HomeMy WebLinkAbout13902-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z14238
No .................. Date February 21 19.8.6.
THIS CERTIFIES that the building ... ~,4 ~ ~ .t.~ q ~ ...................................
5 I~ waters &
Location of Property ~ Ll~le ?econic Bay Rd. Cutchogue
~l~s~ ~oi ....... '8't;eet Har~l'ei
County Tax Map No. 1000 Section 1 1 1 .Block 1 1 ..... Lot 23
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore ~ed in this office dated
.... A.p.r. $1.2. ........ ,19 ~35. pursuant to which Building Permit No .... J .3.9.0.2..Z ...........
dated .... g.a.y.. ? .................. 19 .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 .........
.... Addi.tj. qa..t.o..elc~.s.t~_~g..one familM dwelling
The certificate is issued to . THOMAS & KATHLEEN DESPAGNI
.................... ......................
of the aforesaid building.
Suffolk County Department of Health Approval Iq / A
UNDERWRITERS CERTIFICATE NO ................. #.~ 7.2.7.7. 6. .8 .............
~lumbers certificate Feb. 6, 1986
Building Inspector
Rev. 1/81
]~Oli,~ 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)
N! 13902 Z
Permission is hereby granted to:
.............
~...~....~....
..... ., ...... ~ ...... i.~.~..~ .......
to..~ . ' ... '
at premises IocatJd at ....~.....°...~-..V...~..~~-~.....~...iiii',...~,
...:1.!.!. ......... Block ...................... Lot No ....... .~...~ ........
County Tax Map No. 1000 Secti~L~.. j
app caton dated ~ ...~' . . '"~" -
pursuant to .... ,.~ ..................................... , fy.¥..'~.., aha approved by the
Building Inspector.
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
This application must be filled in typewriter OR ink, and submitted ~ 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 featu res.
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-
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.
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 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:
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 La~n?O. $5.00 Date ..//..~. ?.~/?../'~. ...........
r~ne~New Building ..... %' ....... Old or Pre-existing Building ............ Vacant Land . ............
. . i ............. ' ....... " '
Owner or Owners ................................................
County Tax Map No. 1000 Section ... }.1 ......... Block ..... I.! ........ Lot,, ."~,, .~.. .........
Permit No.~ .~.0.{~)c'Q Z, Date of Permit ~.lt/~'~ Applicant
Health Dept. Approval ............ , ........... Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate
Fee Submittad $ ~ ...*.. ~ .....................
Con stru ction on above described building an~l~t_m eet~o~li~cabl~e~tions.
Rev. 10-10-78 ' Ap p I ,c a n t (./../:4x./'/ -/~ f'.&~i~ ~'~. · ,. ....
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
S5 JOHN STREET, NEW YORK, NEW YORK 10038
FIXTURE
OUTLETS SW)TCHE$
29
DRYERS
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
MULTI-OUT[ET
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
~moke Detoctors.,. 2
E R V I C
E
~own l~arbor Lane
Southotd~ I%Y. ~ IJ. 971
GENErAl. MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors mc~y be ;dentified by their credentials.
CJ)PY. FOR BUILDING DEPARTMENT, THIS COPy~OF CERT!E{CATE MUST NOT BEALTERED IN ANY MANNER.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No. /~ ~-~
(please print)
(p~ease print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
~( p lX~u .~ e~r ,~s ~s ~ e ) ~
Sworn to before me this
_/~.-x~ day of~/~'?/J~-~%~I ·
Notary Public,~c~/./.~ . .County
N~tary~Publi
UNDA J.
NOTARY PUt~UC, State of New Yor~
No. 4822563, Suffolk County
Term Expi~'ee Maroh 30,
FI~LD I'~SPECTION COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
ODE
FINAL
ADDITIONAL COMMENTS:
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1802
kpproved 19 ~ .~. Permit No..[ .~.
3isapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG.
TOWN OF SOUTHO[D
Received ........... ,19...
Date ~p.Y ............. , 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter 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 buildkngs 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-
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 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
hall 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
luilding 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, bui/ding code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessar,2 inspections. . __ ,
· ./Y. ....
(Signature of applicant, or name, if a corporation)
. .L4-. . i c.-.C. .L. . e._..,. .',5.. . . .
(Mailing address of applicant)
gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.. ~.E?.~ .,-.c~L,. C~..~. ...... ~..~Z C/:.O.~. ............................................................
~ame of owner of premises..~...~. ~)..~..a.'~..~..~. ~(~.. ~./-)/E~..(-{ (?. · .~..~.'~ .~. · .(~.~] ~. i ...................... (as on the tax roll or latest d~ed)
~licant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No....~.~..~.7 ...............
Plumber's License No.~.~'~tt)r.~
Electrician's License N .~1~-~,./~..J~..~..~.. · · ·
Other Trade's License No ................ ~
Location of land_on which propose,d work will b~.-g,one 3~Y /¢]Ot'-~..'~/q
...... ..........
House Number Street Hamlet
County Tax Map No. 1000 Section .... ['.]. [. .......... Block ........ 1 I. ....... Lot.. ~ .G~x..~. .....
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 ...... ] ...........................................
b. Intended use and occupancy ............ .?fi~....n.(~. ..................................................
property lines. Give street and block
interior or comer lot.
3. 'Nature of work (check which Applicable): New Building ..... ' ..... Addition .. Alteration ..........
Repair~?i[!l g.g. ,. ~?~' .... Removal .............. Demolition .............. Other Work ...............
st~..~..% ' (Description)
4. Estimated Co {2(2~, O ~ Fee .....................
i ~ (to be paid on filing this application)
5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................
If garage, number of cars .... ~ ....................................................................
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 ............... Number of Sto~es ........................................................
