HomeMy WebLinkAbout21239-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22813 Date DECEMBER 23, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 9245 MAIN ROAD EAST MARION N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 3 Lot 19.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 22, 1993 pursuant to which
Building Permit No. 21239-Z dated FEBRUARY 25, 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 FIREHOUSE AS APPLIED FOR.
The certificate is issued to EAST MARION FIRE DISTRICT
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-299427 - DECEMBER 17, 1993
PLUMBERS CERTIFICATION DATED DECEMBER 22, 1993-RBT. VAN ETTEN PLUMB.
i , xr'~
Building Inspector
Rev. 1/81
FORM N01.111
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)
N°_ I° 21239 Z Date .0021/ 19
Permission is hereb gro ted to:
~ f
. r
ram-..'s~~~ ...~?....~~~~%~,a.....k~ .~c~ ~ ~J-~...
of premises located at
i T•...
County Tax Map No. 1000 Section Block Lot No. I?Z...........
pursuant to application dated e!IZ 19,147 and approved by the
Building Inspector.~~
Fee $
91 /D?-,a~/ t~,
f r. u??......,.... .
Rev. 6/30/80
i
Form No. 6 _ 11477 9'% A7 p
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 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
"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 $15.00, Commercial $15.00
Date "7r. /
New Construction......., 9 Old Or Pre-existing Building.. .IV
Location of Property .....lt .lS..,,,.,,/.[./4lv.XA40... ej4s7'
House No. Street Hamlet
Onwer or Owners of Property RF,4,it grJ;on Fire District,,,,,....... ...j . .
County Tax Map No 1000, Section... „ ,,,,Block..... ........Lot.../.
Subdivision..// .Fill>ed Map............ Lrott...............~......
Permit Noaf.°7 l.. ...Date Of Permit. s!41. fA..APPlicant!~ f. 1
~Lu
re Cdr
11ealth Dept. Approval ..........................Underwriters Approval. „
!Tanning Board Approval Ar,e r CRr
Request for: Temporary Certificate........... Final Certicate....
'ee Submitted:. $
Pt (nffRdA4n f{/pJ
APPLPCANT
TEL. 765-1802
o~S~FFUL/(TOWN OF SOUTHOLD
y
OFFICE OF BUILDING INSPECTOR
A P.O. BOX 728
TOWN HALL
yoy~ol ~~0~ SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date I 23
Building Permit No. V d,3 L Z
Owner
(please print)
Plumber /eo6'r-/ ry n/2''T7aslJ 30vV-dP
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber's signature)
Sworn to before me this
day of a-o P y .
1913 N tart' Public
Notary Public, bounty
JOYCE M. MKIN8
NataryPu61io, State of New York
No. 4952248, Suffolk Cou
Term Expires June IZ 19e `Y-
THE NEW YORK BOARD' OF FIRE UN.D`EF, WRITERS: ;PxGE' 1
1000121 SUREAU OF EL;.ECTRICITY,' %
88 JOHN STREET',,,NEW YORK, NEWl7ORK 10038
Date DECEMBER 17,1993 Application N,•o.onfile 053$1;7793/99 N 299427
THIS CERTIFIES THAT only the electrical equipment as described below and Introduced by Elie app!=cant-nomedon the above apphcotton nu ber sp the premises of . .
E.MARION FIRE DEPT. MAIN ROAD' EAST MARION 't-N.Y
in thefollotcinq location; Basement' ®/st FL ?;2nd Fl Se{Elan • Biork Lat
nws examined on DECEMBER 13 t 19 9 3 „ and found to be in campdcaAGe with the National; Eletxtnca{ _C-?de,, : , j
NxTURE FIXTURES , RAROK C0,01UN6` DECKS OVENS " D15N 1NA'SHER5 EXNAUET FANS I
OUTLETS ECEPTACIES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K 1-w_' KW .TK:W,i AMt;. ,31 P.«. .
3 7 5 1 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL~RECPT TIM CLOCKS EEL1' UIgT yEATE115 MULTI-OUTLET ,,,DIMMERS.".
