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HomeMy WebLinkAbout15471-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy No z]645] Date December l, 1987 THIS CERTIFIES that the budding . pne. f.a.m ~..1 y..d.w.e.l.l.i.n, g ................. Locatmn of Property R.O.W. off Main Road Orient Ho; .............. 'Stiff ................. County Tax Map No 1000 Section .. 0.2 0... Block .9 1 ....... Lot ... P/fi.. J ....... SubdimmonLloyd Terry M£nor Sub .Ffled Map No ..LotNo conforms substantially to the Apphcahon for Building Permit heretofore filed ~n tins office dated · ,..N. qv....5. ,...I .9.8.6. .. pursuant to Much Budding Permit No...I.54. 7. I Z .......... dated .N. ov... 8.,..19.8..6 ...... was tssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for wluch this certificate m msued is ....... .. On.e .f.a.m. lly..d.w.,ell.%.ng., garage and rear deck· The cerhficate is ~ssued to ]~gAqK R..H.E.LM.!N .S.KI. ..................... (owner,,Vl~KErYt~r~Jff, tX X of the aforesaid building. Suffolk County Department of Health Approval 8 6.- .S .0.-. 1.6. .3. 8./. 1.0 / 8,7 ......... UNDERWRITERS CERTIFICATE NO.. N 8 2 7 3 3 3 8 / 17 / 8 ? PLUMBERS CERTIFICATION DATED: MATTITUCK PLUMBING & HEATING CORP. oecember 1, 1987 Bmldmg Inspector Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. I'. BUILDING P E P~,4 IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15471 Permission ~s hereby gronted to' ~.~.~...e.~.....~.~ ~. .... County Tox Map No 1000 Sect,on . ~.~.~. Block ...(~..~ .......... Lot No ..... ~.;..I ........... ~ursuon, ,o ~pp,,co,,on do,,~ .. ~.~. '~ .......... , ,9.~..~., ~n~ opprove~ by ,~e Building Inspector. Building Insp~tor Rev 6130/80 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~i~ULATION [ ] FRAMING [ ] FINAL DATE~~_~ 7~-~0~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBQ. [~'/FOUNDATION 2ND £ ] INSULATION FRAMING [ ] FINAL 7GSiX80~ BUILDING DEPT. INSPECTION ['~UNDATION XST [ ] ROUGH PLBG. [ ] FOUNDATION ;ZND[ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ,,~, F (/ - TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P O, BOX 728 TOWN HALL SOUTHOLD, N Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. 15471 Z Owner Frank R. Helminski (please print) Plumber ~?~,~k ~{o,~',~'- ~l, ~A~-~v~. (please print) '4 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 ~¢ c , . Notary Public, ~//( County Notary Pub~ ^ ~'~"~, ~ TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCy Instructions A. Th~s apphcat~on must be filled in typewriter OR ink, and submitted w ~ to the Building Inspec- tor with the following; for new buddings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographm features 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical ~nstallation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- t~ons, a cert~fmate of Code comphance from the Architect or Engineer responsible for the budding. 5. Submit Planning Board approval of completed s~te 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 property showing all property lines, streets, buildmgs and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddmgs. 3. Date of any housmg code or safety mspection of buildings or premises, or other pertinent informa- tion required to prepare a cerbhcate. C. Fees: l. Cert~ficate of occupancy $25.00 -- B'JSZNgSS $50.00 2. Certificate of occupancy on pre-ex~stmg dwelling $ 50.00 3. Copy of certffmate of occupancy $ .5.00, over 5 :years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ...A.u.~.: ..1.7.:..1987 NewC°nstructl°n ...... O|d or Pre-existing Building ............ Vacant Land ............. .R Q W o..ff .M.a..in Rg.a.d' 9.r.i.e..n.~. New yo.r.k. Location of Property ........ .. :... ........ %. , ..................... House No, Street Ham/et Owner or Owners of Property Frank. R, Helmimski County Tax Map No. 1000 Section 20.1 Part O.~lc~ck Lot. Subd~ws~on. "Lloyd Terry" Minor . .Fded Map No. . .Lot No 11/8/86 Frank & Catheriz~e Helminski Permit No,...15.471......Z Date of Permit HealthDept Approval Au~. 1.0, 1987 App ....................... Labor Dept. royal ........................ Underwriters Approval ........................ Plannmg Board Approval ...................... Request for Temporary Certifmate ................... Final Certificate ..................... Fee Submitted $. 2.5. O0 Construction on above described budding and permit meets all applicable codes and regulations Applicant qle~u F. Heidtmann & Son, Inc. Rev 10 10-78 /.zh l,¢ 7 765-1802 DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING REMARKS: ROUGH PLBG. INSULATION FINAL DATE INSPECTOR ...-.- ~ ~6S-1802 ' C~~ BUILDING DEPT. ~~ INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL INSPECTOR 7GS-XSOZ BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ICe'ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ '1 FRAMING [ ] FINAL REMARKS.- Y .~~.~ /~/~~ DATE ~ h//~ 7 I NSPECTO~/~'/~<~ / ~ [] 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~*~RO~UGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL DATE .,? ,/'~/~ ~ ? / INSPECTOR 7GS-~,802 BUILDING DEPT. INSPECTION FOUNDATION ~.ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL \ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING ~ [ ] FINAL / 1001071 BUREAU OF ELECTRICITY ~ ~~/e7 N 6~7333 THIS CE~IFiES THAT FIXTURES ~ RANGES ~K~~ OVENS ~-DISH WASHERS XHAUST FANS DIMMERS 4/0 1-G .F.C .! . SMOKE DETECTORS-2 G & S Electric Box 715 Southold, 11971 lic.