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Home My WebLink About21942-z TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24199 Date MARCH 8, 1996 THIS CERTIFIES that the building ~ocation of Propert~ 615 ~R&NGE ~OAD House NO. County Tax Map NO. 1000 Section 75 Subdivision Filed Map No.__ ADDITION So~fHOLD, NEW YORK Street Hamlet Block 4 Lot 17 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~4A~H 10, 1994 pursuant to which Building Permit No. 21942-Z dated M~A~{ 14, 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 ADDITION TO EXIBTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RUBSELL H.& DONNA L. ACKROYD & ANO. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. l/B1 N/A H-043319 - NOVEMBER 9, 1994 FEBRUARY 5, 1995-¥ECONIC PLUMBI~ & HF~T. Building inspector FORM NO.3 TOWN OF $OUTHO[D BUILDING DEPARTMENT '[OWN HAU. $OUTHOLD, N.Y. NO 21942 Z BUILDING PERMIT (TH~S PERMIT MUST BE KEPT ON THE PREM)SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) atpre.,,se$,ocatedat ........... ~.,',x: ............ ~-~ ........ ~ .................................... ' ~..~ ........ ~..J..: ........ /..,r.r..~.x ...... CountyTax Map No, 1000 Section ....... ,~',~. ............ Block.......~?..,~.'.. ........... LotNo ........ ?..,~.,, ............ pursuant to application dated,...J~.~,.../.~....., .,~4!2.. ...................... Building Inspector. Fee ~....~..-~ ..... and approved by the 'Building inspector Rev. 6130180 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 '" NAR -~ 8 199~ ' APPLICATION FOR CERTIFICATE OF OCCUPAN~¥~. ~Q_~C!J_~ES.2[~?J(~,!? ........ Ac 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. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% 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. Submit Planning Board Approval of completed site plan requirements. For existing baildings (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 Buildin~ - $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 ~ d~,-~ ,, ) Date ...~ ..................................... ~ew Construction ........... Old Or Pre-existing Bu±lding ................. Location of Property ....................... · .............................................. ~~. Street Hamlet Onwer or O,,~ers of Pro .,Pqe~.a.~:. County T~ Map No 1000', Section.~~..Block..~~..Lot ...................... ..... subdivision ....... d~...~ .......... Filed Map.~.~t~Lot...~ ....... ................... A~p~i~.h).e...~&./4 .... ~ ..'- .... ........ Amora.. .............. Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate .......... i~e Submitted: $ .a.O~.' ~ ...................... ". ~.~0~0 APPLICANT Town Hall 53095 Main Road P O. Box1179 Southold, New York 11971 Fax (5t6) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit No. ~/q~-~ (please print) (please print) I certify that the contains less than 2/10 solder used in the water supply system of 1% lead. (Plu6be~s S~'gna~ure) Sworn to before me this Notary Public, County THE NEW YORK BOARD OF FIRE UNDERWRITERS 8049286 BUREAU OF ELECTRICITY -- 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date ~O~f~ ~}9 , :~.~4 Application No. on file THIS CERTIFIES THAT only the e~tricaJ equipment ~ ~serib~ be~ and i~r~uc~ by t~ appl~a~t ~med on the a~ve ap~ieatJon nu tuber in the prem~es of ~NNA ACKRO~), 615 G~GE ROf~ SOUTHOLD, N.Y. i. the followlng locution; ~ Base--at ~ Ist FI. ~ 2nd FI. OUT Sec~h,n Bilk Lot ~s examlned o, NO~R ~3,1994 and found to be in ~omplianve mith the NaMonal Elect~cal Code. FIXTURE FIXTURES RANGES C~KINGDECKS OVENS DISH WASHERS EXHAUST FANS P~JLBOARDS: 1"4 CIR. 6~ G.F.C.I:'~3 T~CK LIGHTING: - 16 ~NNA a ~lmO~ P O BOX 156 'SOUTHOLD~ ~, 11971 GENIAL ~AG~R Per This ced[flcate must nof be o[tered in ony monaer; refurn to the office o~ fha Board ~ i.correct. Inspectors moy be ideal;fled by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIRCATE MUST NOT BE ALTERED IN ANY MANNER. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 4, 1996 Mr. Russell Ackroyd P.O. Box 156 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 xx not on file. (Enclosed) No Underwriters Certificate on file. 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 # 21942-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 7G5.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH~PLBG. [. ] i~S~TION [,~] FINAL [ ] FIREPLACE&~HIMN~ DATE INSPECTO~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION SST [ ] ROUGH PLBG. ]~NDATION 2ND [ ] INSULATION FRAMING ~ [ ] FINAL 7GS-Z802 BUILDING DI:PT. INSPECTION [ ] FRAMING [ ] FINAL ~/ /'! · INSPECTO~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~INAL 7GS-1802 BUILDING DEPT. [ ] FOUNDATION 1ST [/.