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HomeMy WebLinkAbout15877-zFORM NO. 4 TOWN OF BOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha~L Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17139 Date JULY 29~ 1988 THIS CERTIFIES that the building. ONE-FAMILY DWELLING Location of Propert~ 15098 R.O.W. OFF MAIN ROAD House No. Street 23 Block 1 County Tax Map No. 1000 Section EAST MARION Hamlet Lot 18 Lot No. 3 Subdivision DAVID L. GILLISFIE Filed Map No. 65 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 3~ 1987 Building Permit No. 15877Z dated pursuant to which APRIL 4, 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 ONE-FAMILY DWELLING W/ATTACI~ED DECKS AND GARAGE. The certificate is issued to D P ACRE~ INC. (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2%LTH APPROVAL 87-S0-29 7/26/88 UNDERWRITERS CERTIFICATE NO. N017468 PLUMBERS CERTIFICATION DATED PECONIC PLUMBING & HEATING 4/8/88 Building Inspector Rev. 1/81 FOu~ NO. ~ TOWN O~: SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~ ~5877 Z Permission is hereby granted to: ....... ...... .................... oI ....~:.. _' ~..,~.......~.:..~.:....~ I.?..~ / -o o w. ~ ~....~.~....~....~ at premises located at ......~.......cj..~......j~ ................. "~/'1 ....... ' ........ County Tax Map No. 1000 Section ..... ..~.....'~.....~.. ..... Block ....... .~,...! ........ Lot No ........ J...~. ............ pursuant to application dated ....... ~......~.' ...................... , 19'~..~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survev of pz"operty showing all propertv lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occt~pancy 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling. $25. Q0, Accessory iS |0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 5.Updatecl C.O. $ 50.00 Date ...................... NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. ................ House No, Street Ham/et Owner or Owners of Property ~/2../~...C¢.~..~../../~. ~,~ ..................................... County Tax Map NO. 1000 Section ..... .2..~ ...... Block ..... ~. ......... Lot .... ./..~. ........ Subd v s on .~l.I/W¢.~..~.~..~¢~.tv.~.~ .~ ~v~.~..~}JLJ~.l.¢.Filed Map No ........... Lot No...'~ .......... Permit Date of Permit ........ .. Applicant P: .~z . ~.~,.t'~..1~.' I .1~....' ~- .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ~J 0 17~-e.~. ......... Planning Board Approval ........................./~... Request for Temporary Certificate. ~ ................... Final Certificate ..... .~......... . Fee Submitted $ Construction on above described building and permit meets all applicab e codes and_regulations Applicant -.. Rev. 10-10-7S TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /Y 77 Z Owner '~,,~, ,/~C.,~:- /~/C, (please print) (please print)/ / I cert].ny that the solder used in the water supply system contains less than 2/10 of 1% lead. c~ (~u~er's signature) Sworn to before me khis Notary THE NEW YORK BOARD OF FIRE UNDERWRITERS BURBAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 ~}UME ,~8257087/88 N O~ 7468 THIS CE~IFIE~ THAT ~ examln~ on a~d/~nd to be in ~mpl~en~ ~th the ~ui~ments o/th~ ~, 61 53 52 6~ S~4[~ Dl~COJqHqltu.'T S '! it ¥ I C MOTORS: 1-1 H.P. SMOKE DgTECTO~ :-2 TR~CK DIGHTING :--12 2/0 G & S CONTEACTOR BOX 215 $OUTMOLD, NY, 11971. L£CICNSg NO. 578E Per ,,,~"~ ~ TOWN OF SOUTLIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 ~c~. ~: ISG To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. ff/~/_--/~/An'application for Certificate of Occupancy is not on file. ~/--4~/No Underwriters Certificate on file. ~/_V~/The check is(outdated/~e~)3~5~ O0 /5/ NO Health Dept. Approval on file. /-~/ No final inspection has been made. ~D~ ~__~~ Please contact our office on this matter. Thank you for your cooperation. Building Permit # __/ .~ ~ _~_~ .p Z Building Dept. ***/~/No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) OUNDATION { s~t) - ~ OUNDATION (2nd) OUGH FRAME PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: ?~FINAL DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [/~FINAL REMARKS: DATE INSPECTOR r 765-J,802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] /~DUGH PLBG. / FOUNDATION 2ND [ ,~ INSULATION [ ] FRAMING REMARKS: [ ] FINAL INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND [ ] INSULATION ~F~MING [ ] FINAL DATE BUILDING DEPT. INSPECTION [//~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE INSPECTOR Examined ....... ,19 . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 .TEL.: 765-1802 Approved . .O¥~.'....~. ...... 19~. .?. Permit No../.~..~.?. ?..'~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ' . ...... l ..c ................. - (Si, gnatur,e,,of applica4~t, or name, if a corporation) £ K ....... 0 .... M a~, o. .~r,,. . !.1. 2 9: 3. .... ,. ........ tl~J_iJ_n~ address of a~licant)' ;~i1~;. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ..... D..~..~& ................................................................................ Name of owner of premises .~.P...~.~..~.. ~ ! .~.~.: ......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ........... .7;7,.. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No .......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location o_f land on which nroposed work will be done. f.~.l?.~..7~...~, q.e.D... O.~.. ?..~..~....T.'.~,. 77..~..~. ....... /~o~/~ ~.~,, ~o, .~. .o ~ r. o. . .o. ~. . . ~ ?. . ~.,q. . .R. . e ~. ~ .............................. .~. ~. .s. 77....07..4.a.~.q ~ ........... House Nmnber Street Hamlet County Tax Map No. 1000 Section .. O..P-.l: .0..O. ...... Block .O)....O. 0. ........ Lot...O. 1~ ~0~. ........ Subdivision .ffi.(~.~?..$g.$~{g.~.(~?..O.~:-~.g!.~.~? ~.].~4 ~.t.~... Filed Map No .............. Lot .,~ ............ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy V.~.~ .~...t~.7...~.U..[.C,.D..l.h,d.~....L.O.~. .................................. b. Intended use and occupancy . .~. ~. ~.~.L,..~....~. ~..t.~..I.~.~ . .~...L~..~..t_~.. t'.K).~. .... . . . · · , .............. Repair ' ~i ~' R~ oval ., Demolition . Other W6rk . 4. 10. 11. 12. 13. 14. ,~scription Estimated Cost ....... ! ............................ Fee ..................................... , r :~ (to be paid on filing this appl cation) If dwelling, number of dwelling units ... / ........... Number of c/~,elling units on each floor ............... If garage, number of cars .... ~ .................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimensions of existing structures, if any'. Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dmtensmns of same structure with alterations or addmons: Front ................. Rear ................. Depth ................... !!... Height ......... t" h ......... Numberpf Stories .................... Dimensions of entire new cons!ruction: Front...~..~...~ ...... Rear .. l~.~.r. ........ Depth . .~.~ ......... Height ....Z..~..I ....... Number of Stories .....'~v ................................................. , S~ze of lot. Front... ..................... Rear ...................... Depth ..................... Date of Purchase . .l.2. / J $./I ~ .................. Name of Former Owner . {~:..L.e..~.T~. .~.~. ) .............. Zone or use district in which p' emises are situated ~-.tC.~a". (t2C..so (~ " Does proposed construction viblate any zoning law, ordinance or regulation: A3.O. ....................... ,... Will lot be regraded .dV.O... .................... Will excess fill be removed from premises: . Yes ~r No Name of Owner of premises 'D.i~ ~q~.~g,. I .~ .6 ..... Address g0...$¢$.'}$.6..~g~tt.~C'~4~Phone No..~..Z. '.2 .~.~. ~/ .... Name of Architect ........ ~ .................. Address .......... : ........ Phone No ............... Name of Contractor ....... J .................. Address ................... Phone No ............... 15. Is this property located withinliO0 feet of a tidal wetland? * Yes .~... No .. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dh property lines. Give street and bloc ¢ number or description according to deed, and show street names and ini interior o~ corner lot. ~nsions from icate whether STATE OF NEW,_,_YO/RJ~,/,~ ~ ,, ' COUNTY OF .,P..~rT~/..~ ....... ~'~ ...... ~....../PF~>.~..'~. .... .~. ~..~2..~.. ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ' j (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements coqtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manCer set forth in the application filed therewith. Sworn to before me this .............. day f... .~...F-?~.. ....... 197. , / / -~ ~/ r / q,,~y ~,bt',~,~_t?[.~tw Vo~k (Signature of applic~t) / J No 4644944, Suffolk Count'/ ROI~ERICK VAN TUYL. P.C. I. JC£~ THE WA' SY~I'EMS FOR -THIS ' CONFORM: ~ro THE' SUFFOLK SUFFOLK COUNTY O'EPT~. SERVICES -- FOR' CONSTRUCTION ONLY -" .~:,~L~ DATE: H.$.REF NO.: APPROVED '~' SUFFOLK CO. TAX MAP DIST. 'SECT. BL ,O~1[. tOO& ~$ ' I- ' I DEED: L. TEST HOLE iL. 1 D~TF~~ H$. REB NO. ~ The sewage disposal ano ~a~r supply l~ili~ for ~ ~ocaaon ~ave ~en insured Dy ~ ~oa~ a~/~ ot~nc~s'and ~ ~. SLJFF OLK CO HEALTH L,~-..P~ APPF0 H.S..'~:>~ THE WATER SU~-Y., SY~EMS FOR THIS CONFORM TO THE ~ SUFFOLK CO DEPT. OF HEA APPL ICA NT SUFFOLK C. JDUNTY SERVICES -- FOR' CONSTRUCTION ONLY DATE: H. S. R£F. ~10,: APP~OVEO: DEPT. APPI~ ,~U~FOLK 'CO. TAX SECT. OWNERS ADDRE~: .. DEED: L. ~- P. TEST HOLE ' I S~ES INSIDE 'f '0 --U DOORS - F~ONT ~ARAGE WINDOW, SLIDING GLASS DOORS,, ALL GLASS )'HE At~HITEC'T CERTIF ES THAT TOTHE BEST OF H S KNOWLEDGE THE DRAWINGS CONEOI~I TOi:THE NEW YORK STATE ENERGY CONS RVATION CO,NSrROCTION L~DE: ri I,T sHAc~ ,E~'THE R~sPONs mLiT¥ OF THE CONTRACtO~ TO SU~T THE S~ZE/~D OamN AND:TYPE OF ~CHAN ~lC~ W~ ~:USED' NSUFF amT D~A L AS THE BUILD,Ne. DEPOnENT. ALL THE~OS~AT~.