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HomeMy WebLinkAbout13128-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13544 Date June 21 .,19~.5. THIS CERTIFIES that the building .... Qn..e..f.a..m~.~.Z..dyg. l.~ ~..ng ...................... Location of Property .4. 5...D.o.g. ¥ ps.cl...L .a.n.q..&..3.3.6. 5.. ?.qn..n Yg..~ 9.a.d .... .S.o.u. ~..h.o.~.d. ........ House No. Street Hamlet County Tax Map No. 1000 Section .... .0.5.4. .... Block ... 0..5 .......... Lot ......... 0. ,2 .4 ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. 3.P.~ ~- .Y..2.3. ........ ,1 ~).. pursuant to which Building Permit No.. ~..3 J .2.8. z. ............. dated ....... ~.aT..1.6. .............. 19.0.4., 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 ......... ... p.n.e,, fp..m.i..ly..d.~e..]_.Z.i.n. &,..~ % .'.'.'bb..1.~ .t..f. lo. 9r' .qe. ~.k .............................. The certificate is issued to JON C. KERBS ..................... k'X' ............... of the aforesaid building· Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ................... ~.6.8.9..3 .4 ~ ....................... PLUMBERS CERTIFICATION 6/20/85 Building Inspector Rev. l/al FOu~W NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13128 Z Permission is hereby granted to: ......... ..................... ......... ,.,6 ..~..~...z~..,d.z.~....~., ............................. ........ ~.,~.~.o~..-:..~..:,~.....//?~ ~ ,o ........ ~...~..~..c,,~/~.........~z~.~....~,~.~.~..~.......~,~d~f~ ................ 1 at premises located at ..~.~,.....;,,/~,.~.7.k~/~,C).Q...~'il ................ ~ ............................. ................ .~.! ....... ~.~...~; ...... ~.~:'~.~..,~.~.....~.~.~ .......... ~.~:~..~.......-- County Tax Map No. 1000 Section ,..,~..,~,,,,~.,~... Block ..,,,,~,,..~. ...... Lot No. ,~..~,...~.., ...... Building Inspector. Fee $. Z ~,,,~,,~,~.~ Rev. 6/30/80 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. 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 survey of p~"operty 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 inf, orma- tion required to prepare a certificate. C,. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy__V $1.00 ~..~.~. ~ .~..~~,'.~ '.~. 4.Vacant Land C.O. $5.00 ~ ,,/ Date ....... ....... New Bu Iding ..... ~, ....... Old qr Pre-existin~l Bu~L~g ........ ' .... Vacant Lg.Q~ . ./, ~ ,~ ....... Owner or Owners of Property ....... $-~,?,~... (',, ,~/. ;.. ,'~2.~,~; .~.., ,~,. ,~ ....................... County Tax Map No. lO00Section ...,(~,~.,~ ..... Block .0'~- Lot...0 ,~,,,~, Subdivision ................................. Filed Map No ........... Lot No ............... Permit No../.?.~..~.~.77 Date of Permit .Applicant.. .?~... ~'.. . :~ .......... ,earth D pt. Approva .. .Labor De,t. Approva Underwriters Approval..~.. (¢:~,~..ct ~ ~..~ ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described buil~-g ~ ,~, ~ ~ ~.e_~g. u.~? it meets l~plic ble co es an egulations. ~.) Applicant , ..~ ............... c o. 9 New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted on this site. For further informa- tion regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Daniel J. Larkin Permit No. i0-83-1242 January 31, 1985 NOTE: This not~ce is not a permit Expiration Date NLW YORK STAI'£ DEPARTMENT OF EN fI~ON~,~FNTAI C©N~ERVATION ~0--8g~'[ 242 PERMIT ARTICLE 24, (Freshwater Wetla.ds) ARTICLE 36, (Construction in Flood Hazard Areas) Arthur and Muriel Sammartino ADDRESS OF PERMITTEE 11 Glengariff Road, Massapeqna Park, NY 11762 Corner of Kenney's Road and Dogwood Lane, Great Pond, Southold DESCRIPTION OF PROJECT Construct a single family dwelling with attached decks approximately 85' northeast of Great Pond. Install a sanitary system a minimum of 100' from the western edge of Kenney's Road. Fill property