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HomeMy WebLinkAbout14654-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16721 Date March 18, 1988 THIS CERTIFIES that the building ...QN..E..F.A.M. !.Ly' .D..W.E.L.L. ! .N.G ....................... Location of Propert, 3480 ORCHARD STREET ORIENT House No. Street Horn/et County Tax Map No. 1000 Section 27 .Block 3 .Lot 3.3 Subdivision BEAUJOLAIS ACRE S .Filed Map No, 6373 .Lot No. 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated . .M.a.r.c..h..7.,. 1986 pursuant to wlfich Building Permit No. 14654Z dated . .M.a.r. qh...1.4.: ! ,9.8.6 ............ was issned, 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, decks, attached garage with shop over; wood stove in dwelling. The certificate is issued to CHARLES S. & HELEN K. DE ¥OE ..................... x x'x ................. of the aforesaid building. Suffolk County Department of Health Approval ... §.5.~ S..0 T.2.3.3...~.a.r.....1.6.,.. } .9.8.8. ........... UNDERWRITERS CERTIFICATE NO, P e n d i n g PLUMBERS CERTIFICATION DATED: Mike Jacobi Plumbing and Heating 2/25/88 Building Inspector Rev. 1/81 ~'0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTFtORIZED) N.o 146~4 Z Permission ~s hereb/granted to: ....... .......................... ..... ~...~...,s..~ ....... .o..~_....~......~... ot premises I~cated at ....~...?,...~...~, .......... .~..~/~..~,,...~......~ ........... ..~..~ ................. County Tax Map No. 1000 Section ...... .~...~...] ....... Block ....... ..~..~ ....... Lot No ..... ~'~..:..~ ......... pursuant to application dated ......... ,'~,, .O~4-..,.~.....~..?. ............... , 19.~..~.., and approved by the Building Inspector. I~uilding Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1.802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I~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 apd similar buildings and installa- tions, a certificate of Code compliance from d~e Architec[ or Engineer responsible for the building. 5. Submit Planning Board approval of completed site p~an requirements where applicable. B. For existing buildings (prior to April 1957), Nonconforming 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 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: AddJ. tJons $25,00 POOLS $25.00 1. Certificate of occupancy New Dwelling $25.00, 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 $10.00 4.Vacant Land C.O. $ 20.00 ~//. /~ 5.Updated C.O./ $ 50.00 Date ....... ,~ ................. NewConstr uct~ on...¢'~ . Old or Pre-existing Building ............ Vacant Land ............. Owner oCCro ert ........ '. ..... County Tax Map No. 1000 Section ...... ,~, .~? ..... Block ...... '~, ........ Lot .... ~,.'. ,~ ....... .~.~..~.~ ............ Filed Map No. ~ 3 ? 3 .Lot No. Subdivision Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Construction on above described building and permit meets all applicable codes and regulations, ........................ INFORMATION FOR BUILDING DEPARTMENT WE ARE iN THE PROCESS OF ISSUING A CERTIFICATE OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION AS COVERED IN AN APPLICATION F,I~ED 'frITH THE NEW YORK BOARD OF FIRE UNDERWRITERS APPLICATION NO.__ FORbl IBD 0lEV 1/86) ~N~S~.CTOR OR O N TEL. 765-1802 Building Permit NO. /q~ Owner ~ r ~ (please print) (plc~ase 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, t~~ (pl~r's signature) County Notary Public NOTARYPUDtlC, Stateof~ew¥~k /ermEx~resM&~h30,1~,~ FIELD INSFECTION COMMENTS FOUNDATION Y (2nd) PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ~DITION~L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST[] ROUGH PLBG. ~ FOUNDATION 2ND []INSULATION [ ] FRAMING []FINAL REMARKS: ,, .~p / 7GS-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL DATE_~~ /~/~/ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ULATION FRAMING [ ] FINAL REMARKS: DATE ~/~//~? // ? 765-1802 BUILDING DEPT. INSPECTION REMARKS: FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I/NSULATION / FRAMING [/~ FINAL DATE INSPECTOR~~ Examined .~19.}.~. Approved... * *~ * *Ok~*¢~. 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL °~OUTHOLD, N,Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with } 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 buildh~gs, 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 buildhig for necessary i~,~j//~57~,/ (Signature of applicant, or name, if a corporation) ..... ?... .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O~v~.~. t~ ................................................................ Name of owner of premises ....... ./{.~..t. fi..t-J ...... ~..~...~. ............................................. (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....?.../.~...~.....~?..N..~.~ .... Plumber's License No ............. .0.WN. -~. & .... Electrician's License No ............ O W. tg..~.1~ .