HomeMy WebLinkAbout22062-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24153
Date FEBRUARY 6, 1996
THIS CERTIFIES that the buildin~ REPAIR
Location of Property 24145 MAIN ROAD
House No. Street
County Tax Map No. 1000 Section 18 Block 2
Subdivision Filed Map No.
ORIENT, N.Y.
Hamlet
Lot 29.1
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 26, 1994 pursuant to which
Building Permit No. 22062-Z dated MAY 16, 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 FIRE DAMAGE & WOOD STOVE ADDITION TO EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to
LLOYD A. & SANDRA KALIN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N-331609 - OCT. 28, 1994
FORM NO.'~
TOWN OF SOUTHOLD
;,U~LD~NG DEPARTMEHI
TOWN HALL
SOUTHOLD, N.Y.
N9 22062 Z
BUILDING PERMiT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ............................................................ 19 ....
Permission Is hereby granted to:
~-~2~ ,~x~ ..... ~~....../..~..o..~.~ .................................
..... ..~.~.~.....~ ......................................... ~ ....
to ......... ~..,.'~ ............ ~. ........ ~m~....i.~.....~~ ....................
....... .~...~ ............ ~.~?~ ....... ~ .........................................................................................
................................................................... ~~ ...................................................................
coun~,~oxMap~o. ~000 Sect~on......Z'.~ ............ B~oc~ ........ ~ .......... ~ot~o ...... ~../.. ..........
pursuant to application dated ........./~,',~,',~,',~,',~.~ ........ ~ ................. 1 ~..../~...,x~......, and approved bythe
Building Inspector,
Eee S..2..~..'....~... ........
Rev, 6/30/80
Form
TOI;N OF ,~;OU'I'IK)LD
13U [LI) [ D'C DEPAI{'ItlENT
765- I BO2
'~'~,.a,q, (~ ; ' . APP[,ICATION FOR CERTIirICATE OF OCCUPA~,tCy
A. Tills applicatiou must be filled in by typev~riter OR ink and submitted to the building
iuspcctor with the feilo~ing: for ucw building or ne~ nsc:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Fiual Approw~l item Hehlth Dept. of water supply aod sewerage-disposal(S-9 form).
3. Approval of electric;~[ installation from Board of Fire Underwriters.
4. S%4or~1 statemest from'plumber certifying that the solder used in system coutairs
less than 2/10 of 1% lead.
5. Co~n~rcial building, industrial beilding, multinle resJdenc
auu lust~llatious,~a certificate r~f C,,l~ c ~.~ - ~ . ~o ~,u similar outgoings
respous~ble for the buSlding, ngincer
6. Submit Planuiog 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 nses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed applicatioo and a consent to 5nspect signed by the applicant.
If a Certificate of Occupaucy is deuied, tim Building Inspector shall state the
reaso,s therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelliug $25.00, Additions to dwelling $25.00,
Alteratious to dwelling $25.00, S~imming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2.Certificate of Occupaucy on Pre-existing Buildin~ - $~00.O0
3.Copy of Certificate of Occupancy - $20.00
4.Updated Certificate of Occupancy - $50.O0
5.Temporary Certificate of Occopancy - Residential $15.00., Commercial $15.OO'
~e~ Construction. . . Old Or Pre-existing Building.. ~ .........
ltouse No. Street Hamlet
Onwer or Owners ~.,f Property..
Subdivision .................................... Filed Hap ............ Lot ......................
1leal~h DepL. Approval ........
.................. Underwr[Lers A[)prow*l .........
?~annlng Bonrd Approva~ .................
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1000773
BUREAU OF ELECTRICITY
r~/ 85 JOHN STREET. NEW YORK, NEW YORK',~O038
OCTO;'~ER
3316~9
Date ~'~ ' Jpplicatlon No. on file ~':~:' ~'~ ~ ~*
THIS CERTIFIES THAT
o~y the e~trical equipment ~ ~scrlbed be~w a~ int~uc~ by t~ applicant ~d o~ the a~ve ~plicatlo~ ~umber in the prem~es of
L10~) A. KgL:[H, ROUTE 25, PO~I t71 L, ORIBNT~ N.Y.
in the followlng locatio,; ~ Basement ~ Ist Ft. ~ 2nd Ft. OI~ Section Bilk Lot
~sexa,nlnedo, OCI I]~R 2~1~ and found to be in compliance with the Na~on~ Elect~cal Cod..
