HomeMy WebLinkAbout24305-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25939 Date: 09/02/98
THIS CERTIFIES that the building ADDITIONS
Location of Property: 2445 MINNEHAHA BLVD SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 87 Block 3 Lot 47
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 16, 1997 pursuant to which
Building Permit No. 24305-Z dated AUGUST 13, 1997
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 ADDITIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DOLORES MUROLO ULLMANN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Bu ding In&6ector
Rev. 1/81
FORK NO. 1
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° 24305 Z Dote .......... ...� ................. 19.27
Permission is hereby granted to:
bola /f/2..... � r✓..................
....... ...... ..........................................
-�.. .,,�.....................
................................................................................................................................................................
................................................................................ ............................. ........... ................ ................
at premises located at ...�` T. q ./` ... . .y.................
County Tax Map No. 1000 Section .. t ... Block ......... ...... Lot No. 10
/.................
pursuant to application dated ..... . ..... . ................ 19��cnd approved by the
Building Inspector.
Fee $.. .... ................
...... ..... ..................
Building Inspector
Rev. 6/30/80
Form No. 6 I6 5-- f'3 3 7
TOWN OF SOUTHOLD
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 buildi,
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 2110 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildi
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 a
'-'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 applican
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
'C. Fees
4 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 - $100.00
3. Copy of Certificate of Occupancy - .25v,.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . .. Old Or Pre-existing Building. . . . . . . . . . . //
Location of Property f� uS . M. In?)C �°�Y�.�L. .�L�.:1.. . . . . . . . . .�c�u Yf�O)LT . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property.. r��1� 1 pS �LL yYIC{} � n
County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . . . . . .
. . . . :,. . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . .
Permit No. . Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . , . . .
Health Dept. Approval. . . . . . . .. . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. �=2�. . . . . . . . . . . . . . . . . . . . . . . . ,
APPLICANT
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76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS;
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DATE 3/ z96 INSPECTOR �'' /5v, �
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] "INSULATION
H PLBG.
FOUNDATION 2ND [
[ 04RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: D
DATE %g INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [/] R GH PLBG.
FOUNDATION 2ND [ ULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLA CHIMNEY
REMARKS%
DATE INSPECTOR
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ILDING DEPT.
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REMARKS:
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Security Title 8 Guaranty Co.
John 8 Kathleen Spicer
DA rE 61918ji
PA r r. SECCARCO SCA L4 1" = 30'
PROFES5101VAL LAND SURVEYOR 10M rrONOM`it$ORvii" A rION °rOL4r-
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SAYVILLE, N.Y. 1/792
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WAP OF OESCRISEO PROPERTY S.C.r,M. 1000- BT-3-47 7 NNr
s_rVAT£O Ar LAUGH/NG WATER, r/O SOUrH040 SUFFOLK CO. N. Y.
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John 8 Kathleen Spicer
DATE - 6/9/80
PAT T. SECCARCO SCALE I "= 301
PROFESSIONAL LAND SURVEYOR ;ONro rN'f SONr[�As,O+ ONOL±;Ir-
I09 LOOP DRIVE ON or steno# rzor or rN! Ntr
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(516)567-4773 N.Y.S. LIC.NO.049287 1
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• AP OF DESCRIBED PROPERTY S.C.T.M. /000- B7-3-47
S_/r"rED AYLAUGHING WATER,_T/O SOUTHOLD _SUFFOLK CO. N. Y.
oNUMENT • PIP_E' OVERHEAD t:ABLEVISION LINE c coo/wo or rN,r svever rAr Nor
U NGRINI rN( LAND SO&YLrONJ $if-
b'TAKE N UrILIrY POLE rQ OVERHEAD TELEPHONE LINE NArvNr AAO LAWO ON rr&Orsco
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BOARD OF HEALTH . . . . . . . . . . . . . . .
FORM NO. 1 al SETS OF PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD "SORVEY
BUILDING DEPARTMENT .CIIECR . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN ITAT.1. SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTNOLI}, N.Y_ 11971
�^--� TEL: 765-1802 NOTIFY:
19- MAIL
Alrinntvorl....-.... .!_ 19 Penn;1. No. .!. ....... -....56.Lq.l:7.141.r ......... .. ..
Uisapprorveda/c ................................ . ...................................
