HomeMy WebLinkAbout14732-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildi.g Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z15342 Date .M.~r..c.h..l$,. 19.87
THIS CERTIFIES that the building . O..n.e. f am i 1 y d w e 1 1 i n g.
Location of Property 1105 CARRINGTON ROAD CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section .. l .I .l ....... Block . .1.1 ............ Lot . .1...5. ............
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
H...a.r. qh...3.l.,. 1986 pursuant to which Building Permit No. 14732Z
dated ..... A. p .r 3.t...3 ~.. 1.9. 8..6 .......... 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, with deck, and attached garage.
The certificate is issued to THOMAS HIGGINS
..................... io¥.'o;, ......................
of the aforesaid building.
Suffolk County Department of Health Approval .... .8.6.-: ~ 0.-.~. 3. ............................
N777998
UNDERWRITERS CERTIFICATE NO ..................................................
PLUMBERS CERTIFICATION DATED: 9/24/86
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERJ~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~.~7~2 Z Date ................................... , 19..~...~
County Tax Mop No. I000 Section I/[ Block I / Lot No ..... ]..:...~ ...........
pursuant to application dated ......~....~.......~../. .................... , 19.~.~., and approved by the
Building Inspector.
Rev. 6/30/80
PECTION COMMENTS
FOUNDATION ~ (1st}
FOUNDA'TION (2nd)
· ROUGH FRAME
PLUMBING
INSULATION PER-N.
STATE ENERGY
~ODE
Yt
/ /
ADDITIONAL COMMENTS:
/
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted .. ,.--.----- 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-
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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Adcurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00 OC~.~.~.j.~., (!J(
5.Updated C.O. $15.00 Date ............... I..{.~.~.'~.
Newconstruction ...... Old or Pre-existing Building ...1 ......... Vacant Land ...........
Location of Property . [./...0... ,~,~. (~/. (~IF..'~.~.. 'L' ). l ~ . ..~ .................
House No. Utreet U Ham/et
Owner or Owners of Property ...~;~O. ~/~-.-~...~;.~..t,.C~. ~.l.~.~ .............................
County Tax Map No. 1000 Section ..... /.~, 1 ....... Block ..... L/ ......... Lot...k '. ,~, .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. 1. ' -~. Date of Permit .~. .~ .Applicant (~ J .'~..r~:~..~. ?. ~.~'~..; ' b.~.~..
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 p~rr~t meets all applicable codes and regulations. App cant . ~ ~. '~'~--~¢-~_~)
,..,0.,0.,,
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1000378 BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
..,e ~OV~= 7. 1986 App,,~.,,o. No.o.S.e ,~:~SO29/Se N 777998
THIS CERTIFIES THAT
only the electrical equipment ~ ~scrlbed belo~ and intmduced by the applicant ~med on the a~ve application number in the premises of
John Eich, Carr~gton R~d, V~ston & Haywaters, N.Y. ~tchogue
inthefollowlnghkcarion; ~ B~,e~.ent ~ IstFI. ~2nd FL Section Blm~k Lot
oCtober 30, 1~86
FIXTUEE
OU~1LElr$ SWITCHES
FIXTURES
FLUORESCENT
cOOKING DECKS OVENS DISH WASHERS
~r A T S NO OF FEET
_ RANGES__
I C E
61 55 37 il
DRYERS FURNACE MOTORS APPLIANCE FEEDERS
SERVICE DISCONNECT S
1-STon AC Unit
3 G.F..CX
2 Smo~e Detector&
A,W G NO O~ HI-CFC A.W~G
OF CC COND OF HI-LEG
EXHAUST FANS
DIMMERS
1/0
Stevens Elect. Inc.
P. Oo ~ 1268
Southold, N.Y 11971
L£¢#3494E
GENERAL MANAGER
Per 11
This certificate must notbe altered in any manner; return to the office of the Board if incorrect, inspectors moy be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE ~,,UST NOT BE ALTERED IN ANY MANNER,
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.
{p~mb~r' s signature)
Sworn to before me this
~ day of.~,
Public, County
Notary ~
/ N~tary Public
7GS-1LS0~'
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ~-FINAL
REMARKS:
DATE
,47
oO
f'30
705-180Z
BUILDING DEPT. L
INSPECTION
~.~FOUNDATION 1ST [ ] ROUGH PLBG,
FOUNDATION 2ND [ ] INSULATION
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS. C~/
DATE
/
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ]~ROUGH PLBG.
[ ] FOUNDATION 2ND [~INSULATION
[~FRAMING [ ] FINAL
REMARKS:
DATE ~//-~/~ ,NSpEc'ro. ,/¢~/~
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ~~ROUGH PLBQ.
FOUNDATION 2ND [ ] INSULATION
c]'~FRAMING [ ] FINAL
REMARKS: ~£/-/
BUILDIN~ DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION ZND [. ] INSULATION
[ ] FRAMING _ [ ] FINAL
REMARKS. ~
DATE
INSPECTOR
'FORM NO. 1
TOWN'OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N,Y. 11971
~ TEL.: 765-1802
Examined .~...~. .... , 19 ~..(~
Approved~ . .~ ..... 19~...~. Permit No..) .~.7.~..~...~.
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Bi DG OI-PV~'-'~
TOWN 0~' S( ':,' ', ,, ,',
Received ........... ,19...
Date. /~c~U ~,L ~. 19g~.
