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HomeMy WebLinkAbout14417-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15988 Date ,July 23 1987 THIS CERTIFIES that the building ...O.N.E.. ?.A.M.I. ,Ly..D..W.E.L.L.I..N.G ....................... Location of Property ....4.7,0..D..o.g.w.o.o..d .L.a.n..e East Marion, New York House IVo. Street Ham/et County Tax Map No. 1000 Section 038 .Block 05 .Lot 002 Subdivision M/o Gardiner Bay Ests.Sec. 3 .Filed Map No. 5083 .LotNo. 180 conforms substantially to the Application for Building Permit heretofore filed in this office dated October 29, 1985 pursuant to which Building Pennit No. 14417z dated .. O..c.t.o.b.e..r..3. ! ,...I.9.8. 5. ....... 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 SCREENED PORCH AS APPLIED FOR The certificate is issued to EDWARD & CAROL ANN PEARCE ..................... ?o;,;n'e'r, X .................... of the aforesaid building. Suffolk County Department of Health Approval 85- $ O- 176 UNDERWRITERS CERTIFICATE NO. N 803327 November 25, 1986 PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 FOW, M' NO. ,s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING pI=R~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETION OF THE WORK AUTHORIZED) NM 14417 Z Dote ~ 19.~.*[*~ Permission is hereby granted to: ../..Z ~..~.~,~.~/~:~.~'~...~.. ............ ~Z,~/~.~.~./,.~...~.~......z/..7..~~. .... ,o ......... ~.®~,~....~. . .~.........oz~z~....~. .~/..~.~....~/,z,~(,~..~ ..................... ~,~,~,,,,=,~, ..... ~.za ......... ~.~.~ ........ ~., ................................................. ........................................................ ~. ........................................... ~z~ac<,~e: ~' .~~....~.e...~:~..~z~~ ~ ~ ............. ~:~ ........... ~.~ .......... ~z.~/~ ~..~ m~ ~ No. lo0o s,¢,,o, ....~.~.....~ ..~.~. ....... ~o, No..~.~ ...... Building Inspector. Fee $.....~..~....~.....~.'......~.'~ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 TOWN OF SOU ~,HOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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- lions, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pz~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: Additions $25.00 1. Certificate of occupancy New Dwelling,S25.0.0, Acc~ssory,1$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.wc nt c.o. $ 2o.o0 5.Updated C.O. $ 50.00 Date ........... NewC°nstruction ...... Old or Pre-existing Building ............ Vacant Land Location of Property /Y/7~ ~ o(,~ ~. ~ House No, Street Ham/et Owner or Owners of Property ~ L ~-- ~-~-'~ County Tax Map No. 1000 Section ~ ~ Block J.. . Lot Subdivision ................................. Filed Map No ........... Lot No. Permit No..~.¥¢(.~ .~. Date of Permit ./~: ?./..'~?..Applicant .................................. 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,a~plicable codes and regulations. App cant ........................ Rev. I0-10-78 FIELD INSPECTPON COMMENTS FOUNDATION (1st) FOUNDATION (2nd) I~OtJGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~ A'p~]. 13, ]~987 85 JOHN STREET, NEW YORK, NEW YORK 10038 404132/86 "~" ~'"'""~" ~"' "" ~"~ N 803327 THIS CERTIFIES THAT only the electrical equipment ~ ~serlbed belo~ a~ in*mduc~ by the applicant ~med on the a~e a~pllcation number in the premises of Edward Pe~rce, 470 Dogw~d Lane, Eas~ ~ar~on, N,Y was examined on attd found to be in contpllance with the require.tents qf this Board FIXTURE FIXTURES RANGES C~KING DECKS OVENS OUTLETS I SWITCHES 19 34 23 19 DRYERS FURNACE FUTURE APPUANCR FEEDERS EXHAUST FANS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO~ OF FEET SERVICE DISCONNEC~ OTHER APPARATUS: ~Otors: 1-1bp 3-G.F.C.I. 1.