HomeMy WebLinkAbout16600-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24083 Date DECEMBER 14, 1995
THIS CERTIFIES that the buildin~ ADDITION
Location of Property. 10612 8AYVIEW RD. & 680 JACOBS LA.
House No. Street Hamlet
County Tax Map NO. 1000 Section 88 Block 1 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 2, 1987 pursuant to which
SOUTHOLD, N.Y.
Building Permit No. 16600-Z dated NOVEMBER 5, 1987
was issued, and conforms to all of the requirements of the applicable
provieion~ of the law. The occupancy for which this certificate is
issued is GARAGE & DECK ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
CHESTER M. & PARKER E. DICKERSON
N/A
H-047981 - DECEMBER 1, 1995
N/A
Building Inspefor
FOB. Bi BO. O
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, No Y.
BUiLDiNG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~16600 Z
Permission is hereby granted to:
.... ............
. .
__ "~ , ~ ct--, ~ \~.~ i _ __n_ :, ')-' .....i .................. }
~..~..~..~.: .b~.-...:7 ................... ~..
ot premise, ~<~ed *~ ..~t~.....~.~~,.~....~.~..~.~ ....... ~.
County Tax Map No. lO00 Section ...... ..(~.,,~.,~.. ...... Block ....... ..~..~ ....... Lot No....l...~., ..............
pursuant to application dated ....... ~t~..~......~... .......... , 19..'~...~.., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS I
8~57633
BUREAU OF ELECTRICITY
~-- ES JOHN STREET. NEW YORK. NEW YORK 10038
Date D~C~]~ ~1t1995 Application No. onfile 107~1495/95 H 047981
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application nu tuber in the pr~mises of
JAMES M,DI~SO~, 10612 BA%WIF~ ROAD, SOUTHOLD~ N.Y,
in the following location; [] Basement [] Ist FI. [] 2nd FI. ~]~R/OU~ Section Block
uvds exantined on NaVStaR 27 ~ 1995 and found to be in compliance with the National Electrical Code.
FIXTURE
OUTLETS ~ECEPTACLE$ SWITCHES
SERVIC~ DISCONNECT NO OI
A~D~"Y' ~("w. rom, FU".NPACE GAMOTO"'..~. RitTRE APPUN'oNCE
OTHER APPARATUS:
~NO VISUAL DEFECTS: "An electrical
survey has been made of the exposed
electrical e~dipment in the
premises indicated.' 'No obvious
unsatisfacto~ condition %~as found,
[JNIT HEATER
¢
MULTI.OUTLET
SYSTEMS
NO. OF FEET
Lot
EXHAUST FANS
AMT. H P.
DIMMERS
AMT. WATTS
I~612 BAYVIEW RO~D
SOU%~HOLD, NY, 11971
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentlals.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 16 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 completeJ site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. 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
1. 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-existing Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00
New Construction..~. ...... Old Or Pre-existing Building .................
Location of Property.. ].~i. ~...~ ~ .~ ~ .~.~ ............. .~P.~i~l~/~.
House No. Street Hamlet
Onwer or Owners of Property.,C~.~.~.~.~.~.~. .... ~....~.~...~.z~.....~.~./.~.~.~..~-~..-~..,
County Tax Map No 1000, Section .... ~.~· Block ....... / ....... .Lot .... fZ) ............. ·
Sobdivision.-2~.~- ......................... Filed Map ............ Lot ......................
Permit No .... -: .Da~e Of Permit ..... Applicant ........
Health Dept, Approval ....................... .. · Underwriters Approw~l ........................ .
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate...~ .....
Fee~.Submitted:~0~$...~ ......
............
..... APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS pA~. 1
805763~ BUREAU OF ELECTRICITY
~-- 8.5 JOHN STREET, NEW YORK, NEW YORK 1003B
D, te DECEMBER 01,1995 ~pplicatlon~o. onfiie 1~7~1495/95 H ~47981
THI~ CERTIFIES THAT
theJol~owing location; ~ B~ement ~ Ist FI. ~ 2nd H. G~/OU~ ,Section Bilk Lot
examined on ~0~ ~J ~ ~ ~ and found to be i~ complianc~ with the Na~onal Elect~cal Code.
