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HomeMy WebLinkAbout21757-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Eouthold, N.Y. CERTIFICATE OF O~CUPANCY No Z-233OO Date O(~TOMER 21, 1994 THIS CERTIFIES that the buildin~ ADDITION Location of Propert~ 4250 GREAT PECONIC BAY BOULEVARD House NO. Street County Tax Map No. 1000 Section 128 Block 4 Subdivision Filed Map No. Hamlet Lot 23 Lot No. conforms substantially to the ~pplication for Building Permit heretofore filed in this office dated OCTOBER 20, 1993 ~ursuant to which Building Permit No. 21757-Z dated NOVEMBER 4, 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 FOR AN ADDITION TO AN EXISTING ONE FANILY D~IELLING AS ~PPLIED FOR. The certificate is issued to ROBERT T. POTD~VIN of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N301505 PLUMBERS CERTIFICATION DATED (owner) N/A JANUARY 7, 1994 N/A Rev. 1/81 i!d~ng Inspector FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .././//~. ............................................... 21757 Z t pr mlses located at........~.?.' ...~--~. ................................... CountyTax Map No. 1000 Section ....../~....~....~.. ........ Block .....,~... ................. Lot No..~....~_. ................. Building Inspector, Fee $..~...~. ...... and approved by lhe ~./ ~/Building Inspector Rev. 6/80/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 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. 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 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 Buildinz - $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 ..~..C~Z~.~.~..LT~.~.~.~..~. ............ . New Construction ........... Old Or Pre-existing Building..~ ............. Location of Property...~..~. ~.0 .............. P.~.~ ~;.~..~.~/.~.~.' ..... .4.~.~ .~.~-/ ......... House No. Street / Hamlet Onwer or Owners of Property..K~..~..~:.' .~.~.i.~.~.?.~..~/ ............................ . ... . County Tax Map No 1000, ....... Block... . ........... ................ Subdivision ................................ ... . Filed Map ............ Lot .................. . . .. No ~ ~' Z //~4J.~ ! ..Applicant.8.0.~..~. J.~-.~.'.~.4~Z4.~'..f/'..~... Permit .... I.~;..Z .... Date Of Permit ...... Health Dept. Approval .......................... Underwriters Approval...X .................. . . Planning Board Approval ...................... . . Request for: Temporary Certificate ........... Final Certicate .... ~ ..... Fee Submitted: $. ~ ~..~. ~ o ..... FOUNDATION ( ls t) · FOUNDATION (2nd) 2. ROUGH FRAME & -PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: THE NEW YORK BOARD [(~(~ ~. ~B 1 BUREAU OF ELECTRICITY F--' B5 JOHN STREET. NEW YORK. NEW YORK 1OO:38 Date JANUARY 07,1994 ~pptle.~lonNo...I.. ~257~[93/93 N 301505 THIS CERTIFIES THAT o~y the electr~ca~ equipment ~ ~scrlb~ below a~ int~uced by the applicant Mined on the a~m application humber in the premises of ROBBRR' POn'DgVI, H, PECONFC BAY BI, VD., ~S exa,n ined on D E (~ ~] ~{ B E R 2 Q , ~ 9 9 3 and found to be in complia.ce with the NaEonal Electrical Code. FIXTURES RANGES SPECIAL EEC'PT DRYERS FUTURE APPLIANCE FEEDERS FIXTURE OUTLETS ~ECEPTACLES SWnC.ES FURNACE MOTORS SERVICE DISCONNECT OTHER APPARATUS: S NO, OF CC, COND COOKING DECK__S . V I A. W, G, NO OF HI-lEG OF CC, COND. DISH WASHERS tMULTI'OUFLE - SYSTEMS NO. OF FEET ] 2/0 1 EXHAUST FANS DIMMERS AWG, OF NEUTRAL !-/0 JOD¥ [,It. #230~-g AMOUNT PtEAEE REMIT BY CHECK OR M~NRY ll Ptr THIS IS YOUR RILL FOR SERVICE RENDERED AND IS NOT A CERTIfiCATE OF COMPLIANCE. THIS BILL PAYABLE AT ~HE NEW YORK OFFICE, 85 JOHN STREET, NEW YORK N. Y. 10038 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [~AL FRAMING REMA~S: ~ 765-1802 BUILDING DEPT. INSPECTION REMARKS: DATE ,INSPEC'rOR./g.~.~,~ ~ .... [ ..... SOUTHOLD, N.Y. Examined ............ 19~ Approved ..... ~- .... 19~Pe~it No~/~~ Disapproved a/c ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL >//(Buj;~ng Inspector) APPLICATION FOR BUILDING PERMIT SURVEY ...- ............. c IECK ........... .............. NOTI ~Y: CALL ................... HAlL TO: ~+~.