--b~oke Detector Track Llghtin~ 16' 0" 11 Lites S E R I C E NO OF CC CONO A, W G pER ~' OF CC COND V NO OF HI-LEG Dennis Cler±e , Jr. P. O. Box 284 Laurel, N.¥.11948 Lic. 2342E Per . This certificate must not be ol~ered in on~ manner; re~vrn ~o the office o~ ~he 8o~rd i~ incorrect Inspecfors m~y be identified b~ ~hek credentials. COPY FOR BO LDING DEPARTMENT THIS COPY OF GERT F GATE MUST NOT BE ALTERED IH ANY TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOIJTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No._~_~ Owner (please print) Plumber N~l~om ~bl,~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber s signature) Sworn to before me this Notary Public, ,.~/~,~ I];, County Notary Publ ic~7~ NorARY PUDL?,, S~t! of e~ee' York [~o 4834804, Suffo~ Coun~ T~rm Ezpu~ March 30, 765-180Z BUILDING DEPT,. INSPECTION [ ] FOUNDATION 1ST [~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION ~ FRAMING [ ] FINAL REMARKS: BUILDING DEPT. ~,~ INSPECTION FOUNDATION IST [ ] ROUGH PLBG, .-.Z"/~.~,~,,.,.,~ FOUNDATION 2ND £~INsuLATIo~ F~MINQ [ ] FINAL . .... NSPECTOR ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 9OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ............... 19 Received ........... ,1 9.. · Approved ....... t9 Permit No ......... ~ ~. Disapproved a/c ............... .~.~. ....... O ........ / ~L ~ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT ....... 19 INSTRUCTIONS 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 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, hous,~g code, and regulations, and to admit, authorized inspectors on premises and in building for necessary ij~oe.~ctions. (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. , Nme of owner of premises..~.. ~.. :~Q-&d .d~ ............................ (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. /.~.O...~..~...~../.~..~.~..~.~._:A .... Electrician's License No. ~.~..ff~....~./.c.{~..;~.fi. .... Other Trade's License No. ~..~(...Z./.~..~..~.~.. 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~.~.~ ........ Block . ..~ ........... Lot. ~ Subdivision .~.~ ~&]~}~. Filed Map No. ~ Lot / ~ ( 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n: a. Existing usc and occupancy .... u~. ¢~.'y/ ......... ' ..................... ~s.~d.~,0.,,f .................. b. i~te~ed use and occupancy .......................... ..... ~ 2~', ~¢ '""~¢,,~=~ ..... ,~,, .............. :3'., Nature of work (check which applicable): New Building .......... 'Addition .......... Alteration .......... Rep,.ir: ~'.':i i Remb al Demolitio Othe Work ~. Estimated Cost o ~. Fee '~' (to be paid on filing this application) 5. If dwelling, number of dwellingl units... ! ........... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mix6d occupancy, specify nature and extent of each type of use ..... .-7. .............. 7. Dimensions of existing structures, if any: Front ...... .~. ....... Rear ......... Y.... Depth .... '7. .......... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear ................. h Dept ................... ?.. Height ...................... Number of Stones .............. ~. .....j.. Dimensions of~entire~new construction: Front... ~;~...t~...~.<~. Rear .... ~ff.~.. ~./..~. Depth ~/~...~..~....~'./.~.... Height ... ~..~.'.