with I00 cubic yards of clean fill in low areas. Install driveway. Ail activities as per supplied plans received October 3, 1983. GENERAL 1. Ibc perm~ttee shall ft[~ ~n ~he otf~ce of the appropriate Regional promptly m wutmg o[ the comp[ebon of the work. condilio, the I~avigable a.d flood capacity of the watercou~'se. No claim shall CONDITIONS 95o~0-4 (9/75) (SEE REVERSE SIDE) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /3/j~ (please print) Plumber~(please~ ~ T --~print) ~ 70 I cer%ify that the solder used in the water supply system contains less than 2/10 of 1% lead. / (pi/umber' s signature) Sworn to before me this ~0 --~ day of ~/~_ .~ , // 19.~j. // Notary Publlc~/~/~'~' County Notary Public EILEEN M. ROACHE Not~y Public, State of New York No. 4//~942 Qualifi~l/n Su/folk Co~ty Commiaslo~ Expi~s Mai'eh ~0, 196'7 SPECIAL CONOITIONS 16. 17. Fill should be graded in such a m~nner to create a slight berm along the western edge of property (side bordering on Kenney's Road) and should be stabilized with vegetation. Place haybales between Kenney's Road and construction site during construction. SEE ATTACHED CONDITIONS A - J, M PER~IT1SSUEDATE December 7, 1983 Bldg. 40, SUNY--Room 219 Stony Brook, NY 11794 FIELD iNSFiICTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY o FINAL COMMEN'I'J ADDITIONAL COMMENTS: 7GS-1802 BUILDING DEPT. INSPECTION~ [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~/FRAMING [ ] FINAL DATE INSPECTOR THE Vk1000378 1 Oate April THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 88 JOHN STREET, NEW YORK, NEW YORK 10038 30,1985 Application No. o.yile 294623/84 N 689349 only the electrical equipment as described below and introduced by the applicant nan~ed on the above application number in the premises of Jon C. Kerbs, Kenny's Rd., Southold, N.Yo in the yollowing location; [] a.sement ~ 1st FI. ~ 2nd FL Section Block Lot was examlned on April 25,1985 a.d found to be in compllance wlth the requirements of this Board. FIXTURE OUTLETS 19 DRYERS FIXTURES RANGES OVENS EXHAUST FANS 25 FURNACE MOTORS FUTURE APPLIANCE FERDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E ~ R NO O COND OF CC. COND 1 OTHER APPARATUS: Future Appliance Feeders- 1-2-14, 1-2-12, 1-3-6 Notors- 1-F G.F.C.I.- 1 Smoke Detector- 1 V I C NO OF HI LEG A W, G, OF HI-LEG NO, OF NE RAL$ OF NEUTRAL Charles M. Hall Electric Inc. 760 Long Creek Drive Southold, N.Y., 11971 lie.# 657E This certificate must not be altered in any manner; return to the office of the Board if inco~rFect. Inspecto' GENERAL MANAGER Per 11 be identified by their credentials. COPY FOR BUILDIN¢ ~,NNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 - ' TEL.: 765-1802 E ,amined ;...., APPLICATION FOR BUILDING PERMIT Application No .................. Date .................. 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 tkis application, the Building Inspector will issue 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 Occupahcy 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~emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code,.housir]g coded regulations, and to admit auth°rized inspect°rs °n premises and in buildings f°r('n~e~pecti°~ ~ (~ure o_f applicant, or name, if a~,corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... x ....... ............. .............................. (as on the tax roll or latest If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No -~ ~e~, {~, .~. [ ~ Plumber's License No ......................... Electrician's License No ............. .......... 4 ~]~t¢/ Other Trade's License No ...................... / of land on which~proposed work will be done ..... 0 .... C~¢nty Tax Map No. 1000 Section .................. Block ......... : ........ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............... 