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... .................... ....... .................. ! ............. ttouse Number Street Hamlet County Tax Map No. I000 Section ....... .~. 2 ....... Block .... ~ ............ Lot....."~.'. ~ .......... Subdivision..~..~.~ .~ .~.0. ~..~. !S. ......~ .C.R. ?..~. ......Filed Map No.. ~.~..}7. ~. ...... Lot.. ?. ........... (Name) 2. 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 ............ ~ .......... Nature of work (check which applicable): New Building .... X .... Addition . .. ........ Alteration ........... Repair .............. Removal .............. D~molition ........... ... Other Work ....... , ........ -~ , (Description) 4. Estimated Cost ....... ~ ................ : ............ Fee ..................................... ' (to be l~aid on filing this application) 5. If dwelling, number of dwelling units ....... /. ....... Number o f dwelling unit:s on each floor ...... /. ......... If garage number of cars ~ ¢ dt~ i 6. If business, commercial or mixed occupancy, specify .nature and extent of each type of use 7. Dnuensmns of ex~st~ng structures, ffany: Front.../V...~. [~ .... Rear ....... ....... Depth ....... ' ........ Height Number of Stories I Dimensions of same. structure with alterations or additions: Front ............ i. .... Rear .......... ........ 8. Dimensions of entire new construction Front ~.~ 4- 2c/ ' R~.r ~J~ $' !~¥ ' r~a~,h .... '~ ........ .................. ~ ................ ~- ......~.~. ......... Height .... t.q ( ........ Number of Stories ..... .~.tV. ~ .................. i ............................ 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ...... ~.. ~.O/t/~. ....... 12. Does prnposed construction violate any zoning law, ordinance or regulation: .... ,. 13. Will lot be regraded ............................ Will excess fill be reunited from premises: Yes 14. Name of Owner of premises ./~fl..t,~..M., .~).~.//0.~.. Address ~,g.3. q .(~.g~ff.~ .... .~.F'., Phone No. Name of Architect ........................... Address ............. .0.~[t~ ./f.T'Phone No. Name of Contractor .~!4.~ .~.~.g.~ ..... ~.~..ff.o~. ..... Address ....... ' Phone No ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all 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, COUNTY OF .... S.S ................................................. being duly sworn, deposes and says that he is the.applicant (Name of individual signing contract) above named. ' He is the .~ (Contractor, agent, corporate officer, etc.)! of said owner or owners, and is duly authorized to perform or have performed the sa:id 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 set forth in the application filed therewith. Sworn to before me this ~- ................ ~..~.... ,day of ..... .~7....d/rf~...-~... Nota ubiic,. HI~.£N K. DE VO£ NOTARY PURLIC, State of New ~. 4'/07878, Suffolk Count/~ Term Expires March 30, 1~1 ~County ,//,, SUFFOLK CO. HEALTH DEPT. APPROVAL H S. NO. NOV 13 1985 $.C DEPT. OF HEALTH SERVICES RODEmCK VAN ~UVb. ~.C. LICENSED LAND SUEVEYORS GREEN~RT NEW YORK EXCAVATIBN INSECTiON EQUIRED STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISF~D~AL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE S (s~ (/7'~ r--"-' 27"?/- APPLICANT SUFFOLK COUNTY DEPT OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY ~L/,~/>,~, ~ APPROVED: / - ~, ~i%©LE FA~LY DVVFI ~ hNG ONLY SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT BLOEK PCL OWNERS ADDRESS: DEED: L. ~/A P. TEST HOLE: STAMP SEAL TELEDYNE POST N61239 ,/ / 41)52 ~F -, {;INGLE FA~IIL~ DWELLING OilLY P~O~..s~~' DAT~IV~:AR I 6 '[988 H~. REF. NO. ~~ The sewage disp~at and w8[er supply-facUlties for tt,,I location have been inspected by th:s Bepartment 8ad/~r MAP IWO,GB'7 B, NOV, P_~,tge"Z SUFFOLK CO. HEALTH DI:PT. AP~OVAL H.S. NO. STATEMENT OF INTENT THE WATER ~Y AND tIWAG[ ~AL SY~E~ FO~ THIS REStENCE WEL CONFORM TO THE STANOARD~ OF THE SUFFOLK CO. DEPT. OF HEALTH ~RVICES. (si .... A~ICANT , suFFOC~ COUN'r¥ DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY . DATE: H. S. REF. NO.: A~OVED: SUFFOI,.K CO. TAX MAP DESIGNATION: DIST. S[CT. BLOCK OWNERS AD~[~: l or o4^l . ST:, O~tENT, N.Y IJ9~7 SEAL D'D I T I O td I~t L D~c~ LIVING c. WH ._1 F ; , qS~o'' cl APPROVED AS NOTED ->: . -;C_I -- -- __]Z :---- CODES I~OT RESPONSIBLE FOR ~¥LO" .:. U,_L~FR USED IN W.4TER SUPPLY SYST£M ~..ANNOT EXCEED 2,~10 e¢ ~% LEAD. K LIVING I~TILITY ~{8~0" /OLO'' 9 ~JC 0" ~PP~OYED~ AS NOTED NOTIFY ~JU~L,BING L)~P~RT~SENT AT OCCUPANCY OR USE I$ UN~WFUL WITHOUT CERTIFICATE OF OCCUPANCY ~ dleibutln~ piping Ihall be PLUMBER CERTIFICATION ON/.gAD CONTENT EEFORE CERTIFICATE OF OCCUPANCY '~ USED IN WA TFR $UPPLY SYSTEM Ct/' ~ -g',~CEED 2/10 ,-, '" ~go55 T /bi-o" LIVING APPROVED AS NOTED -~o'rqF¥ BUILDING DEPARTMENT AT t802 9 A~ TO 4 PM FOR THE L]TILIT7' ,OCCUPANCY OR USE IS UNLAWFUL ON WITHOUT CERTIFICATE OF O00UPANCY )NTENT BEFORE OCCUPANCY ~¥C0" lng ou~.~ER USED IN WATER SUPPLY SYSJ~M J~INNOT EXCEED ~tJO W f% LEAD.