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Home My WebLink About16094-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22729 Date NOVEMBER 16~ 1993 THIS CERTIFIES that the building ADDITIONS Location of Property 425 MESROBIAN DRIVE LAUREL~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 145 Block 4 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 29, 1987 pursuant to which Building Permit No. 16094-Z dated JUNE 19~ 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 2ND STORY ADDITION~ SUN ROOM ADDITION & DECKADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. SIMON KLEIN (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-854517-2/26/88 & H-013607-1/18/90 NOV. 6, 1993 - DR. SIMON KLEIN /yldi~g Inspector Rev. 1/81 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO. 16094 z Permission is hereby granted to: ~.~.:...~...~~~..~.~ ...~.~-:....~~...~.~ ........... · ..~~ ........... :.v. ............. .,t. ......................... -'-" --"'- ----"--'-'--',,-- . , ,- · ,~ -.~~~'"'~'~~'""~:"~:"~'"'" ...... ~ ....... ~ ................................. at premises located at ...l~s~.....,...J~..l~....a~......).~..,l~ ....... ~..~ ................................ County Tax Map No. 1000 Section ..... .[....~...~.'~.. ...... Block ....... .~...L~. ...... Lot No...,..o...?.. ............. pursuant to application dated ...... ...~.~..~ ................... , 19.~..']..., and approved by the Building Inspector. Fee $...~..~.'/ ............ Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 A~*PLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-ex~sting Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building ................. Location of Property... ~[ ....... F~.~.".~f~.~....~/~.~. ................ ~.~ ......... House No. Street Hamlet Onwer or Owners of Property...~ .... .~/?.~.~. .... ..~./.~.~. ....................................... County Tax, Map No 1000, Section ..... /.~..~.q...Block ..... ~.~. ...... Lot ........ d~.~. ........ Subdivision ~ .~.~.~/~. ~ ,~.~ .~..~.~/.~. ...... Filed Map.. ~ ?.~ .... Lot... ~.~.. ~. ~. ....... Permit No .... Date Of Permit .... lcant... Health Dept. Approval .......... App ................ Underwriters royal ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. INSPECTORS Thomas Fisher Building Inspector Gary Fish Building Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTI-IOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 CERTIFICATION Building Permit No. Owner: (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of I% lead. Sworn to before me this ~'7~''~ day of_ , 19~3 ANTHONY. ~ :lCD ~OTARY PUBLI0~ S~ate of Nm Yorg No; 41.4726293 ~ualitied In Oue~s Cou~ ~e~. Filed ~n~ Cq 0 THE NEW YORK BOARD OF FIRE UNDERWRITERS :'a,,~:~: '~. ~OL(~(Jg~ BUREAU'OF ELECTRICIT~ , ~ ~- 85 JOHD, I STREET, NEW yORK, NEW ~RK I00a8 o~Jy t~ elect~JceJ' eq.ipme~t ~ ~scribed be~w a~ introduced by ~ ~pli~Ot ~ ~he ~ve application number i~ the p~es of in the followlng locatiOrH" [] l}aseme~t [] I st FI. tt~s examined on~ ~ECEMB~R 1~, t989 FIXTURE SWITCHES OUTLETS 23 20 [] 2nd FL Section Block and found to be in'compli~ince teith the reqtdrements of this Board. Lot FIXTURES RANGES OVENS DISH WASHERS FANS 22 DRYERS OTHER APPARATUS: !~?~IOR ~iRzN~ ONhY--1 G.~ SI'IOI{t; DETECTOR :.-2 ,.RkCK LIg~Tr~ ~NOTE: thi* .:s a partial, not a ('omplete certif:cate~ DERRICK PERKINS 425 MESROBIAN DRIW; LAUREL, NY~ 11498 THIS IS YOUR BILL FOR SERI~ICE RENDERED AND IS NO'~ I "': C E~ ' iJOUNSTREET NEWYOEK;,N.Y. IIDO'~ : ~ INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire/nspector Telephone (516) 765-1802. OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 19, 1993 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Hr. Tim ¥ousik P.O. Box 573 Laurel, N.Y. ll948 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (~utdatcd/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # BP#16094Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 765-1802 BUILDING DEPT. SPECTION FOUNDATION 1ST [ ] FOUNDATION 2ND ROUGH PLBG. INSULATION FRAMING [ ] FINAL REMARKS DATE . INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION XST FOUNDATION 2ND FRAMING ROUGH PLBG. /~NSULATION FINAL REMARKS: INSPECTOR~/~/~~ 76S-J.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST GH PLBG. [,] F?~UNDATION/ 2ND [ ] INSULATION FRAMING [ ] FINAL 765-:1.802 BUILDING DEPT. INSPECTION UNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKs: DATE INSPECTOR 765-t802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~NAL DATE 7GS-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION :)ND £ ~ I/~/SULATION FRAMING [~FINAL UNDATION~s UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDrERWRITERS 1000378 BUREAU OF ELECTRICITY "-" N 854517 THIS CERTIFIES THAT I theel t f,e uipm ' be i~t ce t ' o ye '~ ' nn b in~hepremise~of i, ,hefotlowingt,,c.