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HomeMy WebLinkAbout21492-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall a Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-22477 Date JULY 27 1993 THIS CERTIFIES that the building ADDITION Location of Property 625 GLENN ROAD SOUTHOLD NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 2 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 12 2993 pursuant to which Building Permit No. 21492-Z dated JUNE 22 1993 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ROBERT UINN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - JULY 19 1993 PLUMBERS CERTIFICATION DATED N/A ldi g Inspector 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) 4~ Date ~ 19./ 3 N° 21492 Z Permission is hereby granted to: . .3 ................e7t.......s` ta..~~~X .I C W•• J...... Gz` ;lcQfLri .....E~it..... .I.. . . . at premises located at......(v.. ••-Q~Gl7... Z County Tax Map No. 1000 Section`.......!?............ Block aLot No. pursuant to application dated ......5,!/.Z 19.....ai and approved by the Building Inspector. Fee 7 os Yu.................. ing Inspector Rev. 6/30/80 Form No. 6 ? TOWN OF SOUTHOLD j\ JUL 'L 6 W BUILDING DEPARTMENT +ts TOWN HALL e; GO. O r,~ 765-1802 ~y A'0'AA OF sOs I7,4,:, r, > 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. 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.000, Commercial $15.00 /~clc~~ Date New Construction...w Old Or Pre-existing Building 1! / Location of Property ...........................-Ru House No. n Street Hamlet Onwer or Owners of Property .....~o~e~.?t„(/,~tY'`/.,°.~., G;-!F, County Tax Map No 1000, Section .....Uff Block ...2........... Lot„ Subdivision ....~r{1~4~ ....ef-CrA..e j...Filed Map„~ ~r S uu ...Lot... 1 Permit No..Q).l91C.t....Date Of Permit ................Applicant............................. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate....l....,, Fee Submitted: $....4'r.s:.d.~~ Qom. ybs d o C'~~0 ~ . APPLI FT I ILL. Ec._V.4 E II ,V `IbIE N`f t„,_ ^0 H~ FOUNDATION (1st) c~ FOUNDATION (2nd) m G 2. z tx~ 0 N ROUGH FRAI4E & PLUMBING C 7] 3 3 . m r~ m 1~ H\\I INSULATION PER N. Y. STATE ENERGY CODE x vl a m lose - H 4. 77 FINAL 0 z ADDITIONAL COMMENTS: s r / ra au a m a r~ ' m H 4'2S- =1el y Rd SOv~4a~~ ~y t` ! b I NOr t-d rs !6 s' Zoo vr-e 3J' ~o ' }U ~ ~ ~ :tea a i ZZ U ? ;mi,~'N, ( ~tn N2~29'~0^C 1!4.9L ,i c ' ' • `Rlr. 40 •i,• Q.m ( I 5 25' 23 r:. tSC 63 CLLl' ~°J i :4N .tot 1 . ~ r; )'fir l i r•1~ 2 r 1C .S~i~ll 1-•~ f(i)lm .li t.l t.Yj t l? 1' t YI j t I ~I t~ t °"Y • Il ; .rl 1 x,1 J JUN 14 I993 „ rnxf , ~ i i= Do j> U~ftn' j i N•2~°26~30'E. 134.96 v t8 'plmA I Z ~ _ ~ _ 1p6 u~._ 10 ',Z~~j ' p p ou ~ v oL k\~ a~ ~ In m _ T ! 1'U C I ~ qq ICP I~I~ ~ O g~• _ 01 O l 11-0 z m 0 8 I 5.23°28'30' W. 150.83 17' rr, s e O 6 av gc (1r CJt ° H ° o s~• HIM fill W 177 ~1 0 tolm C F ( ID i ,N; i n I ~C ip „ z in 10 I{ (U~~ m ' \jl y IF~rb Ci it i~ it' >Iz t~ !Zliit~ ~n Ip (n M4 10) t-n 1? ~u b I^ l M-1802 BUILDING DEPT. INSPECTION [ O NDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS:` f I I C 4 f DATE INSPECTOR i M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING t ] FINAL I / REMARKS: { f 4 i I k I ~E [4 ` h 4 DATE INSPECTO , I M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST F ] UGH PLBG. FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL