map No. 1000 Section ........ Block ............... Lot ... ..... ' · ' Filed Map No Lot No SubdJwmon ............................................. , ............ e Permit Applicant ~'~/.c. ~.)A¢ ~-. Health Dept. Approval .(~,:~q 7<7.] ........... Labor Dept. Approval Unde~riters Approval ~.'7.SFfi~.~.~ ........ Planning Board Approval ...................... ' Request for . ' ' FinaICertificate Temporaw Cortd~cato ....................................... Fee Submitted $...~.; ...... Construction on above described building and. per~nlt,m.c~et~ all applicable codes and regulations. r~ . .~ ~ /-~ppdcant ,I;'Y~.~. r.~//~ ................................. THE NEW YORK BOARD OF FIRE UNDERWRITERS 10003~[4 BUREAU OF ELECTRICITY ~ ta5 JOHN STREET, NEW YORK, NEW yORK THI~ CERTIFIES THAT o~ly the ~lectrical ~ipment ~ ~ri~~ be[o~ a~d i~tmd~ced ~ the oppllc~t ~med on t~e ubove application number in the pre~es of ~tc ~. ~i. ~t~n, ~1~ D~vo, ~t H~d Side ~ ~e, ~ld~ N.Y. exa:ntned otl ~y 1, 1~6 and fout~d to be i~t compliance o, lth the ~equlremenl s of thls Board. fiXlU~ [ [ ~ fiXTURES ] RANGES ]C~KING DECKS ~ OV~ ~DISH WASHERS EXHAUST FANS OU~[ET$ gC~PTACLES SWITCHES INCANOESCEHT FLUORESCENT ~Y ~ K, W. A~T~ K W ~ K W ~ K, W, - -- ~L ~ P S~RVI~ DI~ONNECT ~ NO, OF ~ S E R METER ~1,. w w .w .o.o~ cc co.~. ~.~ o t 1~ ~ ~ X I 1/0 i 1/0 ~ Li~tln~ 12' 0" 4 IAt~ B.J. Electric (Jo. Sti llwater Ave tree Cutcho~ue, N.Y. 11935 Lie. 2670E GENSR~L~ MANX~ER This certificate must not be altered in any manner; return to the office of the Board i{ incorrect, Inspectdrs may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. Ti-liS COPY OF CERTIFICATE?US~~ ~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Perrait No. Owner ~[~ (pleas~ pr~n~} (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this Notary Public, County (plumber s si~~ Notary Public ~uo.~"% ,~e~ .h~~''- )')' FIELD ~NSPECT] ON DATE cOMMENTS 1. FOUNDATION (2nd) ROUGN FRAME & 3. ~S~ATION PE~ N. ~. 70j~/~ OF WO ......... STATE ENERGY C~ODE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: FOUNDATION 2ND [ ] INSULATION FRAMING ~AL DATE INSPECTOR~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ~i~NAL DATE 7G5-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ['~]//ROUGH PLBG. [ ] FOUNDATION ZND [ ] INsuLATIoN [/.;J/FNAMiNG [ ]FINAL REMARKS: DATE INSPECTOR i BUILDING DEPT. INSPECTION [ ~] FOUNDATION IST [ ] ROUGH pLBG. [ ] FOUNDATION ZND [c/]~NSULATION [ ] FRAMING [ ] FINAL RE.,.KS.- ....... d/F INSPEL~T~OR ~/~/~ TOWN OF SOUTIIOLD OFFICI~ OF BUILI)ING INSPECTOR P.O. BOX 728 TOWN ItALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This in to advi~e you that the job under building permit n6. 13126Ziasued to Michael Rothman on ._.~/15/84 for _New--~welii~g is completed a final inspection has ( ) ha~ not ( x) 'been done. , and [n order to complete this file, it is necessary that a Certificate of Occupancy be i,qsued. Please fill out the enclosed form, return same to the above office with a cheek for $25.00payable 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 date Occupancy or use in un].awft~l without n Certificate of Occupancy. Please. help us to clear up this matter so that legal action does act have to be taken, Thank yau for yens prompt attention. Very truly J~, Victor Lessard Executive Administrator VL:gnr eric I . 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,, ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 l ..mermit No./S/.t;./ ./7 Disapproved a/c ........ ~ ~ '[ ................ .//. ....... ................... T ."77;. . . . ~Building Inspector) APPLICATION FOR BUILDING PERMIT , .' INSTRUCTIONS Date ............ 19 .~..~ a. This application must be completely filled in by typewriter or in ink and submitted to the Buildin~ 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 perm. it 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.~r alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regula~ons, and to admit authorized inspectors on premises and in building for necessary, in$t:?ecti~as,/)~ /. ................... (Signatt~e of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~.~.qh.a.e.! .J....R. qt.h.m.a.n..../../.-~..~. ~.~.' ./t?....77...,~ p F/¥ ./-/.,0..t%) ................. 4' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. TO REM©VE EXCESS FiLL ~ FROM ABOVE PREMISL~3 BY ~ (Name and title of corporate officer) Builder's License No ....... i'.