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HomeMy WebLinkAbout14296-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. u~A~TIFICATE OF O(~'~PANCY No S-26648 Date JUNE 28, 2000 THIS CERTIFIES that the buildin~ ADDITION Location of Property 1045 ~R(~%~D STREET House No. Street County Tax Map No. 1000 Section 25 Block 2 Subdivision Filed Map No. Hamlet Lot 20.22 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SE~£~ 5, 1985 pursuant to which Building Permit No. 14296-S dated SEPTE~B~ 23~ 1985 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 CLOSET ADDITION TO ~ISTIN~ ONE FA%MILY DW~-IN~ AD APPLIED POR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED III N/A lgIns''~ pector Rev. 1/81 FOII~ NO. I TOVIN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14298 Z Permission is hereby granted to: ./...-....o..c ...O~L~,~,...~.... ................................... .Z.~ ............ ~ ........ :~ ................ fl ..... ,o .. County Tax Mop No, I000 Section ..... .C)....-~...~..~.. .... Block ..... ..C~......2~.. ....... Lot No ..... J.~..,...I ......... pursuant to application dated ....... .~......~. ~.. ....~/.. ............... , 19..'~...~..'~, and approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 BLOG. DEPT. TOWN OF SgUTHOLD .... Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '?pre-existing" land uses: 1. Accurate survey of property showing ail ProPerty lines, streets, building and unusual hatural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. ~ Certificate of Occupancy on Pre-existinK Buildin~ - $i00.00 3. Copy of Certificate of Occupancy - ~ .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~ew Construction ........... Old Or Pre-existing Building ................. ~ ~ocation of Property. . !?..~.~ . .(~ rC ~C~(~ C~T 0 ~- ~..~. ~ ~ Hoese No. Street Hamlet )nwer or Owners of Property...l~.[\~\..~.c~...~-~>. ..... -%.Cr.. ...,Ar~.x..[...............~oo._~ ~.... ... ..,1' :onnty No 000, 8ection... . tC, 5. ..Bloc ..... ................ ;ub division .................................... Filed Map ............ Lot ...................... 'ermit .... Date Of ...... Applicant ............................. {ealth Dept. Approval .......................... Underwriters Approval .......... ~lanning Board Approval ........................ lequest for: :ee Submitted: Temporary Certificate ........... Final Certicate ........... ..................... APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS ].0003'~'8 BUREAU OF ELECTRICITY ~' B5 JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CERTIFIES THAT William Rich Orei~ard ~n thefollowing h,eat~on; ~ Basement ~ Ist ~7. ~ 2nd ~3. S~tion Bilk Lot ~sexaminedo~* J~ ~ ~9~ .ndfoundtobelnco. p~ance~cththereq~iret~ens~fthisBoard. FIXTURES RANGES OVENS EXHAUST FANS DRYERS E MOTORS FUTURE ~ TIME CLOCKS JNIT HEATERS MULTI.OUTLET ~IMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C NO. OF CC, COND A.W,G NO, OF Hi. LEG A,W G ina OFNEUTRALS A.W.G PER ~' OF CC COND OF HI-LEG OF NEUTRAL P, O. BOX 1268 $outhold, N.Y, 11971 Li¢#3494E This certificate must not be altered in any manner; return to the office of the Board if incorrect. GENERAL MANAGER may be identified by their COPY FOR ~BU)LDtNO DEPARTMENT.~ THI~ COPY OF ~ BE ~LTERED;IN,~ ~ANY MANNER. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 \ TEL.: 765-1803 xamined .~. ~.+?n~....~...~..'%,., 19 .pproved . .~o. ~..'[.?b..., 19~ ~. Pe~it No. ~ Y.~.~ )isapproved a/c ..................................... ............................... ........ (Building Inspector) APPLICATION FOR BUILDING PER~IT Received ........... ,19... INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 :ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ition. c. The work covered by tins 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 tall 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 aall 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 ,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. lac applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to [mit authorized inspectors on premises and in building for necessary inslle, etions. ..... AJ. (Signature of applicant, or'flame, if a corporation) · J.O. QQ..C?.d.a.r' p?.:,..~.%s.$. N.a.~. j-9:a.,..I~Y .1.}93~. (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor ............................... William Rich III Iame of owner of premises .......................................................................... (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 144 .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. 1045 Orchard St. Orient House Number Street Hamlet County Tax Map No. 1000 Section ........... ~- Block .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: I £am. dwelling a. Existing use and occupancy .......................... ~ .......................................... clo'set add. b Intended use and occupancy ........................ 3. Naturepfwork(checkwhichapplicable): New Buildin~ ...'... '~dtti~}~)se~ ×× ll)a~ti~ ...... ~epair~l ~ .~. ~ .... Removal .............. °Demolition 'i .' ~. ~.:".~.". i '. '. '. '. ~t'h'e; W'~;~ ." )~.'~ ....... (Description) 4. Estimated Cost .......... ~2©OD...00 .................. Fee ... ~.52Q, 9.0. ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nurnber of Stories ........................................................ · ' f sa ' 'th dditi Re Dnnensmns o me structure w~ alterations or a OhS: Front ................. ar .................. Depth ' Height Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... .... Number of Stones ....................................... H~lght i . 9 Size of lot: Front . Rear ' Depth 10 Date' of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ................................... .................. 12. Does propos, e.d construction violate any zoning law, ordinance or regulation: ..... n 0 ..................... 13. Will lot be re}raded .... n.c~. .................... Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .W:%12.J.~r~. ~%q13. J-.]~[ Address J .0.4.5., 9.~.qlg .~.~.d..~ ~.: Phone No ................ Name of Architect ......... .'. ................. Address ' ";el ' ' ' .ivlla.'~ ~all''' Phone No ................ Nam~ ofContractorK. J:m...D.~.e.'n..k.o.w.s.k..~ .......... Address . .E..~..~,. . ~. . Phone No. 57..77'.2.56. .5 ...... 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, S.S COUNTY OF .................. ............................ : ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ,4/' : (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 conltalned 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 , Notary Public, . ...... ~ ....... County (Signature of applicant) ~ rm t:xpires Msreh ~0, ELD TION COMMENTS ,'OUNDATION f. (Snd) ~OUGH FRAME & FLUMBING NSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: #EE-~-D, ~ BY: V-G,/-- . ~OTIFY BLHL~I'NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE I%LLOWING INEPECTION$: J. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ~. ROUGH - FRAMING & PLUMBING ~. INSULAT!ON 4. FINAL - CON'STRUCTION MUST OCCU? ,HCY OR '~liii~l b~ ATE OCCUPANCY CLO~E T' ,~ODI fir IQ N FL) R N~R~Z M&q.. Vv'tLLIAi~ RICH ORCHARD £?.~ ORIENT ~ N'Y'