HomeMy WebLinkAbout16655-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18914
Date MARCH 23, 1990
THIS CERTIFIES that the building
Location of Property 4250 BREAKWATER RD.
House No.
County Tax Map No. 1000 Section 106
RENOVATION & REPAIR
MATTITUCK, N.Y.
Street Hamlet
Block 09 Lot 001
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 27, 1987 pursuant to which
Building Permit No. 16655-Z dated NOVEMBER 30, 1987
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 RENOVATE & REPAIR EXISTING SUMMER DWELLING AS APPLIED FOR.
The certificate is issued to GUSSIE CANNONE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N-092242 - SEPTEMBER 18, 1989
~ilding Inspector
Rev. 1/81
FOB~ NO. B
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No_ 166 ,,5 Z Date ...~-~....J~... ........................ ~ , 19..~..~
Permission is hereby granted to:
at premises located at ...................... ~.~ ................... ~.~i~-'~.... ...............
County Tax Map No. 1000 Section ...... /...~...~. ....... Block ...... .{~..CJ. ........ Lot No...~..~.L ..............
pursuant to application dated .... ~..~.~......'~....~. .......... , Jg..~.?.., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPART~IENT
TOWN HALL
SOUT~OLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY,
DATE .................
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING. -VACANT LAND ........
Location of Property .~.Z~'O /~~/~.~ ~
' ' ............ Filed Hap ..... Lot
Health Dept. Approval .........
......... Underwriters Approval
Planning Board Approval
Request for Temporary Certificate ....... Final Certificate
Fee Submitted: $ ....................
APPLICANT
rev. 10/14/88
~-,~-~, ~- 3 ~1~.3
co ¢_.- I ?q~¢
~v~ 10/14/88
FOP~ NO. 6
TOWN OF SOU~OLD
BUILDING DEP/h~THENT
TOWN HALL
765- 1802
· APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
'This application must be filed in typewriter OR ink and submilt~ed to the Building
Inspector with the following; for new buildings or new Use: ;i .
I. Final survey of property with accurate location of all buiildings, property lines,
streets, and unusual natural or topographic features. ! .
2. Final approval of Health Dept. o.f water supply and .Sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fzre Und
4. grwriters. . ,
Sworn statement from plumber certifying that solder used ii system contains less
than 2/I0 of IZ lead.
$. Commercial buildings, industrlal buildings, multiple reszdhnces and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings {Prior to April 9, 19573 n .
ou-conform~ng uses, or buildings
sod "Pre-existing" laed uses:
I. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A 4~roperly completed application, a consent to inspect szgned by the applicant
and a C. ertified abstract of title issued by a title COmp~n~ which shall
o a r z t o prior to April 9, 1957.
· i P e e 1 i g Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of amy housing code or safety inspection of buildings
lo: premises, or other
pertinent information required to prepare a certificate.
For Vacant Land 'Certificate of Occupancy:
]. An application for vacant land Certificate of Occupancy shai'll be submitted,
and a certified abstract of title issued by a title cOmpanyI showing Single and
separate ownership of the entire lot prior to April 9, 1957! shall also accompany
the application. If a Certificate of Occupancy is denied, ,the Building Inspector
shall state the reasons therefor in w~riting to the pplzcant.
FEES:
~]- CERTIFICATE OF OCCUPANCy - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $~0.00.
2.. Certificate of Occupancy on pre-existing dwelling - $106.00.
3. Copy of Certificate of Occupancy - $5.00 - Over 5 yearsi-
4. Vacant Land Certificate of Occupancy - $20.00 :
5. Updated Certificate of Occupancy - $50.00
6. Temporary Cqrtiflcate of Occupancy ~ ${5.00 Resldeotla
$50.00 Commercial
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 1179
TOWN IIALL
$OUTIIOLD, N.Y. 11971
September 29, 1989
TEL. 765-1E02
GUSSIE CANNONE
4250 BREAKWATER RD.
I~,ATTIT1JCK, N.Y. 11952
To Whom 5h15 May Concern,
We are unable to complete your Certificate
of Occupancy because ,of the following reasons.
/_ An application for Certificate of Occupancy
is ~ot on file. (ENCLOSED) ~Zf~,
//_~/ NO Underwriters Cc. rtificate on file. "~
._ The check i:;~m~.~ot ou file.) $25.00 ~/-~'
/'_-/ No Health Dept. Approval on file:,
/-_'/ No final inspection has been made.
Please contact our office on
Thank you for your cooperation.
Hnilding Perm[i: I} 1 6 6 5 5
Building Dept.
this matter.
Z
tlc] Plumber .~oldcr Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
FOUNDATION
FOUNDATION
(1st)
(2nd)
ROUGH
FRAME &
,PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
Ye
FINAL
ADDITIONAL COMME
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
FINAL
DATE ~,/~/~/~
/V
INSPECTOR
11 3511,2
/)ate
THIS CERTIFIES THAT
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
8E JOHN STREET, NEW YORK, NEW YORK 10038
$i~iPT~714BE~ '18, '1989 Application No. onfile 57396188/88 I~I 092142
PACg 1
o~~equiprnent as described belmv and introduced by the applicant named on the above application number in the premises of
TIIO14AS M~R$1CANO, BR.~liJ4ATii~ ,W?I~L,, POL~/13~ ~I~TTUCK~
in the followlag {ocatlon~ ~ Base.eat ~ Ist Fl. ~ 2nd FL Section Bilk Lot
~s examined on and found to be in compliance a'ith the requlre.~ents qf this Board
FIXTURE ~E FIXTURES RANGES :~KINGDECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS CEPTACLES SWITCHES
FLU~ESCENT OTHER
DRYERS ~RNACE MOTORS FUTURE A~UANCE ~EDERS TIMECLOCKS DIMMERS
MULTI-OUTLET
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
hl)I)ITTOt~I-- t
TRAC~ Li£(,H l
NO, OF CC, COND A W G, NO, OF HI-[~G A W G, NO, OF NEUTRAl A. W G,
PER ~' OF CC, COND OF HI-LEG OF N~UYRAL
SAGE & GADIgMANN INC.