`",SY,ST~bt4
AMT. K. W. OIL H, P. GAS N. P. . AMT. NO. `A; W. G." AMT:: AMP - ' tyM[ + ;-Ak0s, TRANS; ,,AMT, : N, NO. OF FEET, qMi., r, . WAiiS
dF
SERVICE DISCONNECT NO.OF S.: . E R, t. i Y , T' • G: E:.: n i .
METER OFCOND, A Wt O..<=. G....•
AMT. AMP. IYVE EQUIP. Iq 3W 103W 303W 3 ,e 4W NO . PCO
'..OAF.,NI-wo-l' :170 bf NEUTRALS „"'OF NEUTRAL.
ERK OF CC CONa- NO.'OF'HI-LEG -
OTHER APPARATUS:
121
ELECTRIC HEAT THERMOSTAT-1„
ELEC. ROOM HEATERSt1-2.0 K.W.,1=1 0'K,W:
`~LICs1E2"82
PAUL R. BURNS
275 TOWN HARBOR LANE -
11971 OENERALTMANAdER
SOUTHOLD t NY, 11
This certificate must not be altered in any manner; return'to the'office•%~f thq.'Board:'f ,(ncpTTest: IgtpB ldrs may,•,fxe 4dq ;b1# ihe~f, redeliti#!Is.` ;
M-lW2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS: _101
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ vf'FOUNDATION 1ST [ I ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS
f ~
i
DATE loin 11-D INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND kf-INSULATION
[ FRAMING [ ] FINAL
REMARKS: C
DATE I t d~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST (V'] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[FRAMING [ ] FINAL
REMARKS: -7
DATE l INSPECTOR
Fl.., J Si1LNTC 95
4,
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FOUNDAATION (1st) l
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FOUNDATION (2nd) _ cr
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INSULATION PER N. Y.
STATE ENERGY
CODE I ,
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FINAL
ADDITIONAL COMMENTS: x
ro
H
9
O
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y
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3. Nature of work (check which applicable): New Building Addition 1/. Alteration
Repair Removal , Demolition Other Work
1 4vescription)
4. Estimated Cost f. Fee 4 / GL U~I~h ,../(JO~~~~ V ( ~
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...N. Number of dwelling units on each floor
If garage, number of cars .
6. If business, conunercial or mixed occupancy, specify na tie and extent of each type of use ...Gl~ G~ .
7. Dimensions of existing structures, if any: Front Rear ~e Depth :.7.0 .
Height Number of Stories I .
Dimensions of same structure with alterations or additions: Front ...'5..... Rear . .
Depth Height .....:w Number of Stories .
8. Dimensions of entire new construction: Front ......1. Rear Depth
Height ......l Number of Stories
epth ............i .
~ I............
9. Size of lot: Front 7.~ c
Rear ~~•S ~ Depth ;Zc'~ c S.']
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: 0 .
13. Will lot be regraded WO Will excess fill be removed from premises: Yes No
14. Name of Owner of premises G 4'51./'l*44Y~ .~/d am dress y 6,`I Phone No.
2~~1t272- ~ x,..J . (1,,//D1J dress ..!6;~ u Phone No.
Name of Architect . r(3"/.......... y7T.~7JL.. .
Name of Contractor Address Phone No............... .
PLOT DIAGRAM
Locate clearly and distinctly all 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.
p&44--"J S
STATE OF NEW.YORK, S'S
COU Y OF. ..`0 F!f b LGL . .
. T. r .a0'Y-.r" being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the...........LY~?~~~~~
(Co ractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have perfonned 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 s
.......day of 19 f:5.
Notary Publi(jaj:2 (t . County
CLAIRE L GLEW
Notary Public, State of New York naturapplicant)
•
No. 4879506 (Signature of Qualified in Suffolk County
Commission Expires December 8, 19
FORM NO. 1
FEB 2 2 10 ;J i TOWN OF SOUTHOLD
BUILDING DEPARTMENT
W A Poxe!_¢.. ' TOWN HALL
61.DC~. 63Ei'f. SOUTHOLD, N.Y. 11971
TOWN OF SOUTiiOU)
QQ TEL.: 765-1802
Examined :',4
19/ Q Received 19
Approved ~ 19/6~&Peimit No.c~?:,/~?. ,
I
Disapproved a/c
uild nspector)
APPLICATION FOR BUILDING PERMIT q
Date 19
INSTRUCTIONS
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. ~ce according to schedule.
b. Plot plan 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
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 a,nd in building for necessary ' e for
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee's, agent, architect, e gineer, general contractor, electrician, plumber or builder.
