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HomeMy WebLinkAbout14838-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15632 Date April 13, 1987 ONE FAMILY DWELLING WITH ATTACHED DECK THIS CERTIFIES that the building ................................................ 570 Hickory Road Southold, New York Location of Property ........................................................ House No. Street ' ' 054 06 8 County Tax Map No. 1000 Section ............ B]ock ............... Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 30, 1986 pursuant to which Building Permit No, 14838Z dated ............................May 3, I 986 . 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 ATTACHED DECK The certificate is issued to . JOHN R. DEMPSEY, INC. .................... x .................... of the aforesaid building. Suffolk County Department of Health Approval .... 85- $ O- 227 N795336 UNDERWRITERS CERTIFICATE NO .................................................. F~e~bruary 10, 1987 PLUI{BERS CERTIFICATION DATED: Rev. 1/81 I~ORM NO. ~ 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) N.o 14838 Z Date Permission is hereb/granted to: ...... ...... L.~.~...~..~ ....................................................... ...,.~.~ ..~......~ ........ ,~ ~..u...~..~'?. ....... ,o ..~.~....~.....~.....f.~i...~.~..~..~....¥~.....~..... ..... at premises located at ..~'..?...~.......~..'..~........~..~,.......~..~~'~ County Tax Map No. 1000 Section .....O....~.....~.. ...... Block .... ..C)....~. ........ Lot No ...... .~ ............... pursuant to application dated .... ~......~..O. .................. , 19..~...~., and approved by the Building Inspector. 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 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 sFmilar 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~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. Fees: 1. Certificate of occupancy $5,00 2, Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Date .... .&~.~,~. ?! 1987 $15.00 New Building ..... ,~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~70 Hicko?% .Road~ Southold House No. Street Ham/et Owner or Owners of Property .... ~Tp.kq ..R... Dem~.sey, In c. County Tax Map No. 1000 Section .... -5.4 ......... Block ,, ,6 ............ Lot .8. .............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..1.~.6~.~.~. , Date of Permit . .~.--.~.-.8..6..Applicant ...J.o..h.n..1~. t..~.e.~?.e.~. !..I.n..c; ...... 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 .~,~~...~....~..~..~.~./... (~..~-~.'~\ .C~., .~.,,, 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) Plumber ~%~ ~% (please print)' I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (piumbers signature) Sworn to before me this Notary Public, ~0FFo~ County Notary Public THE NEW YORK BOARD OF FIRE UNDERWRITERS 10001~1 ~UREAU OF ELECTRICITY; 0.,. ~,.~...,,0. ~o.o./,,, N 7.. 5336 THIS CERTIFIES THAT J~n Den~ey, Hicko~ I~ S~vie~ ~ ~ne> ~t~d, ,~ection FIXTURE EWITCHEE FIXTURES ~__~ DRYERS FURNACE MOTORS SUTURE APPLIANCE FEEDERS RANGES .~RVIC~ DISCONNECT S Lot EXHAUST FANS DIMMERS OF NEUTRAL }~otors: 1-1hp 3-G.F.C.L 1-S~3ke D~tector Tr~ck I&ghtir~; ]6' 8 Lites Paul R. Burns 275 T~n Southold, N.Y. 11971 Lie. 282E GENERAL MANAGER 7..~j,,1:~ This certificate must not be altered in any manner; return to the office~ of the Board if incorrect. Inspectors may be identified by their credentlals. COPY FOR BUI~.DING DEPARTMEHT. THiS COPY OF CERTIFICATE MUST ~OT ~,L~ERED IN ANY MANNER. F1ELD INSFECTION FOUNDATION ~(2~d) ROUGH FRAME & PLUMBING COM ~ENTS INSULATION t STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-~802 BUILDING DEPT. iNSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL 765-1802 BUILDING DEPT, INSPECTION NDATION IST [ ] ROUGH PLBG. [ ] FRAMING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FINAL REMARKS: INSPECTOR ,,~~ 765-1802: BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND ~j~INSULATION [ ]FRAMING /~//.[ ]FINAL~ 765-~02 BUILDING DEPT. INSPECTION [/~F~NDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE 7//~//0~' INSPECTOR, //~;~ · kS~"~ ,~; FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y, 11971 TEL.: 76541803 Examined.. i.~ .C~cr.~..., 19~.(e. Approved.....~. ?~ .~a,., 197.~. Permit No. ! .~. ?..~..