FIXTURE FIXTURES RANGES C~KINGDECKS OVENS '~ DISH WASHERS EXHAUST FANS
OUT.TS rECEPTACLES ~WlTCHES
DRYERS ~RNACE MOTORS FUTURE A~LIANCE ~EOERS SPECIALREC'PT. TIMECLOCK~~ BELL UNIT HEATERS MULTI-OU~LET DIMMERS
SYSTEMS
1 F 2 '~ : ~ 2 6~
$ERVI~ DI~ONNECT NO. OF -~ S E R V , :, ..... ~ , . E
SHO~ DETECTOR: .~ 1
2.3865~THURMAINA' RURO]~DERoA LIC. ~2334-E~ ~
, ~, '[' 1957 ~ - GENERAL M~AGER
ORIE~
Thi~ cert;ficofe musf nor be ~lfered in any m~nner; return to the o~ice of fha Board i~ inc~rrecf. Inspecfors m~y be ;de.tiffed by fhelr credentlols.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
765-1802
BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST
[ ] ROUGH PLBG.
] FOUNDATION 2ND [ ]INSULATION
[ ~FINAL
[ ].~MING
FIREPLACE & CHIMNEY
DATE:~/~/~~N S PECTO~~z~
7G5-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INFLATION
FRAMING [/~NAL
REMARKS:
DATE INSPE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ~ROUGH PLBG.
[ J FOUNDATION ZND [~INSU~TION
I'~F~MING [ ] FINAL
REMARKS:
DATE
INSPECTOR
Town Hall, 53095 Main Road
P. O. Box 1179
Southo[d, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
May 18, 1995
Mr. Lloyd A. Kalin
P.O. Box 94
Orient, NY 11957
Re:
Prem:
Arthur Karcher - TM~1000-18-2-29.1
24145 Main Road, Orient NY
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 permlts involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22062-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
** - AN ADDITIONAL $35.00 IS DUE FOR THE BUILDING PERMIT
ANENDMENT TO INCLUDE THE WOOD STOVE BEFORE THE
CERTIFICATE OF OCCUPANCY CAN BE ISSUED.
CO~M£~/TE
FOU ~ D ^._T lION __~.( ~ s t )
FOUl{DA T I OI.! ( 2nd )
ROUGH FRAHE & /
· PLUMBINGF/
INSULATION PER N.
STATE ENERGY
CODE
FI;IAL
ADDITIONA'L COM~IENTS:
! r~ {~_ ~ [1 ~ ~ ~ FORM NO, 1
I II1¢ BUILDING DEPARTMENT
80UT~I~DN
I, ,,~ ~1 ' TEL. 7~5 ~O~
1971
~ .~ : -
Disapproved a/c .....................................
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
CIIEcK ....................
SEPTIC FOR~! ..............
t;O?I Fy
c^ ~.t. ;3~.3:'./..3 I.Y.-..*, .......
~'!A ¥ L TO:
. (~dil~g Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... 19...
INSTRUCTIONS
a. This application must be completely filled ih 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 plm~ 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.
' d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
~hall 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
mspeoto~ on premises and in buildm for necesla7 i:~7~ti' · ..... ./.~.: ..... .~ ............
- (Signature ~licant, or name, if a corporation)
.......
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electrician, plumber or ,builder.
Na ne o ownero premises..:. ..g .... ....... ...............
(as on the tax roll o~x[atest deed)JJJJJ~J~0V,~J JJ$
If applicant is a corporation, signature of duly authorized officer.
