HomeMy WebLinkAbout23144-z 4a
7
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24454 Date JUNE 20, 1996
THIS CERTIFIES that the building ALTERATION
Location of Property 260 GR. PECONIC BAY BLVD. LAUREL, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 145 Block 2 Lot 1.6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 14, 1995 pursuant to which
Building Permit No. 23144-Z dated NOVEMBER 30, 1995
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 JOHN DILLER
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED JUNE 7, 1996-STEVEN BURNS
B '1 ng Inspector
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 .................. .... ®............ 19.
N2) 23144 Z
Permission Is hereby granted to,
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.....e ...................` �.. .......
�/ � /.dam
at premises located at.......G2•ao.......` •F ate,../.' ?rG:�'... . . ..... ........ ..1..a. r..........
/. •` ...........................
County Tax Map No. 1000 Section ...... .7. Block......... ......... Lot No. a..Sf ..............
i pursuant to application dated .................. .K........, 19...1and approved by the
Building Inspector,
y GP7
Fee$../.. ...��—...
................... ..............
Building Inspe or
Rev. 6130/80
I ,
f
Tows
765-78C2
JUN 1 m
71996 '�
1.
,=7 - FOR C ?L
TOWNBLDG DEPT
sus: be =__--- =- jc :;r?ewr.:_r OP. ink arc semi z=edzo p TF1 c,
=he .Dlioc_a_: _.,_ aewbui'_c=g or aew use:
survev o_' Drcnerrp a accuraze '_xa=ion o= a_i buiicings, opzr ._nes,
Streets, and unL•SD.a_ a2tL`ra1 Or :CDog=aDC_c _ea____s.
_. d 3nD=0v2_ __0m Hfl2.�:.': Den=. 0= wa=d= sepp v an C sewe=Zoe-C_spcs� :0rmi .
Dur-ova_ ofc 2'e____cal _ns=a..2:i0n =ram Board o= _ __e Unde=z. _:ars.
4. Stora s=a=emen: :rom plumber zna= :he soiaer used — v_ stem con=aus
_ess chin 2/10 c_' read.
�. 1.:7mmerC_a1 Otis=C_+g, =3Cll5::fa 1 OL'_Cf=g, mn__-71e =es Caences anC s—=_2r oti__c_12
and ims=a__a=_ons, _ cer=__ics=a of Code Compliance from a_.._-=ec: or engineer
responsible -or =he build_mg.
Sub" : ?'_annus Board Approv oz comnle:ac sitz plan rzcuiremencs.
r
�. nor eS_S=_ag DL ig5 � ] 0_ ..,, .� 0, 10571 ncn-con_orm�g uses, or OL"__C_.gs anC
nDC�-eS=S:_3en _and uses:
_ . .ccuraza'su=ev of _oDe_ _; sn0'w�.g all _ rODer" __ne5. scree-_s, OL'__c_ag anc
unusual -a=ural or =onog=aDC_C _aatures.
_DDer:,' C0mD1e:eC am Lica:_on and a consen= =o spec: s_znec c;v =he
Cer:___ca=e of Occupancy __ den_ec, ::he 3u4_id_ag _nspec ar -shall s=a=e :he
reasons =ae=e_or in .__=_3S cc :he
_ ,,..rr_c_ca=a of Occupancv - New dwell- Ing 52_5 .00, Add_:_cas =o d-we___g ._.,.00 .
_-=-:'o..s 522.00, Sw'_Z=.ing poo_ 525.00, iccessor, bu-.._ns
ddc?=_ons :., accessory 'cu_lciag 525.00. 3us_�=_sses 550.00.
_. Car=___ca=e^of Occupancy on Pre-_xis=i_ig 3uiidus - Si00.00
00Dv of Czr=_f_ca=e ,._ Occuzancv - .25c
Undated uar=___..c=a of Occupancy - S50.00
5. 'emDcrarc Cer=_5ica:a of Occunancc - Pesiden=_al 515 .. 00, Commerc_a_ 51_5.00
Daze . . J.�'a ( ':.�. . . . . . . . . . . . . . . . . . . . . . . . . .
