HomeMy WebLinkAbout16113-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date July 31, 1987
THIS CERTIFIES that the building .... .A.d. d..i.t.i.q n. ..................................
East Marion
Location of Property 3825 Stars Road
County Tax Map No. 1000 Section 22 ...Block 2 .Lot 26
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... ~.u.n..e. 4..,. 1987 pursuant to which Building Permit No. 16 113z
dated ............................
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 .........
Construct an addition to existing deck as applied for.
The certificate isissued to PHILIP AND MARIA ELENA FRUMENTI
(owner, ~bYoX ~oF~}blPX X X X X
of the aforesaid building.
Suffolk County Department of Health Approval ....... N / A
UNDERWRITERS CERTIFICATE NO ................ .I,I.8. 2. .2 .57.8...3 .u.l.y...2.7.,.. ! .9,8.7 .........
PLUMBERS CERTIFICATION DATED:
N/A
Building Inspector
Rev. 1/81
· OR~ NO. $
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N, Y,'
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No_ 16113 Z
Permission is hereby granted to:~'~ , ,o ,
· ......... ...............
..~...~.z....~...~......~,,...~./,...//~3~
........................
.... ,~,F.a....,~g,,~...../..,..,,...,. ........................................... .~ .....................................................
at premises located at ....~.~.~.~..~ ........ ~..~...~ .....................................................
County Tax Map No. I000 Section ..~....~..,~, ..... Block ............. .?'... .... Lot No ....... ...~..~. .........
pursuant to application dated ..... ~./.~.. ....................................... , 19..~r.~.., and approved by the
Building Inspector.
Fee $.....'~...
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
76_5- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ,~ -..--.---- 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 featu res.
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.
§. 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:
I. Accurate survey of property showing all property lines, streets, buildings 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 $25.00 -- BU$INgSS $50.00 ACCgSSOR¥ $10.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..........................
NewC°nstr'uction ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . .-~.~.~),,~...
House No. Street Ham/et
Owner or Owners of Property . .~:)]~/.l~] {o..?.../~)39.~./~..~'/,45~ .~/..~.D..ft?(~,~. T./' .................
County Tax Map No. 1000 Section ..... . .¢~-.~ .....Block ...... ~ ....... Lot .... .¢~...~. ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No~. 'l,~, / ~ '~ Date of Permit (~7 ~.~: ~'~..Applicant .~. ~ ~ ./~J~..
Health Dept. Approval ....................... Labor Dept. Approval .....................
Underwriters Approval ~ .~..~;-.~..;~..~. .......... Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permi~ meets all a~able codes and regulations.
A ,,cant ....................
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
1 85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIE~Jq~I~YA'I~ ~, 198 7 491858/87 ,
only the el~trJcal equipment ~ ~scrlbed below and int~uced by the applicant ~med on the a~ve eppllcat~on nu tuber in the premises of
Phillip Frumenti~'3825 Stars Rd.~ E. ~arlon, N.y.
i. ~he foltow~ng location; ~ Basement ~ I~t FI. ~ 2,~ FL Section Bilk Lot
~sexatnlnedon July ~011~7 and f°und t°be ln c°mpllanceu'ith the req~rementsQf tb s B°ard
DRYERS
FUTURE APPLIANCE FEEDERS
TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO, OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E R V I C
OF NEUTRAt
Maria Elena Frumenti
3825 Stars Rd.
E. Marion~ N.Yo, 11939
GENERAL MANAGER
Per 11
This certificate must not be altered in any manner; return to the office of the Board if inco~'rect. Inspectors may be identified by their credentials.
COPY FOR
~ !R.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [~FINAL
/ /
U[[D~TION (lstJ
UNDATION (2nd)
UGH FRAME &
PLUMBING
SULATION PER N. Y.
STATE ENERGY
CODE
ADDITION[L COMMENTS:
~:Z- ,
Examined ............. 19 .~..7
Approved...~/~. ~ ...... , 19
~.~. Permit
No./.~//.~..
Disapproved a/c .....................................