~. ..... Number of Stories ..... Z~ ................................ z '~ ...... ~ ....... Size of lot: Front .... Zo..~..F-.~....., ....... Rear ....~...~. ~?. ........... Depth . .~.. 7: .?./.../.-.-'~. ....... Date of Purchase ....... ~.~.~.7.~.~.. ......... k..~,.N~m~of~nnerOwner .~.~.~t.~.q..('.~.~.~'..~. ............ Zone or use district in which p~emises are situated ~,.'. :.~q. ..... *.~ ...................................... .Does proposed construction violate any zoning law, ordinance or regnlation: . ~..o. ................. Will lot be regraded ...... .2~....~jo. .............. Will excess fill be removed from premises: (Y~s~ No Name of Owner of premises .~.i?..~..~..~. o.~ ff~..~f..~.. Address/?.~./.~.~?.~?.?.~. ~.~'?.{Phone No.¢/.~.~. .'~.. ..... Name of Architectt~.~..~.&4.~.~? ~ ~fg.°.C.~ .B'~... .... Addrass~.~..~..~,~ ?q/.~.C..~.w..~Phone No. ff..~/...~r?. Name of Contractor ........ ~ .................. Address ................... Phone No ................ 9. 10. I1. 12. 13. 14. Locate clearly and distinctly al property lines. Give street and bloclq interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................ PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, j He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 manger set forth in the application filed therewith. Sworn to before me this ' ............ ?.....~. .... day ~f .................... 19 Notary Public, ..... ' ! ........ County (Signature of applicant) SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. .... _ ~'~.0 5LJ~.',/~'?~.~'=L~ ~0~ STATEMENT OF INTENT ~ ~ ~i ~ ~~,~ ~ ~ ~ ~ ~ ~ ~ .~'~- ~ ...... ~, r'~ .... .~ , ,-.~ ~ ~- THE WATER SUPPLY AND SEWAGE DIS~SAL .. ~..~.~,__~ ~ ~ _.~ ( ~ . . SYSTEMS FOR THIS RESIDENCE WILL --~' ~ .~ CONFORM TO THE STAND. DS OF THE ~ ~ SUFFOLK COUNTY DEPT. OF HEALTH ~ ;INGLE FAMILY m~,~ I V,~:';~ ~'~, ~,' [ ~ < /. , SUFFOLK CO, TAX MAP DESIGNATION: ~ '~ ~c~[~; ~O '~ 1" DIST. SECT. BL~K /,~0~ '~ ~ // ~o~e~?~ OWNERS ADDRESS: -... ~ ~ ........ : /. : TEST HOLE STAMP 's ':¢~ ~" - SEAL ~ ('pc:v~ ~,~;, ~ ~,~ ~-c,/4 ' RODERICK VAN TUYL, P.C. I ~ LICENSED LAND SURVEYORS ~ou~) GREEN~RT NEW YORK SUFFOLK CO. HEALTH DEPT. AII~Pll'OvAL H.S. NO. STATEMENT ~ INTENT C~ TO T~ STAND~ ~ THE ~FF~ CO. ~, OF HEALTH ~RVIC~. ~IC~T .. s..~. ~.: ~F~ ~. TAX MAP ~~ ~ ~~ VAN T~YL, P.C. ~ N~ Y~K SUFFO[ ? ONL? H.D. REF ....... DATE THE SEWAGE.~DISPOSAL AND WATER 'SUPPLY FACILITIES FOR THIS LOC/~!,O,~4~AVE BEEN INSPECTED BY THIS DEPARTMENT AND FOU{~ TO B~A ~ I.S F A ~T 0 i:~_~.A~.. Chlef-'of Wastewater Management Section GREEN~RT NEW YORK SUFFOLK CO. HEALTH DEPT. APff~OVAL H.S. NO. STATEMENT OF' INTENT THE WATER SUPPLY AND SEWAGE DI.~aO~AL SYSTEMS FOR THIS RESIDENCE VlflLL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH ~ERVlCr~. (SI ,~ APPLICANT SUFFOLK COUNTY D~PT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.: <~- $O - 1'7~=~ APPROVED: SUFFOLK CO. TAX MAP DE~GNATION: DIST. SECT, BLOCK PCL. OWNERS ADDRESS: DEED: TEST HOLE IL~NG DEPARTME~ AT ~ AM TO 4 PM FOR TH~ FOLLOWING INSpECTiONS: 1. FOUNDATION - ~ R~U[RE~ FOR POURED CONCR~ ROUGH- FRAMING & FE~IR~ INSULATION FINAL - CONSTRUCTIO~ ~ B~ GOMPLET~ FOR C ~ ALL CONSTRUCTION '$HAEE ~E~ 'STATE CONST~UCTI'O~ ~' ~E~ ' :CODES, NOT RESPON~I~E~ ~ DESIGN OR CONST~U~I'ON E~O~5, L IO'.- o" lB- G .I If copper tubing is used for water distributing sys em; piping shall be of types K or __L only_ SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1% LEAD. pLUMBER CERTIFICATIOn. ON LEAD coNTENT BEFOR~ CE}2TIFICATE OF OCCUPANCY ,t I t,1