REMARKS: f l { i I d~ DATE Mh~ INSPECTOR f J M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ FINAL ' REMARKS: _ 4 f E E F E INSPECTOR DATE 71 _ -c.o _q_ a THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000378 BUREAU OF ELECTRICITY 83 JOHN STREET, NEW YORK, NEW YORK 10038 Bate" 3ULY 21,1943 Application No.onfile £31468'793193 N 289106 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in thepremises of ROBERT QUINN, 625 G~-Ly~ENN AVENUE, POLE44, SOUTHOLD, N.Y. in thefollowing location; LJ Basement I 1st F1. E] 2nd Fl. OUT Section Block Lot was examined on JULY 2 , 19 9 3 and.found to be in compliance with the National Electrical Code. FI%TURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W AMT. K W. AMT. KW. AML K. W. AMT. H.P 4 5 7 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT K. W. Oll H. P. GAS H. P. AML NO. A. W. G AMT. AMP AMT. AMPS. TRANS. AMT. H. P. SYSTEMS MAT. WATTS NO.OF FEET SERVICE DISCONNECT NO.Of S E R V 1 C E MIT. AMP. TYPE METER L A. YW , S. 3W 3 A' SW 3,e' 4W NO.Of CC COND A. W. G. NO OF HIAEG A W. 'G' NO. OF NEUTRALS A. W. TRAL EOUIP. PfR.9' OF CC. COND. OF W. G. OF NEUTR OTHER APPARATUS; i NOTORSII-F [f.E', G.P.c.It-1 i STEVE'S ELEC/S,ALBERTSON LIC,43494-E P.O. B08 1268 SOUTHOLD, NY, 11971 GENERAL MANAGER 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. i BOARD OF HEALTH FORM NO.1 -'3 SETS OF PLANS TOWN OFSOUTHOLD r-SURVEY BUILDING DEPARTMENT r CHECK JUN 1 41UJ3 TOWN HALL SEPTIC FORtt SOUTHOLD, N.Y. 11971 ,i TEL.: 765-1802 NOT IFY', CALL Ex mined19tfAIL TO:... Approved 19a Permit No.... 7.f , Disapproved, a/c ul d1 Ir"' v APPLICATION FOR BUILDING PERMIT q / Date 191. INSTRUCTIONS (l a. This application must be completely filled in by typewri ter 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 stieets ' 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 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 ins ect' ns. (Signature of a 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. ............v„I`ller Name of owner of premises Mr~ Pl /~?Pf ...RP//?P/ v<' Y (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. /3© ~a } M„Z.• , • , , , , Plumber's License No . Electrician's License No . Other Trade's License No. 1. Location of land on which proposed work will be done. , , , , , • • • • , 6 ? o . House Number Street Hamlet p- County Tax Map No. 1000 Section -0 . , • Block Lot Subdivision ..:W8S.-_t. erea. • .95- ~ Filed Map No. . y Lot . (Name) 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy !.Vle ! `mil rfY... r~E'S1r~~kL'~ b. Intended use and occupancy 1e„ .,y 5=.~ 1 `f;"Ekd~,:~-A . . . . a. 1 k - Ft4~~1tp"; d'•:S=~r+:•~< {~~Piyx::2::68Y1ftiSh't tet->B ~Fitrt':!,si~iM r'.e~dfl3~. 3. Nature of work check which , . , , , . ( (applicable): New Building , Addition ! Alteration Repair . nemoval , Demolition Other Work . (Description) 4. Estimated Cost . . . . . . . . , Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garaga number of cars , , , 6. If business, commercial or mixed occupancy, specify nature and exte t of each type of use , , , , , , , , , • • • . 7. Dimensions of existing structures, if any: Front f • , C.G Depth . . . NuinberofStories Dimensions of same structure With alterations or additions: Front • . • . • • . • • • . . ' • • Depth . Rear..... Height . mber of Stories . 