~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely tilled 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 inspections. .... (Signature of aplgficant, or~ame, ffa o p at' ) .................. . ...... (ma±ling addr6ss of appl±cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... qb .~.~.~0..,7. ................................................................................. Name of owner of premises .~.[:~Y'~ ................................................................ (as on the tax roi1 or latest deed) I~ .a~.c n .~ ¢ ~~.e.~.d ul Y ;;~rlz.~.;;fi c e r ' Builder's License No .......................... Plumber's License No..~.:...~.. O...~'.'~.. '..~,q.~..... Electrician's License No. ~. &~.%.*45 .......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..................... .. ....... .S'-to ;; ................... House Number let, Couuty Tax Map No. 1000 Section ....~..~. ........... Block.../,~ ............. Lot..~. ............... Subdivision ...... lq/~.. .......................... 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 .... V~ .(.~..~..~..... L~:i f'~2 .......................................... b. Intended u~and occupancy ~.¢,,1~ ~.~ .r~. iL y Nature of work (check which applicable): New Building ...... :... Addition .......... Alteration .......... Repair .............. RemOval ............ Demolition .............. Other Work ............... I (Description) 4. Estimated Cost..~.~. ,O.~.© ........................ Fee ...................................... ! (to be paid on filing this application) 5. If dwelling, number of dwelling Chits.. If garage, number of cars . .-2...: .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of ea ...... . ....... 7. Dimensions o.f existing structure~, if any: Front ............... Ret ........... Depth .......... Heigt ............. Number of Stories ........................................................ Dimensions of same structure wiih alterations or additions: Front ................. Rear .................. Depth ~ Height Number of Stories 8. Dimensions of entire new constrgction Front..~.~3.t. Rear ;1.~( Depth 5[0/. 9. ~H. eight . ~.~ ........... Number of Stories .. [ ........ ~ .......................... , ................. 10. Date of Purchase . .\ /.g.~ .... ! ................. Name of Former Owner .~¥..~hk~'L.~ ................. 11. Zone or use district in which premises are situated...~,~-,S.\.~5,~ .~.~, .X . 12. Does proposed construction violate any zoning law, ordinaffce or regulation':' 13. Will lot be regraded .~.O. ........................ Will excess fill be removed from premises: /Yes No 14. Name of Owner of premises ,,59.~..~,~.E, .w~.~h~.~)?.CAddress .QM .?f-..~o. c,..~.t ....... Phone No. 3~.}.~: .Gg..~ ...... Name of Architect .......... i .... .~ ............ Address ...... Phone No ................ Name of Contractor ......... ~ ................ Address ................... Phone No..: ./. .......... 15. Is this property located withint.00 feet of a tidal wetland? ~ Yes ..... No l~ .... * If yes, Southold Town Trugtees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ...x..X~ .~,.~...k-~.....~..~.~J~.~.~. Ni ........ : .......... being duly sworn, deposes and says that he is the applicant (Name of'individual signing contract) above hauled. He is the...(D.X~ ~..~. ........... i .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyI 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 mannerlset forth m the application filed therewith. Sworn to before me this : ............ .~. ........ ,..day of.:...~ ......... 19 .J'~. _~lt/~~rl~,.~ ~.~ ~(Signature~ appli~n'ti *'" - '7, LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH D/PT. APPEOVA ,L.' 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 SERVICES -- FOR CONSTRUCTION ONLY IDATE: H. S. REF, NO., APPROVED:, , , DEPT· OF HEALTH APPROVAL OF SUFFOLK CO. TAX MAp DESIGNATH~N: BLOC~ SEAL ~rn~ mm SUFFOLK CO. HEALTH DEPT.' APPROVAL H.S. NO. S5- 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.' (S) /~PPLIc'AN'T" SUFFOLK COUNTY DE;PT, OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S.,REF. NO.: APPROVE D: ' SU~'FOLK CO. TAX MAP DIST. ~CT. BL~K ' PCL. . ~OO~;..Z~ ......... ~, ~- SEAl' sOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/I0 of 1~ LEAD. OCCUPANCY OR E IS UNLAWFUL _ ,,,,, US .,~_~,', ~,~,. WITHOUT CE ~ ~ ' LOv?~tG INSPEC~ONS , ; ;~/'"~ r.,;',t?'`'NG & PLUM"lNG I PLUMBER ~E~L:~ e=~ RE , ~,, =.=.. ~. ~uP~,~. ~'* *o~,.**.T~ ~L~ I ........ '-- ' ' ........ I " ---14 0 O0