~...-- .... ' .......... Plumber's License No. i df. 7. 5~-. ~ ' Electrician's License No... ~.-. ~..-.. ~. ~x:7.~,...,~ Other Trade's License No .......... REGRADING LOT DRIVEWAY CON:':TR UCTION CESSPOOL CONSTRUCTION CELLA~ CONST~UCIION :,. OTHER Location of land on which proposed work will be done .................................................. 14. 5'0. Cedar Avenue Southold ' House Number Street Hamlet County Tax Map No. 1000 Section ..... Q7.8. .......... Block ...8. .............. Lot...1.8. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vacant Lot b. Intended use and occupancy ........ g¢~$O¢q~$~$.Qg¢.FoW$$7.g~¢~ ................................ Estimated Cost ........ 6.0.0.0.0,.. ......... Nature of work (check which a~plicable): New Building ....... 'Addition .......... Alteration .......... P, epair .............. Removal ............ Demolition .............. Other Work ............... - ' (Description) (to bo paid on filing this application) 5. If dwelling, number of dwellinglunits ........... Number of dwelling units on each floor ................ If garage, number of cars .....; ................................................................. 6. If business, commercial or m~xed occupancy specify natt~re and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... tteight ............... Number of Stories.. ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. D pth ' Height Number of Stories 8. I)lmenslons of entire new construction: Front ..... 3.2. ........ Rear .... 3.2. ......... Depth ...4.6...8. ........ tieight 27 '6" ' ' ............... Number of Stones ........ 2. .............................................. 9. Size of lot: Front ...... 1,1,6.. i ........... Rear .1.2.1.. Depth 1.8.0 Iq .2.0z¢..S 10 Date of Purchase , Name of Former Owner 11. Zone or use district in which pr~mises are situated ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................lq° ........... /.-7~-~... 13. Will lot be regraded ...... ye~ ................... Will excess fill be removed from premises: 4 Yes No 14. Name of Owner ofpremises'i. Mic, lla, e.1, .4.. Rothmqq. Address East Marion,. NY Phono w,, 477-0249)' ........ ~l<~J '~. ~d¢4~;*M ............................ i ........ i name o~ Arcngec~ ......... i ................. Address ................... Phone No. Name of Contractor ......................... Address ........... ~i ...... Phone No. ' i PLOT DIAGRAM ~ Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockJnumber or description according to deed, and show street names and indicate whether interior or corner lot. ~F-td.$'t/~ /--O ~" /~O. O STATE OF .NEW YORK, iS.S COUNTY OF ................. ' 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 saki owner or owners, and is duly authorized to pvrform or have performed the said work and to mike and file this application; that all statements contfiined 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 '. ........... .~.~ ..... day o~... · .~...~. ............ 19~../~. Notary Public, ....~..~..~,.~...~....') s:f/ County /, / , /t /a 6. 14M NO'I'ARY PUBI.IC, Slate oi ,Now ~,ork .~' ........ rj/./a ............................... i~ 0.4107378, a, ~0 I (,ounty .L It"t* [~r, re,~ ~,~r(,~ 30, / /Wi,AP OF PtEOPE2.TY' AT RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NE~ YORK SUFFOLK CO, HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS For THIS RESIDENCE Will CONFORM TO THE STANDARDS OF the SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOr APPROVAL OF CONSTRUCTION ONLY DA'rE' jO H. s. REP.NO.. APPf~OVED. ' SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT bLOCK PCL OWNERS ADDRESS: DEED: TEST HOLE STAMP SEAL ,IAN , S.C. DE_p~ OF..,...../ ami rater m~ If copper tubing is uaed for water distributing system; piping sha~l b, of types K or L only :~UPPL Y SYSTEM CANNOT ON LEAD CONTENT BEFOR~ CERTIFICATE OF OCCUPANCY USE HLA FUL CERfiFICATE OF OCCUPANCY iZLo,' ,C FEE~_~'~(~ -- ' NOTI~ BUiLDiNG D~ 765-1802 9 AM TO 4 PM FO~ THE FOLLOWING iNSPECTIONS: 1. FOUNDATION "TWO ~EQU~ED FOR p~UR~D CONCRETE ~. ROUGH - FRAMING & pLUMBING 3. INSULATeeN 4, FINAL - Cqf'c~PUCTION MUST BE CO,MpI,ETE FOR C. O. ALL CONSTRUCTION SHALL THE REQUIREMENTS OF THE N.Y. STATE CoNSTrUCTION & ENERGY CODES, NOT RESPONSIBLE D~IGN O~ CONSTrUCTiON ~' / .M/b¢//t. t, ,,,.,.,..,t.©. ,,. T