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HomeMy WebLinkAbout22302-z Y FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23450 Date JANUARY 15, 1995 THIS CERTIFIES that the building NEW DWELLING Location of Property 110 BURGANDY COURT SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 3 Lot 3.17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1994 pursuant to which Building Permit No. 22302-Z dated SEPTEMBER 7, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & OPEN PORCH AS APPLIED FOR. The certificate is issued to NEIL REGO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-94-0063-JAN. 12, 1995 UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 12, 1995 PLUMBERS CERTIFICATION DATED JAN. 12, 1995-BERTSAND PLUMB. & HEATING r Building I Spector 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) N® 22302 Z Date MPT?MW.. Z 19..9'{..... Permission Is hereby granted to: CHAPDONNAY WOODS ASSOC. - A/C REGO, NEIL P.O. BOA 641 SOUTHOLD, NY 11971 to CONSTRUCT A ONE FAMILY DWELLING WITH ATTACHED GARAGE AND OPEN PORCH AS APPLIED FOR. REGO, NEIL at premises located at .......1.10 BURGUNDY„ COUATp SOUTHOLD NY i 4 County Tax Map No. 1000 Section 5.)........... Block ..............3.......... Lot No. .......3.:.»............. pursuant to application dated ........AUGUST„ 16 # 19, and approved by the .I Building Inspector. Fee $...z.. r Building Inspector Rev. 6/30/80 / l THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE i F- 1065081 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date JANUARY 25,1995 Application No. on file 86652794/94 N 340453 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 I`ns' 1 CHARDONNAY WOODS ASSOC., SOUNDVIEW AVENUE, SOUTHOLD, N.Y, in thefollowinq location; ® Basement © Ist FL ?X 2nd Fl. GAR/ATTIC/OUT Section Block Lot 17 was examined on JANUARY 10,1995 and found to be in compliance with the National Electrical Code. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMt. K.W. AMT. K.W AMT. K.W. AMT K.W AMT H. P. 30 50 32 29 1 2 ~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W OIL H.P GAS H P AMT. NO. A W. G. AMT. AMP. MIT AMPS. TRANS. Amr H P NO.ST SYSTEMS FEET "T WATTS 1 F 2 - - 2 - SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC. COND. Of ACC. w. G COND . AMT. AMP. TYPE EQUIP 104W 1%3W 3%3W 3%4W NO Of HIiEG OF A. MI EGG W.G NO OF NEUTRAl3 A. W.G PER% OF NEUTRAL 1 150 CB 1. X 1 1 1 1 OTHER APPARATUS: MOTORSt1-k' H.P. G.F.C.I:-10 SMOKE DETECTOR:-3 [2~4!ceC.v? FRW ELECTRICAL LIC. #4405-E SERVICES, INC. P. 0. BOX 1154 GENERAL MANAGER RONKONKOMA, NY, 11779 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. Form No. 6 r TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. 1 4. Sworn statement from plumber certifying that the solder used in system contains Less than 2/10 of 17 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. B. 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 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-existing Building - $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 Date )CAA? I?~jtgS~ New Construction... Old Or Pre-existing Building.. / Location of Property....jjQ ~~a?~ w,vq.. I.........COLctto!-b.............. House No. I 1 Q Street Hamlet Onwer or Owners of Property ....7.'I1..1: County Tax Map No 1000, Section....... I.... Block I......... Lot... 3.4.7 Subdivision. ..Failed Map..4.. ......Lot... 2 ,~G?.~l~o!^V:/8~7~1S,C;~.~oGFu`~i~ Permit Date Of Permit.. . Applicant. Health Dept. Approval........... ..........,.Underwriters Approval...... Planning Board Approval Request for: Temporaryn Certificate........... Final Certicate........... Fee Submitted: $.....c7i~ ~ a .4g4gs .........0 -COZ'a345a APPLICANT Qo5~EFOur~v TOWNS OF SOUTHOLD TEL,. 765-1802 OFFICE OF BUILDING INSPECTOR N P.O. BOX 728 TOWN HALL y0 0~ SOUTH OLD N Y. 11971 C E R T 'L F I C A T I O N Date January 12, 1995 Building Permit No. 30 Owner rc t ,L- R2~ 0 (pleas print) Plumber Bertsand Plumbing & Heating, Inc. (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. plum4/e- Sworn r's signature) to before me this -LLt4.-da.y of January , 19~, - ~,60 0 7'ir % % o Notary Public Notary Public, Suffolk County EILEEN M. 90ACHE Notary Public, State of Now York No.4826942 Qualified in Suffolk county Commission Fxpires January 39, 99y v M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL REMARKS:. ~4L Y LDATE 1 INSPECTOR - _ Jt4b1E NT° N ~ b Iv FOUNDATION (1st) H FOUNDATION (2nd) 2. o ROUGH FRAME & evf CJ PLUMBING W 3.