:aw Cons=_uc=ion. . . . . . . . . . . Old Or Pre `le` g. /� . . . . . . . .
_oca=ion of Prope==y. . . . .RS. & . . . . . . . . . . .P�� . ... . (d!, . . . . . . . _!�Ct JeJ1 . . . . . . . . . . . .
House No.
11 Scree_ Hamlet
V. h.
-�nwer or Owners o °roper:y. (S h.d'. V'�'t�?L��}, . . . .�. ?��. . . . . . . . . . . . . . . . . . . . ./. . . . . . . . . . . . . . . .
:our.cy las Man No 1000, Sec=ica. . . . . /7. . ✓.3-ock. . . . . Gx . . . . . . . ..-0c. . �� 6 . . . . . . . . . . . . . . .
ubdiviscor.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .riled uam . . . . . . . . . . . .roc. . . . . . . . . . . . . . . . . . . . . .
No. .!^ 3� Y.Y. Of Pa i:. . . . . . . . . . . . . . . . 001 can:. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-:.. Depc. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Uncle-rteZe s _. . rov`. . . . . . . . . . . . . . . . . . . . . . . . .
3oard Apnrova_. . . . . . . . . . . . . . . . . . . . . . . .
.__L"_'sz 0 r. _emDora- .�,er___-..c:2.. . . . . . . . . . _ ria_ . . . . . . . . . . .
DGSO 0
-_ Sub..._:__.. . _ . . . . . \ . . . . . . . . . . . . . . . . . . . .
S�Y93
FOLI,- TEL. 765-1802
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
Hca '
o .tiV�+ rn P.O. BOX 728
TOWN HALL
v%jao� �p� SOUTHOLD, N.Y. 11971 .
C E R T I F I C A T I O N 1q,96 t€
s -, r �PET
�W ry°�QUbor,L
Date
Building Permit No. lf L
Owner
(please print)
Plumber to(y 1f,),fV5 W7
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1; lead.
(plumber ' s signature)
Sworn to before me this
day of 'j-yA'e'
19 % . — Onn.., Mu
Notary Pu z is
Notary Public , .SV-F-ftI1 K County Joanne Fagan �
Notary Public,Suffolk
County,NY#01 FA4991777
Commission Exp.2-10-9
o��SpFF01.t �
c� Gyp
N Zi
Town Hall, 53095 Main Road p O Fax(516)765-1823
9y�Ol 0� Telephone(516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
June 5, 1996
Mr. Jeff Hallock
P.O. Box 302
South Jamesport, NY 11970
Re: John Diller - SCTM#1000-145-2-1 . 6
Prem: 260 Peconic Bay Boulevard, Laurel
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx 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 # 23144-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
F(ELI) INSPECTION REPORT DA'I'S COMMENT:_
---- -- - --- - -- ----
----------
- d
- "
�I II � S
H
rouNDnTtoN ( IST) ° II
-- --------
n
FOUNDATION (2ND)---- pI M
_
ROI1C11 Fl2AM1?
PLUMBING I -------II - — ---- -
-------- -----
l� - - ----
INSULATION 1'ER N. Y . M
STATE ENEIRCYfN
II
CODE I
- c
FINAL --
I II
---_---_-- -----------»»---------------------ADDI'1'IONAI. COMMENTS:
M -�A
H \O \�
z `V
r
ni
d
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
zz
DATE IVIVA10 INSPECTOR Jrut4
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ 7INSULATION
GH PLBG.
FOUNDATION 2ND j
[ ] FRAMING j / ] FINAL
[ ] FIREPLACE & CHIMNEY
P
REMARKS: 2J
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ] FO DATION 2ND [ ) INSULATION
[ FRAMING [ ) FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ��
Ila-4,
DATE 3113016 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[V11 "'FOUNDATION 1ST [ ] ROUGH PLBG.
