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HomeMy WebLinkAbout14832-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate No.. Z148~3 Of Occupancy Au ust 22, ... Date ....... ~ ........................ ,19 86 THIS CERTIFIES that the building .~.e.m..o.d.e. 3:. e..d..&., a..1 .~.e.p.q .d..b.a.S. ~ r.°.qm. ............. ; Location of Property s.u..cFq .k, b?.e.n..a? Cutchogue, .N Y. I~ouse rye. Street Hamle~ County Tax Map No. 1000 Section 109. .... Block 05 .... Lot 1 .S ' ~ubdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......p..p.r $1 25 z .......... , 19.8..6pnrsuant to which Building Permit No .... ....... 1.48.32g ......... dated . ?l.a.y...3., .................... 19.8.6., 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 ......... Remgdel. ed and alter, ed bathroom in existi, n.g. one family dwelli~xg. 7he certificate is issued to J.ohn J: Miller. Jr. &. Michael Powell (owner,~e~Z g.~t~q~b'~ x x of the aforesaid building. Suffolk County Department of Health Approval ............... N.../.~ ......................... UNDERWRITERS CERTIFICATE NO ................... .~.7.6. ~ ~.0.0. ...................... Plumbers Certification dated ..... ,J, ul,y 22~, .1986 ..... Rev, 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14832 Z Permission is hereb/granted to: ~:..../...~......~~ ................... .~~..~.~.....~..:~......,..:..~.~ ........ , . ~~.~.~ .......................... ~ ........... ~ .......... .~ .......... ~. ................................. o, ,rem,~es ~=ted at ..L~....~..~....~....~.: ....... ~..~~ .............. County Tax Map No. 1000 Section .... /...0....~ ......... Block ...... ..0...~.~ ......... Lot No ..... /,.~. .............. pursuant to application doted ...~.......~....~... .................... , 19.?....~.., and approved by the Building Inspector. Fee $,.~.~...~.. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, NeY. 11971 765 - 1802 APPLICAT[©N FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in,typewriter OR ink. and submitted g ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with ~ccurate location of all buildings, property lines, streets, and unusual natural or topographic featu res~ 2. Final approval of Health Dept. 'el water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installatio~ 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. Accurate survey of p~Coperty 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 requ ired to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5 .Updated C.O. $15.00 Date NewConstruction ...... Old o~.Pre-existing Building ....~. ....... Vacant Land ............. Location of Property ../.~.~. ....... .Z~..~...C~...~.~.f.~.~.~./.~.....~../?.... ~/C/.~. Q..~. Ho,,, Ne. Owner or Owners of Property . .~..~?..~..~...~./. ~ · .~.~ ./~m~.. .... ~....~../.~ .~.C...~... . .o~.~..~.~. County Tax Map No. 1000Section .,../.~.?. ...... Block ...~..~'~.. ....... Lot ..... ./.~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No~. F.~. ?..2~.... Date of Permit .~/~../..~.~..Applicant/~.~..C~..~.../..~ Cd'~'(_~;/,~9 Health Dept. Approval ........................ Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate.. ~ .................. Final Certificate ....................... Fee Submitted $ ............................. Construction on above described buil~.ing ar~0~ermit meets all applicable codes and regulations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ,Lgl0JJ:L2[ BUREAU OF ELECTRICITY ~J'~ 85 JOHN ~TREET, NEW YORK, NEW YORK '1OO38 ..,~ A,,~,~s~ ~.~, .L~,~ ~li~.,,o.~o.o.~,~ 4u~4~.xl~, N 764500 THIS CERTIFIES THAT only the ol~trtcaJ eqoipment as described below and introduced by the applicant named on the above oppl~cotlon number in the premises of kl~chael ~owil & Ooh~ ~-~ilie~, New ~uffolk ~oa~, Cot. G~ar I{([., (]u~cho~ue, ~Y in the followlng location; [] B~sement ~ Ist FI. FIXTURE FIXTURES OUTLETS SWITCHES ~LUOR~Sc~Nr [~ 2nd FI. Section Block Lot and found to be in compliance with the requiretnents qf this Board. RANGI:$ COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: ~'rac~ i~hC~ ~ E R V I C E NO, O~E~C~COND O~ CC. COND A, W G NO. OF HJ-tEG AWG, OF HI-LEO OF NEUTRAL Paul Burns 275 Io~a aarbor Lane Southold~ NY 11971 GEN~KAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR B~ILDING~ DI~PARTMENT. THIS COPY OF CERTIFICATE MUST NOT, BE ALTERED, IN ANY/vtANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No./~3 OwnerA~ ~06~~- ~-~' (please print) ~piease 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 ~ Notary Public, (plumbe~r' s~ County 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION' 2ND [] IN'ION [ [ ] FRAMING ~ FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~ROUGH PLBG. FOUNDATION 2ND [~,~NSULATION' [~FRAMING [ ] FINAL DATE · INSPECTO TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ,of the fei%owing reasons. /5/ An application for Certificate of Occupancy is not on file. ~No Underwriters Certificate on file. /~/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit ~ J ~ ~ ~_ ~ Z Building Dept, ***/5/ No Plumber Solder Certificate on file.' ( all permits involving plumbing being issued after April 1,1984 ) FIE~D I~S £~EC T ION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined....~.~,~.~ ..... 19 ~.~ Approved .... .~...~..~..., 19.)9.