Name of owner of premises .Q . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature Of;duly authorized officer.
(Name and title of corporate officer)
~II~ I
Builder's License No, .4~.~.
Plumber's License No. .
Electrician's License No. !
Other Trade's License No .
1. Location of land on which proposed work will be done. .
q ys IcU2. U? o?a.?.................. . !!?k........... .
House Number Street Hamlet
County Tax Map No. 1000 Section .',....3~ Block Lot ...~4
Subdivision Filed Map No. ..1........... Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .........y
b. Intended use and occupancy . . : . . .
,y..
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J
- - - - - - - - - I r ?,1 ° n, -equip en- Shall fur.hisih and N r.hish and install all material LIM ~AhfM~Yh10~/
and 'equmen.t shown,, , I1st.ed, 1 lsted, or described on the
drawings., subject to qualifiCa{ qualifications, conditions, or !/OLUNTEE/L~1/CG/YAxfMSr~/
I.. exceptions. as noted. Contracts ,Contractor shall furnish all m -
labor, scaffo,I di ng, and tools red tools necessary to complete the
_ 7 1- - L Work
(D7 /0 °46 "H[!GO (qNL, p.Cti 4WB%/9 411tGYNGJ--- Pk5wO G4rN B^'fN/D[acc fiBipa»2! 2/l5/iNli 2• All work shall cpn45or!n to all app
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• ~/y/iNy h!/ao DN 9/r~a 5lGp DN 9R E,pa%rzLNF
ContraCtor shall verify all dime i all dimensions and conditions z
prior -,to construction and on and shall report any
l hoelooN1 AANI, discrepancies to the Architect bi chitect before proceeding with Y
work.
4. Contractor shall do all patch all W prgect title. patching required due to
removal of existing work and/or t k and/or the installation of new \
work.
I y 40510 RX/Y7OA/,
- a, /9 pM /N~u!/YrroN, UNDERWRITERSCERi1rICATE I 5.- All new 'work shali match and m tch and meet flush toexisting,
REQUIRED work as closely as possible unles able unless otherwise noted. W
~2 CnK 9f1En?111N~ tovEim~~ 6. 'All materials shall be installed installed in strict conformance
(~CCNhN~jJCAfE - GvirN l5X ou217. pApaz with manufacturers' requirements uirements and specifications. = drawing title.
/INb 5ruee 1d MafiN,
. 7. Provide all -labor, materials. ec erials. equipment and serviCeq, ?z
APPROVED AS NOTED and 'perform all operations -r ations -required for complete a f'<b//~~aY/~l
DATE: B.P.N installation of wgr'k as indicates indicated on the drawings.
~"KS .401515 /b"O.G. I,~GUM/NUH/2R19N/Nh scaled.
NOTIFY' UILDING DEPA ENT AT B•, Drawings are not tc be scaled. Z
Ica 2"Ka' ye Aneuot I ~ ~ ~ /GrN,4dpf3catx, 765-1802 9 AM TO 4 PM FOR THE ~jf1L~-e _ ain all required approvals,
~etEV fo /iirou~ FOLLOWING INSPECTIONS. ..gy~pG U11 1 9. Contractor shall obtain all I FOUNDATION - TWO REQUIRED '3/. permits, certificate of occup of occupancy- and inspection O date. scale.
FOR POURED CONCRETE approvals, except Building Permit i ng Permit. /2, /q/i qy, A5 N6tn~
~ ~{1/.[%O/1Np /OY64C0 2. ROUGH " FR.AMWG V, PLUM9ING
~uyy/"MMYDCy VA~7A2 ,I INSULATION / - CO issue.
