HomeMy WebLinkAbout14258-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building addition to existing dwelling
Location of Property ....2.7.0.5. .................. B..c.i~qe...L?. ......... .C.u.L. ?.h.o.g..u. ? ......
House No. Street Hamlet
County Tax Map No. 1000 Section ....0.8.5 ...... Block 002 .Lot 001
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fded in this office dated
·..~.u.~u..8.t..7. ~..1.9.8.5. ..... pursuant to which Building Permit No. 14258Z
dat~d~p.~..e.m.b.e.~...1.1.,...1.9.8.5. .......... was issued, and conforms to all of the requirements
of the applicable provisiorls of the law. The occupancy for which this certificate is issued is . to, .cons truct
an addition to existing one family dwelling, as applied for.
The certificate is issued to ...... R.a..lp.h. & Patricia Pugliese
(owner, levee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .. N/A
N81590.9
UNDERWRrrERS CERTIFICATE NO .................................................
PLUMBERS CERTIFICATION DATED: July 10, 1987
Rev· 1/81
TOWN OF $O~THOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, No Y.
BUILDIHG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No_ 14258 Z
Permission is hereby granted to:
~~.....~.~ ......................................
.~~.~...~.:~:......~,.~.~.~-. ........
~ ~r "-~' ~ ... ~...~Ld~.~... ~q. ~~ ~
'~"'"'~'~'~"'":: ............. :": .......... ~ ................ z""~'~' .......................................
mt premises located at .,:~,~..°...~....]\~,4,....~-.c~C~L ........ ~~-~ ..................
County Tax Map No. 1000 Section .... .~......~...~.~.. ...... Block O ~ ~ Lot No ..... ..~ ........ ~ ......
to application dated ...~-~..~..~.....'].. ....................... , 19.~,.,'~.,'],,,and approved by the
pursuant
Building Inspector.
Building Inspector
Rev. 6/30/80
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
v~ (p~mber" ~
Sworn to before me this
/~/ day of >Wu ,'
Notary Public,
County
Notary Public
FORM NO. 6
TOWN OF $OUTHOLi
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
~PLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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 property 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. S25.00, Accessoryi$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 $]0.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..........................
NewConstruc Lion. .-~.. Old or Pre-existing Building ............ Vacant Land .............
Location of Property . /. ~.~ ~/-. .... .,5/~7/. ~-; ..............................
House No. /~ . Street ~'~ Hamlet
Owner or Owners of Property ,.,,,.-~.).f~//f... Z.z'~.~.'
CountyTax Map No. 1000 Section . .~. ,~.'.~..~. ...... Block . ?.'.~.~ ....... Lot. ~.~. ~. ........
Subdivision ................................. Filed Map No .......... .~c~t No ..............
·~"' ~' Permit ?.~.-'~?-7 IQ~'~/~''?' . ~ .~-.
Perm,t No./.4/:,~9+Dr~.Z. Date of J. :-.~..~..ApplicantF. ~ .-'~ ./~./~.../~C/.~ct .....
Health Dept. Approval ........................ Labor Dept. Approval .................... ...
Underwriters Approval ........................ Planning Board Approval .... . -,;,~ .............
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ~..~.. ~-~.
Construction on above described building an~mit meets ~kap~pticabl.~e codes and regulations.
. . ? / //,
~ . ~pplJcant ~_ ~..~&~.~ .........................
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
100056~ BUREAU OF ELECTRICITY
~ J~e :3. ~9~7 B~ JO.. ST.EET..EW ~O.~,
THIS CERTIFIES THAT
only the el~ tricol equipment ~ ~scrlbed below and int~duced by the ap~cant ~d on the ~ ~pp[~cat~on n~mber ~ the premises of
~. ~lph ~glieze, 2705Bridge L~e, Cutchogue, N.Y,
in the follo~ing location; [] Basement
u~sexaminedon 3une 8, ~gS?
Fl. [] 2nd FI. Secthm Block Lot
and found to be in compliance u, th the require.~ents qf this Board.
FIXTURE FIXTURES
OUTLETS SWITCHES
44 41 5
RANGES OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO, OF FEET
OIMMERS
SERVICE DISCONNECT S E R V I C
OF NEUTRAL
OTHRR APPARATUS:
~150 Waist ~73o 2~70 Watt
&*G.F.CLI. 1-Smke Detector
Vincent ~tnzo ~~--~'~
112 .' Mo'ffman Street
Valley Stream, NoYo 11580 Lie.2~76E f~ GENE~A[ MANAGER
~Js certificate must not in any manner; return to the office of the Board if incorrect. I~specfors may be ideht;f~d by their credentiaJs.
COPY FO~ BUILDING DEPARTMENT. THIS COPY OF ~ERT F C~TE'MbsT ~0T. BE AL~EREO N ANY MANNER.
7GS-~802
BUILDING DEPT.
INSPECTION
FOUNDATION ~ST [ ] ROUGH' PLBG.
FOuNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
[ ] FINAL
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION ZND [ ] INSULATION
[ ] FRAMING
REMARKS: ,,,
FINAL
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ R~OUGH PLBG.
[ ] F0~DATION 2ND [ ] INSULATION
r~MING
[ ] FINAL
REMARKs, .....
DATE INSPECTOR
/
765-18~2
BUILDING DEFT,
tNSPECTION
[ ] FOUNDATION ZST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
FRAMING
DATE,,~
INSPECTOR
7GS-1802
BUILDING DEPT,
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND[ ] INSULATION
~I~A
FRAMING [ L
7GS-1802
,BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
fIELD INSPECT]
OUNDATION
(1st)
COMMEN1
)UNDATION
(2nd)
UGH FRAME &
PLUMBING
~ER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined .q~.~ .~....~..I.t.,., 19
Approved . .~..~..'~...('~... 9.., 19~.f. Permit NoJ.~ .')'?: .~..~...
Disapproved a/c .....................................
(Buil2ing Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Received ........... ,19..
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ets 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
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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
hall be kept on the premises available for inspection throup~hout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy,,,
hall have been granted by the Building Inspector.
k APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
[egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necess~g*~ec~tio~.~r~ ~ ~'~,{, _k,, ~~"74,,~
.2.
-- (Mailing address of applicant)O'
~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
,.. ................................................................................
~ame of owner of premises ~.~9. &,~....~..J'. ~.T~ ,'~,t'~. .... . .~.td..&. ,~-,.fi.,~. $..,~ .........................
! (as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done.. ~.~ ~'~.~.~. .... .~7...~...'~. ·~. ................... ,..
7.o.r. .......... .,..,,..a ................. G. ............
House Number Street Hamlet
County Tax Map No. 1000 Section . .~>~..fi'. ......... Block .. ~...~?.o~ ........ Lot..t?..~.?. ...........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy.. ~. ,1~..~::..1]. Jl ./~..&. ........ .~..,~M. i~..... ~..~.~//.'..d--.~. ...... ,- ........ .~....
b. Intended use and occupancy
3. Nature of work (check which ~pplicable): New Building ..... ' ..... Addition ....... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
J · (Description)
4. Estimated Cost ......... /.,~ ~ i~ 6 ...... Fee
,, ~'~ (to be paid on filing this application)
5. If dwelhng, number of dwelling umts ............ Number of. dwelling units on each floor...l ............
If garage number of cars '
6. If business, commercial or mixed occupancy, specify natu, re and extent of each type of use ~$~'..~/~.~...~'~.l;.~'
7. Dimensions of existing structures, if any' Front. I.~'.. ° . . Rear
, · .. .~. ................. Depth .,~3../~ .........
Height ].t// ............ Number of Stories ] .......................................................
'Dimensions of same structure with alterations or additions: Front . 7.~. ~. 10 ' Rear . ~..~ .~A....
Depth · · ~. ~.' ............ i · · · Height . ./.I~ .................. Number of Stories. J. ...................
8. Dimensions of entire new construction: Front . 6.~:G. ........ Rear l~O.~ ........... Depth ~.O.~. ..........
Height . ./~ ........... N-U?- ber of Stories... I .................................... ;...~. ...........
9. Sizeoflot' Front ...~l,~: ~{,$~ Rear /.~ 0~... ~ . .,I)~ .7.th , ~)$ .
10. Dateof,Purchase~,,.~...tlt..10. g.l ............ Name of Former Owner /'~0~../(..~-.~.~.~.~.~./. .......
11. Zone or use district in which premises are situated ................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ... ~r.~. .........................
13. Will lot be regraded .... ~lf.*i .................... Will excess_fill be removed from premises: Yes No~
14. Name of Owner of premises ~.~. ~ i0~{. · .~.f/.~. ~..].~'~'~. Address ~/1 .t ~. 6.fi'. ~, bl.~'. .~.. Phone No. ~.~'~.'..~. ~O~.~...
Nam¢ of Architect ......... I .................. Address ................... Phone No ................
Nmne of Contractor ~ Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, anti, indicate all set-back dimensions from
property lines. Give street and blocl: number or description according to deed, and show street names and indicate whether
interior or corner lot.
IZbfl. C3
t
, STATE 0F NEW~OBK,, I S ~
COUNTY OF ~ ..... ~
· ...~~~...~: ..................... being duly sworn, deposes and says that he is the applicant
(Name o~ndividual sig~ing contract)
above named.
Heis the ..................... ~...~ ........................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authorized to perform or have performed the said work and to m~e and file this
application;that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfo~ed in the mmffer set forth in the application flied therewith.
Sworn to before me this
'
Nora, Public, . ~.~. ~ .~ ........... County
. . '. .' .~ ~gnature of applicant)
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CODES. NOT ES~NSIBLE FOR
,'*~ESIGN OR CONSTRUCTION ERRORS,
OCCUP~ OR
USE IS UNLAWRJL
WITHOUT CERilRCATE
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