FIXTURE RECEP I [ FIXTURES [ RANGES COO~K~IN
DRYERS ] FURNACE MOTORS I FUTURE APPLIANCE ~EDeRS
SERV/~ DI~ONNECT. I~.OE] ..... ~ 5
MULTI-OUTLET
SYSTEMS
NO. OF FEET
· V I C
A. WG
',C,ALREC,,' ,,Z ,LOCj:. U,,'--'EEE
R
OTHER~PARATUS~
*NO ¥I$U,~ DE?ECT$: "Ars electrical
survey ~as ~een ~ade o~ t~e e~pose~
electrical equipment in the
premises indicated." "No obvious
unsatisfactory condition was ~ound.
10612 BAYVIEW ROAD
SOUTHOLD, NY, 11971 GENERAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect, inspectors may be identified 'by their ~edentials.
(1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
Town Hall, 53095 Main Road
P. O. Box 1179
Southo[d, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 12, 1995
Mr. Chester Dickerson
155 Nountain View Manor
Torrington, CT 06790
**** THIRD NOTICE ****
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed) **
xx No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 16600-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
** - ACCORDING TO THE CODE OF THE TOWN OF SOUTHOLD, IT IS
UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE UNTIL A
CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED.
VICTOR LESSARD
PRINCIPAL BUILDING INSPECTOR
(516) 765-1802
FAX (516) 765-1823
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
OFFICE OF BUILDING INSPECTOR
TOWN OF $OUTHOLD
January 23, 1990
Mr. Chester Dickerson
P.O. Box 846
10120 Sound Ave.
Mattituck, N.Y. 11952
Re: Building Permit ~16600-Z
Premises: 14100 Main Bayview Rd.
Southold, N.Y.
Suff. Co. Tax Map ~1000-88-1-10
Dear Mr. Dickerson:
During a review of our files, it was noted that the above
building permit has expired, and a Certificate of Occupancy has
not been issued.
A final inspection was made on October 31, 1989 and a
notice was sent with the application for C.O., requesting an
Underwriters Certificate and a check in the amount of $25.00.
To date we have not received these papers.
According to the Code of the Town of Southold Article
XXVIII 100-281 and 100-284 a building permit is needed for
construction of an addition to an existing dwelling. It is
unlawful to occupy a dwelling or use said addition until a
Certificate of Occupancy has been issued.
In order to avoid any legal action you must correct the
above violation immediately. Please send the appropriate papers
to this office so that we may issue the Certificate of Occupancy.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Vincent R. Wieczorek,
Ordinance Inspector
VRW:gar
TOWN OF SOUTFfOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TO~VN HALL
SOUTttOLD, N.Y. 11971
TEL. 765-I ~02
To Whom This May Concern,
We are unable to complete your CertifiCate
of Occupancy because .of the foil. owing reasons.,
~ An application for Certificate of Occupancy
is not on file.
_~ No Underwriters Certificate on file.
~/' Tile check is (outdated/not ~1-~%3~e. )~. OG
/-/ No Health Dept. Approval on file.
/--/ No final ins.pection bas been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # / ~ _~ .Q .~ Z
Building Dept.
***/5/ No Plumber Solder Certificate on file.,
( all permits involving plumbing being
issued after April 1,1984 )
765-~LSOZ
BUILDING DEPT.
INSPECTION
INSPECTOR
Examined J).~.4~.., 19'$.-/.
BOARD OF HEALTH ..
· , 7 .
FORM NO. I SURVEY ........
TOWN OF $OUTHOLD CHEEK -
BUILDING DEPARTMENT SEPTIC FORM ............. .'
TOWN HALL
NOTIFY
SOUTHOLD, N,Y. 11971
TEL.: 765-1802 CALL ................
MAlL TO:
Approved .~.~..~.., 19~..~. Permit No.}. .~..~. ~.~ .~..
Disapproved a/c .....................................
................................ ........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... !9...