(°. Permit No?..~. ?..~.~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. , -- , ~ . ~ INSTRUCTIONS ~,4 ~A~,~ ~ ..... ' ........ a This apphcatlon/~tst~e C~l~!(~[~ly~filled~,*in by~typewnter or ~n~u~i~{~o~e Bmld]ng Inspector with 3 sets of plans, accurate pl~¥~l~o~cale../~'ac~o~d~ng.to schedule. ~ .... ~, _,~,,,~.~. ~, .. ~t~¢~%~ b. Plot pl~ showing location'~d~fifl}~.~p!lO~gs on premid~s} ~el~figfl{h~tbf~6~m~g premises or public streets or areas, and giv~g a det~led description of layb~f o;f property must be drawn on the diagram which is pa~ of this appli- cation. c. The work covere4 by this application may not be commenced before issuance of Bufld~g Permit. d. Upon approval'of this appt~co[~on, the Building Inspector will issued a Build~g Pemit to the app~cant. Such pemit shall be kept on the pr~i~v~b~'~;~6~q~R~ign throughout the work. e No bmld~ng s~alBb~upm;~9}r~gs¢~ z~Whol~or m p~t for any purpose whatever until a Certificate of Occupmacy shall have been granted by t~o:z~fil~.~]g~p~e~o~,,~ ~{ APPLICATION IS HEREBY MADE to the Bml~ng Dep~tment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ordnances or Regulations, for the construction of build~gs, additions or ~terations, or for removal or demolition, as here~ described. The applicant agrees to comply;w~th, all applicable laws, ordin~ces, building code, ~using code, and regulations, and to admit authorized inspectors on prem~ses~ build~g for necessa, inspections. /~ / ~ ~ State whether applicant ~s owner,~[~s~ee[.3g~nt, architect, en~neer, general contractor, electrician, plumber or builder. .... .................................................................. .... ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... Location ofland on which proposed work will be done. /.~)...(~.. .... . .~..~.~.~.... · .~..~.~..~...~.q ...~.-. rd... House Number Street Hamlet County Tax Map No. 1000 Section .... /.~..~. ........ Block...~-.. ............. Lot.../~ ............ 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. Intended use and occupancy .../?.~ .~...~.~'~.~ -- . ./~...~?~.~ .................................. 3. ]Nature of work (check which applicable): New Building .......... 'Addition .......... Alteration I Repair .............. Removal .............. Demolition ......... ~ .... Other Work ............... (Desc ption) 4. Estimated Cost ........................... Fee . ~...: ~ ...................... (to b~e paid on firing this application) 5. [ If dwelling, number of dwelling units ............... Number of dwelling uhits on each floor ................ ! If garage number of cars 6.! If business, commercial or mixed occupancy, specify nature and extent of each tYpe of use ..................... 7. i Dimensions of existing structures, if any: Front ............... Rear ..... i ........ Depth ............... Height ............... Number of Stories .......................... i ............................. Dimensions of same structure with alterations or additions: Front .......... i ...... Rear ................ '.. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ...... ~ ........ Depth ............... ~ Height ............... Number of Stories .......................... 9. i Size oflot: Front ...................... Rear ..................... j Depth ...................... 10. i Date of Purchase ............................. Name of Former Owner ................. ............. 1 1. iCone or use district in which premises are situated 12. [Does proposed construction violate any zoning law, ordinance or regulation: .. J ............................. 13. [Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ............. ~ Phone No. :Name of Architect ............. Address Phone No ................ ,Name of Contractor .......................... Address .... ...... .........~ Phone No ................ 15. i Is this property located withinti00 feet of a tidal wetland? * Yes ..... No ..... · !If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from proparty lines. Give street and block number or description according to deed, and sh6w street names and indicate whether interior or corner lot OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY El:) IN WATER EXCt:r&' '- NO'r[~:¥ ~3~L13 ~G oEpARTM~T AT 765-'~O~ ~¢ ~ TO ~ PM FOR THE STAT~ :CONSI'~LICTIO~ & ENERGY CODES~, NOT~E~JNslBLE ?OR TiFICATION BER cER T E, EFORE If copper tubing ~ u~d pL.U.M. ~D coNT_EN~,~,uPANCY for wmt~ dl~dbmlng ,yetem; piping I~hIII be CERII.~ STATE OF NEW YORK, cOUNTY OF ................. S.S .... ; ............................................. being duly sworn, deposes and says that (Name of individual signing contract) ahoy6 named. he is the applicant He is[the (Contractor, agent, corporate officer, etcl.) ;~· of said owner or owners, and is duly authorized to perform or have performed the Is~i~ work and tq make and~flle this application ;that all statements contained in this application are true to the best of his'kh~3~le~li~a~h~;,~J~i~;ia~fld ;th~it the workiwJll be performed in the manner set forth in the application filed therewith. Sworh to before me this Notary Public ......... .~.. . County p~ HELEN K t)E VOE ................ #Ol'h~ PUBLIC, Sta.tp.gfY~.~°rk. ~ gnature of applicant) ~, 4707878, Su~.~l~ u0 inly ~,'7 Term Expires Match ~0, l~__-k,/