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Home My WebLink About15388-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southo[d, N.Y. Certificate Of Occupancy No .... g~.5.8.~0 ....... Date ......... .G..u..n? 8, 1987 THIS CERTIFIES that the building .... .o.n.e.-~ f..a.m.i.i.,d..d..w.e. 1..1.i.n. ff: .................... Location of Property ..... 62 O0 ............ .~.a.~ .n..R.o.a..d .............E.a.s.~, .M.a.r.i..o.n. ..... House No. Street Hamlet County Tax Map No. 1000 Section ...... 3. ~ .... Block ....... 1. ....... Lot .... lP./.o.. ~ ...1. .... × × Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 3, 1986 15388Z ..................... pursuant to which Building Permit No ...................... October 9, 1986 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 ......... New one-family dwelling with two-car garage and two roofed porches. JOSEPH CHEREPOWICH The certificate is issued to ..................... [o~,n'e'r,~~ ..................... of the aforesaid building. Suffolk County Department of Health Approval 86- SO- 191 UNDERWRITERS CERTIFICATE NO ................... N808066 6/1/87 PLUMBERS CERTIFICATION DATED: Building Inspector Rev, 1/81 FORM NO. ~ TO~N OF $OUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEP, J'AIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15388 Z Permission is hereby granted to: /~ ........................ .................... ...... et premises located at ..~...~....~.....~...~..'.....(~ ......... ~..c~.....~....~ ...... ..~...:.[~..., ...... .......... '"T ...... ~' ................. ~' ................. '-'"~' .......................... ~' ............. F2 , ~', County Tax Map No. 1000 Section ...... ...~)..[.:~...~. ..... Block .... ...~...~ ........... Lot No..../..O....I.....[ ....... pursuant to application dated ...... (~....~...~......~ .................... , 19.~..~.., and approved by the Building Inspector. Fee $..'~. ~. :.~. ~... Building Inspector Rev. 6/30/80 Building Department Southold. N.Y. 11971 ~ ~LDg. OEP'L 765 - t802 ~. TOWNo~~soUT¢~O[D APPLICATION FOR CERTIFICATE OF OCCUCA~CY~ ~[~l ~' Instructions ~.~ ~ ¢~ ~/ A. This application must be filled in typewriter OR ink, and submi2ed ~ ~ to t~e Building In~ec- tot with the following; for new buildings or new use: ' 1. Final su~ey of property with accurate location of all buildings, prope~y lines, ~reets, and unumal 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 Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and in~alla- tions, a certificate of Code compliance from the Archit~t 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*exi~ing" land uses: 1. Accurate m~ey of p~perty showing all property lines, streets, buildings and unumal na~ral 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 pe~inent informa- tion required to prepare a ce~ificate. Co Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $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 ,~.'/1/.~.?'; ............... NewC°nstpucti°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~..~..~ House No. Street Hamlet Owner or Owners of Property 3 e -~ ¢.~. ~ .¢~. ~ ~..~¢.~. P~ ~., ~ ~- .~. ..... County Tax Map No. 1000 Section ...O...%.$~ ........ Block . / ............. Lot. ,/, 1. (.~.~ &-(')... '- pN Subdivision .... : ............................ Filed Ma o..:" ........ Lot No. ~' ............ Permit No. J.~,.~ ~ .Z.. Date of Permit/.~.~. ¢/~. ~¢..Applicant ~/¢.,~,..~. ~¢.~./~ ~$. Health Dept. Approval ~/~ '-- .................. Labor Dept, Approval . Unde~rJters Approval , . ./~ .4~.~ .............. P~anning Board Approval .................... Request for Temporary Certificate ..................... FinaJ Certificate . ~ .................. Fee Submitted S... ~ ¢.O..~Q ..... Construction on above described building and permit meets all applicable codes and regulations. 