4 FINAL - CONSTRUCTION MUST \ rFR IQ 1993
BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y. W drawing no. -
STATE CONSTRUCTION & ENERGY ,Eb
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS To the best of my knOwNd„e a belief, and' /AA/, belief, and' W Aj
profession,11 i gg....~a'ii 'f " , i"Iians and
are in conTiance ~5r;th the irer5,'r York Sta1 ii{'ans and specliic<ji°inn BOO
York State En rg%
Conservation Code, sections L} pa i
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15.-TE810 1993
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1. Contractor(s) shall furnish a N furnish and install all material ~ghfMA/1/0N
and equipment shown, listed i, listed, or described on the
- drawings, subject to qualifi - exceptions as noted. Contra, o qualifications, conditions, or (/DUJN?6E2~//lG//A/~fM6NY,
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Lod tools necessary to complete the
i i _ - - _ - - - - labor, scaffal di ng, and tools work.
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prior to cd~.arruction ar ction and shall report any
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work. W project title.
4. Contractor shall do all pa' all patching required due to
UNDERWRITERS CERTIFICATE removal of existing work and/ci fork and/or the installation of new \
REQUIRED work.
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work as closely as possible un Issible unless otherwise noted. W
-'~"m~ ~llt%nnaN~ LO?BT~v b. All materials shall be install be installed in strict conformance
f~CLAI?!CG lA7E sw 1 a D a mom. j with manufacturers' requiremen .equirements and specifications. = drawing title.
BNb *an ~a -
APPROVED AS NOTED 7. Provide all labor, materials, iaterials, equipment and services, =
DATE: B.P..q and perform all operations perations required for complete
FEE' installation of work as indica as indicated on the drawings.
'~"#S"abPS/5 /b O.G, , ' I ~UM/NflMC2A5N///ti NU' Y BUILDING DEPAR T AT 765-1802 9 AM TO 4 PM FOR THE B. Drawings are not to be scaled. Ie scaled
F FOLLOWING INSPECTIONS I iZ
CGN 2"IrG'yY/+fe AtKNac ~ i ~ - i ~">N, 1"'pfDrA4~~ I F(iUhIO;,TtOn, - 1VUO REQUIRED 9. Contractor shall obtain a: Dbtain all required approvals,
r~7VEI~ M /~IQL/L FOR POURLO CmNr.RETF permits, certificate of cc e of occupancy and inspection O date. scale,
2 ROUCH - PRAf' N-G V, HLUMBIN6 approvals, except Building Per, 7 INSULATION , . lding Permit. /f, /$i I2j A%Nl)/~i/7~
F~IAC/XrrvANrzLave2ev -I 4FINAL - CONSTRUCTION MUST
WHHGMM pp/y ?A/M2 BE COMPLETE FOR C.O. m issue.
ALL CONSTRUCTION SHALL MEET \ FED 10 1993
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR W drawing no.
DESIGN OR CONSTRUCTION ERRORS
µED ARCy~ r ( 1 . j,
~lLG SAIL. ~~~~~OM to fie best of my knowledge, belief, sdge, belief, and
rnoiessional jr UVep plans
~~`~rrse plans and specificatoen.
in CnI,'IIT';;:,,:I 11r,"1 101 .399~r~ I'h"+Fc3 State Enorgy
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21. All work shall conform to all -m to all applicable Federal. State N
and local Building Codes. ides.
C=/linN~i SrIID~ rn ; Nl/ ~l'/A/O NY r' z'. Contractor shall verify all c ify all dimensions and conditions ~Z
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discrepancies to the Architect work. N
W project title.
4. Contractor shall do all pa all patching required due to
removal of existing work and/o cork and/or the installation of new N
work. ~ q~C/~6 Aid/rail,
match and meet flush to existing
.q. All new work shall match anc work as closely as possible Jr risible unless otherwise noted. W
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b. All materials shall be instal be installed in strict conformance
i?lrx 5I1PnflliNGr COru~ev with manufacturers' requiremer requirements and specifications. = drawing title.
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installation of work as indica ,
/ILOM/NOM N/Ny B. Drawings are not to be scaled. C~II~ be scaled. Z
obtain all required approvals,
-an 2^e~ G~>e a rN'bx -GEN. /op ~ioo , 3~7 ~ Contractor shall ?btain a K/ permits, certificate of of le of occupancy and inspection O date. scale.
~iOLfG~ ID /4/ociC I . OLDG D'- approvals, except Building Per ilding Permit.
OF SOViIiO..__0 i m issue.
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