HomeMy WebLinkAbout21620-z i
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23022 Date MAY 31, 1994
THIS CERTIFIES that the building ALTERATION
Location of Property 1250 MARLENE LANE LAUREL
House No. Street Hamlet
County Tax Map No. 1000 Section 144 Block 2 Lot 38
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 26, 1993 pursuant to which
Building Permit No. 21620-Z dated AUGUST 24, 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 TO CONSTRUCT ALTERATIONS AND REPAIRS TO AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to RALPH & CAROL PALMIOTTO
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N313084 MAY 9, 1994
PLUMBERS CERTIFICATION DATED RALPH PALMIOTTO MAY 13, 1994
ZZ44'4'~
Building 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) qq
N Date S`~1 19.<..~...
21620 Z
Permission Is herebnt d to:
..s-
/-P~rq-A;
I
at premises located Q....eR~ltzt.......................................................................
,I County Tax Map No. 1000 Section Block ..........17 Lot No. 21
pursuant to application dated ~ 14........, and approved by the
Building Inspector.
d-V
Fee S../..5../.
Building Inspector
Rev. 6/30/80
/'a Form No. 6
TOWN OF SOUTHOLDq'
BUILDING DEPARTMENT 'ji
a
/l TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUP
LD t
A. This application must be filled in by typewriter OR ink ar;d submitt~;: Lo cite build
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 Underwr:i..
4. Sworn statement from plumber certifying that the soldtu used in ~.ui conLaiI'
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar bui.ldi,,n-;
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirement,.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Vie-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 i,nr-r+ sign, J
If a Certificate of Occ,:;,r_r,- l-i: Led, the Bui.l,. tn,
reasons therefor In writing to tL~. appl.icant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling 525.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory F,r,i', ing $2;•.!i~,
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.: ,
New Construction........... Old Or Pre-existing Building....
Location of Property..j2:o MIRLENE L41JE_ AMTFtTuck N.y. s,
House No Street U'u"!, L
Onwer or Owners of Property... _ `rely OG AtP/-/ _41 .k"/0T~v
County Tax Map No 1000, Section... Block ...p.z .........Lot...
Subdivision 9.......z Filed Map...... ..Lot..
Permit No'?f~~.r~f Of Pormi_t.F ~L ~~3....Apl,! 6,4jf,11 ^~9`i`UAI-l AL.016,:7`76,
,
Health Dept. Approval..f ..:....................Underwriter:;
Planning Board Approval
Lj
Request for: Temporary Certificate.
Fee Submitted:
p,
l10 ;~.J•N,~. .t k.~.'.
CDC a3oa~
INSPECTORS
t V-;
L(Jf;.
SCOTT L. HARRIS, Supervisor
Thomas Fisher ' luu Southold Town Hall
'a5
Building Inspects P.O. Box 1179, 53095 Main Rote?
Gary Fish ~'~"~°„7 y7~js Sout`ts,i, New York 11971
BuildingInspectcT I'ar.:516) 765-1823
Telephone (516) 765-1800
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 7654802 TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:_ SI3 9~
Building Permit No. Q/ 6 -Qo Z-
Owner: y
(please print)
/f>a+4+W44Aai - : (14R01- rt k41.4W >°A~ rnroTro pU,,s/~~Ps
Plumber: -8V ~PP~~cf/NT
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers Signature) ~y 9P/~~rCNAl7'
Sworn to before me this
day of 19 / `y
Notary Public, County
o ry Public
(/mil I r JOYCE M. WILKINS
F Iy ry~ Public. State of New York
MAY T@rm9ExpireBJur a County
q TOWN OF S jj
OLD
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date HAY 09,1994 Application No. on file 05836494/94 N 3130£14
THIS CERTIFIES THAT -
only the electrical equipment" described below and introduced by the applicant named on the above application number in the premises of
RALPH PALMIOTTO, 1250 MARLENE DRIVE, MATTITUCK, N.Y.