~"ROUGH PLBG. [ ]/FOUNDATION ZND [ ] INSULATION / [~/] FRAMING [ ] FINAL 765-1802 BUILDING DEPT. [ ] FRAMING [ ] FINAL REMARKS: ./INSPECTION % : i 1. CO~f~I£NTS . FOUNDATIOI.; 2. ROUGH FRAME &. 'FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIO C OM:{IE~;TS: 3. Nature of work (check which applicable): New Building Addition .......... - ......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work .............. 4. Estimated Cost ~/5~, ~0 (Description) ...................................... Fee ...................................... (to be paid on filing this application) 5' l[d've~ing'number°fdwellingunits ....... / ....... Number of dwclling units on each floor ' · garaoe, number of cars ( A-IF/~ct4h-~ · ' ............... 6. If business, commercial or mixed occupancy, specify nature and extent of each t e of use -- 7. Dnnensions of existing structures if an,,' F~-* ~; & -- ~P-' ' ....... ,; '--:, .......... Lamensions of same structure with alterations or additions: Front ....... .~. ¢ ....... Rear ~ ..... .~..('7..,i ...... Depth .......... /2~7. ....... Height ........ '~'~:: · Number ~ories ...... /. ...... , ........ 8. Dimensions of entire new construction Front .... ~. · Rear Height ' /~ x, ....... / .......... ". ..... Depth ' ~.~ .~.' . . ' 9. S~ze of lot: Front ...... /. c:°..O, " ''") '~'~3', ..................... c.-,.,~ ............... 10. DateofPurchase .5~/~>.~.. ........ ~ear..~; ..... '-' ........... Dep_th ...t.(~. ........... 12. Does proposed construction violate any zoning law, ordinance or regulation· /./O , Name of Contractor ....... . .~..~.. /'~,v ~//~ - 15. Is this property within 300 feet of a tidal wetland* *Veo ''''[; ............ · If yes, Southold Town Trustees Permit may be required. ... PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or prol3osed, 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 whet~ler · interior or corner lot. / STATE OF NEW/YORK, ' ~ cou v OF s.s ......... (; c, ~ ~ rq ~ c.~.~o ~.? ~ ~://-~u~4 being duly sworn, deposes and says that he is the applicant (Na~e of individufil signing contract) above named. He is the ~ ~ (Contractor, agent, corporate officer, etc.) ~f said owner or owners, ~d is duly authorized to perfom or have perfomed the said work and to m~e and file this ~pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the york will be parroted in the manner set forth in the application filed therewith. ~Wom to before m~s . · ..... or.. ..... HE[.EN/D, HO~NE ' NoteW P~Siic, State of ~o. 495~364~ Ou~lifiqd in Suffolk CounW ~ -~ (Signature of applicant) . ~ Commisoion E~p~s May TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 BOARD OF HEALTH ..~'3 SETS OF PLANS /SURVEY ......... SEPTIC . . . Disapproved a/c , . , (guli~ling Inspector) APPLICATION FOR BUILDING PERMIT Date ............ INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Im 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part~ cation. , c. The work covered by tkis 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 availabl~ for inspection throughout the work. . e. No building shall be occupied or used in whole erin part forany purpose whatever until a Certificate .f 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, ( ~rdinances or Regulations, for the construction ofl buildings, additions or alterations, or for removal or demolition, as here in described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regula :ions, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applican;~; ~n'e~ (Mailing address of applicant) State whether applicant is owner,~lessee, agent, architect, efigineer, genera/ contractor, electrician, plumbe~ or builder. iK°A-IG' [Cd$..~ELL, ~ DONN,q ACKT~/) y b Name of owner of premises .... "'Q 'i .......... (as on the tax roll or latest deed) If applicant is a corporation, signatur~ of duly authorized officer. (ame and title of corpora;re officer) Plumber's'License No. ~ .17 L~.~.~ 5 Electrician's License No t~ u/,~. ~'~ Other Trade's License No ' Location ofland'on which propos6d work will be done ......................................... I ........ tl ..... ouse Number ~ St ....... ' ........... : feet Homier (Name) ................... State existing use and occupancy of premises and intended use and occupancy of proposed constr.uction: Existing use and occupancy !.0 M L~ ~. J b. Intended use and occupgncy ~'tc~ ~'"[/~- ' ' :ctor, with 3 mblic streets of this appli- )ration) /1971-0/~6 91 l°'7 3o'~6 ? / /