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HomeMy WebLinkAbout22430-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OC~3PAN~Y NO Z-23986 Date OCTOBER 24, 1995 THIS CERTIFIES that the buildin~ REPAIR Location of Property 63335 MAIN ROAD House No. Street County Tax Map NO. 1000 Section 56 Block 4 Subdivision Filed Map No. BOUTHOLD · N · Y. Lot 15 Hamlet Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 20, 1994 pursuant to which Building Permit No. 22430-z dated NOVEMBER 1, 1994 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 REPAIR EXISTING COTTAGE UNIT AS APPLIED FOR. ELECTRICAL INSPECTION CERT. PLUMBERS CERTIFICATION DATED The certificate is issued to JAMES L. BEDELL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ~5677 - MAY 4, 1995 SEPT. 22, 1995-JAMES L. BEDELL Rev. 1/81 Building I~spe~tor/ FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ 22430 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Coun~Tox Mop No. ~000 Section ........ ~ .... B~ook ............ ~ ........ Lot No. .,,.':',.~ ................... pursuant to application dated ................. . .~.....~.~...4~? ............ 1 9...~.. ~.~....., and approved bythe Building Inspector, Fee $..,..~.,~.,..~, Rev. 6~30/80 Yhls application must bo fiiled in by ty~euriter OR ink *nd submitted re the building inspector with the following: for new building or new use: l. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or topographic features. 2. Einai Approve] from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical instaiietion from Board of Fire Underwriters. &. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and instalia~tions, a certificate-of Code Compliance from arnhitect 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: l. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application end 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. Eees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelliug $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-existin~ Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 a. Updated Certificate of Occupancy - $50.00 5. Iemporary Certificate of Occupancy - Residential $15.00., Commercial pete .. ......................... ~ew Construction ........... Old Or Pre-existing ocation of ......... .......... ......... ~ouse No. Street Ilamlet ~ubdivisio, .................................... ~J ]cd Hap ............ but ...................... ;l~alch Dept. Approval .... ~ .............. Um[erwr~cers Approval ....................... 'lan.lng 8onrd Approvoi ....................... '~equest for', Temporary Certificate .......... ~' I / , rz,m~ Ccrticete .......... Submitted: $. Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit NO. Owner: ~¢-2~ Z ' v (pleaSe print) Plumber: (please print) t~ I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. //¢¢l~mber~s Signature~ Sworn to before me this Not~y Public,~F/~~ County .¢'//./ / .~ , ... /' ..'~;:~.-z~.'~. /./. ~F~"~ ~¢~. . ~OLORES 3. SAVITSKY ~ ~ ~o~ry Public, State of New 'fork / / // No. ~-8774476 Suffolk CounW. ' ~ ~ ~; ~pires August 31, 5-4-95 ELECTRICAL INSPECTION SERVICE INC. 375 DUNTON AVENUE EAST PATCHOOUE, NEW YORK 11772 5677 APPLICATION NO. ON F Soul:hold TOWN:  BY: ~al~g ~d~ll , LIC. NO. ~ ~; [ lISTED ~ INSPE~ED ON: 5-4-95 A~ m~ FO~D TO BE m COMPLIANCE WITH THE~); ~ , ~ ' NATION~ CLEriCAL CODE. ' '" :~TION. .BASE ~ 1ST 2~ 3~ ATTIC SMO~ DETECTOR DETACHED GAUGE OH BE ALTERED IN ANY MANNER. IDENTIFIED BY THEIR CREDENTIALS. PRESI~DENT ' '" };L~, ,"J F CODE FI;IAL IO}/^'L CO.q~IE~ITS: 765-1802 BUILDING DEPT. INSPECTION [ [ ] ROUGH PLB~,~- [ [ ] INSUL~I~N [ ~N~L [ ] FIREPLACE & CHIMNEY REMARKS: ] FOUNDATION 1ST ] FOUNDATION 2ND ] FRAMING 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ~] INS~LATION/ [ ] FRAMING [/~"FINAL [ ] FIREPLACE & CHIMNEY. REMARKS:~.~g,,.,-.,~- ~ ~~ ..-, DATE 2'65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL 765-~.802 BUILDING DEPT. [ ] FRAMING [ ]FINAL BUILDING DEPT. INSPEC )N [ ] FOUNDATION 1ST [,~J ROUGH PLBG. ~ ~FRAFOUNDATION ZND [ ] INSULATION MING [ ] FINAL BUILDING DEPARTMENT SOUTHOLD, N,Y, 11971 TEL,: 765-1802 , (~ilding Inspector) ~ cATtoN FOR BUILDING PERMIT INSTRUCTIONS BOARD OF REALTH 3 SETS OF PLANS SURVEY ................... CHECK .... MAIL a. Th~s app~icat~~n must be c~mp~ete~y ~~~ed in by typewriter ~r in ink and submitted t~ the ~Bui~ding ~nspect~r~ wittt 3 ~ts 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 streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 aall be kept on the premises available for inspection throughout the work. ¢. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy :tall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department ,fo~r,t?e.~i~s~anee of a Building Permit pursuant to the .uilding Zone Ordinance of the Town of Southold, Suffol~k C.o'u/ity; .N.~,'~.'y~t~ and other applicable Laws, Ordinahees or :egulations, for th~ construction of buildings, additions et alteratiOn'gg'.o~ fdf'~emoval or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, o.rdinanceg,:b~il~l:ifi~::¢gde, housing code, and regulations, and to dmit authorized inspectors on premises and in building f~,'~¢~ss~..ry~in~e4~i6ns. ~, -' ~{b~gnature of pp: , na e, if a corpor~.tion) '~ ~ ,'~5~ ; ~5 ....................... ~ ~' '~,? ~ ~(~admg address of applicant) ;tare whether applicant is owner, lessee, agent, arch~tect,,,e~i~tneer; .~ner~,aentraetor electrici'an, plumber or builder· "' ~'~'~' '~"%~ ............................................................................. 'APPIIOV D AS ~ FE . · . 765-1802 9 AM TO 4 ~1 FOR THE (Name and title of corporate officer) FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE , Builder's License No .................. 2. ROUGH . FRAMING & PLUMBING 3. I~SULATiON Plumber's License No ........ : ................ 4. FINAL CONS~RUCTION MUST OE COMPLETE FOR C,O. EJectrician's License No ....................... ALL CONSTRUCTION SHALL MEET THE REQUiREMENTS-OF THE N,Y. Other Trade's License ~o ...................... STATE CONSTRUCTION & ENERGY' coo~s, NoT RESPO. NSmLE EOR · ,. .................................................... House Num bet Street Hamlpt Co~m~ r~ ~v ~o. moo s~o~ .~d~ ......... moc~ .~ ........... ~ot .~.~ ....... Subdivision .................... [ ................ Filed M~p No ............... Lot ....... ......... State existing use and occupancy of premises ~nd intended use and occupancy o~proposed construction: . - ............... , ............. r Ii $. Nature o check which app cable): New Building .......... Addition .......... Alteration .......... Repair . ~ ......... Removal. .............. Demolition ............ Other Work ............... 4. Estimated Cost i (to be paid on filing, this'application) 5. If dwelling, number of dwelling unjits .... z( ......... Number of dwelling units on each floor i .............. · If garage, number of cars ....... ,. . 6 If business ci 1 mix d ~ ............................................................... · , commer a or e OCCupancy, specify nature and extent of each type of use ........... Dep~ . ~& ~ ............ j HeiSt . ~ ~t ....... '.. Number of Stories . ~ .............. 8. Dimensions ofentirenewconstmciion: Fron* .~.'~.. . Rehr *o o ~ '~.' ~. ~ Height ~ X~X.. Number of Stofie~ ~ ... j j · · · k~e~ ....... ~epm ~r~ ....... i 0. Date of Purchase ~.M ~ ~ . . Name o~ F ~ ~ ~ ~;~ .... ] l. u ~lct 1~ WlllCn premises are slmatea..~ ......... f.. 12. ' ................. Does proposed construction violate'any zoning 1~, ordinance or regulation: . ~ ................. 13. W~llot beregraded ~ i . . Wilt excess fill be rem-v-~ ~ " 'Z '" ' ' '~' · ............... u uu Irom premises: Yes 14. Nm e of Owner of premises ~ ~, ~&ddress~f~~ ~Ph~e No ~ - Nme of Contractor · .' Address ....... Phone No .............. [5. Is this property within 300 feet of a eidal wet,and? ~Yes ........ No. ~.. ~If yes, 8outhold Toon Truseees Permit may be required. '' .... PLOT DIAG~ Locate file~ly ~d distinctly ~1 bOild~gs, whether existing.or proposed, and. indicate fil set-back d~ensions from prope~y Hnes. Give *treet and block nu~mber or description accord~g to deed, and show street nines and ~dicate whether inte~or or coruer lot. . v~ ~ for water distributing~ ~ ~~~ ~ ISUN WFUL of types K or L on,, ~ 'Z~ ~. PLUMBING ~/'~ ~/~ ~ ~ ~ . ~ ' ~ PLUMBING WA8~ WATER UNE8NEED ~ ~ ' ~TE OF OCCUPANCY ~ ~ ~ ' . ...... '~~- '~< ' '~f~ ............ being duly sworn, deposes and says that he is the applicant (Name o f individ ual signin~ con tract) ~bove named: I (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly ~uthorized to perform or have perfomed the said work and to m~e ~d file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be perfomed in.the m~ner sbt forth in the application filed therewith. ,worn to before me this~ .....