HomeMy WebLinkAbout24599-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25707 Date: 05/05/98
THIS CERTIFIES that the building ALTERATION & ADDITION
Location of Property: 1945 GLENN RD SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 1 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 11, 1997 pursuant to which
Building Permit No. 24599-Z dated JANUARY 13, 1998
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 2ND STORY ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to LLOYD SIMON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N452327 04/30/98
PLUMBERS CERTIFICATION DATED 04/20/98 PECONIC PLUMBING & HEAT.
Buil ing InspeaFtor
Rev. 1/81
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)
Date.....JANUARY...,,...13........................... 19...98....
24599 z
Permission Is hereby granted to:
.......B..HARR.I NGTONA.(.A✓.,C.).L...S.I.NL1N....................
.......46.5...GO.OS.RC.RE.EIG..I-A........................................
SOIJTNOL D. .........
to .....CQNSTRUCT...AN.-AL•TERA•TION...AND...2ND...6-TORY...A•DD•I•T•I.ON...TO•••A•••S•I•NSLE........
.........FA N.I.L.Y...JQWEL.I„S NO...AS..APP-L-1.ED••F OR..............................................................................
.................................................................................................................I................................................
.................................................................... ... ................................... ...............................
...............................
at premises located at................1.9..4.5.....GI.ENN-RR.............................................S.OLITF{DLI)...........
.................................................................................................................................................
County Tax Map No. .....4.7..3889...... Section ...q.7.,S............. Block .....0.081......... Lot No. .02..7...............
pursuant to application dated ....DECENB.ER.....11......................... 19,.....9.7....., and approved by the
Building Inspector.
Fee$........7..5.,9A..,.,
. ..... .... .................
8uilding Inspecto
Rev. 6/30/80
Form No. 6 'A
TOWN OF SOUTHOLD 7
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 fro% Health Dept. of water supply and sewerage-disposal(S-9 form) .
31 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-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.
C. 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.
2. Certificate of Occupancy on Pre-existing Buildine - $100.00
3. Copy of Certificate of Occupancy - .25C..
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date01 0 . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . .. Old Or Pre-existing Building. . . . . . • . .. . . . . . . f �j
Location of Property. 1pyr 9/�' �W • • • •• • • ' • • �'�� " "
.. . .. . . . . .. .. .. .. . . .. .. . . . .. . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property.. . . . '( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . .7f. . . . . ..Block. . . . . X. . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Subdivision.L. .. . . . . .�. .. . . .. . .. .. . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No:: ' .'�././ . . . . . .Date Of Permit. . . /1�&4 . . .Applicant. . . .li./_«...
Health Dept. Approval. . ... . . ... . . . . . . . . . . . . . . . .Underwriters Approval. . . .. . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. .�. . .
Fee Submitted:r/ $. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
}gv . . . APPLICANT. . . . . . . . . . . . . . . . . . . . . . . .
GU2_ CQ5 ?0
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1OM121 BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
Date APRIL 30,1998 Application No. on file 15733198/98 N 452327
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
LLOYD SIMON, 1945 GLEN RD. , SOUTHOLD, NY
in the following location; ❑ Basement ❑ Ist Fl. ® 2nd Fl. Section Block Lot
was examined on APRIL 24,1998 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
S
OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. I H.P.
6 16 10 6 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS SELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. I A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS
NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC GOND. A.W.G. .W. A.W.G.
AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W pER 0 OF CC.COND. NO.OF HI-LEG A9 G.OF LEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
PADDLE FANS-3
G.F.C.I:-1
SMOKE DETECTOR:-4
PAUL R. BURNS LIC.#3897- L L
PO BOX 1061
SOUTHOLD, NY, 11971-0932 GENERAL MANAGER
11
Per
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.
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LI9 MAY I
TOAhlii 01F SO i0iD
Town Hall, 53095 Main Roady - a Fax (516) 765-1823
P. O. Box 1179 177Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N�
DATE:(_�C,®lf!®/ vim'/d
Building Permit
No .
