HomeMy WebLinkAbout25646-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26391
Date: 04/20/99
THIS CERTIFIES that the building ALTERATION
Location of Property: . 3534 GREAT PECONIC BAY BLVD LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 128 Block 6 Lot 5
Subdivision Filed Map No. -- Lot No. --
conforms substantially to the Application for Suilding Permit heretofore
filed in this office dated MARCH 11, 1999 pursuant to which
Building Permit No. 25646-Z dated MARCH 24, 1999
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 SC~RRNED ENCLOSURE "AS BUILT" FOR AN EXISTING UNHEATED CONCRETE PORCH
FOR EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to EDWARD R MILLER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N/A
N485481 04/12/99
N/A
FORM NO. 3
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)
PERMIT NO. 25646 Z Date MARCH 24 99
Permission is hereby granted to:
EDWARD R MILLER
for :
CONSTRUCTION OF A SCREENED ENCLOSURE "AS BUILT" FOR AN EXISTING
CONCRETE PORCH(UNHEATED) FOR AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
at premises located at 3534
County Tax Map No. 473889 Section 128
pursuant to application dated MARCH
Building Inspector.
GREAT PECONIC BAY BLVD LAUREL
Block 0006 Lot No. 005
11 99 and approved by the
Fee $ 75.00
uorized Signature
ORIGINAL
Rev. 2/19/98
Form No. 6 ~
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
mo
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
Vpre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural 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.
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.
2. Certificate of Occupancy on Pre-existing Building - $i00.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Location of Propert ...~..~. ................... · ..........
House No. Street Hamlet
Onwer o .Owners o ~roper=y ............................................ . ......................
County Tax Map No 1000, section..].l.. ....... Block .... ..... ...............
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ...... Date Of Permit .... ,..--~ ...................................
Health Dept Approval · Underwriters Approval .w~.. ............
Planning Board Approval .
Request for: Temporary Certificate ........... Final Certicate...~. .......
Fee Submitted: ,. ...................
,4 . S l l :z .i ..... ..........................
APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~A~I
~175~o~ -u.,^u OF .,.=CTR,C,TY
~-* 40 FULTON STREET~ NEW YORK, NY 10038
Date APRIL 12,1999 Application No. on file 17998699/99 N 485481
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
ED HILLER, PECONIC BAY BLVD.. LAURELr~ NY
in the following location; [] Basement [] ]st FL II 2nd Fl. Section ~ Block Lot
was ~xamined o# ,~PRIL 07,1999 and found to be in compliance with the National E~lectrical Code.
F XTURE ~=~'=a'^~'LES eW T~-uee FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
=' I " I I I I I I
DRYERS I FURNACE MOTORS IFUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS [ BELL IUNIT HEATERS MULTI-OUTLET DIMMERS
I I
SERVICE DISCONNECT I NO. OF S E R V I C
SIB] ROOH- 1
OD C. ~*LP, CTRIC T~C.
P~O.BOX
I~UREL, NY, 119~B*-~518
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials,
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER,
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE &CHI
[ ] RO/~3H PLBG.
[ ] II~ISULATION
~FINAL
DATE /~///~//~ INSPECTOR
~'~'I~D INSI~C~ION REPORT
~~m~m~~m~'~
DI~DATION (]ST)
UNDATION ( 2ND )
DATE
,UG'It FRAME &
ISULATIONFER N. Y.
STATE ENERGY
CODE
FORH NO. ]
TO~N OF SOUTIIOLD
BUILDING DEPARTHENT
TOI~N UALL
SOHTItOLD, N.~. 11971
~L: 765-1802
SURVEY ........................
CHECK .........................
SEPTIC FORH ...................
NOTIFY:
CALL ..........~.~. .....
HAIL TO: ....................