~578-E Per_ Th~$ certdtcate mu~t not be altered m any monner, return to the office or the Board if Incorrect Inspectors may be ~dent~fmd by their credenhals COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY t,,L6,NNER OUNDATION 1st) OUGH FRAME & PLUMBING (2nd) iNSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL EXPIRES TWO YEARS Approved Dmapproved a]c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD, N.Y 11971 TEL · 765-180:3 (Building Inspector) APPLICATION FOR BUILDING PERMIT T__..,< 5,!.&:2 Hecel. ved .......... ,19.. Date November 3, 198.1 INSTRUCTIONS a Ttus apphcatton must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witl: sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showu~g location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc strc~ · or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tlus apt , cation c The work covered by ttus application may not be commenced before issuance of Building Permit d Upon approval of tins apphcahon, the Building Inspector will issued a Braiding Penmt to the applicant Such pert shall be kept on the premises available for inspection throughout the work e No building shall be occupmd or used in whole or in part for any purpose whatever until a Certfficate of Occupan shall bare been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding PermK pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regnlahons, for the construction of bmldmgs, additions or alterations, or for removal or demolition, as herein descnb, The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authomzed inspectors on premises and in bmldmg for necessary inspections Glenn F.. H..eidtma.n.n..& .Son. ~ .In.c.. .... (Signature of applicant, or name, if a corporation) P.O... Box. 9.32.,..C..u.tch. ggu. e ,...N..Y.. 1.1.9.3.5. (Malhng address of apphcant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Genreral Contractor Name of owner of premises Frank R. & .Catherine L. HelrqiB~ki .......... (as on the tax roll or latest deed) If apphcant is a corpmahon, mgnature of duly authorized officer (Nalne and title of corporate officer) Builder's License No lQ ............ Plumber's LlccnseNo Ma.t.tituck Pl. um. bing & Heating Corp. Electnctan's L~cense No .G &..$ EJ-.~9¢ri~o1 Contr. Other Trade's Lmm]se No .... I Location of land on winch proposed work will be done N/O Mate. Roast Orient ilouse Number ~ O Street }lan]let I County Tax Map No 1000SecUon '-~i~P@.rt OfBl$ck . ..... Lot ~/~9 / Subdwmlon "Lloyd .T.e.r. ry" Minor Sobd. ivi$iq~ledMap No Lot l (Name) 2 State existing use and occupancy of premises and intended use and occupancy of proposed construchun a t xtstlng use and occupallcy b Intended use and occupancy One fam%ly, dwelling 3 Nature of work (check which apphcable) New Braiding Repair j~.., {} ,, ~ . Removal. 4. Estunated Cost . ~ 9.0,00.0.00 5 If dwelling, number of dwelling units If garage, number of cars .. ~ . Addmon Alteration ....... Demohhon ....... Other Work .... (Descnptmn) (to be paid on filing this application) one . Number of dwelling units on each floor .... 6. If business, commercial-or mixed occupancy, specify nature and extent or each type of nse. 7. Dmlenslons of existing structures, ff any Front. . Rear ......... Depth .......... ltmgl~t Number of Stones ............ Dimensions of same structure with alterations or additions Front ........ Rear ...... Number of Stones ........... Depth .... Height. '56'0'; .... Rear 56'0" .. 8 Dm~ensions of entire new constrtictlon Front ............... Depth 3.3~ 1" ttmght .21 ~ ..... Number of Stones .~.~.1~...t;.w.o. ............................ 9 Slzeoflot Front 1/~0' .... Rear .1-5.0' ......... Depth fi. 5.8' .... 10 Date of Purctmse ......... Name of Former Owner ............. I 1 Zone or use district in which premises are situated It. es ~dent.:j.a.1. ................. 12 Does proposed construction violate any zoning law, ordinance or regulahon ....no. ............ 13 Will lot be regraded ....... y.e.s... : .... Will excess fill be ten. roved froln premises 14 Name of Owner of premmes Fra.n.k..He.l.m.].n.s.k.i AddressG..r.osse Po2mt.e.,..H.xi~tlibneNo ..... Name of Architect Wa.r.re.n .Sam.bach.. .. Address~illis.t.o.n p.a.rk,. ~m~e No Nmne of Contractor .He l..d.~m, a.n.n...&. S.o.n., I.n.c Address Gu.tc. hog.u.e. ~...bi.. Y :. Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an&indicate all set-back dm~enslons fro property lines, Give street and block number or descnphon according to deed, and show street names and mdmate wheth interior or corner lot See attached survey STATE OF NEW YORK, COUNTY OF . Su~fQ]~k .. S S (Name of individual signing contract) above nan]ed. · being duly sworn, deposes and says that he is the apphcal tle is the ........... Cont~ra¢l:c~r ......... (Contractor, agent, corporate officer, etc ) of smd owner or owners, mid is duly authorized to perform or have performed the said work and to make and file th apphcat~on, that all statements contained mttus apphcahon are true to the best of Ins ~owledge and behef, and that tl work will be pertormed m the m~ner set forth ~n the application filed therewith Sworn to before me thru ~ .... day of. ~O Z~, ....... . ~v ~C. ~.. . County N~a~ Publ~ ~e ~ N~k. / / (S~gnature of apphcan o ~22563, Surfak C~ Term E~Jres ~r ~. ~,V ~ J © SINGLE FAMILY DWELLING ONLY EXPIRES TWO YEARS FROM DATE OF APPROVAL J Ri,. ZO t~ ,,°~oo Ftd~ I; pU~I PLUMBER CERTIFICA;TION ON LEAD CONTENT BEFORE F [-J