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HomeMy WebLinkAbout22958-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23899 Date SEPTEMER 20, 1995 THIS CERTIFIES that the building ALTERATION Location of Property 435 HUMMEL AVENUE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 63 Block 2 Lot 16.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 4, 1995 pursuant to which Building Permit No. 22958-Z dated AUGUST 22, 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 FINISH 2ND FLOOR OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT". The certificate is issued to ROBERT ADIPIETRO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO.—N-327835 - SEPTEMBER 22, 1994 PLUMBERS CERTIFICATION DATED SEPT. 30 1994 - TANDY PLUMBING & HEATING dz- 1-3�7 Buildin nspect r 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) NP 22958 Z Date..........0 .. ................. 19..0?.... Permission Is hereby granted to; ......... -......,�.I : .. . . a.l..... ........... ............ o � ........../.. �./. ....Yd....... to ....../ ✓r.. ,�..........77el ......�a'.Je✓vr>�.'�..'...... .... ..L . ........................... .......... ....... e.1.......... . .... ell ..... ........ . ............ ....... ..er ........................ .............................................................................................................................. ................................... .................................................................................................................. ................ at premises located at............� w/ ........................ County Tax Map No. 1000 Section ...�..�..-d1 .. .. Block............. ...... Lot No. ."... ..... pursuant to application dated .............4 ...1.............., 19... and approved by the Building Inspector. Fee$....../.�?.... . Building Inspect Rev. 6/30/80 6 ToOla or souTnoLD jl' V BUILDINC DEPARTMENT V TOWN HALL 765-!802 BLDG. DEPT. TOa WW OF gOUTHOLD D 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. �. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 12 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. 1B. 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 Otcupancy - 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 $30.00. 2 . Certificate of. Occupancy on Pre-existing_ Bui.ldine - $100.00 3 . Copy of Certificate of Occupancy - $20.00 4 . Updated Certificate of Occupancy - $50. 00 5. Temporary Certificate of Occupancy - Residential $15.00,/ Commercial $15.00 Dace . . � . . /.!J. .) J. .4i . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or re-existing Building. . . . . . . . . . . . . .. l �.d...°. . ; . !.19Location of Property. . . . . . .. . . .. . . . . . . . . . . . 4,7 �. House No. J,,�/J Street Hamlet Onwer or Owners of Property . . . f`;—v6 e . ./� � !!/?-iJ. . . . . . . . . . . . .��.). . . . . . . . . . I . . . . . . . . ;ounty Tax Map No 1000, Section . . � .✓. . . . . . . Btock. . . .A. . . . . . . . .Lot . ./ S . .L . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed PI;,l3 . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . Date Of PermiC . . . . . .Applicant . 6. ( j�' �f(?. . IlealLh Dept . Approval . . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . . 'lanning Board Approval . . . . . . . . . . . . . . . . . . . . . . . . / 'equest for: Tempornary Certificate. . . . . . . , . . . Finnl CerticaLe. . . . . . . . . . . - e ca . ee Submitter a 4>1 - Town Hall, 53095 Main Road �z y Fax (516) 765-1823 P. O. Box 1179 , 4 Telephone (516) 765-1802 Southold, New York 11971 � 1 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N 2 p DATE• Building Permit No . O 3 J Z Owner: / wL: C7/FGVC ` V�^�Yt'Ie 'Glro� � (please print) Y P.Iuinher: Q41 ;"166 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this '�4 day of Notary Public, �i+G �ti/� County NOTARY PUBLIC,STATE Of NEW YORK oualitied In Sulloik C0..N0.52.4510158 Commission Exnhea Ajo f 30,i9..r2..