...... .......
v.........
idling Inspector)
APP .I .ATION FOR BUILDING PERMIT J_
INSTRUCTIONS
,
a, '1h;s appl icat.iOu must lx+ carpi eirly fi11oK1 in by typcRaritcr or in ialt aril sn"itted to the %tilding Inspector wi
3 sets or plans, accurate plot plan LO scale. Fee accoriing to scbechde.
r
b. Plot plan sixxwing location of lot and of luilclirugs On promises, relationship to adjoining premises or public
streets or areas, aril giving a detai lecl clescript icm of layout of property must be drawn on the diagram which is part of
this application.
c. 'Bre work c(mered by this application may not be camenced before issuance of Wilding Permit.
d. Upon approval of this application, the Building Inspector will issue a Ikui Tding Permit to the applicant. Such
permit shall be kept on the preunises available for inspection tlrO>gjxut Lhe work.
e. No building stroll be occupied or used in wixile or in part for any purpose whatever until a Certificate of
Occupancy shall have been Trmted by the Bounding Inspector,
AM,lumm IS tow- gy fW1E to the 17uildinp Deprtrmnt for the issuance of a Building PermiL prrsrnnt to the
I4uilding Zone Ordinance of tlx: Town of Southold, Suffolk Cninl.y, Now York, awl ether applicable I:nws, Ordinances or
Regula[ioxrs, for tlxt construction of tmildings, aklitions or alterations, or for remwai or drool it ion, as herein
described. The applicant agrees to carquly with all applicable laws, ordinances, Wilding code, Ixuusing rale, aril
reMilatioms, aryl to axfait mttlurimd inspectors on premises awl in droit g for necessary ins ct�//
. ......:..... -. ...:Tr...........
(Sign hue of applicant, or nTme, if a corporation)
.........................
(I'Llil;ng address of applicant)
Slate whether applicant is owner, lessee, agent , nrrhitect, engineer, general contractor, electrician, plrniuer or builder
�stsri��........................................................................... ..
\ 1 aP OYED"A5"NDTE ..'.
Nrme of Owner of premisesLLr1�AJ ...._...DATE:
(as on Ole tax roll. or latest lord)
FEE:
IF nppl icant is a corporat iom, signature of duly mutinorNOTIFY BU LD1NG DE T :
dcuuPKICY OR 765-1802 9 AM TO 4 PM FOR '
...............................•••• BSE IS UNLAWFUL FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRE
(Nan aryl title of corporate officer) WITHOUT CERTIFICATE
FOR POURED CONCRETE
OF OCCUPANCY 2. ROUGH - FRAMING fL PLUMBIN
Ikuil<]ers License No. ......................... 3, :NSULATION 4. Flt'AL CONSTRUCVON MU`.
Plumbers License No. ......................... .RE40MFLE,E FOR C.0
All CW4TRUCTION SHALL h1Et
Electricians License No. ..................... ! THE REQUIREMENTS OF THE N,
Other Trade's 1.1cense No. .................... tTA E CONSTR 1ClPON , ENERC
I. IncaLior of laml on uldch nosed work will Inc drnne_,.�'4 .7. (.'!. SOT �YI r°�BLE FO
Far ! !r�
CONST
.............Y�?�nt� 1h�._.. �y�....._........-...So.� .o. .......................
Ikuse Nmber //S��trppee'�t
Ginty 'fax llap No. 1000 Sectinrt✓..4. .. Block ..1J. ......... T,ot ..0.7. ......
FAbdivision ...................................... Filoxl Map No. ............... Tot ...............
(Name)
2. State existing use awl occupancy of promi.TR ail inteml 1 use col occupancy of proposed construct ion:
a. Existing use aril ocngnancy _.��.E'.1.v.0.S. nn.._.._.. O.o1;.c.....:..................................
b. Inlerxled use aryl ox:arpuncy .__... C...........................................................
AL TT002 f TIVIEOR
1fx:Y wnN 10 911,:2,Di1dul Ytttt9"
y4wo0 AOtU2 m Laililaw
fiboa::4*n 10,014
.....,......1,E VbL.S setng93 mtaT
4, V.It ill- (Alk (dxcck VAIi If al qd icah le): Mu IkIi ld hlf. .. ... . . .. . Nkll lin'\ ... . . . .
Alt el al tun . . . .. .. . ..
N:INlIr ..... ....... ItOlrNal . . . .. .... ... . Dolal 11 loll .. ... ... . .. . 0111e1 Wolk . ... ... .......... ..... . . .... .....,
I,. list iwal exl (bst/ .J.ODA. ... .... .... . fete . . ... ... ..
........ ............................