[ ,114OUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE y INSPECTOR
3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . .V/' . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Description)
4. Estimated Cost . . . . .101.Iro . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
S. If dwelling, number of dwelling units . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . .
Ifgarage, 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 . -ZF. . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . 3A. . . . . . . . . . Rear . .36
Depth . . . . . .al . . . . . . . . . . . . . . Height . . . . a z. -r. . . . . . . . . . . . . Number of Stories . .a. . . . . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front , . . . . :.3fv. . . . . . Rear . . . . Yfv. . . . . . . . Depth . . . t.7, . . . . , , , , ,
Height . . . . . . . .W. . . . Number of Stories . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . . . . ..... `7 . . Rear . . �`!;. . . . . . . . . . . , ,
l�� . . .� . . . . . . . . . . . . . . Depth . . �y.3 . . . . . . .
10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: ./k/.p. . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded . . . /UJ. . . . . . . . . . . . . Will excess fill be removed from premises: Yes No
14. Name of Owner of premises . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . .
t
Name of Architect .� ate. 1= �0 . . . . . . . . . . . Address . . . . . . . , . . . . . . Phone No. . .7a? .. . . . . . . .
Name of Contractor �.0 : . .�4(Rck., . . . . . . . Address . PA 9��X.3Qa . . Ill?Q. , Phone No. .7.�
15. Is this property within 300 feet of a tidal wetland? *yes. . No. . . . . . . . .
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly,,all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
I
i
YN60I rEX W>f' hA
I
la.� pal os; +s,
' I
kk' I
STATE OF NEW YORK, S.S
COUNTY OF . .Swatte . . . . . . . .
. . . . . . . . . . . . . (76�.��p . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. nn
Heisthe . . . .1p . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief;and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me th('s, , M
day of. . . . . . . . . . . . . . . . .. 19 .
Notary Pub County
CLAIRE L.GLEW.
Notary Public,State of New York • • • . • • • • • • • . • • • .
No.4879505 (Signature of applicant)
Ouslified in Suffolk County
Commission Expires December 8,19
- BOARD OF HEALTH . . . . . . . . .
f( FORM NO. 1 3 SETS OF PLANS . . . . . . . . . .
R P,...:_..,_... . . .... . . .. TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . .
wov 1 A 199 TOWN HALL SEPTIC FORM�p. . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
IAfg."ii TEL.: 765-1802 NOTIFY ; •-)�a :�a�1.
' , V:�j_> CALL . . 6 . . . . .
Examined . . . ., 19��� MAIL TO
Approved . . . . . . . . . . . . . . . .. 19/f . Permit No. 06 . �-� . . . . . . . . . . . . . . . . . . . .
Disapproved a/c . . . . . . . . . . . . . . . j . . . . . . . . . . . . . . . . . . . . .
�� . . . . . . . . . . . . . . . . . . .
(Building Inspector)
AP KATION FOR BUILDING PERMIT
Date . . . . . . . . . . . . . . . . . .. 19 . . .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3
sots of plans, accurate plot plan to sc�le. 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 appli-
cation.
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
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 Buildipg Inspector.
APPLICATION IS HEREBY MADE 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, and to
admit authorized inspectors on rem
p premises and in building for necessary inspections.
'
(SignalYteoXa(plicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, llessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner ofp remises . .34,,�. .�.� 2>�. . . . . . . . . . . . . . . . . . I . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation,signatrire of duly authorized officer.
. . . . . . .(Name and title of corporate 'officer)
Builder's License No. . . . . . . . . . . .
Plumber's License No. . .l4e �. . . . . . . . . . . . . . . .
Electrician's License No. . . . ,I' . . . . . . . . . I . . . . . . . .
Other Trade's License No. . . ' . . . . . . . . . . . . . . . . . .
ro
I Location of land on which P posed work will be done. . 1 co�t5 . avcQ... . . . . . . . . . . . . . . . . . . . . . . . . .
<.��
. . . . . . . . . . . . . . . . . . 1„0« . . . . . . . . . . . . . . . . . . . .
.
House Number Street Hamlet
County Tax Map No. 1000 Seciion . . . . . . . . . . . . . . Block . . . . .a. . . . . . . . . . . . Lot . . • •�` 6• • • .
