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HomeMy WebLinkAbout22609-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFI~AT~ OF OCCUPANCY NO Z-23517 Date MARCH 1, 1995 THIS CERTIFIES that the building ALTERATION Location of Property 622 LIGHTHOUSE ROAD House No. Street County Tax Map No. 1000 Section 51 Block 2 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 2.6 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 15, 1995 pursuant to which Building Permit No. 22609-Z dated MARCH 1, 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 ALTERATIONS IN EXISTING ONE FAMILY DWELLING FOR BEDROOM "AS BUILT" AND APPLIED FOR. The certificate is issued to EDITH GOLDE~F~AR (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-342936 - FEBRUARY 16, 1995 PLUMBERS CERTIFICATION DATED N/A ' - ~ ~lding Inspector Rev. 1/81 FORM NO.3 TOWN OF SOU'[HOLD BUILDING DEPARTMENT TOWN HA~L $OUTHOLD, N.Y. N9 22609 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: , pursuant to application dated .......................................................... 1 9 ................ and approved bythe Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL '765-1802 TOWN OF ~OUT~OLD ~TOWN OF S_OUTHOLD '1 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: ~-I, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 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 1% lead. 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: ~-i. 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. CJ 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwellin~ Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinz - $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.OO New Construction ........... Old Or Pre-existing Building ................. Location of Property .... ~ .~...22% ............. .~./..~.~...~...~..~..~.. ,../~... ....... ~.&~7-/7~2~ House No. Street Hamlet Onwer or Owners of Property .................. ty 1000 ,b--/ 2. 2, Coun Tax Map No , Section .............. Block ............ · ... Lot ..... Subdivision ...................... Fi~ed Map ............ Lot ........ 'ermit..~. './/.~.~ Applicant ~.~..~.. '';'~--~-~ ' Health Dept. Approval ........... gnder~r~ters Approva~ Planning Board Approval ........................ Request for: Temporary Certificate ..... Final Certicate.. ~ Fee Submitted: .... .................. -' FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~TMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18477 Date OCTOBER 18~ 1989 THIS CERTIFIES that the building CONVERT BARN Location of Property 622 LIGHTHOUSE ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 2 Lot 2.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 15, 1986 pursuant to which Building Permit No. 15576-Z dated DECEMBER 18t 1986 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 CONVERTED BARN TO ONE FAMILY DWELLING B~ PER PLANS SUBMITTED ON SEPTEMBER 25, 1989. * The certificate is issued to DAVID SCHLAGER & EDITH GOLDENHAR (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 86-80-230-JULY 17, 1989 UNDERW-RITERS CERTIFICATE NO. N-027740 - AUGUST 12, 1988 PLUMBERS CERTIFICATION DATED 7/24/89-MATTITUCK PLUMBING & HEATING CORP. *ALL OTHER UNFINISHED AREA UNHABITABLE. NEW BUILDING PERMIT REQUIRED. Building In'sp~ctor Rev. 1/81 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~II~ATION FRAMING [/~INAL THE NEW YORK BOARD OF FIRE UNDERWRITERS 1135185 BUREAU OF EL. ECTRICITY ~ 85 JOHN STREET, NEW NEW YORK 10038 YORK, FEBRUARY 16,1995 ~6911~9~/95 N 342936 Dat~ ~pplicatlon No, on file THIS CERTIFIES THAT o~y the el~trical ~uipment ~ ~serlb~ be~w a~ int~uc~ by t~ applicant ~d on the a~e application number in the prem~es of EDITH GOI~ENH~, LIGHTHOUSE RO~, SOUTHOLD, N. Y, in the followlng location; ~ Basement~ Ist FI. ~ 2~d ~3. Section Bilk Lot FMBRU~Y 13,1995 ~s examined off and foundTo be in compHd~ce with the ~a~'onal Electdcal Code. FIXTURE 5 ' A~ FIXTURES OUTLETS ~ECEPTACLES SWITCHES INC DESCENT FLUORESCENT OTHER 2 2 DRYERS I FURNACE MOTORS I FUTURE APPLIANCE FEEDERS AMI,K,W, I OILH,PGASH.P, IA~T,NO,, A W.G, SERVICE DISCONNECT NO. OF S AMT. AMP. IYPE ~.~. 1~ 2W 1 ~' 3W 3 ~ 3W 3 ~' 4W OTHER APPARATUS: SMOKE DETECTOR: -1 RANGES SPECIAL REC'PT E R TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET  SYSTEMS AMT, AMPS, TRANS, NO, OF FEET V I C E EXHAUST FANS DIMMERS NO OF CC. COND A W O. NO OF HI-LEG A W G, ,40 OF NEUTRAJS A. W, O. PER ~' OF CC. COND OF HI-LEG O~ NEUTRAL MODERN ELfiCTRIC EAST, INC. 10470 ROUTE 25 HATTITUCK, NY, 11952 ~ ;': ' LtC.#~253~~ MANAGER COPY FOR BUILDING DEPARTMEN1; THIS COPY OF CERTIRCATE MUSI~NOT BE ALTERED IN ANY MANNER. ..... ~LDG. D EPT.~ TOWN OF-~6UT'fiOLD . J FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 B~ARD OF HEALTH suRvEY ......... Approved.....~././. ....... , 19 .~). Permit No...~. ~:'~.?~ ~.~.3~.~.~ .~¢/.~....~..~d.~94~_.