P.O.BOX 1768
not
GENERAL MANAGER
Per
~n manner; return to of the Board if
BUILDING DEPA THIS COPY OF -: ALTERED IN ANY MANHER.
~U°uu~D ~/~'snD
, Z,9 '.g'z/ :,.
Examined..~.~.. ~v¢., 19 .t?
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved . .~.~ ·., 19 Permit No.
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
BOARD OF HEALTH .~...
3 SETS 0~ PLANS .......
SURVEY .......... ~'
SEPTIC FORM ·
NOTIFY
CALL
MAIL TO:
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 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 comply with all applicable laws, ordinances, ,b~ildiog code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessar~nsl~ect~s.
~O ~_Cz5 ~{ ~ ~'i ~' e-~ ~[. [~ lt~~ re of e, ifa corporation)
Stat, e,,whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises.. G.-.~.~.S [ .~?.. C[2} ¥~ I'~. '.~..~ ~-___ ......
(as on the tax roll or latest deed)
Ifi '~:n~a cj~ration, signature o f duly a~ized officer.
(Name~id title of corporate officer) -
~L CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
'Builder's License No../. ~ O ~) '~'_.~.2 ......
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No .......................
Location of land. on which proposed work.will be done~..~ ~-J .~.~..~ ............................
......... ..................
House Number Street Hamlet
County Tax Map No. 1000 Section,, . · ·/6.)~? .......... Block..~. ~.~. ............ Lot. ~..0./,×~ ..........
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...:~/~.~. .... h.~{~)~..' ...................................
b. Intended use and occupancy . .~..~. ~ .~...~.C.... ~ .... .....................................
3. Nature of wo[~(check which applicable): New Building ..... ' ..... Addition .......... Alteration ..........
Repair :. ~ ......... Removal .............. Demolition .............. Other Work ...............
-1~ (Descriplion)
4. Estimated Cost . /~.t ~ Fee .~.?. ~
· (to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling uhits on each floor ................
If garage, number of cars .......................................... ! ..............................
6. If business, commercial or mixed occupancy, specif, l,~jnj~lre~l~d extent of, oea~tj iii]q/of use ......... ,,~. ~.l .......
7. Dimension. s 9J~existing structures, if any: Front...~.~.~. ~ ..... Rear '.~,ff. ~J?. i.~. ...... Depth ...'~) ........
Height . l~l~.' .......... Number of Stories... I.. .................... i ............. ~, .t. ~ .......
Dimensio~ns 9_frsame structure with alterations or,~dditions: Front '. ~.~.~..~.i~f. ..... Rear. ,..e~...~...t...
Depth..~..~'f~. ................. Height.../.~ .................. Nunther bf Stories .....
',8. Dimensions of entire new construction: Front..~_... Rear i .... ii ........ Depth i ..............
Height ............... Nutmber of Stories
9. Size of lot: Front ~. ~.,.2,~. ............. Rear...4.~'!~i i i i i. iiii .~. 'b~i~ ' i~.'e.'~. ~
10. Date of Purchase ............................. Name of Former Owner .............................
11. Zone or use district in which premises are situated ....................... , ..............................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..!../k~'~. .......................
13. Will lot be regraded ....... ,~ ...... ' .............. Will excess fill beverlY, ed fronmnzemises:
14. Name of Owner of premises tE.. .%U tXO¢.ddress yes
Name of Architect ........................... Address ............. i ......Phone No ................
Name of Contractor ........ ~ ................. Address .... : ........ i ......Phone No ................
15. Is this property located within 300 feet of a tidal wetland~ ~es ..... No ~..~
~If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildiflgs, whether existing or proposed, an&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.
STATE O F NEW YJ~J~ Y//~' SS
cot./ STY OF '
· ~.. ~,..~ ~ % ~ .............. being duly sworn, deposes and says that he is the applicant
(Name ofin~i~dual signing contract) .
above named.
He is'the ............................... ; .., ~. ...... ,2 :'~ ...................
(Contractor, agent, corporate officer,:~.)
of said owner or owners, ~d is duly authorized to perform or have perfomned:$h~ ~r~ ~to m~d and file this
application; that all statements cqntained h this application are true to the be?t d(~l tis knowledge and b~i~fi and that the
work will be perfo~ed in the m~ner set forth in the application filed therewith*
Sworn to b~fore m~~
........................~ ~ ~~dayo ........... ,19~:~( r ,
Notaw~blic,~~~ County /~ ~
: ,, / ...............
N~ PubiC, 8~te ~ N~ Y~ [ ~ (Signature of applicant)
~ No. ~79~05 ~ ~
Ouall[l~ In Suffolk Coun~ ~
Commlssion ~xp~ros Oeoamber 8, 19 ....