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 ~0~ - (please print) Plumber~Co~*c~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this , ,~ .day of &~¢~ ~.-~tr'~' Notary Public, St~t~ of New Yolk No, 4844762 Quslifi~l in Suffolk County Commission Expires Mar~h 30, 1= Notary Pub l/lc Notary Public, ~/~-~ff~ County THE NEW YORK BOARD OF FIRE UNDERWRITERS 1135021 BUREAU OF ELECTRICITY e2~r~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,e ~.~ 6,19e7 App,ic.,io.N .... f,,.~s[els/87 N 808066 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Joseph Cherepo~ich, 6300 Main Rd., Ea~ Marion, 1~,~, inthefolloteinglocatlon; :[] Basement ~ IstFI. [] 2nd FL SectionO3~BIock ~ Lot 1,%1 ~'~a'nined°nApril 30, 1987 ,,,dfou,,dtobei,,eompllanceu, l,h~he~equlre,,,en,~ofthisBoord. (pa~t) FIXTURE OUTLETS RECEPTACLES SWITCHES 61 63 FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS 66 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Smoke Detecto.r s-2 S E R V I C E NO, OF CC COND AWG AW.C.-, AWG, OF CC. COND ~,4/o NO OF~EUTRAL$ 4/0 Three "C" Rto[ Bo~45M- Sound Ave. Riverhead, N.¥.~ ~1901 ~ic.~3327E 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~/~INAL REMARKS: ~SFECTION 1. FOUNDATION ~(lst) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY CODE F I N A~ A] ION[L COMMENTS: 7GS-~,802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [~ ]ROUGH PLBG. FOUNDATION ZND []INSULATION [~FRAMING []FINAL DATE ~.~/~/~? I NSPECTO~/__~ 7GS-X802 BUILDING DEPT, INSPECTION ~UNDATION XST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL / / 76~.t~ BUILDING DEPT. INSPECTION [ ] FOU~NDATION ~.ST [ ] ROUGH PLBG. ~]./FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION, INSPECTOI~ ? THE SYSTEM~ CONFOR: SUFFO~ ~SI~ SUFFOLL SERVt~ C~$TR~ DATE __ H. S. RE; APPRO¥~ SUFF( ~'~.., FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .O-..e.~....~k~.~..~..., 19 ~.(,v Approved . O~....1~.....~. ·., 1~.(~. Permit No./..~.~.~..~.~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT l:lecelved ........... ,19... INSTRUCTfONS 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 M~DE 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 building for necessary inspections. ..... ~.o. ~4.~,..c-... e,..~-~..t~ ..~. :.~. ~,~,.. t tqm..' ..... (Signature of applicant, or name, if a corporation) .... .'e~...t.~,. g,~...Co, n,. ~,.,,~..%,'~.tt .......... 3 ,,.~..~. ~. f.~.~.T...~4: .':(.: ............... ........ ~~s of applicant) State whether applicant is owner, lessee, agent, architect, engineer, en~ontr~ct.or~electrician, plumber or builder. Name of owner of premises ...~ o. ~. ~ ~.~... ~.~ ~-~ O.A~.,. ~.o..~q/.~..e....~k.. .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...~.o. ~. ~. ~.T_..~ .o.e~ ~.-...p..v.~.s~ ........ (Name and title of corporate officer) Builder's License No -- Plumber's License No..7.~.~..-. ~.-. ............. Electriciaii'§ License No..~.~..~.'.' .~ ............. Other Trade's License No ...................... 1. Location of land on which proposed work will be done. I') ~. ¥ .~...~..~.~..~.. ]~..--. ?..~?..~..ur,../?.~...~. !.~.~?..~?/.~.t&.... .... (~ 3. .~. ...... I~.~, ~,~..g.~.: ..... ~ ~, ,~,-~. . ~. ....... .~. .... ~N. :.".[.: ............................ House Number Street Hamlet County Tax Map No. 1000 Section . .0..3...~> ........... Block .. ] ............... Lot ~.,/.: f: ./'707.~/~ .} ..... Subdivision '" ' 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 ..................................................................... ~nd ~..t~....t..~..~'~ I.. t,.~' ' .~ ~ ~,,-.-. . .... b. Intended use occupancy .0.~.~...,e,j.~,~,,.~,~?.~a ...................... 3. Nature of work (check which applicable): New Building . Wf'... i .... Addition .......... Alteration .......... Repair . ~ ,.. ~}..~,~.~.. Removal .............. Demolition .............. Other Work ................ ~ (Description) 4. Estimated Cost .... 