Owner; 110I G( '.I/ma7-L�
( ase print/)
Plumber: f eC04zr )/Q177k1VG V-
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead. /
i
Plu e Signa re)
Staorn to before me this
day of /� / 19_
KJ
Notary Public , ` (/k/ �Lf� County BARBARA G�f// JZ
Notary Public,State of New yore
No.01ST4844752
0?ualifled in Commission Expires Soopt.so,19/
o�Og1dFF0j.t
�� Gybe
Town Hall,53095 Main Road y Fax (516)765-1823
P. O. Box 1179 Telephone (516)765-1802
Southold, New York 11971 �,j, • ��
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 29 , 1998
Lloyd & Phyllis Simon
1945 Glenn Rd.
Southold, New York 11971
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is (not on file. ) $25.00
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 24599-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1` 11:1.11 Illli l'GC11 till III;I'llll'I' IM'I'B I;UIIIIEIITlI 'v
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M-1802
BUILDING DEPT.
INSPECTI ®
[ ] FOUNDATION IST ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE n& CHIMNEY
REMARKS: r
DAT INSPECT
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLAC & CHIMNEY
REMARKS:
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE 'z 7 �� INSPECTOR
M-1802
BUILDING DEPT.
INSPECTI®
[ XFNDA
TION 1ST [ ROUGH PLBG.
TION 2ND [ ] INSULATION
[ ] FINAL
[ ] FIREPLACE & CHIMNEY
�7
REMARKS: (_(/
DATE INSPECTOR
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LA
D BOARD OF HEALTH .
n FORM NO. 1 3 SETS OF LANS
U TOWN OF SOUTUOLD SURVEY . . . . . . . .
DEC I ' BUILDING DEPARTMENT CHECK • . . - • - • • • • • -
TOWN HALI. SEP'T'IC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
so Lft' " 6! o•oerr, lt.§�i�i TEL: 765-1802 NOTIFY: '
CALL
Erornihhed..//./11 Op .., 19.... l 5l G MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved..��/. 19.... Permit No. � ....................................
Disapproved'/aa/ct71.................................. ....................................
?,ICATTON
7BUTLDTNG
dingr)
AP FPERMIT
Date.A . . . . . . . . . 19 7r
INSTRUCTIONS
a. This application oust 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 application.
c. The work covered by this application may not be ccmnenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
permit shall 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 shall have been granted by the Building Inspector.
APPLICffION IS HEREBY MAL, 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, aznd to admit authorized inspectors on premises and in building ffo{r� n�ecessa inspections.
(Si nature of: applicant or if a corporation)
G�5- u3` creek �-A-
• 5®�.cf o(� �.. ...7..........
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plus ber or builder.
.........i4..t�........../......... lL ........................................................
Now of owner of premises .1'�.r.lrlo'I�- .... �'•�i,r.... � ........................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Name and title of corporate
officer) T7'
Builders License No. .4.s1.�./`�..- .b........
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. Location of land on which proposed work will��be done..............................................................
�Q4 .......................�Le,J..!4...................... Socti1 vLoe............................
(louse Number Street Hamlet
County Tax Map No. 1000 Section .....7.g....... Block .+.............. Lot ?:n7 ...........
Subdivision ...................................... Filed Map No. ............... Lot ...............
(Name)
2. 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 .... ................................. C't=fCs':," .id?,.....,�..................
IIhpY wv41 3o nts,e;ilcSh:'a rt"10 4
ygmeoa 91oltu?n,baildaua
Bt+OtS4'b�lr.PO.oNt
r....o., Jc VCM asriq;tiT 0110'
r 4
1 Ranrwal icable): New Ikhilding ..........
Addition era ton ....
1 KiiurL
of vack (dhecIt mova l ............ Demolition ............ Ocher Work .a' ..
tion)
4. Estimated Cos I..S.b�. :.
.,........ fee, ...................
(to be paid oro pili Lhi
5. If (Melling, nanber of dwelling!,hnits ...(� ...... timber of delIing units on each 'floor ................
ifgaM4je, amber of cars ..... ................................
6. if business, munercial or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing structures, if any: Front................ Rear ............... Depth .................
leight ........................1 Mnber of Stories ......................