Date ................ ,19 ....
a. ~pplicati~a mast be cc~fletely filled in by tyge~iter Or in i~ ~ ~tt~ to ~ ~ilding Ins~tor ~1
3 ~ts of pl~, ~ate plot pl~ to ~ale. F~ ~co~i~ to ~le.
b. Plot pl~ ~ l~ti~ of lot ~ of hildi~ ~ ~s, ~latio~ip to ~joini~ p~s or ~lic
sit, ts or ~e~, ~ givi~ a ~tail~ ~ripCi~ of l~t of ~ ~t ~ ~ ~ ~ di~m ~i~ is ~rt of
this ~liati~.
e. ~ ~ ~ ~ ~is a~lieati~ ~ ~t ~ ~ ~foce isle of ~ildi~ Pe~t.
d~ ~ ~1 of ~is ~liati~. ~ ~ildi~ I~ctor ~11 is~ a hildi~ ~t to the ~li~t. ~
~t ,~11 ~.~ ~ ~ ~s ~il~le for i~tia that ~ x~rk.
e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le ~ in ~ for ~ ~ ~at~er mtil a ~rtifieate of
~ ~all ~e ~n ~mt~ ~ ~ hildi~ ~tg.
~I~ I~ ~t ~ to t~ ~ildi~ ~nt for ~ isle of a hildi~ ~t ~t to the
~ildi~ ~ ~i~ of ~ ~ of ~ld. ~ffolk ~, ~ Yo~, ~ o~r ~li~le ~s. ~i~es'or
~lati~, ~r ~ ~ti~ of ~ildi~s. ~iti~ or alterati~, or for ~al or ~llti~. ~ ~rein
&~riM. ~ ~limt ~s to ~ly d~ dl ~li~le 1~, ofli~s, ~ildi~ ~, ~ing c~, ~
(Si~t~e of ~lic~t, or ~, if a co. ratio)
(~ili~ e~s of ~lic~t)
State ~be~er al~licant is o~er, lessee, agent, arahitect, eagincer, general contractor, electriciau, plumber or builder.
....................
(as on the tax roll or latest deed)
If applic~t is a corporation, sigeatur~ of d~ly authorized officer.
(Name and title of corporate officer)
l~ilders License No ....................... . ..
Pl~bers License No ................... .. . .
Electrici~as License No ......................
Other Tra~'s License No .....................
I. l~catien of laad on daich proposed york ~ill be dene ....................
................. ecg. nit.. .............
...... . ................ .....................
Cowry Tax Nap No. lO00 Section ................ Block ................ l~t ................
~ubdivision ...................................... Filed Nap No ................ Lot ...............
(~)
2. State axlst~ng use and eompaney of premises and intended use and occupancy of proposed construction:
a. .......................................
3. ~ature of work (check ~id~ applicable): N~ B~ilding .......... Addition ....~. ..... Alteration .......... ,
l~e[~alr ....... .. .. . Removal o.. , l~olltion Other ~ork
(Description)
If
[
s' · 6 ? . ~o
I
~ of ~dt~t .........
............ , ............... ~ress ~ ~
~ of ~tr~tor ....................................................
~LOT DIAO~
~m~r interior or co~r lot.
..being, duly sworn, deposes end ,says that he is tie applicant
(liana of individual signit~ contract)
above naned, i
Ile is Lhe ........................... ~ ......................................................................
(Contractor, agent, c~rporate officer, etc.)
of said miner or o~mers, and is duly aUthorlr~l to perform or have performed tim said work and to make and file this
application; tbet all ntat~rents contained in this application are true to the best of his kon~tndgeaid behef,' ' ; and
that the work will be perfonmd in tl~elmaoner sat forth in the application filnd thercadth.
S~om to before ne this
..... ..... any
......
LINDA J. COOPER
Notary Public, State of N. ew Yo~k
No=4822563, Suffolk County_.-)
Term ~p res December 31, tiF ,c~-~'
(Signature of applicant)
3. INSULAllGN ~
4. FINAL - CO~ MUST
BE C~dPLETE FOa C.O.
ALL CON~nWCIION ~iAII M~I'
THE REOUIREMENT~ OF
STATE CONSTRUCTION & ENEI~Y
CODES., HOT RESPONSIBLE
DESiGN/OR (~NSTRUCTION
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIRCATE
OF OCCUPANCY
CERTIFICATE
RE®mEO
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