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Home My WebLink About23473-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25132 Date JULY 11, 1997 THIS CERTIFIES that the building. Location of Propert~ 14909 MAIN ROAD House No. County Tax Map NO. 1000 Section 23 Subdivision ALTERATION EAST MARION, N.Y. Street Hamlet Block i Lot 2.3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 8, 1996 pursuant to which Building Permit No. 23473-Z dated MAY 31, 1996 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 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NO~uV~%N H. WHITEHEAD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-406248--12/18/96/ & H-55669 -- 6/16/97 PLUMBERS CERTIFICATION DATED JULY 10, 1997-MIKE JACOBI PLUMBING & ~EAT. Rev. 1/81 FO~V,e NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA~IT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 23473 Z Permission is hereby granted to: .~ ...... ~.Zz.,., .......... ~,,.z,.~.,~..::~ .~:..&~.z~..z.~..~..~"~.,,4~. ..~.~..~.z:.....~~...,....~..../z~,~, - , ,~...~ ........... ~ ....... ~~ ........ ~.....~.:.~... ..... ~ ...... ~Z~J ... . ~ ~ / . ~ ......... ~ ..................................................................................................... ~,~,,~,,,~,,a ~, ........ Z~..~. .......... . ....................................................... ................................................. ~ .~_~ ......................... County Tox Mop No. 1000 Section ...~.. .............. Block ...... .~..Z ........ Lot No.......~.?..~.-. ......... ~,,,,,,o,,, ,o o,,,,,,~,,,,o,, ,,o,ed ....... "'~..~........./...~. ................ , ,,..,Z..~'"' o.~ o,,,,,o,,ed ,,,, ,,,, / Building Inspector. Fee $ ....................... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMEBFf TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ao This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for mew 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 plumbar certifying that the solder used in system contains less than 2/10 of i% 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 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 i. 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-existinR Buildinm - $100.00 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 New Construction ........... Old Or Pre-existing Building .... .~. .......... /~'~ House No. Street Hamlet Cou=ty Tax Map No 1000, Section....~..~ ....... Block....~.~ ......... Lot .... ~.,.~. ............. Subdivision ............................... .. . .. Filed Map ............ Lot ...................... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval . .~. ........... Request for: Temporary Certificate ........... ~'~ C~ .......... Fee Submitted: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOXVN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No.~.]%~Q (please print), Plumber,,.~i~ ~/~ ~-~-~ 6 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to befo~ me this NOtary Public,~County (plum~. '~ signature) Public JOYCE M. WILKINS Notary PublJ~, State of New York No. 4952246, Suffolk Count~ Term Expires June ~2, 119,..~. ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE i i 7 5i~J®3 BUREAU OF ELECTRICITY F-- 85 JOHN STREET, NEW YORK, NY 10038 THIS CERTIFIES THAT NOVON WHITEHE~ I~, 149~9 ~iN RO~ E. ~'~ION~ N.Y. in the fotlowJng location; ~ B~ement ~ I~t FI. ~ 2nd FI. OUT .~tlo, Bilk Lot ~ examined on DECEP~ER 13,1996 and found to be in compl~nce with the N~on~ Elec~cal Code. FURNACE MOTORS RJTURE APPLIANCE SERVIC~ D!-cC-OHNECT 1 2(30I CB OTHER APPARATUS: RANGES SPECIAL RECE ~RTER QUIP I~f2w V I ~ISH I EXHAUST FANS WASHERS MULTI.OUTt~T DIMMERS A, WG, AW.G, OF CC. CON0, NO, OF HI.LEG OF HI-LEG 2/'(3 -' 2/(3 Q.C. ELECTRIC INC. P.O.BOX 518 LAUREl,, NY, 11948-(3518 LIC.#3823 GENERAL MANAGER Per !l ~h~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by t e~r credent,als ~ - ' BUREAU OF ELECTRICITy 85 JOHN STREET, NEW YORK, NY 10038 ~.~ J~E 16,1997 ~pplicatlonNo. o.file 13~58196/96 H ~55669 NO~ H. ~!TEHE~, 149~9 ~IN RO~, EAST ~ION, N.Y. 12 24 14 QTH~R UNIT HEATER~ MULTI-OUT[E1 DIMMERS SYSTEMS $ERVIC~ DISCONNECT S E R V I C E OTHER APPARATUS: PANELBOARDS: I-8 CIR. G.F.C.I:-3 SHAKE DETECTOR: - 12 125 BOX 337 ~ EAST MARION, ~t,. 11939 Per~MANAGER ;hisce~ificate mustnot be altered in any manner;return to the office oftheBoard ifincorre~.lnspectors may be identified~,their credentials. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I/,~NSULATION [ ] FRAMING [i./] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~~..~~ ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTIO I [ ] FOUNDATION 1ST [~/]' ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]~UNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ~j~SULATION [ ~FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE //~~~rY INSPECTOR~2~ - FORH NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD~ N*Y. 1197 T~L: 765-1802 Disapproved ~/c ; ....... ~'" · .......... APPLICATION FOR BUILDING PERHIT BOARD OF HEALTH SURVEY ........................ C.EcK d/.. J// ................... SEPTIC FORH ................... NOTIFY: MAIL TO: .~-~- -%..~..~.~t. .......... · ~. ~ ~.$. ~...ti..~.~. ?.. ?. P.O~. .......... . .~.~..~.T...~...*~. ?..~.~...~..~... Z ......... INSTRUCtiONS a. Ibis applieatlo~ re:st be ~mpletely filled in ~ ~iter or in i~ ~ ~itt~ to ~e ~lildi~ Ins~ctor wi~ 3 ~ts of plus, ~te plot pl~ io ~ale. F~ acco~i~ to ~le. ~ b,- ,, ~ot pl~ ~i~ i~tx~ ~q , o~, ~ of ~ildi~q ~ ~ms, ~lati~ship 'to Mjoini~ ~m~ns or ~lic st~ts or, ~as, ~ givi~ a ~tail~ ~rlpt4~ of l~t,~ef '~r~ ~t ~ dr~ ~ ~e di~,~ida is ~rt of this ~li~ti~. c. ~ ~k ~ ~ ~is a~licati~ ~ ~t be ~n~l ~fo~ is~e.of.~ildi~ ~t. d. ~ a~l of ~is ~liqati~, t~ ~ildi~ In,cLot will ~s~ a ~ldmg Pemxt to the ~lic~t. ~t ~all ~ ~pt ~ t~ ~s ]~ail~le ~r in~ti~ theft the ~rk. i e. ~ ~ildi~ ~all ~ ~i~ or u~ in ~le or in ~rt f~ ~ ~ ~at~r ~til a ~rtiflc~te ~ ~mll h~ ~n ~t~ ~ }t~ ~ildi~ In~t~. ~I~ IS ~t~i ~ to t~ ~ildi~ ~r~t for ~e isle of a ~ildi~ Pe~t ~t to t~ ~xld~ ~ ~i~e of ~ ~ qf ~ld, ~lk ~ty, ~ York, a~ other ~li~ble I~s, ~i~es or ~lati~s~ f~ ~ ~st~ti~ of ]~ildi~s, ~iti~s ~ alterati~s~ or f~ ~al or ~liti~ ~ ~in ~ri~. ~ ~lic~t ~s to ~ly with M1 ~licable 1~, o~i~es~ ~ildi~ ~e, ~si~ ~lati~s, ~ to ~t ~i~ii~tors ~ ~i~s ~ ip ~ild~ for ~es~ in~ti~s. ............ (Hailing address of applicant) ......... th~ ~.~,~+~-A~-~I~-~ NOTIFY BUILDING OEPARTMENT AT If ~llc~t is a ~rati~, si~ m of ~ ' [ FOLLOWING INSPECTIONS: 1, FOUNDATION - TWO REQUIRED .......... WITHOUT 3. INSU~TION 0F OCCUPANCY ~il~rs Licen~ ~. ~ ~l= BE COMPLETE FOR C.O. ........................ ALL CONSTRUCTION SHALL MEET gl~tricims Li~ ~.. ~r ~'s Li~n~ ~... ~i I. ~ati~ of 1~ ~ ~i~ ~: .... l.~ ~ ~ ....... ~.4~. · ~! ~ivisi~ .................... 2. State ~sti~ ~ ~ ~ ~ o~ ~s ~ inte~ ~ ~ ~ o~ ~ ~s~mcti~: a. ~sti~ o~ ~ ~ ~ ~ ~ ~~ ................ THE. R~Q~IREMLNT8 OF TUE N.Y. "'"'"--~--- ~'~' ~ STA~E' CbhSTRLICTtON & ENERGy ~- ............ CODES, NOT RESPON~HRL~ FOR ~ ............ DESIGN OR CONSItiUCllON ~ ~ ~11 ~ ~ .......................... St~t ~ ~let .~,.~ ....,~ ..~,~. ..... ~ .~3~ ...... 3. la~tnre bf ~ork (cl~ck Mdch apl~licable): ~ Iksihling .......... ~kliti~ .......... l~l~ir ........... ~al ............. l~lici~ ............ Ocher ~ ~.~.~J.~.~..~q~g. (1~ri1~)~,~$~S 6. Estill~t~l (to lm ~ld on filing this If garage, ~l~r' of cars 6. If I~fii~mss, ~mrcihl or miml m~y, s~ci~ ~ture a~l ~tent of each t~ of u~ ...................... 7. I)i,iensi~, of ~isting 8th~mres, it any: r t..Yt; ......... .... ...... ......... ~ Cl~iO~t ~.~....~ ................. ~der o[ Stories ..... ~ Dimensions o[ sam stnmtn~re ~ith alterati~s or ~Mitions: Front ..~ ..... l~ar . ~ ....... mpth .... ~ ......... t~i~,r .... ~ff~ ........ ~dmr of Stories .. ~ ...... fl. Dimensions of entire ~ ~st~tim: Frmr ...~.~.~ ..... l~ar ..&~ ...... I~pfl~ ..~.~ ..... Igi0tr ...~ .............. ~s~l~r of Stories ...~ ~ .......... 9. Si~ of lot: l~mt .................... I~ar .................... ~pth .................... II. ~e or u~ district~Jlt]~in ddd, pr~i~s are simtM .... ~ .... ~W.~ ...................................... 12. ~s prol~ml ~mt~tim violate any m~ing l~, n~i~me or regulation: ..~ ................. 13. 9ill lot I~ regr~ ...... ~ ......... gill ~eas ~ill I~ r~ ~m~'~i~s: ~m~ of Ardlit~t ..... ~ ......................... ~ress .............................. ~m~ ~ ............... ~ of Cm~ractor ..... ~ ......................... ~Mress ............................... ~m~ ~ .............. 15. Is this p~r~y within ~ f~t of a riehl ~e~lml2 ~ ~B ..~.... ~ .......... PLOT DIAGRAH l~cate clearly and distinctly all buildings, ~hether existing or proposed, and indicate al! aet-lmck dimensions Froa~ property lines. Give street and blonk r~aber or description according to deed, and sl~ street na~s and ir~licate ~~. ~..~~..~ ............ I~ing duly s~rn, }lelx,~s a~l ;ays that he is the appl (~ of iml[vidtml signing contract) "' Ik~ is the .............. (C~tractor, .agent~ cor~rate o[ficer, etc.) ~ ~ ~ nf said ~r nr ~rs, and is duty authori~ to ~rfonn or h~e I~r[o~.~ the ~id ~ and to m~ and file this application; that alt star,rants c[mtait~l in thi~ all~~i,catlon are tn~ tn tim Imst of his kl~l~e al~ t~liefi and thak the ~rk will 1~ l~rfon~}~ in 'lhe mem~r ~t fortli in the al~l. icatlon film tler~ith. ~m to I~fore ,e this ~ , ~ta~ fi~lic ..................... :~ ' " . * ~ N~ARY PUBUC. 8tat~.,~. , ,. o. 4