2'..d~ .,~.a[ ?. ~. .................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............ Number of dwelling units on each floor ./?.~-.. . .,.. If garage, number of cars ,2. (,~ h It. ......................................................" 6. If business, commercml or mxxed occupancy, specify na. tuy~,e and extent of each type of use ...... : ~ ......... 7. D~menmons of exmtxng structures, ~f any Front. ~ ....... Rear=~lJ~.'. ....... Depth ~ ......... Number of Stories Height ...................................................................... Dimensions of same structure With alterations or additions: Front ................. Rear ................. Depth ................... i... Height ........ · .............. Number of Stories ........... ·.! ........ 8. Dimensions of~entire new construction: Front. ~.O.~.~..~. ...... Rear o~. ~.~.~ff ....... Depth 3.tat' ........ ,... Height ~,~, ........... Nuinber of Stories . ~.~. ................................................. .. 10. Date of Purchase .../~'~'.~; .i ................... Name of Former Owner ~. bi i~,l~ ~. p,.~,~.~ .- .......... 11. Zone or use district in which premmes are situated..--. .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded . . . th(O.. 'i .................... Will excess fill be removed fro~jc~ises: Yes .. Address Co~/~J~. 0~-. ..... '.t~ne No. ~.. ~... ~.~.... 14. Name of Owner of premise,s~ .~ ~P~.~.(~d. ~a,*'t'~ ~¥ fi - o Name of Architect][~ .~ $ .~, .~., ........... Address C*./~.~..~.o.~..~.. ..... Phone No ................ Name of Contractor .~. P.~..~...~.~..~'~m-~t~.~&. t.~. f Addresskl~.v~.i~.~ .'1.~ .~.~.~. ~.4"~'hone No.'~'.~r'~.~.~.~...~./ .... 15. Is this property locate~ within t:00' feet of a tidal wetland? * Yes ..... No .W~... · If yes, Southold Town T~ustees Permit may be required. . I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end. indicate all set-back dimensions from property lines. Give~ street and bloc]: number or description according to deed, and show street names and indicate whether interior or' corner lot. STATE OF NEW YORK, S.S COUNTY OF .... ~ ~ .,,.~.~.~.e,,./g... ~ ~, ~. ~ . .~. ~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual si ning contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners and is dhly authorized to perform or have performed the said work and to make and file this application; that all statements corttained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .... · ~ ........... day of...(~fe~ ...... 1 . ~ry~ic~, ¢ ......... ~ ~ ........ County ~ ~f~ ~"/~" · :~' · · I i (Signature of applicant) OOZ i-~'r rn mm ¢ 0 LICENSED LAND SURVEYORS grEENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS Of THE SUffOlk CO. DEPT. Of HEALTh ~ERVICES. (s) APPLICANT SUFFOLK COUNTY SERVICES -- FOR CONSTRUCTION ONLY DATE DEPT. OF HEALTH *APPROVAL Of H. S. REF. NO.. APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. ·,./.f~,~ ,~-,4 OWNERS ADDRESS: DEED: L. P. TEST HOLE ' STAMP SEAL arm ~ ~o/~ RODERICK VANdal, P.E. LICeNSeD LAND SUrVeYOrS ~SUFFOLK ~0. HEALTH DEPT.IApPROVAL · H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. Of HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.: APPROVED; SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL, OWNERS ADDRESS: DEED: L. TEST HOLE SEAL t /,, SINGLE ,,/' EXPIRES TWO ¥ ROD~ERICK VAN.,T.~L. P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAl H.S. NO.__ ILY DWE,-L-~_~'%....,, ct.::: :V.- :- ~UV ,-,-'" STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR TH,S RES,DENCE W,LL CONFORM TO THE ST~[~I~ARDS OF THE SUFFO~_O_: DEP/~.. (~/)~'EALT"/]//- SERVI~S. SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ON;~[p 30 1986 H. S. REF. NO.: SUFFOLK CO. TAX MAP DESTG;NATION: DIST· SECT· BLOCK 'PCL. OWNERS ADDRESS: DEED: L. TEST HOLE STAMP SEAL I~one 4~7.0400 P'Jr' O' !1 ~ ~e:a LC o '1 i Pho~'~e 4/7' 04ilo ~,~'~" ~' Main