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HomeMy WebLinkAbout14479-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No .... z.1.50~O ....... Date .~q~gP~.C....27, ................. .. 19~. Alteration & additio~ THISCERTIFIESthatthebuild~g ............................................... Location of Property 37(2 Williamsburg ~rive Southold, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section . 0 7 8 .Block 0 5 .Lot 009 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .bi o..v.e.m.b.e..r..1.8. ~ ...... , 19 .8 .5. pursuant to which Building Permit No. 1 6 4 7 9 Z December 17, 85 dated ............................ 19..., 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 ......... .~ ~.~.e.~.~ ~ ~.o.~, ~.n.a..a..a.~A~.~..o.n. A?..e.x.~.s..%~.~.~., ?.ny..( .a.m.~.~.y., .~y?.~..~ .~.n.g. ............. The certificate is issued to ...~. a. ~ .t .e.v.. &.. ~.a.v..3 .o.e.d. ?..~ .m.~. ~. h. ............................. (owner, ~.~z~ [e~,qb~)x x x of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N66463 UNDERWRITERS CERTIFICATE NO .................................................. Plumbers Certification dated September 5, 1986 Rev. 1/81 IPORM 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) 14479 Z Permission is hereby granted to: ......... ..~.~.....~.~.....~.~,.~. ............. ........ -g..:. .................. ........... ....~z.c~....~_.Y.~.t..~.,..'-/..:....~.~.~ ,o ......... i~.,~,~.~.....z~c'z:-~f.~ ~..~ ...... ~-z... z~.~..~.~o.~.....~ ............. ........... ~---~..~.~..%..,~.~ ~.......,~...~_J-.~..~.~ ................................................................................ at pram,sas located at ..... ~.,.~. ........ ..~.~J,.~..(.(.~-~4..~.~.LJ.~'/~,.~ ........ ~ ..................... ....................................................................................................................... ;;~:l.r,c.~:f.~/,,~,..: ...... pursuant to application dated ~J,~....~........~...~. ........................ , 19...~....~.,-~and approved by the Building Inspector. Fee '..Z~.....~.. ..... ~.~.~ ................ 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 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. Commemial 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. B. 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. C, 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 ...~..~...~. :..~,~. J..~,~,~.~... NewConstructIon ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property '~rTO .'~,,LLC~,~,~"~,~,'A~ ~>~t~_. ...~,?.~'~,t~.u~-?~ N,.~,/. House No, Street Hamlet Owner or Owners of Property ~' ~-'~ ~'/~ .~ ?' ~5,~ ~ ~ t~' t--~ . CounW Tax Map No. 1000 Section ...O..~J .~. ....... Block .. c~. ~' Lot.. ~.~. ~. Subdivision ................................. Flied Map No ........... Lot No .............. Permit No. I ~,%1,, ,~,, ,~,',~. Date of Permit pplicant ~'~ ,~', ~',~,,~. ~ .......... ~,; ........ Health Dept. Approval ,'~,~k ?~, ~ ~ ~ ~ ......... Labor Dept. Approval , ~ ..................... . ~ ~9.~. /~ - ~'-7~ I ...................... Unde~riters Approval ..... ~ ............. anning Board Approval Request for Temporary Certificate ..................... Final Certificate , ,~ ................. Fee Submitted $ .~, ~, ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~ ..~..~. ..................... Rev. 10-10-78 £0% I5oqo TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No._[%~qq ~--. Owner_ ~ ~Ao ~-~_ ..c~_~% %-~ %k (please print) Plumber_?~_e.o~c- (QI~(~,~.~6, 6 ~-~- . (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plu~e[r~' s signature) Sworn to before me this 19 ~. Oualifltld in Su~olk CounW_ ~ ~ml~lon E~lre~ Ma~ 30, I~ Notary Public / THE NEW YORK BOARD OF FIRE UNDERWRITERS 1135021 BUREAU OF ELECTRICITY ..,. ~ ~, ~6 ~.,,~,,o.~o.0.~,,~ ~0s~/~ N 766463 THIS CERTIFIE~ THAT only the electrical equipment ~ ~scribed belo~ end i.trodaced by t~ applicant ~med on the obove application number in the prem~es of k~rjory ~ Wal~ ~i~, 370 WiXli~urg Drive, i. th. follo~.g &~catlon; ~ .se ent ~ ;st FL ~ ~nd ~7, Se~tlon Bilk and~ound to be in compl ante w th the req~ireme~ s of thi~ Bourd. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE 30 42 DRYERS E R V I C 2/0 · hree C Electria At · Box 45~ So~nd Avnoue River~a~,N aY 11901 Lto#3327~ OBNERAL MANAGER 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. )nspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE Iv~UST ~O'T BE ALTERED IN ANY MANNER. 76S-~802 BUILDING DEPT. FOUNDATION INSPECTION [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL RE:MARKS: DATE ~ 7GS-X802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~INSULATION [ ] FINAL £ ] FRAMING REMARKS: ..... DATE 765-1802 BUILDING DEPT. INSPECTION ~.