{{ (to Ile Iwid oil filing this appl icat ill)
Ika II iu}I, IlrlixOr of tk+elI ing units . ..1. . .. .... . tit mixer of (kvLlI iog lxliis 1x1 each fluor .. . . . . ... . . . .. . .
If garage, rxniler of call ......... ...... ... .... .... .... . . .. .. . ..
G. If Ixlsh"s, "Ic uercial or mixed tx:cu}loucy, slx:cify culture alxl extent of each type of use..... ... ...... ..... ...
7. Ilinicosi[xls(�o`f existing atlucLures, if any: Froot.::v.Q./......... !tear ,.. Q....... . Ik: )lll
Ike igllt ..6./. ............. .... Mmiiwr of Stol les . .1.... ... .. ........f.�
Dinensinhls of kaIle stiltuJure with alters lolls or exkliliuus: Flo ... .. ., hear . .. . . ....
.. .la ... .. . ... ...i.. Mrlixer ill' Stories .. ./ ...... ....
g. Il iueusinls of enlirc Ixw erxlsr nx:l int: Fnxd. 'Al..... ... .. . , Rear .I�.. ........ lkeplh
... ... .....
.............../. Mniter of Stories .. .. �.. .. .. ...... ...
9. Sirxe of tut: FI(NIL Pg?..'.. . ........ hear ..f.4?..... ....... .. Depth �..7„�. ..��.T..
10. Ilille of hadlaseRZ... . .. MNIe of Polucl\Q+uc ZoP n.... .�..�.�. .r........ ......
It. Zixke or use district in iilddi premises ace sitlwtctl .0 r.$T.. ao.C?...................................... ... ...
12. Ikxes pallxrsed conslriwi-i"Iviolate any zonfilg law. ordinalwe or regulaciolo: .)Q&....... ..........
I'l. Will lot Ix: regralktl ...0 S:?........... Will exi:ess fill Ix: rurove(l fr(An pruni: s: YES M)
i
I/l. N:ues of (bnler of pt gni ses)L2�4S?s.. �1-r.+�.):1./.)... /uklres::" y�.. i.�:n.'.. �5.... ... mooe
Nine of Ardiilecl Alklress .... ..... .. ................... Pllune Mk. .. . ... . .
Kittle of (<xltta Ur .... ........ .......... ... ...... ... Mklless . . ... .... ... .,.... .....
.......Illolxe Ml. ..... .. .
15. Is Ihis prolxerly within 7U(1 feel of a tidal uet.lalxl? k YRS .......... M) . ....... ..
*IP YES, $XYIIKMD '1L7WN 'IMSIlli.S PL MIT MAY IUi IUi(j(1IWil).
PLOY' DIAGRAM
14x:a(e clearly 111xI disfiMlly all Ixlildit5gs, edlelher exist iog or prolxlseIl, and ilxlicate all set-Iwlk diaensiuns
frill prollelly rilx�s. Give stree-L ant hlol:k uadIer or Ikscriplinl according to dein, alxl slxlw street nallles alxl irxlicia.
rdletlier interior or coaxer lot.
:il'A'IP. (xi W14 Y(Aw
... . ... . ..... SS 3CA7i11f;±'�"J2A�Tifi1t'A3C�11
IDa�,s1�13q
. . .. ... ... ... ... . .....Ix:iu1; duly ;vAa It, dclNlaxe:: all eery:; that Ll: i;: Ihr. app!ic:ud
(Mile of ilxlividual signing conlrilcl)
alxwe tlulxYl,
Ike it: IIIc . ... ... . ... ..
.......... . ..0.W,f%)Iw. ... .. . ... ...... ... .. .. . ..... . . .. ... ... .......... ....
............
((.(NltraClor, agent'., corIKIlate uflieel , etc.)
of ::aid (moor or rxnxoa, alxl is duly mahuriz(rl to lerlonx of have lick loaned the said weak ani to ncJce allll file this
appi irat ion; that al slat(venls c.(xllailxal ill Ihis app! ical im are Inx: to like Ixmt of his knlmlolge mNl lkid iefi and
tial Wile milk will Ixe Ix:rfonted io the urinxv' gel litho ilk file applicul.iou filed Ow Wilk.
:rvxnrl to
1� Nlq this
. .... . 1`� .. ....(lily o .. .. ... .. 197.J.ttyy
...
M)liuy 111b1ic .— .... . . .. .:.I "a-->iJ. �"�"{'�
OSERTI.SCOTT.JR. (Sigoahne of Applicant)
Public.Stats of Now
Qualified
in Suuffol�kpgo�U�n�W
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