~io.; [] B~,eme,t [] ~st F~. [] 2,~d FI. Outside Se,'tio. BI.c~ Lot t~wts examined on February ~ ~9~8 attdfoundtobeincompllancewiththereqtirettentsofthsBoard FIXTURE OUTLETS ~ECEPTACLE$ SWITCHES FIXTURES RANGES OVENS DISH WASHER FLUORESCENT EXHAUST FAN DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS ~JNIT HEATERS MULTI.OUTLET SYSTEMS NO, OF FEET DIMMERS SERVICE DISCONNECT S E R V I C NO OF CC COND A W G. NO OF HI.LEG A W, Q*, NO OF N~UTRAL$ PER ~' OF CC, COND OF HI-LEG ]. 2/0 ~ OTHER APPAR T S: , Installation o~ rough ~iring and Service on~y. ~ini~h by other~ Complete hotlse appro~ 64 Openings Sw. Listed & Recept. ) OF NEUTRAL 2/0 Steres Elec'tric Inc. P.O. Bo~ 1268 GENERAL MANAGER Per /~ This certificate must not be altered in any manner; return to the office of the ~oard if incorrect. Inspector~ may be identified by their credentials. COPY BUILDING DEPARTMENT. THIS COPY OF CERTI NOT:BE ~LTE ANY MANNER. BLDG. DE TOWN OF 60UTHOLD Disapproved a/c ..................... ,. ............ i-~ (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH'~...'""'~¢''. 3 SETS OF~.~PLANS FORM NO. 1 SURVEY '~'~/'~ ..... TOWN OF SOUTHOLD CHECK ........... BUILDING DEPARTMENT gEPTIC FORM ............. TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL - C~2.qP~.'; ~.~.~.~-.. Date .................. , 19... INSTRUCTIONS a. Tiffs 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 Buliding Permit pursuant to the Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applic~l~Laws, Ordmances o Regulations, for the construction of buildings, additions or altcrations,~rr~f~r removal or der0~lition/as herein described. The applicant agrees to comply with all applicable laws, ordinances, t~ild~ code, hou/~ dode, a~d~gulations, and to admit authorized inspectors on premises and in building for necessary inspectio~as. / / ~ ~' (Signature of ap~icant, 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 ..... .,~....~...~.d. ~..&~.....,,~..&../..~..~...'-...~... ~ ~.~..,~....~..C-.~. ~./.~. ¢ ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... c~..'.z:M../2~..~ ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done~ ................................................. .-. . · . . .............. .a../f. ¢..,¢.:d..-v.. .................... .6 .................. . ./V.y'. Honse Number Street Hamlet County Tax Map No. 1000 Section . ./.~. ,("-- ................... ............ Block ...... .~. .......... Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended nee and occupancy of proposed construction: a. Existing use and occupancy ........................................ b. Intended use and occupancy ...... ~...~.~'..'7 .... .~..~t~./. ~ ..... . .(~.... ~/...'?~.. ~ ................. 3. Nature of work (check which a~plicable) New Building ..... Addition Alteration . Repair .............. Removal .............. Demolition ............ Other Work ............... : t (Descrip~tion) 4. Estimated Cost ~-~'?.~ ~ (kD Fee ...... " (to be paid on filing this application) 5. If dwelling, number of dwellingiunits .... ~'~'~ Number of dwelling units on each floor... ~ .......... If garage, number of cars .... i ........... ~'r' O' '~'~ ................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ~ .......... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... ~ · N mber of Sto i Height ............. u r es ................................................... ith Dimensions'of same structure w alterations or additions: Front ................. Rear .................. Depth ................... i.. Height ...................... Number of Stories... - 8; Dimensions of entire new construction: Front .......... ~ ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size oflot: Front ........... ' ........... Rear..' .................... Depth ..;_:......-........... i . . Name of Former Owner . ' · ' · ' ' · ' 10, Date of Purchase ., .................. 11 ....... · Zone or use dlstnct in winch premises are situated ..................................................... 12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... !...,¥'~. .......... ,... Will excess fill be removed frgm premises: Yes 14. Name of Owner of premises. ~...c~..~.~.../~..d?~.~../~ .~Address .~? ./.{~¢~,~..~.~A~.~,~. Phone No..~. ~{~... ~..'~.~.... Name of Architect ................... Address ................. Phone No .... Name of Contractor ........ i . Address .... : ........... Phone No. 15. Is this property located iwithin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town TrUstees Permit maybe required. ' PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, $.S COUNTY OF ................. ...... ~.C'~.4'7.../?.~.-'~..../(./..~. ~--i~.. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................... ' ........................................ , . ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ~ 8tlt~[l~V0[ : ' ,' 'y-"~'" ~ignat~reofappJcanti · w ruBLrc, sbte of . No,_4707878, Suffolk Count~ ~*,*m t~pire~ I~rch 30,19-.&.L