BOARD OF HEALTH ......
3 SETS OF PLANS .......
'Fo.m suRvEY.
TOWN OF SOUTHOLD CHECK
BUILDING DEPARTMENT S~.PTI¢ I?ORH ............. :
TOWN HALL
$OUTHOLD, N,Y. 11971
TEL.: 765-1802 CALL ................
MAIL TO:
~BJ , '1:' APPLICATION FOR BUILDING PERMIT
TOWN OF SO9 ~'~0, o j
........................................... INSTRUCTIONS
Date ... ff 7. ~ .'7.. ..... .., 19 .~.7.
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 appl/cant. 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 ~ 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 bufldi~g for necessary, inspectio~']~.~g>~---- ----- --.'--4...--: ·. ~.....[...... · · · ·
(Signature of applicant, or name, if a corporation)
.... rT,';t
(Mailing address of applicant) ! { ~ ~ ~
State whether applicant is owner, lessee, agent, architect, engineer, general ~ontractor, electrician, plumber or builder.
A
owner of premises'/~.~..~-/¢q..,q-~~ 'o'n' t'l~e' t'a'x' x:o'l{ ;; idt;~t' lJdd)
Name
of
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) -
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No ..... ~/.~.~. q?]~'..-,-'~.~. ~. ....
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location ofland on which proposed work will be done ...... .~..~..~.....~..~ ........................
House Number Street Hamlet
County Tax Map No. 1000 Section .... .~..g .......... Block ..... .~. ........... Lot...d.~. ............
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 ....... ~. · · ~. · · .~.~. · .~..':'~..~.. ..... !.. ...........
b. Intended use and occupancy ....................................... ~": .- · ......
3. Nature of ork (check which applicable): New Bmlding .......... Add~tmn .......... Alteration ..........
Repair .............. Rem0vall .............. Demolition .............. Other Work..~_ ~.
.~/,~;L' ~ (Description)
4. Estimated Cost.. ~, i ~ Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling!units ............... Number of dwelling units on each floor ................
If garage, number of cars ........................................................................
6. If business, commercial or mixe:d occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ..........
Height Number of Stohes
D~ensions'of same structure with alterations or additions: Front ................. Rear ..................
Depth ................... ~.. Height ...................... Number of Sto~es ......................
.... 8. Dimensions of entire new const~ction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front ......... Rear ...................... Depth ......................
10 Date of Purchase ' Name of Foyer Owner
11. Zone or use district in which pr~mises are situated .................................... {~. ~..: ...........
12.
Does proposed construction~m~y~n~ law, ordinance or regulation:~ ----~ ............... j~. ...............
13. Will lot be regraded ..... :~ ~--~.~x ~. ~: :-~ ~,... Will excess fill be removed from premises: Yes No
. .............. ffT.~ ~.~r~...
14. Nme of Owner of premises ~.~.. Address . ~.~ * $ g~ ~' Phone No.
Nme of Architect ' Address Phone No
Nme of Contractor ........ , ................. Address .... : .............. Phone No .......... ,....
15. Is this property locaced~within 300 feet of a tidal wetland? *Yes ..... No ..~'
· If yes, Southold To~ Trfistees Permit maybe required.
.. ~ PLOT DIAG~M
Locate cle~ly ~d distinctly ri build~gs, whether existing or proposed, and~indicate ~1 set-back d~ensions from
property Hnes. Give street and bloc~ number or description accord~g to deed, ~d'show street names and indicate whether
interior or corner lot.
,
STATE OF NEW,YORK, . ~ S
COU~Y .......... OF .~~
sigXi;;.o~X;;:c;~. -~ ~---~ -~ .......... being duly sworn, deposes and says that he is the applicant
Of
individuhl
above named.
He is the ....... ~~ ' ................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authorized to perform or have performed the said work and to ~e and file this
application; that all statements con~ained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfomed in the m~n~r set forth in the application filed therewith.
Sworn to before me this
......... ~ ......... day o~..~ ......... 19 .~.?
.............
_ ' nO .eo6 n ...........