INSTRUCTIONS
a. Tkis application must be completely ~led 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 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 inspectionz~//
(Signature of applicant, or name, if ~-e'ort~d'ration)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ... [.~. ~. ?..~..~ .... ~.l .¢r¢-. I .~..~. ...............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Bnilder's License No ...... . .l~u:'...~tfX~.. .............
Plumber's License No.
,
Electrician s License No.- ......................
7
Other Trade's License No.' .....................
1. Location of land on which proposed w(~rk will be doqe ..................................................
............. u.ox ....... ............................
House Number Street Hamlet
County Tax Map No. 1000 Section ... ](4 ............ Block . ./( ............... Lot ...................
Subdivision . ..0 .~.~.. ~? ! .i9 ........................ Filed Map No ............... Lot ..~.. ~ .........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construcfion:
a. Existing use and occupancy ...~.~ ./}.C..fl..N:F .........................................................
b. Intended use and occupancy ... p.l.q .ff..: 5(! ?. ~.~.~].. :? ?.~..l".v7 ! ¢,~ ....................................
3. Nature ofwork (check which appilicable): New Building / Addition Alteration
Repair ..............RemoVal .............. Demolition ......... Other Work ...............
'~ ~.~, t~q ~. (Description)
4. Estimated Cost .................... Fee .
i ' (to be paid on filing this application)
5. If dwelling, number of dwelling umts .... t. Number of dwelling units on each floor ................
If garage, number of cars .. ~ .i ..................................................................
6. If business, commercial or mixed ioceupancy, specify nature and extent of each type of use . ~ O .................
7 Dimensions of existing structures~ if any: Fronf~. ~. ~ Rear Depth
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or--Front ................. Rear ..................
Depth ..................... i. Height ~ ............ ~ ....... Number of Stories ......................
81 Dimensions of entire new constru,'ction: Front ..... (o.[.'5~C... '". Rear ~--O.--f~' . De-th
Height .../~.14:~C ...... Number of Stones ] g ........................
9. Size of lot: Front .... 10. ~..~. 3~ .~. ,~.... Rear ..... [ 9.O.: .~. 7..~. ..... Depth . ,~ ~.q21..~r~., ...........
10. Date of Purchase . .~'~..~.0..i.i[ 9.~;~ ............ Name of Former Owner ~4Aqt~ .a.t~ ~ ~ .e.~gt~figf~.
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation ...[~.~. .......................
13. Will lot be regraded . .kJ.~..~.q...! ...... ~ ............ Will excess fill be removed from premises' (fY~s~ No
14. Name of Owner of premises ~f'[4 ~ ~1~.~ .-~.Ctq'/~ ..... Address ti .~.~,W4 * t>q(..4~c[i.~,.~, Phone No. ~.t~.~ .~.~. ~.. [..
Name of Architect ........... ~. · ;. ·., .......... Address ............. Phone No ................
Name of Contractor' .q~f(O ~.c... i .[~q.,.~.~ ...... Address.td~.~ & ~,~.Cw..CePhone No..q't~.~,
15. Is this property located ~ithin 1.00 feet of a tidal wetland? * Yes .....
No
· If yes, Southold Town Trusltees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all l~uildings, whether existing or proposed, and. indicate ail set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, S.S
(~O UiNFI'Y OF .................
...... ...... , ...................
(Name of ifi~tividual sigm~g contract)
above named.
being duly
sworn, deposes
and says that he is the applicant
He is the ............................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dulyl 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 manner ~et forth in the application filed therewith.
Sworn to before me this
3 ] ....... day of.i'. .... 19
Xlotary Public .........
..., ..
Signature of applicant)
Term Expires March
'~' ~,._ ~,~
!
SyFFOLK COUNTY HEALTH DEPARTMENT ..'.:<.~.. ,.!
S,C &~i:'t OF
~-. SINGLE FAMILY DWELLING ONLY
DATE;]~ ~ ~U~
TITLE I'-dO.- ~-5 '0~0
HAp AMENDED
SIATEM£NI OF INIENI
THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO, DEPT. OF HEALTH SERVICES.
(s)
APPLICANT
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES -- FOr APPROVAL OF
CONSTRUCTION ONLY
DATE.
APPROVED:
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL.
13(X~- !t i t I
OWNERS ADDRESS.
48 : E, '",,'--~:~';~-' ~,"" AU
~ N ..... 4--,~
¢.-A~2Ok2xJ CITY, N.~ > ~5~O
DEED: L.
TEST HOLE
STAMP
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO.
STATEMENT OF INTENT
............... . . ,,F ~ :,. /~ ¢% (.,~. ; [ , 2 ~ ~ , THE WATER S~LY AND SEWAGE DISPOSAL
~,~k~,~ ~ ~ k4 j SY~EMS FOR THIS RESIDENCE WILL
; CONFORM TO THE STANDARDS OF THE
~ ' A~LICANT
~O~, SUFFOLK COUNTY DEPT. Of HEALTH
ii SERVICES -- FOR APPROVAL OF
~ / CONSTRUCT tON ONLY
DATE'
/" DIST. SECT. BLOCK PCL.
'// OWNERS ADDRE~:
:/
/ ,
', ,''
}, /" // DEED: L: . . P.
FEB ~
S.C, DEPT. 0F LICEN~D LAND SURVEYORS
HEALTH S~VI6[S GREEN~RT NEW YORK
Mf W~TER
IllllM
APPROVED A8 NOTED
NOTIFY BUILDING DEP~RTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1 FOUNDATION TWO REQUIRED
FOR POURED CONCRETE
2 ROUGH FRAMING & PLUMBING
F
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