Dimensions of sae structure wiLh alterations or additions: Front ............... Rear ...............
Depth .................... Ileiglt .................... tumor of Stories ...............
R. Dinenalcxns i
pf entire new construction: Front ................ Rear ............... Depth ..............
lleidit .. °yt F,.y.............f linter of: Stories .....................
9. Size of lot: Frunt ...........1........ Rear .................... Ik:pth ....................
10. 11ale of Purchase ..............p...... Nam of rouser Omer ........................................
11. 'Lone or'use district in which premises are situated ..............................................................
12. Does proposed construction viol!aCe any zoning law, ordinance or regulation: ........................
13. Will lot be regraded ...........,......... Will excess fill be removed from premises: YLS DD
14. Nacos of (Mier of premises ....li...................... Address .............................. None No. ..............
Mane of Architect .............'�...................... Address .............................. I'thooe No.
..............
Nare of Contractor ................................... Address .............................,.Ilion No. .......
15. Ts this property within 300 fee: of a tidal wetland? * YES .......... MO ..........
*1F YIS, mmilI.l) 'IC1m moiSims PElmr' MAY UL RC/illlltl:ll.
PLOT DIAGRAM
i..cx aLe clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street anPiblock number or description according to deed, and show street nares and indicate
c°Ihether interior or corner lot.
SI'A'lli OF "MY ,,,l4�r
OUIINIY OF ...
...::54 ........
I f SS,
••••••:4.m •C•\•�...T:\Qv J,`,.- ................being duly sworn, delxhses and says that he is the applicant
(Manic of individual. signing rontr ct
above named,
Ileis the ..... .............................................................
(Contractor, gent, {corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have lmrformed the said work soil to rmke aril file this
application; that: all staLenents contained in this application are true to the best. of his knowledge std belief; and
that the work will be perfoaned in 111'1 ninner set forth in the application filed therewith.
Sworn to before nm/Quellfledin;S
r r�
........ ......Notary Public .. ..;... ...
... ... ....
SOew
OTT,JR, (Signature of Applicant)aifote lk CoutlY
No.01SC4',12508
Term Expires May 31°I
- . -
- _I: ' ' _ '_III " ( '•� _ - % - - �\ � =
i
JII 'T ill
rAE
QUIIIED
-- pRovial ERMALSIN CAID ENTING �E B
C LSI DEVICES AS TO PANT.902-6(K)
N.Y.STATE BUILDING CODE. OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT
OF OCCUPANCY TE
If I copper tubing is used
-
----- --- - --- - - -- --. . - piping shall be IJPTE: AP D evNOTD �
-- - -- — _— or water distributing
system; -
of types K or L only
FEE.
NOTIFY BUILDING DEP AT
PLUMBING 7G5-1802 B AM TO 4 FOR THE,
ALL PLUMBING WASTE FOLLOWING INSPECTIONS:
&WATER LINES NEED I. FOUNDATION • TWO REQUIRED _
TESTING BEFORE COVERING FOR POURED CONCRETE
2. ROUGH • FRAMING $ PLUMBING
3. INSULATION
PI UMBER CERTIFICATPON 4. FINAL - CONSTRUCTION MUST
ON LEAD CONTENT BEFORE BE COMPLETE FOR C.O.
a r r
ALL CONSTRUCTION SHALL MEET
CERT/FI A" E 9 w^ N:Y.
— C � OF CSCC.lP..4edf„d' OF THE. SII
I LE- (02
I �� _ SHE REQUIREMENTS „
Y- 11 I
SOLDER USED lI�' TEbe� TP,TE CONSTRUCTION ® ENERC,Y
T '/,"=1'0" c d. -(mES. NOT RESPONSIBLE FOR
rr SUPPLY SYSTEM CFS Pu r"0T 'IF'W N OR CONSTRUCTION ERROR
EXCEED 2110 of 9°, LamA D. . '
PROVIDESMORE•OEfECTINf
ALARAI DEVICES ,, y
AS TO PARE 72L1"
N.Y$BU
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rxe Ml E (SIS lLblt{2 DRAWING NUMBER
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