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HomeMy WebLinkAbout15358-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16395 Date November 13, 1987 THIS CERTIFIES that the building One family dwelling Location of Property 870 CHESTNUT ROAD SOUTHOLD House No. , Street Hamlet County Tax Map No. 1000 Section . .0.5.9 ........ Block 03 .Lot 4 . 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated S e p t. 29, 1986 pursuant to which Building Permit No. 15358 Z dated.........Oct°bet ..... 6,..............1986 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 family dwelling, 1st floor only, 2 car garage. The certificate is issued to CARL J. & LISA ANN PARK (owner, Te~,~z~ of the aforesaid building. Suffolk County Department of Health Approval 86-S0-126 Oct. 26, 1987 UNDERWRITERS CERTIFICATE NO ....... P.e..n.d.kn. g...I.1./.5../.8.7 ................ PLUMBERS CERTIFICATION DATED: Peconic Plumbing & Heating 8/28/87 Building Inspector Rev. 1/81 ~OK~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiHG PERi, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15358 Z Permission is hereby granted to: ...~,,J,,.. ~ .~.... ~2, ..................... ..~..o..~.....~2.,~ ......................................... Ot premises located at ....~...~. .......... ~~.....~ ......... ~ .... County Tax Map No. 1000 Section ....... ..~...~j... Block ....... ..0.....~ .... Lot No.......~f..~.)......: .... Building Inspector. ~e~ ,...~.~.:.......<~ approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPAN~ Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- ~lor with the following; for new buildings or new use: · 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. 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 pz~operty 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: Additions $25.00 1. Certificate of occupancy New Dwelling,S25.0,0, 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 $]0.00 4.Vacant Land C.O. $ 20.00 NewCons truc tion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property. ~] [~..~ .~_, ~'~..~ .~. Rbaol ........ House No. Street Hamlet Owner or Owners of Property ~....~',..~. L[ ,,,~..ZA['-~ f~ .... ~,~'..J~ ................ County Tax Map No. 1000 Section .... .~..~.9 .... Block ..~.A ........ Lot...~.~.~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.J ~,.~.~.~-, Date of Permit I.O.l.~.l.~'~p .Applicant ~),,~'.]..~)-~,..~.'~ .~Y..I,~i~,~. 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 permit meets all applicable codes and regulations. Applicant .................................................... Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALl-, SOUTHOLD. N.Y. 11971 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 19F& · No'tary Public~.~F~fJ~' County FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE Y. O~d~ FINAL ADDITIONAL COMMENTS: BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION ~INAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]/~/NSULATION. FRAMING [z/'J FINAL DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION I NSPECTOR~/-~~ 765-1802 BUILDING DEPT. INSPECTION [~]~UNDATION ZST [ ] FOUNDATION FRAMING ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [~FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE /' 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ~/ROUGH PLBG. FouNDATION ZND [~ INSULATION DATE ~ hole ~ AREA = 30,522 SQ. It is the ~pplicant's responsibility to maintain ad~qu~te ~amtery dfstance between ~]1 w~l. er supply and sewage S. 4T ~49 '40" 151. 152.45'ACT ./olF .E'EN M. CO.WAy SINGLE FAMILY DWELLING ONLY EXPIRES TWO YEARS ~FROM~DATE OF APPROVAl. 0 r~ I- u) o TEST Hf E SUFFOLK COUNTY DEPARTMENT OF HEALI~H SERVICES FOR APPROVAL OF CONSTRUCTICN ONLY ~ "~ ['~ ( 0 ? 3'ho waler supply & sewage disposal sys- tems for this residence will conform to the standords of the Suffolk County Depart- ment of Health Se~ices. N.ZS. LIC. NO. 49668 ~RS ~ ENGINEERS, P.C. P.O. Box Cbs MAIN ROAD SOUTNOLD, N.Y. 11971 SURVEY FOR LISA PARK AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. ro00 059 0,5 - 4.2 SCALE I"= 40' dAN 3l, 1986 Prepared in accordance with the minimum ~ondards for title surveys as established by h,e LI.A. LS. and approved and adopted l[~-~,Gr such use by 1:he New York State Land 'Title Association. 86- 124 CHESTNUT N. 4'7 °49'40"E · ~n~ ' ' p~p~ (49. 8) - ROAD I~O~ 00' 44.2) I~/.8~' 151. 82° MAP 152.45 'A CT' AREA 30522 sq ft ~ N/O/F HELEN, M. CONWAY cERTI FI ED TO.' LONG ISLAND MORTGAGE CORR AMERiCANtTITLE INSURANCE CO. CARL d. PARK I. IE/A AN~ PARK .; i SUFFOLK COUNTY OEPARTMENT OF HEALTH SERVICE~ ' TSI~G~E FAMILY DWELLING ONLY. DATE 0 C !,~TH.s. The sewage disposal arid water supply facilities for this location have been inspected by this Department and/or other ~.