Subdivision . . . . . . . . . . . . . . . II. . . . . . . . . . . . . . . . . . . . . . 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 �. . Siv •�wn.y . .�'ewv .� �»4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancyl . . . .S° ^ 2 . . . . . . . . . . . . . . . . . . . . . . . :.... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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WATER
SURVEY FOR MUW 2, /982
MAI?, 3/, 1.982
JOHN C. D/L L ER NO v /O /980
OCT 2/,/980
AT LAUREL DATE OCT. 6, /980
NOV 14 1995 ��i��,� ' TOWN OF SOUTH04D SCALE: / " = 50 '
SUFFOLK COUNTY, NEW YORK NO. x,80- 484
,
BLDG.DEPT. ■UNAUTHORIZED ALTERATION OR ADDITION TO THIS
L, Tom OF SOUTHOLCD 3_„yj SURVEY IS A VIOLATION OF SECTION 7203 OF THE
NEW YORK STATE EDUCATION LAWxe OF N
*COPIES OF THIS SURVEY NOT BEARING THE LAND SqP Fk,
SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIERD TO BE A VALID TRU /
*GUARANTEES INDICATED HEREON SMALL COYERUNPD ONLY TO O'Ej I\ n' / O9T
THE PERSON FOR WHOM THE SURVEY IS PREPARED d. O
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- Z
*NEAREST WATER STAIN—MI\t *SOURCE OF WATER. PRIVATE PUBLIC— MENTAL AGENCYAND LENDING INSTITUTION LISTED
III BUFF CO. TAX MAP DISI 1000 SECTIONJ.!'"1_BLOCK Z LOT PIC I HEREON,AND TO THE ASSIGNEES OF THE LENDING ,
*THERE ARE MD.DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARAWYEES ARE NOT TRANSFERABLE ? '�
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
III TH ,THAN THOSE SHOWN HEREON. OWNERS
* EWATER titpi LY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE *DISTANCES SHOWN HEREON FROM PROPERTY LINES
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC
OF HEALTH SERVICES. PURPOSE AND ARE 1T40T TO BE USED TO ESTABLISH
APPLICANTS PROPERTY LINES OR FOR THE ERECTION OF FENCES
ADDRESS
TEL 400 OSTRANDER YOUNG a YOUNG RRHEAD, NEWYORK
NOTE MONUMENT O = STAKE ALDEN W.YOUNG,PROFESSIONAL ENGINEER
AND LAND SURVEYOR N.Y.S.LICENSE NO.12,845
HOWARD W.YOUNG, LAND SURVEYOR d
*THE LOCATIONOF WELJ.(W),SEPTIC TANK(ST)BCESSPOOLS(CP)SHOWN HEREON N.Y.S.LICENSE NO.45893
ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
TDY POST E0494
PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE
CERTIFICATE OF OCCUPANCY KQUIRED
0)— SOLDER USED /N WATER
SUPPLY SYSTEM CANNOT A�PPP�OV�D�S NO D
EXCEED 2/70 off% L L1, -'DATE., '/��Z-�E.
a�!
._._.._.. EE: �
r'' NOTIFY BUILDING p P T
�- %765 1802 9 AM TO 4 PM FOR THE
- PLUMBING ' FOLLOWING INSPECTIONS:
I ! -1 - ALL PLUMBING WASTE ' I. _FOUNDATION - TWO REQUIRED
&WATER LINES NEED • FOR POURED CONCRETE
I TESTING BEFORE COVERING 22• ROUGH • FRAMING & PLUMBING
INSULATION
'4.
_ FIN
JO - CONSTRUCTION MUST
bE'COMPLETE FOR C.U.
` N ALL ONSTRUCTION SHALL MEET
Qtl 'ENE EPUIREMENTS OF THE N.Y.
AIFfi CONSTRUCTION & ENERGY
If Copper tubing is used ���& NOi ,gESPON919LE FOR
for Water distributing ��' CONSTRUCTION ERRORS
. ,. P
L
system; piping shall b
of types K or L only
c „J
,
D -
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w
OCCUPANCY 0R
------- USE AS UNLAWFUL
A "VVITHCUT CERTIFICATE
- _
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t=—)(I�T. 4 13 1
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