~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION DATE []FRAMING []FINAL REMARKS: INSPE~I'OR~~ FIEL~ INS~ECTI~)N DATE COMMENTS FOUNDA_TION . .__ FOUNDATION 2nd) ' PLUMBING INSULATION PER N. Y. STATE ENERGY ADDITIONAL C O~MENTS~: ~ s,,::~ I6 t0 ,*7 -t .> FORM NO. 10 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. Box 728 Southold, N.Y. 11971 Town Hall Main Road Southold,N.Y. ~ ,APPT~TC'AT]'~I l~(%Q ~EVELOPMENT PEP~MIT Instructions: The application to the Building Inspector includes (each ~n duplicate) 1. Form No. 10 filled out in ink or typewritten, 2. Sur- vey of premises with elevations above mean sea level, 3. Drawings of pro- posed work. The application must give complete information to show that the proposed can comply to the Local Law No. 1-1980, Chapter 46 of the Code of the Town of Southold known as "Flood Damage Prevention Law" of the Town of Southold. The applicant must submit approvals that any other agency requires. General Standards as required in Section 46-17 of the law to minimize flood damage: A. B. C. D. Anchoring of structures, including tanks and mobile homes Use of construction material and methods Design and location of utilities Subdivision proposal with drainage, public utilities design and base flood elevations ~pecific Standards as required in Section 46-18: A. Residential construction B. Non-residential construction C. Mobile homes The applicant must submit plans and specifications as well as any other information requested by the Building Inspector to substantiate the facts that the structure has or will have the lowest floor, including basement/ cellar, elevated above the base flood elevation or; if permitted by the Federal Regulation, that: 1. such structure is flood proofed in such manner that below the base flood level the structure is water tight with walls substantially and impermeable to the passage of water, 2. that structural components are capable to resisting hydrostatic and hydrodynamic loads and effects of buoyancy, 3. applicant must submit certification by a registered professional engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied. Coastal High Hazard. area (V Zone) 46-19. Applicant shall submit plans, specifications including the required certifications and such other in- formation as the Building Inspector may require in that the provisions of 46-19 are complied with. Mobile homes are prohibited. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation with all space below open except breakaway walls. Sand Dunes. If sand dunes exist on the premises and the applicant pro- poses to alter same, plans and specification must be shown in detailed nature of any alteration submitted. Building Permit. A Building Permit is also required for any structure. Both a Development and a Building Permit must be issued before any work can start in a special flood hazard zone. A written disapproval or a permit must be issued within ten (10) working days. During construction, the inspector shall be notified in time so he may make the required inspections. Upon completion, the required certification of the final elevations and work must be submitted before the approval to use or occupy can be 'approved. (Fill out the form on the back of this sheet) 11/85 Applica~on Recei ,,/t'~ 19%~} Disapproval Issued 19 FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT IN THE TOWN OF SOUTHOLD .£. Type o~ Development Proposed: Addition and/or Alteration Other (specify) . 2. Elevation Data inlrelation to New Structure (including storage tanks Flood Proof Below Base Flood Elevation-- above mean sea level of: '7. (a) Lowest floor elevation, including basement fact inches (b) In a V Zone, bottom of lowest structural member feet inches Owner of Premises Location of Property: i Street / County Tax Map No~, Dist. Subdivision ~--~-~-- Hamlet 1000, Section O?~Block (2)~-- Lot(s) Filed Map# --- Lot (s) Permission to be granted: Owner as above'New Owner Under Contractl Lessee Name'if'not given!aboge Approval from other(s) DEC Health Services Building Permit Contractor Phone Mailing address / before Permit is issued: Wetlands (Town Board) ZBA ~ Planning Board the applicant, am the Owner__, Co-Owner New Owner __,:Under Contract , Lessee ..... , Agent __, Contractor , and agree to comply with all applicable sections of the Code of the Town of Southold; County, and State and to admit suthorized inspectors to premises authorized to perform or have performed the said work and to make and file this application, that all statements contained in this application are t~ue to the best of my knowledge and belief and that the work will be performed in the manner set forth in the application filed therewith. STATE OF NEW YORK COUNTY OF SS .... ._ Notary Public ' Applicant's mailing · address and phonei# if not given above lil/85 DAY OF Szgnature Examined .