~.ci~ and f.,~nd t~l~..sati~o~'y. ~[O~'~v-~ ~'~-, ~'~-~ L,~, ,. C-hieflof Bureau of Wastewa~er Management 0 ~o 0 TEST HOLE ~n~ , SURVEY FOR LISA PARK 'AT SOUTHOLD TOwN OF SOUTHOLD SUFFOLK COUNTY, N.Y. I000 05'9 - 05 4.2 SCALE 1% 40' JAN.51, 1986 MAR. 16; 1987 Sept. Prepared in accordance with the minimum sfandards for title surveys os established b'~ the L.I.A.L.S. and approved and adopted for such use by The New York State Land TitJe Association. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined .~.~. Ia., 19~.~. Approved ~..~.~...l~.....~.., 19 '.~.~ Permit No. ]..~..~.?~.~..~. ~ Disapproved a/c ................................. .~. (llil'tl~n g Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 7~ ~--~ Date ................. , 1 .. 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 parc 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 pelunit shall be kept on the premises available for inspection throughout the'work. e. No building shall be occupied or used ix~ whole or in part for any purpose whatever until ~t 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 SouthQld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulation.s~ for the construction of buildings, additions or alterations, ox~ for removal or demolition, as herein described. Tlie applicant agrees to comply witli all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on p~emises and in building for necessary inspectionS. ,,~ ~x ~:n*--, [') State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~'/A~... Plmnber s License No .................. Electrician's License No. ~.'n?~..T'r ......... Other Trade's License No .................... ... Location of land on which p. roposed work will be done .................................................. ........ ?..o. ..... ...... , ..... ........... ltouse Number Street Hamlet.. County Tax Map No. 1000 Section . .'~.. ~ ........ Block ...... ,~ .... Lot ....... .~.~X ......... 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 lnte~deffuse and occ~pancy , ' , ...... , .... 3..Natur~of work' check which applicable): Nero Bgilding ......... Addition..,.. Alteration Repair .. :.,.'~.~t 'i~ Removal ....... ' Demolition .... l' · Other Work ' 4, Estimated Cost ...... ..--~ .............. Fee .., (to be ~aid on filing this application) 5. If d~b~lling, number of dwelling units.. [ .... Number of dwelling uniis on each floor ................ If garage, number of cars ........... i i~. i '. i i i ........................ i ............................ 5. If bnsiness, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front... Rear ~ Depth lteight Number of Stories Dimensions of same structure with alterations or additions: Front i Rear Depth Height ...... Number of St rl ....... Height .c?5?.W..':...~ Number of Stories [ '/..z.. .. .......... -. 1. Zone or use district in which prbmises are situated ......................... i ...................... (~].. · ~ Does proposed construction violate any zoning law, ordinance or regulation' ~. Will lot be regraded ...... a..~_... · ,. ...... Will excess fill be removed from premises: Yes Nmne of Architect ........................... Address ............... i ....Phone No ................ Name of Contractor .......................... Address ............... i ....Phone No. ;.2. ............ 5. Is this property located wtthinl.o0 feet of a tidal wetland? * !Yes ..... Now. .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. in ~icate all set-back dimensions from operty lines. Give street and block number or description according to deed, and she' v street names and indicate whether terior or corner lot. JATE OF NEW YORK, 3UNTY OF . . . S.S (Name of individual signing contract) eve named. ; is tile .................................... ..... being duly sworn, deposes, and says that he"rs' .... the apphcant (Contractor, agent, corporate officer, etc.)l said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this plication; that all statements contained in this application are true to the best of hisIknowledge and belief; and that the )rk will be performed in the manner set forth in the applicatlon filed therewith. ,~orn to before me this ............ 4.7 ....... day of.. i. .......... )tary Public,.. ,~..~.'. , .~., .~. , .~/~.., , .: ,'County gfl. k~ g. I~ ~0~ " [ I, ~ Main Road GREFNPORY, N.Y. 11044 Phone 477-0400 ~ Main Road GREENPORT, N.Y. 11044 *~,'e ~ PLAN NO.