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HomeMy WebLinkAbout16158-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No z16391 Date November 12, 1987 THIS CERTIFIES that the building One family dwell lng. Location of Property 780 Minnehaha Blvd. Southold House No. Street Hamlet County Tax Map No. 1000 Section 0 8 7 .Block 0 2 .Lot 4 3. 1 Subdivision..L.a.u.g.h.i.n.~ Waters Sec. I .Filed Map No. .LetHe. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....J.u.n.e...2.2.:. 1987 pursuant to which Building Permit No. I6158Z dated Jun e 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 ......... One famzly dwellzng, and dec . The certificate is issued to ROSS & JEANN-E MC HUGH of the aforesaid building. Suffolk County Department of Health Approval 87 - S O- 85 I 1 / 6 / 87 UNDERWRITERS CERTIFICATE NO. N 835 I 19 9 / 30 / 87 PLUMBERg CERTIFICATION DATED: Perfection Plumbing I l/l 1/87 Building Inspector Rev. 1/81 ~OBM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJVtlT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED} NO_ ~6!151~t z Permission is hereby gronted<~: · .... .L ~.....~ _.~..~..'_. E .......................................... et premises located at ...~..~.~.......~~..~...~,~..~...~....:......~.~~ ............... ,....q[~. .................. ~ .............. .~.....%~ ............................................................................................. County Tax Map No. 1000 Section ....... ..~...~...'7. ...... Block ....... ~..~:J~.. ..... Lot No.....~...~.;...1 .......... to application dated ..... ....~..~ ..................... , 19.~..].., and approved by the pursuant t Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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* lions, 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 survey of pLroperty 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: Additlons $25.00 ?OOL$ $25.00 l. Certificate of occupancy New Dwe~lin§ $25.00, Accessory ,$10.00 ]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 ~.Vacan% Land CoO. $ 20.00 5.Updated C.O. $ 50.00 Date ]1/11/87 New Cons t,~' u c t; i on ...... Old or Pre-existing Building ............ Vacant Land ............. 780 Minnehaha Blvd. Southold, Location of Property ................................................................... House No. Street Ham/et ROSS & JEANNE MC HUGH Owner or Owners of Property ............................................................ 087 02 43. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. .6 2.2../.8 Appli J.C. Kiffer PermitNo...........]6158Z Date of Permit . ../ o.7 cant ........................ ...... .... 87-SO-85 Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval N835 I I 9 Planning Board Approval . ' Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ 25.00 Construction on above described building and permit meets all applicable codes and regulations. Applicant J.C. Kiffer Rev. 10-10-78 c0 io ioTi THE NEW YORK BOARD OF FIRE UNDERWRITERS ]~ ~ BUREAU OF ELECTRICITY THIS CERTIPlE~ THAT only the electrical eqoipment ~ ~scribed below and introduced by t~ applicant ~m~ on the a~ve application number in the premises of in the following loc~~fa19~ Iai FI. ~ 2nd Fl. Sect~m Bt~k Lot a~s examined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SW~TCHES FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI*OUTLET ~IMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: :L-4.5kw. ~ox 215 ~S~t ~AGER Per . / ~ X) This c~rtificote most not be altered in any manner; return to the off,ce of the 8oar~ {f incorrect. Mspectors may be identified by their credentials. ~OPY FOR ~BUILDING D~PARTM~NT. THI$ COPY OF CERtifICATE MUST NOTBE A~TER~D IN ANY TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 1197! TEL. 765-1802 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 1% lead. (plumber' s signature) Sworn to before me this /,,, ;'~' day of 19 Notary Public ,~County / ~ota~y Public REGINA I~. MATTHE~,'S NOTARY PUBLIC, State of New York No. 52-4636665, Suffolk Count~ Corniness,on Expires ~ U[~DATION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION ?ER N. STATE ENERGY CODE · ADDITIONAL COMMENTS: j~ 765-1802 BUILDING DEPT. INSPECTION [ ~OUNDATION tlST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION INSPECTO . 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST []FOUNDATION 2ND []FRAMING [ ] ROUGH PLBG. [ ] IN,.SULATION [~FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE 765-Z802 BUILDING DEPT. INSPECTION ~ ~UNDATION 1ST []FOUNDATION [ ] FRAMING REMARKS: [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL DATE~ INSPECT 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~INAL I- 0 ,.,3 0 I ~',~.7 .Ix ' 0 ~ k~ , k Z 0 0 Z z .< . TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1B03 Examined · . .~.,¢'A'L&..~...., 19~. 7. Approved .~. 34"A~..."~O...., 19 .~.~ Permit No. },~.~ .~.~..~.. Disapproved a/c ..................................... BOARD OF HEALTH · 3 SETS OF,~LANS -['-~--~- 'FORM NO. I SURVEY . . TOWN OF SOUTHOLD CHECK .......... ~ BUILDING DEPARTMENT SEPTIC FORM ............. NOTIFY ~. ~.~. CALL - MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ....... 19... 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,4temolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bug.~.g cod. e,"~3qJ~dg code, and regulations, and to admit authorized inspectors on premi, ses andin building for necessary ~~~~~~.at. e~,, ~.~.'.l~...or name ifa corporat'on) (Mailing address of applicant) Name of owner of premises . .~...':'~C.L-?~. ~ .....~.~'..~-~T, .'--~.-.~e. .......... lr.'~,~,: .......................... . ~/' (as on the tax roi1 or late~t deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of cOmor~te officer) . ALL CON, TRACTOR' S QI~jS(~~{~J~K C~UN~Y#LICENSED Builder s License No. ~~...c-~...f~?.~?.~£% .¢Z3~ / Plumber's License No ......................... Electrician's License No. Other Trade s License No ...................... ,, 7/ /] ,~ I. Location of land on which proposed work will be done. . ~. .~. .~ . . ...~. . . ~..,~.. . .~. . . ~.jr~ ... 72.. ............ .... ........ House Nmnber Street Hamlet County Tax ~ap No. 1000, Section .... ~ ~.. :~, .0.~). .... Block...~. ~.'. ~ ........ Lot .~ .~. ~.." .O..O../ ...... Subdivision .~~..~.~...4~. :i~... 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 ..................................................................... b. Intended use and occupancy .../... [.~.~./~('.... ~. ~.-.('~: .......................................... i3. Nature of work (check which applicable): New Building Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ~ OO ~ (Description) 4. Estimated Cost.. t..,~./ ............................... Fee ........... ........................... " (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~. ....... Number of dwelling units on each floor ..... /. .......... Ifg arage, number of cars ......................... :. ............................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type. of use .... '..--'7 .............. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Heiglit ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ........... ....... Dept ~ Height .......... Number of Stories .... .. .... . · ./..~ ....... ~ ~, ......... ~ ....... 8. D,mens~ons 9J~e/nt~re new construction. Front .... ~.~...(Z... ....Rear .... .~...~. '. .....Depth .../¢~. ......... o~,~ej, ght 1" ~'~ ......9" Number of Stories ..... ~'. ..... ~r,,' ...................... ;. .... 9. i eof ot: Front ..~..~,,.~.. ............ Rear ..... /..~....~. ........ Depth Z/~.I~..~.....~.~.~5~'"'[ .... 10. Date of Purchase ............................. Name of Former Owner ............... I 1. Zone or use district in which premises are situated .......................... ~ ./ ........................ 12. Does proposed construction, ):iolate any zoning law, ordinance or regulation: .... /.~'..~' ................. : ...... 13. Will lot be regraded .... /Y~9~. ......... . ........... Will excess fill be removed from premises: ~----Yes. 14. NameofOwnerofpremises ~,J.../t~..~ff..~.~4.. Address/.~. 77..6~.t,irt.~../x~: .PhoneNo ~"~ Name of Architect ............... , ........... Address ' 't)J~tP~.'~c"'ar.'/.t~'~ Phone No' ' . i' ~' ' ' NameofContractor ~1 ~. t('tt2,¢~/~..~ Address ~.~)i2~i-[;'; ~'d';5'kJ. TJ,.- ,. ...... ' .................... ,,a, · · ./.,~.'r~va'-4~ ~'none mo. ~ ._~.q ....... )~.. 15. Is this property located within 300 feet of a tidal wetland?-~P~.~. No .~'.. · If yes, Southold Town Trustees Permit ma~ be required. PLOT DIAGRAM Locate clearly and distinctly all buildh~gs, whether existing or proposed, and. indi'¢ate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. TATE OF NEW,~OI~R, .~/1 ,. ,. !OUNTY. OF .,~... ..... 4t..~. t~~. ~7 ./~..~.. ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. ' ' ...... ~ .... ' [e is the ...... .................................. (Contractor, agent, corporate officer, etc.) "" '~' :*'~"~ ~ ~ ~[ .... " f said owner or o~ners md is duly authorized to perform or have perfomed the said work:and to m&e and file this pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ,ork will be perfon~ed in the intoner set forth ~ the application filed therewith. worn to before me this ..... , ................. z ..... day of..~~..