'D~ensions of same structure Mth alterations or additions: Front ................. Rear ~,-~.g ...............
Depth ................... ~... HeiSt ...................... Number of Sto~esz.~ ..................
8. Dimensions of entire new construction: Front Rear .7~epth . .
Height ......... NuCberofStofies~~ ..... ~~...:~('j~'.~ ~' ~
10. Date of purchase .......... ~ ................... Name of Fomer Owner .............................
11. Zone~or use district in which p~emises are situated ...................... ~ ...............................
12. Does proposed construction violate any zoning law, ordinance or re~lation' / ..... . .~ .
13. Will lot be regraded ...... ~ ..................... Will excess fill be r~m~d fro~:pr~ ' Yes No
14. Nme of Owner of premises ~.~.~[ ....... Address ~~ .... Phone No ................
Name of Architect .~ ..... ~. ~...~ ......... Address ....... .':.~ ......... Phone No ................
Nme of Contractor~./~t2 .~O ..... Address ~./~/.~, .... Phone No.
' ] P~T DIAG~M
Locate cle~ly ~d distinctly ~1 .bufldh~, whether existing or proposed, and. indicate ~1 set-back d~ensions from
number or description according to deed, and show street nines and indicate whether
STATE OF NEW YORK,
COUNTY OF ................
S.S
................................................ being duly sworn, deposes and says that he is the applicant
(Name of individual si ning contract)
above named.
He is the ..................... i ................................. * ..................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to ~nake and file this
apphcatmn that all statements con,tuned m th~s apphcation are true to the best of his knowledge and belief;and that the
work will be performed in the man,er set forth in the application filed therewith.
Sworn to before me this
Notary Public .......
HELEN K, DE VOE ~'
NOTARY RUBLIg, State ot NewiYor~
No. 4707878, Suffolk
Term E×p~res March 30,
j r
~ccpper lubing is used
for water distributing
.;,. ,.m: pip;n_,2 ~h. II h~
of types K or I only'
SOLDER U~'ED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED 2/10 of 1~ LEAD.
PLUMBE!? CEB, T[FICATIOI~
LEAD CONTENT BEFORg'x
CERTIFICATE OF OCCUPANCY
A?rP, O~) AS NOTED
DATE: ~--]I/2['BP, :~ ) SOJO;~ '~
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 A~ TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - ~O REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3 INSUt ATION
4. FIN~,L - CONSTRUCTION MUST
BE C%~PLETE FOR C. O.
ALL CONSTRUCTION SHALL MEET
THE REO~HP~MENTS OF THE N Y,
STATE CONSTRUCTION & ENERGY
CODES NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
~ I~ ~ TIL
TM
I CCUFANCY
:_ Ai?I:7IT I ON
ELEVATION__(~
ELEVATION~
7
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PE'CONIC
consultants
One Bootleg Alley P.O. Box 672 Greenport,
516- 477-0030
ASSOCIATES Inc.
N.Y. 11944
F-I
~= All rooms end occupisd spaces nhnl! be
heated to 7g' F. at 24" o~ ~$nlshsd ~loor ,hen the outlide
temperature is g' F. and the prevailing #isdn ars 15 mph,
~ fabricated in accordance ~lth S~ACA Standards
including transitions, bends, t&ke DE/S, etc., designed ~or
minimum static losses. Duct material bo be galvani~ed sheeb
metal PI 26 gauge up to 24 inches ~ide and Z& gauge shove 24
inches made. Ss~ms and Joints shall be such that leakage
not more than 3t. Ducts shall have rigid /tbarglasa
acoustical and therm&~ liners, 1 inch thick /or supply and-
1/2 inch /or return.
2" ~s'~ rig--iberglask routed in cram1 apa~e areas
insulation ~ith va~ot barripr,
~: ~all and ceiling unite to be H&~t & Cooly
or Air Guide ~odel V ~ith adjusbable opposed blade dampers,
adjustable discharge vanes and enamel ftniahed trim, Floor
units to be Tuthill and Bailey, 43gg R-EO.
~eturn Grilles to be Tuthill and Bailey Nodal ~ith adiustabls
opposed blade dampers.
System Balance and Completeness: Heating system to be
complete ~ith all components and items normally supplied.
Each supply and return for each space to be properly balanced.
.'" B5
ro er
~0
PECONiIC ASSOCIATES Inc.
: consultants
~~10~. One Bootleg,~lley P,O. Box 672 Greenport, N.Y. 11944 "
PLUMBING
All Plumbin and sanitary work to be done in accordance with
New York State codes and Suffolk County Health Department
requirements~
Pipinq:
a. Type "K" copper throughout water supply system.
b. 3/4" main, 5/8" risers, 1/2" branch lines to all
fixtures.
c. Place shut off valves in accessible location to each
fixture.
d. Sose bibbs to be frost free with interior drain and shut
off valves.
5. .All Pininq Routed In Crawl Space Arc- shall be insulated with
1 1/2" rigid insulation.
4. ~: American standard.
Tub - Recessed: Selected by Owner.
Hater Closet: Selected by Owner,
Lavatory: Selectgd by O~ner.
5. Sanitary Drainaqe and Vent PiDin,7: ABS plastic Schedule 4~
or PVC plastic. 45 degree fittings.
6. Supply an~ install all mi~ellaneous materials such aa
flashing, cleanouts, valves, hangers, unions, trim, etc.
normally installed with good trade practices.
'"d" ~,eui, q TrZIIP wi
,~,, , /-~" WA~f~2
j': ,:
r) Lu M611qG
~u,t. DYF VAZ V~,
PECONIC ASSOCIATES Inc.
consu tants ,
One Bootleg AIIley P.O. Box 672 Greenport, N.Y. 11944 =ILO'
516 - 477-0030 *,,,,~. "