8. Dimensions of entire new construction: Front . 5 4e ,c(........... Depth .Height Number of Stories . . 9: Size of iur: Front . Rear Depth . 10. Date of Purchase . J/tct'e.rli, /78'8' • • • • • • • • • • . • .....Name of Former Owner ,•QM.4N.~..QP~~t!'(........... . 11. Zone or use district in which premises are situated . . . . 2. Does proposed construction violate any zoning law, ordinance or regulation: Me . . 13. Will lot be regraded A6o p 0 • • •t• • • • • • • • ....Will excess fill be removed from premises: Yes 14. Name of Owner of remises . •~OAer. , f.`, 4+(i Nr. , , Address la ~~~+yY e^~ , , , Phone No . Name of Architect ~r ~PN'f . , , , , , • , , , , , Address Phone No. . Name of Contractor . L,`o 1. jR , eel • • , , , , , . Address APOq• X W 15. Fs this Phone o. ,7,~5';l f~ property within ,300 feet of a tidal wetland? *yes............. No.. *If yes, Southold own Trustees' Permit may be required., PLOT DIAGRAM Locate clearly and distinctly aill, buildings, whether existing or proposed, 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 whether interior or corner lot. i i i I ' I i i i STATE OF N R COU Y F .r.Y.dLl~ ,SIIS GL.. ~I • ~ A being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ieis the Contracto ,agent, corporate officer, etc.) )f said owner or owners, and is duly uth ~ p orm or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the vork will be performed in the manners~t forth in the application filed therewith. ;wom to before me this da of . 1 votary Publ J ~-~C.Ci~• unty ii GLAiRE L GLEW . , . Noten'Pubt14 State of NMI" (Signature of applicant) QualNiedoin Suffolk Cout ~r Cotnmiselon Expires De"MM .e I , v~ Wi Q, rgiH °/v hx Sevn F,n,cN Fi 14 TIY N:Z 5 G Doc F'. A^>Sr MOU7 1~ 'f /Jrf(' _ ~ ex ~ , Iv ~ ~ F yr, or falSr $!~I40, G ll I I I 7* ~ -Farr ~F y14 LPTHINL- M ~R 3 ~4F,~ , n r 4 r•~ j _ 1 e . WI F' CRAW L O 2 K 6 C",J ~ Lti O C M -FRnv lo£ VENTII,AIiCN 1 2x! RIDGE _ _ A yLbl. KL BrN f IwSN R/~~ CG'nl O NEW ROOM c 1 w Q( m'. xI ~ fit 1 r. e / U LLI '~.6 25-12• G u, 5 lu ~ Yne 1 n'• r UNDERWRITERS DERTIFIDAYE C•' Ib'D P, / / REQUIRED _ PLDl-rlcN - j fN~wl ?-~A~ knneRS, k'' 13 314H 2C0f F't('MR'CN .t er%` - ~XrW~ I-(1 (.1 (~1 t.. Ex~si l3 ns' FLl)s 5'/z' g ~F'LA hl_~ -L6DT2~~L_A ray axN i " ~ yr' I Ftt.Si C 1 M1R •Ti f C - _ _ ryR . 4,-_R„~ MkTCN Er r I h 80(-"' i ' - , ~EAIFY E~°~"f Ctt»D1 i~0N.: ff 'v r'vEU TIr'O" 1`',1`9 NA ~PPF Ay7 ~nl- I ~-"PLT C..q NRf.G~ ~Sj@~~rYPe. i a 5 c_Hrur,EFS dry JFe ~ C.+vPSn~n IS - iCFQUIRE - CDX A Y2 P.t UMCE~,, LAYME~7 , ' I - gt p. ~•yr(6 bus , . Tq!,HITI'. aA; SM^~ - ¢IV+w~ - - - - C, r - DAMP r 'Q~, ,A Ertrs Not PRO P. 6. FwGHA~s, 8s~i _ ~ •M I _ s c w' CTI 0 q i4 . B FGAaYM1Ib AT 6EPA ` FEE NOTIFY g 9 AM TO 4 PM .765.1802 Og TME - - Ig~? AC~wT C/+I ~,j~ - - _ 1f - ~LU NGINSPECFI DREOUIRED RIHII SIOC (~(S 111 Si Dt j~EU 2, v~Pi~~ Ll. S~bE I. FOR POURED MNCRETPLUMBING ' OR kL~y/~ T C, nG. i 21 ROUGH . FRAMING g. OCCUPANCY OR f i INn ALAt10 CONSTRUCTION MUST RF C:OMPL AWFUL TRUCTION SHALL MEET USE IS UNLAWFUL THE RF.OUfREMENTS OF TENS N.V. WITHOUT CERTIFICA .RTIFICATE a c~NCr,r rs STAtE DONpTR RESPONSIBLE FOR ODES OF OCCUPANCY " CONSTRUOTION ERRORS DESIGN OR y ICY D".10 ~Ilk CNn~i ~s TA -L-AN 6-7-93 NE w- Kt'r ~aa}.ddr~~n~~' Bnr~,. `4 ~ f'~<<~A~yyr' ~ ;p . !F N IRS 6N-N1 _ - .hb!)1Tion1