-v THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGF7 1 1015026 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 .1EP'I'F14F3F7R 22,1994 844'15594/94 N 327835 Once Appliea tion No.on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of PINE GROVE CONSTRUCTION, 435 H01114WL AVENUE, SOU` HOLD, N.Y. Ca in the following tocation- ® Basement ® I st Fl. U 2nd H. OUT .Section Black Lot tvas examined on "'tb'1;''f'h31130 '19,1994 artafound to be in compliance with the National Electrical Code. —_ �__ FIX OUTLETS FIXTURES RANGES COOKING DECKS _OVENST H WASHERS EXHAUST FANS ECEPTACLES SWITCHES OUTLETS INCANDESCENT FLUORESCENT OTHER AMi. K W. AMi K W AMi K I K.W AMT, 11 P L2 44 19 12 1 12•Ll _ — DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS AMi. K.W. OIL M.P. GAS M.P. AMT NO. A W G. ,AMT AMP MAT AMPS TRANS. AMi H P NO.OF FEETfAMi. WATTS 1, F' 1 2 0 — -- SERVICE DISCONNECT NO.OF S E R V I C E METER NO Of CC GOND AWG. AWG A W G AMT. AMP. TYPE EQUIP 1-9 3W 1.9 3W 3$3W 3 A 4W PER tY Of CG CONK NO OF HI LEG OF H4lEG NO Of NEUTRALS OF NEUTRAL 1 100 l'[1 1 X 1 �4 1 — 4 OTHER APPARATUS: i 110T0118:2--l" H.P. S110KE DETECTOR: -2 Pc� PEAK E1,F1C'TRTr, SERVICE LIC.47124, 54 STRAT1,E11 DRIVE SHIRLEY, NY, 11.967 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. o�osoFFot�-�o C4 x Town Hall, 53095 Main Road ip e Fax (516)765-1823 9y�lpl � Telephone(516) 765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 15, 1995 Mr. Robert Adipietro 435 Hummell Ave Southold, NY 11971 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. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 22958-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU ION [ ) FRAMING [ NAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE HIMNEY REMARKS: lJ DATE f INSPECTOR t FIELD INSPECTION REPORT HATE_ COMMENTS II / it FOUNDATION ( IS'C) li 31-- --- -------- ------------- --- 1a ----- ------- I II FOUNDATION (2ND)___ t l ROUGH FRAME 6 --- PI.UMRIN6 I-------II — ---- ------ ----- -------- I II INSULATION PER N. Y. \gyp STATE ENERGY --------I' -`— ---�—^ ------ H -------II------ --- -- - contCODE I-------Ii----�--------------------------- \ H � 1 F I NAL. I I � ---------=-------------== oZ ---- ADDITIONAL OMMENTS: k% LA H \ z a ----------------------------------------------------------------------- r ---------- ------------------------------------------------------------------------------ - H J BOAPO OF HEALTH . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC F0RH . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 / TEL.: 765-1802 NOT11 FY ; Examined . . . . . ? 1 /f j CALL . MAIL r o Approved �4 9f 19 Permit No. . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . _ . . . . . . . . . . . Id n@sg, €, •- uilding Inspector) LICATION FOR BUILDING PERMIT .r.�..�_ Date . . . . . 19,.'. . INSTRUCTIONS a• This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 street: oar 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 Occupant} shall have been granted by the Building 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 hereirr described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti n (Sianatur.e . . . .���. . of applicant, or n e, if a corporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) 1 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. �.1 ✓ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i Name of owner of premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ? 2 i Name and title of corporate officer Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. .0S.�.�.� .~. .. . . . . . . . . Electrician's License No. . .7 . . . . . . . . . . . . . . . . Other T'rade's License No. . . . . . . . . . . . . . . . . . . . . . I. Location of land n which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j L) 3. �. . . . . . L � r °L. . . . d�' . . . . . . . . . . . . :. . . . - © �� l�a.l,� f . ... . ./.Ifs!. . . . . . House Number / 2Street Hamlet, �1 County 'fax Map No. 1000 Section . . . f.17 - . . . . . . . . . . Block . . . . . . . . . . . .. . . . Lot . /. . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) Y ' State existing use and occupancy of premises and intended use and occupy of proposed construction: a. Existing use and occupancy . . . .0./.�. 1 QAWC� . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . b, Intended use and occupancy . . �.M. , • • !Q S • • � a y 0.uu"Z"^-K*A . . . t� a6 fd1�AYe3• "}%"". . . . . . . . . . . . to fil 3. Nature of work (check which applicable): New Building . . . . . oval ' ' ' ' ' • • • • . Addition . . . . . . . . . . Alteration Repair Demolition . . . . . . . . Other Work r)1\43-A, 4. Estimated Cost r (Description) . PI c� o,.r . . , J Fee . . . . . . . . . . . . . . . . . . . 5. If dwelling, number of dwelling pnits . . . . . (to be paid on filing this application) If garage, number of cars . . . . ,I Number of dwelling units on each floor . , , , , , , 11 , , , , 6. If business, commercial or ntixe occupancy, specify natyre and extent of eacl,'type of use . . , , . 7. Dissensions of existing structure , if any: Front . . �� , , , , • . • ' '1* ' ' ' ' ' - ) ' ' • ' . • • • Height Rear . .3. Depth . G7�.�:. . . . . . . Number of Stories . , • Dimensions of same structure with alterations or additions: Front • . • . ' ' ' ' ' ' ' ' Depth ions o .enti , new co . . . . Height . . . . . . . . . . . . . . . . . . . : . . Number of Stories Rear . . . . . . . . . , . . . . . . . . ction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth Height • ¢er of Stories . . . . ... . . . . . . . " " ' • • • • • • 8. 9, Size of lot: Front Dimensions of entire new constnl . . . . . . . . . . . . . . . Rear . . ��{s�- . . . . 110. Zone or Purchase hhh • • • • • • • • • De t a .t7, , , or use district in which t rer1�T T �Iame of For er Owner V GN ` W g rises are situated . .!/��.5:�,1?.� . . ,lb, 1wU9. . . . . ( . .�. . . . . . p �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate an zoning law, ordinance or regulation: �� • . . . . ' 13, Will lot be regraded Np y g 14. Name of Owner of premises ,�/ i i • • Will exccsg fill be removed fro premises: Yes No P JYP L? .�d. ✓. . . . . Address 41."? teo: . t4i!Ct� ./Phone No. �LYX. Jrl'f'tl.Q Name of Architect . . . . . . . . . . . • • • • • • • • • • • • . Address . Name of Contractor . . . . . • • • • • • • • • • • • • • Phone No. . . . . . . . ,.,y, . . Address 15. Is this property within 300 feet of a tidal wetland? " " " " Phone No. . . , . . . . , , , Yes, , . . . . . No • *If yes, Southold Town Trustees Permit may be required. " " " " ' PLOT DIAGRAM Locate clearly and distinctly all 4uildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed,sand show street names and indicate whether ulterior or corner lot. FATE OF NEW YO ' R , 0UNrfY OF . � o �� . . . S. �'✓� �' - AAI '•`O,'i • • • • • . . . . . being duly sworn, deposes and says that he is the a (Name of individual signing contract) y PPlicant )ove named. isthe . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly an thorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the irk will be performed in the manner set forth in the application filed therewith. ;ors to before rn ° this pOf /`j . . . .'. . .da f , . . '; . . . . . . . . 19 !.J Mary Public, . . . . . . . . , . . . . . , il . , . . . . . . . . . County Signature of applicant) I I el I I v -� OCCUPANCY OR USE IS UNLAWFUL - iP USE CERTIFICATE yylZ„ OF OCCUPANCY _ _ _ —_... - _. t1F-1F•Iti.11hrl��t� Ei " ac. 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ALL CONSTRUCTION SHALL MEET T}�F I`- "� 9'rl F'I' T�� TI'I E`zG �LntJ: r THE REQUIREMENTS OF THE N.Y. !!.gz T� jk4tE t!E-e,-T pp- rTf krJoLJ LE LyE� • 1 STATE CONSTRUCTION & ENERGY IIJF ' Ar�ID sr-ur-F itil c.nl Fopl1AhIGE • CODES. NOT RESPONSIBLE FOR � EQ4.( ccn1SC�VA IotJ 1• „i f TION ERRORS DESIGN OR CONSTRUC