~.~ '.'? '~Disap2roved'. a/c .... . ............................ 2..;. · // ·.a ' ' ~'<~..----"- ' APPLICATION FOR BUILDING PERMIT Date ' 19 CALL . . ' ........ HAIL TO: INSTRUCTIONS a. This application must 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 stkeets or areas, and giving a detailed description of layout of property mu~t 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 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 herein 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 inspectio~ns.- ...... ..... ? ...................... --' . (Signatur~ of applicant, or name if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder. Name of.owner of premises .......................................................................... (as on the tax roi1 or latest deed) If. applicant is a corporation, signature of duly authori2ed officer. (Name and title of corporate officer) Builder's License No .......................... Plumber s L~cense No ......................... Electrician's License No. Other Trade's License No ...................... I. Location of land on which proposed work will be'done ..... . ............................ : ........ - ....... ... ..... ....... .... '. .... . House Number . Street Hamlet Cotmty Tax Map No. 1000 Section .. :...' ........... Block ............ ' .. Lot ................... Subd~wsmn..; ..... . ............................. Filed Map No ............... Lot ............... (Name) 2; Stat~ existing use and occup.ancy of premises and intended use and occupancy of proposed construction! a. Existing use and occupancy .... ' ....... ' use 'an '. ~'' ,~" b Intended d occupancy ..... ' ( ppli ) Building ' ,~dditi 3. Nature of work check which a cable: New ' , ~ ........ on .......... Alteration ...... Repair Removal Demolition . Other Work 4. Estimated Cost ..... -- ................... Fee .................................. ~ ~~ ~ ~. ~1~ (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits .............. ., Number 0f dwelling units on each floor ..... : .......... If garage number ofc~s 6. If business, commercial or m(xed~ occupancy, specify nature and extent of,each type of use ............... 7. Dimensions oi existing structures, if any: Front. ...... ~ ....... Rear .......... Depth ......... ' .... Height ............... Number of Stories ..... D~ensions of shine st~cture wi~h alterations or additions: Front . ............. Rear ......... Depth .... ' ................. ~. HeiSt ....... ' .... . ........ ~ Number of Stories .......... '.; ...... 8. Dimensions of entire new construction: Front.. .... ; Rear ......... .. · ~elgat ............... ~umoer of Stones ....... 9. Sizeoflot Front ~ ' ~ ' .... ' "'~"L' ................... 10. Date of Purchase . ~ ..................................... ~eptn .................. ........... ~ ........ · ......... Name of Fomer Owner ........................... 11. Zone or use district in which premises are situated .... ' ' 12 Do ti l~t gl ' di~" ................................ . . es proposed construe on rio e any zonin aw, or anco a n: . , ........................... 13. WH116t be regraded ....... : .................. Will excess fill be removed kom premises: Yes No of Owner of premises Address . Phone No ' ' Address Phone No N~e of Architect ............................................................. N~e of Contractor Address ~ Phone No ' 15,' I~ this property within 3)0 feet of a tidal wetland? *Yes No · If yes, SoutholdT ~wn Trustees Permit may be required. PLOT DIAG~ Locate clearly ~d distinctly ~1 build~gs, Wheth&r existing or proposed, ~d. indicate M1 set-back d~ensions from prope~y hnes. Give street ~d block ni [tuber or description accord~g to deed, and show street nines and indicate Whether ~tefior or corner lot. 9 STATS OF NE~k~ / ...... ~ i~'. ~ .~D. ~. G~. .... being duly sworn, deposes ~a says that he is the applicant (Name of individual signin~ contract) ' ~bove named. He is the.., ...................... ,. . , i (Contractor, agent , corporate officer, etc.) >f said owner or owners, ~d is duly ~ut)o~ed to perfom or have perfomed the said work and to m~e ~d file this tpplication; that all statements contained ~ this'application are flue to the best of his ~owledge and belief; and that the ~ork w~l' be perfomed in the m~ner s~t forth ~ the application filed therewith. ;worn to before me thi~ . day of .. . nu.,,,,~y: 4~7~505 '~ ~ _ . . ' . ~ ' (Signature of apphcant) . ,M... i -i s.~°4 SUFFOLK CO. HEALTH DEPT. APPI~OV~{.' - STATEMENT OF INTENT THE WA, TER SUPPLY AND SEWAGE DISPOSAE SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE, STANDARDS, OF:THE ~UFFOLK C(:~. DEPT. OF HEALTH ts), ~ . ", "~ : -i >APPLICANT ' : '.' ' co~sT~u~ ~0~ O~[y: ,, :: ,.,. 'D~T~: ' ' -' ' .. '. SUFEOLK CO. TAX MAP DESIGNATIOIq:: DIST. SECT. BLOCK PCL. OWNERS Al)DRESS: ._ ,~ ~).:..: ,.