.............................................. NOTIFY BUILDING DEPARTMENT AT
(Name and title of corporate officer) 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
Builder's License No .......................... 1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
Plumber's License No ......................... 2, ROUI~I - FRAMING & PLUMBING
$, INSULATION
Electrician's License No ....................... 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
Other Trade's License No. ' ALL CONSTRUCTION SHALL MEET
..................... THE REQUIREMENTS OF THE N.Y.
' STATE CONSTRUCTION & ENERGY
1. Location of land on which proposed work will be done ................... COO~$.- .NOT..RBS. F~ONSI.BLE..F.O~..
DESI~-~.J~
,C~N, SyR2-t:ICTION
ERRORS
.... ....
...................................... .,..~.~./.~ ,f~c-. ~. ~..z ...... ~.{~j.~ .....
House Number Street Hamlet
County Tax Map No. 1000 Section . [~>. BloCk ~ ' Lot. ~--
Subdivision ............... ' ...................... Filed Map No ............... Lot .......... .....
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
I/,~¢,,~.~ ~ ~-,.~ ~.~, -~c/. ............
a. Existing use and occupancy ............................ q..
b. Intended use and occupancy ./Z~.~.-P,2, ....................................., .....................
3. fw c wh~h~apcplicable): New Building .......... Addition ~ ,:; *, .q -~r ~A ~ · ....
...... ~ oval .............. Demolition ......... ' ' !! Altoi'atibn~!.. .
...... Other~Worl/-~r~7~. :,:... .....
.~.~ ~ " ,, ..,_(Description)
4. Estimated Cost ..... ~- O ~ -
.... · / ...................... Fee ........................... ~ .........
, (to be paid~9~l~l,g~ication)
5 If dwelling numberofdwellin~units '
' ' ............... Number of dwelling units on
If garage number of c~s , -~ .......
6 ' If busine'ss ........................................................................
· , commercial or mixed occupancy spec~y nature and extent of each type of use
7 Dimensions of existing structures if any: FrOnt Rear .....................
Height Number of Stohes ............................. Depth ...............
an i;il ............ ' .......................................................
of same structure With alterations or additions: Front Rear
Depth Height ...................................
8 .............................................. Number of Stohes .............. . ........
. Dimensions of entire new construction: Front Rear
Height Number of Stories .............................. Depth ...............
9. Size of lot: Front ...................... Rear ...................... Depth ......................
10. Date of Purchase " ..... Name of Foyer Owner ......
1 I. Zone or use district in which pr. raises are situated ........... ..........
12. Does proposed construction rio ate any zonin aw, ordinance or regulation: .......................... . ......
13. W~I lot be regraded ........ ~ ................... Will excess fill be removed from premises: Yes No
fp
14. Nme of Owner o remises .................... Address ................... Phone No ................
Nme of Architect ......... : ................. Address ...... Phone No ......
Nme of Contractor ........ , ................. Address ................... Phone No ................
15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.~'.
· If yes, Southold To~n Trustees Permit may be required
P~T DIAG~
Locate clearly ~d distinctly ~1[ build~gs, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensions from
property ~nes. Give street ad block mmber or description accord~g to deed, and show street nines and ~dicate wheth~
~tefior or comer lot.
STATE OF NEYC, YO]~IL~, ~
coum-¥ :, .'; ,
.... ~ X.ff.o.~.f/i'~' '~ ' ' /~...~. . / ? I%.,) beingduly sworn, deposesand saysthat heistheapplicant
(Name ol/ihdi~}cit;~lTs]g~i~g, c"" ~n~;a'c'ti ..........
above named.
He is the ..~ ......... .... ........... ~ ........................................
· I actor, agent, corporate officer, etc.) ..................
of said owner or Owners, and is duly aluthorized to perform or have performed the said work and to make and file this
.application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
.Sworn to before me this
............. ..... ......
NOTARY PUBtl~d$'~gte of N,Y, ' ..............
No. 472508_,,~,,.uff~l,k C.o.,u{I~..! ' (Signature of applicant)
Term F. xpir~s May 31, 19..,~.~'