~% ~.o ~f./~ .... INSTRUCTIONS :,~ .. . m2 a. This application must be completely filled in 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 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 muht be drawn on the diagram which is part of this appl/- c~tion. : c. The work covered by tiffs 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 appl/cant. 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 describbd. 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 ~~ -- (Signature of applicant, or name, if a corporation) · .. A:~'~[o,~, ~,~..~.. · ~.~. ~. ~ .......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................. . ........................... Name of owner of premises ....... .~..~'~..~. ~ r.~..~.~.~.. (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. /~~ ~...~7. x ./4.,~, Plumber's License No...,z.~ ~.4 .v .P. ............. lectmc an s L~cense No. .~..3 o o - E Other Trade's License No. ,/,¢.~ .4 ,/(-.:. ,//~: ....... 1~. Location of land on which proposed work will be done. itouse Number Street Hamlet Cou'nty Tax Map NO. 1000 Section ... I ~.~'. .......... Block ."..q ..... ' Lot...~3 ............. Subdivision ...... . .................. . ......... '. Filed Map No ............... Lot ............... (Name) , Stat~ 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 · · .~.-'r.*.~*,.~, ~ , .,~O ~ ~,~¢~ ~,- . .3. Nature of work (check which a plicable): New Building'. ......... Addition ....... Alteration ... Repair ' Rem:oval Demolition .............. Other Work 5 '"" (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 garage number of cars ~ 6 If business commercial or mixeld occupancy specify nature and extent of · ' ~ , ,each type of use 7 Dimensions of existin~ structures if any: Front .... Rear ............... ' ..... Height Num "bet of Stories .......................... Depth .............. ............... ~ith ........................................................ Dimensions of shine structure alterations or additions: Front Rear Depth ' : Height .................................... 8 .................... + ..................... ;.. Number of Stories ........ ' ' · Dimensions of entire new construction: Front ......... Rear .............. Height Number of Stories ..................... Depth ............... 9. Size of lot: Front ......... ,, ........ ~...R.ear ...................... Depth ..' .................... 10. Date of Purchase ........... : ......... . ....... Name of Former Owner ................ 11. Zone or use district in which pr~mises are situated ' ' ' ~: ...... .12· Does proposed construction vioiate any zoning law, ordinance or regulation' . .......... 13. Will lot be regraded .-' ....... ' ' ' ' , ~' .............. ..... ,t"~"i ...... .~..~d ........ WUl excess nu De removeu Ir~m nremises' y . 14F Nme of Owner of premisesA"ot.~e,~..~'~... ,tr~F.~Ot,,~4ddress~..~..~.....~. i>lt~t ~,~t;~,,~.t~n~ u,, ',,it 9'f', e~'tz~N°. mame ol contractor...u,. ~n~ ~.,~ ............... Address ............. ..... Phone No ......... ' .... 15.' 19 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 ail!buildings, whether existing or proposed, and. indicate all set-back dimensions frown property lines. Give street and block humber or description according to deed, and show street names and indicate whether' interior or corner lot. STATE OF NEW.YO,~R.K, . ~ COUNTY OF ...3~.L~P..OC~... SIS (Name of individual signin~ contract) above named. He is the ' ' (Contractor agent corporate officer etc ) of said owner or owners, and is duly iauthorized to perform or have ' ' performed the said work and to make and file this ~pplication; that all statements contaiged h~ this'application are/rue to the best of his knowledge and belief; and that the ,york will be performed in the manner s.'et forth in the application filed therewith. Sworn to before me this ....... : ..... ~..~ ........ d~{ of. i9..cX~.~ F,C...' ..... , ~9 9.~. W(~ta ,c .......... ~.'tA,~ .i(~.% -.., ..... '. County · - '~' ' ' /\' tk~u.,~ ............. ............................. · ' / } . _.~.~m~N~Y~ ' (Signature of a licant · · .. C-/ " Ilo. il8~S.Sm'l~Oo0n~t_. PP ) · -. ! . Ter~ Expires May 26, 1~3,3- © q