~..~ .... !.7.,. 19 ,~. ·~' Approved .~...~...~ ..... .-~..., 19 ,~.%.'~ermit No. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Disapproved a/c ........ ~ ................ ....... <' ' ....... APPLICATION FOR BUILDING PERMIT 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 wilt issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throu~out 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~ap, l~l?ant,ffr/n~me, if a corporation) ... ......... ii~l'ailin' ' '; ~ldress'" ' ~tabbii~2~;) ............ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises .I.I..gt-~V.,J.O..~..q~ .... ~'.?.~.?.:: ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. I (Name and title ofcorporate~officer~ Builder's License No .... ~Z.~7'..../. ........ Plumber's License No ............ ~.~ ........ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...570. l.l. . .sh t¢. . . Dr:,?. .<. . , . . . .5.o. .o. ld , . . .......... House Number Street Hamlet County Tax Map No. 1000 Section ...... .O. 7.~. ...... Block .... .O...~. ......... Lot....O..~.. ~. .......... Subdivision ................ (~q'ah~4) ................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed donstruction: a. Existing' use and occupancy .... " - / b. Intended use and occupancy ........................... ~ ....................................... / 3. Nature of work (check which applicable): New Building .......... Addition ......... Alteration .......... Repair .............. Removal .............. Demolition ........ Other Work ............... .. [ o~ (Description) 4. Estimated Co~t ........ ~.,~../..~..~...~.. rte be paid on filing th~s applicatmn) ¢. , 5. If dwelling, number of dwelling units .. [..~/. /... Number of dwelling units ion each floor ................ If garage, number of cars .... t2 .~1.~ ..................................... ! .......................... 6. If business, commercial or mixed occupancy specify natBre and extent of each typ, e of use . .~.. 7'. .... ...., ........ 7. Danensmns of ex~stmg structures, ~f any. Front .... .~.D. ........ Rear . . . .g..~.. ! ......Depth . .. ~{/ ......... Height ............... Number of Stories ...~7). ~ ..................... ; ........................... Dimensions Of same structure with alterations or additions: Front ....... . .~0. ~. !I .... Rear ..... ~..O' ....... .... Depth .0,~. Height ... Number of S:tones .... .0. ~ .~. ............. 8. Dimensions of entire new construction: Front ............... Rear ......... ' ......Depth ............... Number of Stories Height ............................................ ........................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............ Name of Former Owner .I. l 1. 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 ....... ~ .................... Will excess fill be removed ifrom premises: Yes No 14. Name of Owner of premises .................... Address ................ I... Phone No ................ Name of Architect ........................... Address ................ i' · · Phone No ................ Address Phone No Name of Contractor ............................................................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ind )roperty lines. Give street and block number or description according to deed, and show nterior or corner lot. icate all set-back dimensions from street names and indicate whether STATE OF NEW YORK, S.S : COUNTY OF ................. ................................................. being duly sworn, depokes and says that he is the applicant (Name of individual signing contract) abov'e named. ' He is the .......................................................... ~ ........................... - (Contractor, agent,,corporate officer etc.)i of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best of hL, knowledge and belief; and that the work will be performed in the, manner set forth in the applicatiofi filed therewith. Sworn to before me this ' ' ............... ; ........ ~ y o]r ........ No, 4~8-~ (Signature of applicant) -4 '\ II 1-t APPJTOVED AS NOTED FEE: ~..~, By: ~ NOTIFY BUILDING D£~/~RTMENT AT 76S-lBO~Z 9 AM TO 4 PM PaR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N, Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR OCCUPANCY 'OR USE IS UNLAWFUL'" IF copper.lubing is use,''1 DESIGN OR CONSTRUCTION ERRORS. ,o..o,.rd,.,,,b~,,,. '~ITflOUTCERTIFICATE sys em; pipi :g shall ~e ~"" -- ,~'~-~"*' ~,." OF OCCUPANCY PLUMBER CERTIFICATIo.N' ON LEAD CONTENT BEFOR~ CERTIFICATE OF OCCUPANCy SOLDER USED/N ~TER ,.~UPPL Y SYSTEM CANNOT .EXCEED 2/10 of 1% LEAD, ';i¸ u~ O© '1 iff It-: .......... 1- I I ? ( ..... % { '1