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HomeMy WebLinkAbout21540-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22498 Date AUGUST 6~ 1993 THIS CERTIFIES that the building Location of Property 3905 W~LLS ROAD House No. County Tax Map No. 1000 Section 86 Subdivision ALTERATION PECONIC~ NEW YORK Street Block 2 Lot Filed Map No. Lot No. Hamlet 14 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2{ 1993 pursuant to which Building Permit No. 21540-Z dated JULY 15~ 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 FINIS~ SECOND FLOOR IN EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to SUSAN Q. KERR (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MIA PENDING - AUGUST 5~ 1993 N/A Rev. 1/81 FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 21540 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .....~./~,/, .~.., ............................................... / Permission Is hereby granted to: .OT..,~......~.,.....~,~ ........................................... . .~.~.~...~.~.~..~..:....,...~../..~_. . .............. ~ Coun~y Tax Map No. 1000 Section ...... ~.~ ........... Block ........... ~ ........ Lot No....~....~... .............. Building Inspector. 1 9 ................ and approved bythe Rev. 6/30/80 Form No. 6 BUILDINGTowNHALLDEPARTMENT 65- g02 JUL - 2 . APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by t~pewriter OR ink and submitted to the building inspector with the following: for new building or new use: i. 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 1% 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 ~Tpre-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 i. 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 $15.00, Commercial $15.00 ew Constructzon ........... Old Or Pre-exzstzng Bumlding .......... House No. Street " 'Hamlet Onwer or Owners of Property .............................................. ... .. . County Tax Map No 1000, Section ..... ~ ....... ~lock ..... ~ ......... Lot ...................... ~Subdivision Filed Map Lot Health Dept. Approval ........ Uuderwriters Approval Pla lng ard Appr val Request for: Temporary Certificate ........... Final Certicate .... ........ . .......... INSPECTORS Victor Lessard Principal Building Irapector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Soothold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD dULY 23, 1993 SUSA}lA. KERR P. O. BOX 152 PECONIC, NY 11958 RE: PREMISES @.3905 WELLS ROAD, PECONIC To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT $ 21540-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. ~OUND~TIO~ ~0UGH FRAHE & -~LUMBING ~I~SULATION PER N. STATE ENERGY CODE FI:~AL .o..=,.~.,,., THE NEW YORK BOARD OF FIRE UNDERWRITERS ELECTRICAL DEPARTMENT k 1 A.J. REED, GENERAL MANAGER R~PON D TO: j;;~' 65 John Street I D 41State Street I ~ 570 Delaware Avenue I ~ 217 Lake Avenue ~202A~erialRoad N~ YORK, NY 10038 ALBANY, NY 12207 BUFFALO, NY 14202 ROCHESTER, NY 14608 SYRACUSE, NY 13206 (212) 227-3700 (518) 463-2122 (716) 884-1155 (716) 254-0141 (315) 463-8552 THiS IS A REPORT OF (SEE BOX CHECKED HEREUNDER) · ;' ,,,~,,~,,[~,,~?N-INSPECTION B. [] INSPECTION ,/'0 EI~De,~FI~N: ' - ' · C./~ELECTRICAL SURVEY OW~/, .... i A~-I~ECTION: We ha~ re~iv~ your applicaffon f~ an ins~tion o~ the e~ri~t i,~tallation mad~ by you at the ~ ,, .~,, . ~emises.:nam~ herein but we h~e been unable.to make the inspectlO'n for the following reason: ~loor Iocauon and n~ ~t~ant not Iumis~ed ~'~Fl~cation o[ b~lding n~t fumishod ~ ~.~ ~ ~loa~ ~do tho noeo~arg in~mafl.n:.'or suo~ ~*ran~ for our ~o~* ~o. t~ rpromises on. t~ ~mon form att~..[o~urn ,t to thru 0~..~ . . ~'" Apl:; icant~s ~gnature Date / B. C. ,. / I~[~N OR ELEG'~'~-I~$~F~j~f~[~w'~have ~t~;~ at~t~ prem,~'~C~¢oCn t~~'.,.~l~r,cal ? :?~eu,??~H~ta M ~'~fthat we can ~~ate of ~nge ~ t~e re~q~ti~,~nder ,~ ~[ed wo~ ~ ~ff~ntly t u.~[~, ,,'~na~~p~nd f~~.~ cation .. -u~sDe~t.--... w. on : ~r:,,:~,,,'~ .... ::': e, m ~, ~'~ (for.. insnecfl~ch~eceived..:';' '.~,u, ~,- .~r: :~. ~.on not c~~O~V ~ :'~L:;;~S~ ~Xl~m~ not co~.~l;~ m.~  .~.'l~M: Code nu~l~if'~;lC~l~ ~LACK colum~fl~~ wl~ ~~ un~r~~ ~t~_E~L~~U~rvlce Con~~nn~r ~nac~ aEUA~CE ac' ~e ~oor ~[A~. '~.~ ..... F~eRj~A~ RED ~cF~E~K ~EO; viFLOOR BLACK?' ?,' nu~ec ,,~q~:;~ ~ Date -?I ~ > H D~ ~{ ,' ~'~. ' ' NOTICE ~l~l~~ao~p~[~Scotuo~ueq ~m~p coqe un~peL form to request re-inspection when modifications have been made. APPLICANT'S SlGNA~RE DATE NOTE: IF THIS IS A REPORT OF ELECTRICAL SURVEY, A NEW APPLICATION MUST BE MADE FOR RE. INSPECTION. r r -13T 765-1802 BUILDING DEPT. - INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL REMARKS THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ [ [ 8 !i077 BUREAU OF ELECTRICITY -- JOHN STREET, NEW YORK, NEW YORK 1OO'48 85 Oate A[I~I~' 13,:[993 ~pplicationNo. onfile 048'~.