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 he 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 t{ave 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, j0ousing code, ~3d regulations, and to
admit authorized inspectors on premises and in building for necessary inspejTfioB~. [) ~
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant i~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .~~..~.t.? ~..~-,~.' .~.;i~ i i i~--i~..~ (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.. ~ ..............
Plumber's License No .........................
Electrician's License No ....................... ' ~
I
Other Trade's License No ...................... /~ ,T~ ~&~a., ~'/0/~ .42 // .~...~.
Location of land on which proposed work will be done.. .~D,~.y .~./..~..c~.. ~f.~....9(.1].~..~.o. ~.~. ....
House Number Street Hamlet
County Tax Map No. i000 Section ~. ~)DO..~..~-~. Block ..... /. ............ Lot.../.~. ............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use an?_~cup: o~posed construction:
3. Nature of work (check which applicable): New Buil
Repair .............. Rem'oval ............ ~'tion ...... ~ ~ '
! ion)
4. Estimated Cost ........ ,~.~, .c.? ~ .............. Fee
' (to
5. If dwelling, number of dwelling units.. Number of dwelling un{ts on ~ 4".; ~ ...~.
If garag , nu ber of cars .................................. ':: .' ...................
6. Ifbus~ness, commerctalorm~x~doccupancy, spec~fy nature and extent of each type of'use ...' ...... 2 ...........
7. Dimensions of existing structures, if any: Front ................ Rear .............. Depth .... ............
Height Number of Stories " ~ ' · " ' '
Dimensions'of same structUre With alterations or additions Front ................. Rear ..................
Dept ...................... Height .......... ~ "' · · '-'/r .... Number of Stones ......................
-- B. Dimensions of entire new const:ruction: Front.. o.Q,~/.~. ~.~... Rear ............... Depth ...............
Height .... , ........... Number of Stories .........................................................
9. Size of lot Front ,/.,~J ~.~..Z".'; ~ -Rear .... .. ............ Depth ......................
10 Date of Purchase ~ Name of Former Owner
11. Zone or use district in ' ' ' '
which premmes are situated .....................................................
12. Does proposed construction vi~late any zoning law, ordinance or regulation:
13. Will 10t be regraded ........ ) ........ - .. ,/. ....Will excess fill be removed from premises: Yes No
14..Name of Owner of premises ~.~ ff~."~*~-~. ~'~[.~,, ~...*'~'ACrdre~S/¢/.~.~.~..~.~.~..~. ~.. Phone No.~;~.~ .~-~.O.
Name of Architect ......... i .................. Address ................... Phone No ................
Name of Contractor ~ Address Phone No
15. this property located with 300 feet of a tidal wetland? *Yes ..... No .....
yes, Southold Town Permit may be required.
/ PLOT DIAGRAM
. :
and distinctly all
~es. Give street and bloc~ numbe~
whether existing or proposed, and. indicate all set-back dimensions from
description according to deed, and show street names and indicate whether
lq
STATE OF NEV,~-YO,~(//,,. ! ~.S
COUNTY OF .~N.,//~./..f.~ ......
...... ?......: ..... bei,,g d,ly sworn, deposes and sa,s that he is the a,plicant
(Name of individual signing contract).
above named.
He is the.... ,'. ....... i ....................................................................
; (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly 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 mann6r set forth in the application filed therewith.
Sworn to before me this
et ' .~Z
........................ day o~ .... ~'~..~2r/%~.. .......... ,19...
Notaw Public ......... .'.~.'...~...~% .~/..,¢t'~C. ounty
' . ~o~1~,_47078 7.8..PI/Bt/C" 8uffolkSlat~ 0t~u~ty~¢/~ ~ ((Signatureg of apvficant)pp
lerm
F, ooF
TI-II
SECTION "4A" (turn
down slob)
.t
i-~t
ROOF;HEATHING
LAYOUT
F, oOF "~"
SECTION "4 C"
SECTION "4 B"
(formed foundotion)
2184
SHEET
TOTAL
4
5
CORNER
DETAIL "3A"
SECTIONAL GARAGE DOOR
,JAMB DETAIL
SHEET
TOTAL
5
CH£~T~£_~_'~_~~~E_ E. D/£K~o~ \
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