4. Estimated Cost .......... Fee ............................. , ' ' ' pl' ' ~ (to be paid on filing this ap ~cation) 5. If dwelling, number of dwelling units ........... Number of dwelling units on each floor.. ~ ........... , 7. If garage, number of cars ..... ; ............................... 6. If business, commercial or mixedloccupancy, specffy nature and extent of each type of use ..................... 7. Dimensions of existing structureg, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories '. ..................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth . ................... i. Height ..... ~ .~. ' ' ' i ........ Number of Stories ......... ' ........... 8. Dimensions of entire new construction: Front ........ Rear . .~x. qfC. .......... Depth ............. Height . ~:~..8' ......... Number of Stories .... ~ ...................................... ......... 9. Size ofloi: Front .... ! .~.. f?.....: ....... Rear .... /. ~..f. ............ ne,~th ...F~-. .......... . 10. Date of Purchase .... ~./~.~.~//..! .................. Name ot~Former Owner l'~b'.~.~-~v.'~.. · .~..c~ .v~*v..lV.~'~-.9. · 11. Zone or use district in which premises are situated ..... I...d~./...?~.. ·..k.W-..~ ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .k)..<-~. .......................... Will lot be reoraded . c~ ~i ..... .~ . . . Will excess fill be removed from premises: Yes 13. ~ .... ~.. ... ~ ......... 14. Name of Owner of premises . &.~..v~...: .~..e.~.~.~,.. Address ¢; ~?..~C~..~. ~....~..~'..x~,. Phone No.. ~.~.?. ~ Name of Architect ....... ~.':./~'~.~.. ......... Address ........... .~ ...... Phone No ................ Name of Contractor . ,2. ! ......... Address ................... Phone No.. · Locate clearly and distinctly all property lines. Give street and block interior or corner lot. STATE OF N ~EW.Z¥gJgK/ COUNTY (Name of individual sigping above named. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from mmber or description according to deed, and show street names and indicate whether S.S .................... being duly sworn, deposes and says that he is the applicant contract) He is the .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dt ly authorized to perform or have performed the said work and to make and file this application; that all statements con :dined 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 .......... C~.~..../~..~...day qf ..... ~..., 19c~ff ~,. - ' (~mmlNMa I~me Maroh ~, 1~.0~ -- ~ ~ (Si~aturo of app~c~t) ~ ~ ~,,.:; S~t"F. ....... . NO. ,, , , . I ,,~, ~ ~' · . : . ~,~ ,,, i ' , ..... ' ~ ~UA~&~EE$ INDICATED H[REON SHALL RU~ ' ......... ~E WA~ SUPPLY AND ~EWAGE DATE: , DENSE WILL C~F~M TO THE SUFP. CO. D£PT. OF FOR APPROVAL OR aONST~UE~L"ION APPROVED: [N?I~IT DI~AL ~YSTEM8 FOR THI$ WILL CO~NFORM TO THE STA~DA~DS~OF SUFFOLK CO. DEPT. (S) API~LICANT ,'s If copper tubing is used SOLDER USED [N WATER "'i fo£ woter dlslribudng SUPPLY S~'~M CANNOT system~ piping shall be EXCEED 2/10 of 196 LEAD. ~[ ~p~s ,~ or L only NOTIFY BUILDING DEPAR T AT 765 18029 AM TO FOLLOWING IN?ECTIONS: 3. FOUNDATION - TWO REQUIRED FOR P~URED CONCRETE 2. ROUGH - FRAMING & PLUMBING 4. FINAL ~ CON%T~UCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUiReMENTS OF THE N. ~ATE CONSTRUCTION & ENERGY , CODES. NOT RESPONSIBLE FOR OCCU?g C¥ OR USE LA [:UL ~OL~ER ~E~ I~ WATER SUPPLy SYSTEM CANNOT EXCEED 2/10 of 1% LEAD. PLUMBER CERTIFICAT[05~ ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY If copper tubing is used for water distributing .,,~ em; piping Shall be ~ types K or L onl~y FOLLOWING INSPECTIONS: 1. FOUNDATION - ~O EEQUI~ED FOR POURED CONCRETE 2. ROUGH - F~MING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRtJCTION SHALL ME~ STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, :i !