~9~/93 ~ 286:~8~ THIS CE~IFIES THAT o~y the electrical equipment ~ ~scribed below a~ int~uc~ by t~ ap~icant ~d on the o~ve appl~ation number in the prem~es of inthefollm~ingtocation; ~ Basement ~ IstFl. ~ 2nd ~. ~/~'~'~Ie/Oi]? Section Bilk Lot ~s examined on ~ ~ ~ [I ~ ~~ ~ ~ ~1. ~ ~ ~ and found to be in compZ~nce with the Na~onal ElecIdcal Code. FIXTURE FIXTURES RANGES C~KINGDECKS OVENS DISH WASHERS EXHAUST FANS DRYERS ~RNAC[ MOTORS FUTURE A~LIANCE ~EDERS SPECIALREC'PT. TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS P.O,gO~ 164 This ce,ifi(ate must flor ~e altere~ in an~ ~anner; return to t~e office o[ t~e Boa~a if incorre(?. Inspe(tor~ ma~ be idenfifi~ b~ their (reaenti~ls. COPY FOR BUILDING DEPARTMENT. THOS COPY OF CErTIFiCATE ~US~:HOT BE ALTERED IN ANY t~ANNER. b I / 5; 5*' ?;ll~# TOWN OF SOUTHOLD ., .'.-~"¢ . BUILDING DEPARTMENT ' ., Town .AL, , sO.JT.O._O, N.,,'. ,,9. ,,\~,~ ./'. - ~ TEL.: 765-1803 Disapprov~/~ ~ Y~ ......................... : .... . ~uildin%~l~spector) APPLICATION FOR BUILDING PERMIT Date 7- O -- 19~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 tsets 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 sti'eets 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) ..... (Mailing address'of applicant) //,~,,~-.~--- State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ....~...~..~'.. 2. Xf- .~',~- - -~. - · · ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriied officer. (Name and title of corporate officer) Budder s Lmense No .......................... Plumber's License No ......................... ' Electrician's License No ....................... Other Trade's License No ...................... Location ofland on which proposed work will be done. .~. . .-~. . ~.~..~'...~.,.~,./.,~..~..'~..~..i . ........ . ....... .... ...... House Number Street Hamlet County Tax Map NO. 1'000 Section ... :'~"~' .......... Block ....~. ...... ' .. Lot.../-~. ............. Subdivision ......... Filed Map No ............... Lot ............... (Name) S[at~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...- ........... · ....................................... ~ ............... .. b. Intended use and occupancy . . . ~ ................ . ...... ~ .... · 3. Nature °f work (check which applicable): New Building .......... Addition Alteration ~ ' Repair .......... Removal .. , ........ Demolition .... ; ......... Other Work ............... 4. Es,imatedCostl ' ' Description, (to b~i~on filifi~ this application) 5. If dwelling, number of dwelling units Number of dwelling units o'~ e~ch floor~ .............. · If garage, number of cars ... ' 6. If bus/ness, commercial or mixed occupancy, specify nature and extent of.each type of use ?~:. ~ ~'. ............... 7. Dimensions of existing structures, if any: Front ............... Rear ........ ight .... ~ll~pth He Number of Stories.. . Dimensions of same structure with alterations or additions: Front .......... ' · ................. Rear.. 8. Dimensions of entire new construction: Front .............. : Rear ..... De Height ............... Number of Stories ................ ' ......... pth ............... !~i ' Sbfvo£1t,~! t'ront .......... . ......... ~.. Rear 10. Date of Purchase ........ '" ............. Depth ................... · .. Name ef Former Owner Zone or use district in which premises are situated .............. · construction violate any zoning r~ .................... I2. Does proposed law, ordina ce or regulation: .......... ' ...... 13. Will lot be regraded .... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ........... , ........ Address Name of Architect ................... Phone No ................ Name of Contractor ........................... Address ................... Phone No ................ .......................... Address ............. · ...... Phone No ............ ' .... tS. Ia this property within 300 feet of a tidal wetland? *Yes ........ No ......... ~If yes, Southold Town Trustees Permit may be required. ', · .-. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and. indicate all set-back dimensions fror~ ~rop.erty lines. Give street and block number or description according to deed, and show street names and indicate whether mtcnor or corner lot. . A PROVED AS NOTED FOL~O'~ViNG INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, IN~LILATION ' 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHA~ ME~ THE REQUIREMENTS OF THE N.Y. STATE CONS~U~ION & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR CONS~UCTION ERRORS STATE OF NE~-4~R]~)~'~ / ]~ $ S COUNTy OE__. ~2~.?f-j"~,l,?,~.. ' ........ .... .......... (Name of individual signing contract) ...... above named. being duly sworn, deposes a~d says that he is the applicant (Contractor, agent, Corporate officer, etc.) .... of said owner or owners, and is duly authorized 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 w/il be performed in the manner set forth in the application filed therewith. ' Sworn to before me this (Signature of applicant).