< y I Illy INSULATION PER N. Y. b STATE ENERGY CODE 4. dt~ m FINAL Ze - 4' ~a_-wit 9e'~ o ADDITIONAL COMMENTS: M ' 'SI W a y O b • r y i S ~ H M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU TION FRAMING FINAL ` REMARKS: 4 - r 0 ~e DATE INSPECTOR ppp~ 765-1802 BUILDING DEPT. INSPECTION [ ) FOUNDATION 1ST [ OU'GH PLBG. F NDATION 2ND [ ] INSULATION [ FRAMING FINAL REMARKS: s i :.gat DATE ' INSPECTOR 23oZ~ M-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: 1 DATE © INSPECTO Ir / / 'r T D IS l5 U G 1w BOARD OF HEALTH FORM NO.1 3 SETS I) PLANS TOWN OFSOUTHOLD SURVEY x$1994 BUILDING DEPARTMENT CHCC7:z*4~.0.3............ .r TOWN HALL SEPTIC F0RN i B DEPT. SOUTHOLD, N.Y. 11071 OLD TEL.: 765-1802 NO I FY ; / r r tOr-t~. C CALL Examinedyv. 197 MAIL T0: Approved .l..........119 permit No. . Disapproved, a/c _ _ . • (Burl ng Ins ctor) APPLICATION FOR BUILDING PERMIT Date ~ lAe. INSTRUCTIONS , t a. This application must be aompletcly~ llled in' icy typewriter of in ink and submitted to the Building Inspector, with 3 sets of plans, accurate.plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. a. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. -1 • . . e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of. buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i sp ctions. / (~t7 N In & . ..QC~ eJh~$ (Signature of applic:Tt, or name, if a corporation) ~~OwS®tp........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.c<.// i~ . Name of owner of premises gi !~-:'P50........................................................ (as on the tax roll or latest deed) If applic t}iaa eorpo~ration, 'siignature of duly authorized officer. (Name and title of corpora officer) Builder's License No. . Plumber's License No. , Electrician's License No. J. , Other Trade's License No. 1, Location of land on which proposed work will be done. tla.I. J X. I House Number Street hamlet . County Tax Map No. 1000 Section Block (9?? 0® c.7 Lot .~.~!7....... Subdivision oiMI)P 1Y!Ay,CU¢P'Gt G 7~ Filed Map No. rr ame) Lot - . (N 1 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ';t . . . . . . . b. Intended use and occupancy ......$?j~ C.,Q . . 3. Nature of work applicable): New Building L/ ~v . Addition . Altera4 : _ ~,on 1 P„ , • • . • , Repair (checl. which >'rtoval • • • , , , , , , , Demolition • Other.~ W;ptk . , , ; ; , , , , , • 4. Estimated Cost (De;cription) ? Fee M1~ j ( paid QPat. _ ion S. If darallen nummb of f dwelling units , Number of dwellinE un nits on each floohfloor S . g S cars ...i`Ji 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . ' Height of existing structures, if any: Front • ' • • • ' • ' ' ' ' ' Rear .Depth . g . Number of Stories . • • • • • • Dimensions of same structure with alterations or additions: Front Depth . Height. Rear.................. 8. Dimensions of entire new cns • ' ' ' ' ' . ' ' Number o Stories . • . . • • . • • • . ruction: Front (rQ.~ , , ,Rear . 42 . Depth Depth ;3',S,', Height 0 tuber of Stories . 9. Size of lot: Front ...l).':-) Rear ..11.......... 10. Date of Purchase • . • • • . Depth .0..6. . 11. Zone or use district in which r Name of F rLner Owner . 12. Does ro osed construction violate any zoning law, ordinance or regulation: /I 13. Will lot be regraded ,per . • • • • • • , Will excessfill be r moved om premises: Yes o 14. Name of Owner of premises , i,.11- tL ~Z f) , , , Address (~G2•!50 K ~ Name of Architect hone No. 3 - o l60 .115%. Address Phone No... Name of Contractor , ' 4'SStP 15. Is this property withint300 ft of a tidaldwetla~s 4 eNo.7r9s ;368; *If yes, Southold Town Trustees Permit may be required. No..' PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensmon.s from property lines. Give street and block jnumber or description according to deed, and show street names and indicate whether interior or corner lot. I I >TATE OF NEW YO - :OUNTY OF , S.~S 1 • • • , • • • being duly sworn, deposes and says that he is the applicant ( ame of individual signing contract) bove named. fe is the ~.Z f~ ~°?L.... . (Contractor, agent, corporate officer, etc.) £ said owner or owners, and is duly Authorized to perform or have performed the said work and to make and file this )plication; that all statements containicd in this application are true to the best of his knowledge and belief; and that the ark will be performed in the manner s~t Torth in the application filed therewith. vorn to before me this .....day of .I Igy. Mar y Public, b,tX/A County HEL.ENE0.HORNE G/.• ~ Notary Public, State of New Yor No. 4951364 (Signature of a he Qualified in Suffolk County S pp ant) Commission Expires May 22, 199... V i 0 v ~ N19037100`E 162,63' V ~U W 18 50 134, lB' 12.6' 0 Lf~• Fc>..,uP 26.5' n, EL, L~. q_ v `Q M A !1. 50, 14.r ~4 'V m W. o o°o G2#MWO pal# n ~ z p o~a'~^3 "i Can µ""mt,- At et as ~p A m of s~A 38G~?,'.m o noaq ®'Y 3 M n ww.In..4go p o °'^w ape n^~ rI Of3 f It C o< o~ m Y amz aP;RAS o o ~y~' 4 Q ~ro'cbp ~ ~ a~S a~a~e9^ » r c' p 4 ~,,(pc in <~iF. 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