~C BE A~USTABLE 45 DE~[ES - 75 DEeREES F. ' . INSULATE ~L ~Ts ~ND P ~ES ~ REQmED BY ~ODE. -: ' ~ F, 8EPLACESTO DE P~Qv DED. W TH A D~PER FOrt OUYS DE C~BU~TION AiR. 150~200:CF~ FLUE TO HAVE ~16HT SEATED THIS tS TO CERTIFY THAT THESE PLANS ARE TO THE BEST, OE HY, KNOWLEDGE BELIEF. AND PROFESS ONAL JUDGMENT IN COHPLIANCE WITH THE NEW YORK STATE CONSERVATION co s. ', - ',' REVISIONS DATE DESCRIPTION COM, t4. NO. ' O WN B OR NEGLECT ON HIS PART, J z,-o" Oo~,t,,',t ,ON~ .2. T 1 k-' J --r' T/k/ IZ _%~,-7i01,¢ TNRU COlYC., ~L/~15 , Ni:, 2_ .... { " i /vg'./ '- - g REVISIONE DATE BY THESE PLANS ARE ANINSTRUMENT OF SERVICE AND ARE THE PROPERTY OF THE ARCHITEC~ INFRINGEMENTS WILL BE PROSECUTED. CONTRACTOR EHALL VERIFY ALL CONDITIONS AND MEASUREMENTS IN THE FIELD AND BE RESPONSIBLE FOR FIELD FIT AND QUANTITY OF WORK. NO ALLOWANCES SHALL BE MADE IN SEHALF OF CONTRACTOR FOR ANV ERROR OR NEGLECT ON HIS PART. DESCRIPTION .t ,, I Ir 40L f" ~o T o~ _ / {', -m L '~ L/,'.,'£ OF REVISIONS DATE BY ,THESE PLANS ,ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF THE ARCHITECT· i:' OR NEGLECT ON HIS PART, DWG. NO. DESCRIPTION ..-~--~-.~- ~?~::~/,':K~ ; ,F~ . 7~/M,~;5.'=- ~L h ,.. %, / REVIt DATE BY DESCRIPTION -I ',=. 0 © V o m,~l DATE OF WOR~ NO AL~O~ANCEB SH~LL BE M,~DIE ). 3Tt~T~I~ NOTED.. L' PLI. ItBING 5'~TDt TO 031'~LY WITH ARTICLE g AND T~ ENERGY DOORS - FRONT, SIDES, INSIDE TO GARAGE- U-40. WINDOWS, SLIDING DLASS DOORS, ALL GLASS - UI,Gg. THE ARCHITECT CERTIFIES THAT TO THE BEST OF HIS KNOWILEDOE THE DRAWINGS CONFOI~ TO THE NEW, YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE. IT SHALL BE THE RESPONSI§!LITY OF THE CONTRACTOR TO SUBHIT THE SIZE AND DEStDN AND TYPE OF MECHANICAL SY',STEHS WHICH WILL BE USED IN SUFFICIENT' DETAIL AS !S REQUIRED BY THE BUILDING DEPARTMENT, ALL THERMOSTATS SHALL BE ADJUSTABLE 45 DEDREES - 75 DEGREEs F, ALL DOHESTIC HOT WATER 140 DEDREES HAX. SETTIH~. INSULATE ALL DUCTS AND PIPES AS REQUIRED BY CODE. ALL FIREPLACE5 TO BE pROVIDED WITH AD'AMPER FOR OUT!SIDE COI'IBUSTION AIR. 150-200 C,FJ'I. FLUE TO HAVE TIBHT SEATED DAHPER MAX. AIR LEAKAGE 20 C.FJ'I.' THIS IS TO CERTIFY THAT THESE PLANS ARE TO THE BEST OF MY KNOWLEDGE BELIEF, AND PROFESSIONAL JUDGMENT IN COMPLIANCE WITH THE NEW YORK STATE CONSERVATION CODES, SIGNED DATF OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY SOLDER USED IN WA TER SUPPLY SYS'rEM CANNOT EXCEED 2/10 of 1% LEAD. PLUMBER CERTIFICATION ON LEAD cONTENT BEFORE CERTIFICATE OF OCCUPANC~ T~51' ~.oLF_ ~ If copper tubing is usedy for water distributing~ iystem; piping shall I~ of t~pe~ .K. or L only , 7": .:L n REVISIONS DATE SY THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF THE ARCHITECT. COMM. NO. DRAWN BY 5C&LE 4°~ ~ _ ,~ DESCRIPTION D /' " '" ' /; ,,,, z ;0" DO W^/ ,,':*/W~ 2- -4" ',% 2 IZ 8" ~v~ J t...c,, t~ L L ~ c7-/ o/,/ /:~U'h'ZYA 770/V ?Z A// BY DESCRIPTION 2 OF~-~ A ) W? y:z., _, ,2')7 ~q~ -.4 REVISIONS DATE BY TBESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF THE ARCHITECT. INFRINGEMENTS WILL SE PROSECUTED. CONTRACTOR SHALL VERIFY ALL CONDITIONS DESCRIPTION COMM, NO, DRAWN BY ~*,&. SCAkE, //4 L- /. DATE DWG. ,3 ,% A I 4 Z/v/,v'4 /4 o fz, 0 f-:6 ~ // C TI 0 >w" - 6~,~c£ -- '/4- ~ /.'e' 40~ f" REVISIONS DATE BY DESCRIPTION I