in thefollowing location; ® Basement ? 1st Fl. ? 2nd F1. OUT Section Block Lot
was examined on MAY 02 r 1994 and found to be in compliance with the National Electrical Code,
FIXTURE ECFPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K. W. T. KW. AMT. K.W AMT. H P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNITHEATERS MULTI-OUTLET DIMMERS
AMT K. W. OIL H. P. GAS H. P AMT. NO. A. W G. AMT. AMP. AMT. AMPS. TRANS. AMT P. N. SYSTEMS AMi. WAiiS
NO. OF FEET
i
SERVICE DISCONNECT NO.OF S E R, V - I C- E
G. NO. OF HI-LEG A. W' G. NO OF NEUTRALS A. W G.
PMT. AMP. TYPE METER t]W 1 ,e 3W 3 R" 3W 30 AW NO. OF CC COND A. W
EQUIP. PER .e OF CC. COND. Of HbLEG OF NEUTRAL
1 200 CB 1. % 1 210 1 210
! OTHER APPARATUS:
G & S CONTRACTOR LIC.0713 BOX 215
SOUTHOLD, NY, 11971 GENERAL MANAGER
1, 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 0 F CERTIFICATE MUST'IUATBE,ALTERED IN ANY MANNER.
1 LD ll;S"ECTION COMMENTS
_ H
FOUNDATION (1st)
FOUNDATION (2nd)
2.
z
o ~
ROUGH FRAME &
PLUMBING
eS !<fl. , y
3. L~ I - b
- - ~ m
y
INSULATION PER N. Y.
STATE ENERGY
CODE -4e*
4. crs v OLC
M •2~ z
FINAL 9 ~Y d
o
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ADDITIONAL NTS: p
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ass-1"2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS: We'd
ell
/^DATE INSPECTOR r
eer-A C-21
INSPECTORS
,K SCOTT L. HARRIS, Supervistrr
a Southold Town Hall
0-
Thomas Fisher k P.O. Box 1179, 53095 Main Road
Building Inspector
Gary Fish So Fax d, 6New ) York 21971
Building Inspector Telephone (516) 765-1800
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:. 8'12 3 /`J3
Building Permit No.
Owner: /IAN ^qJ-0rtlEy
4404/FANrpleaseAROLt*i?,4ji { )044rni6 77-0
Plumber: I/ f P,041CVN 7
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(P1 hers Signature) )l fIVP1-IC,1A)T-
Sworn to before m this ~j
day of (i ' 19 v(~
Notary Public, County
Notary Public
CLAIRE L. GL.EW
w PuNo 48796O' NewY~ ~y/~
QSIon Ed
Tres DMembst 8, p/~
lE'T
Commission Exp
BOARD OF HEALTH
FORM NO.1 ,,~3 SETS OF PLAYS
}`SSSr`J TOWN OFSOUTHOLD URVEY
JUL 0199 13UILDING
OWN DEPARTMENT
ASEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 Q
Examined Y... 19 9~ - MAIL T
Approved , , , , 199 Permit No..1~~
Disapproved a/c • .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT p
Date 6........., 19 /.3
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. 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
$uilding 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 in ections. Q~
- (Signature f applicant, or name, if a corporation)
~ZSv fPAR 16-,) E"..14-10 67.... .
(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, 1 ei-00 , ,
(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. ~LA) A)
Plumber's License No. !Off', &
Electrician's License No. ...0W.A1.16~.........
Other Trade's License No.
1. Location of land on which proposed work will be done .
~Z a......... GC-CNE. .-vj .........~1A77-J7-uc~
House Number Street Hamlet
County Tax Map No. 1000 Section Block z' Lot. . 3.g!.......... .
Subdivision Filed Map No. Lot
(Name)
2: State existing use and occupancy of premises and intended use and //occupancy of proposed construction:
a. Existing use and occupancy A/vr • ®l PS / cf e~i Y Tc~'
b. Intended use and occupancy j.6fi 4 PS l.cr? tiy? ° ' ,
a .
- ,fir,,.,
nif'(; X
3. RNature epair of work (check which applicable):
Repair lr Removal New Building Addition Alteration
Re
, • , • , , , , , Demolition , . , , , Other Work
00 (Description)
4. Estimated Cost ..,7s 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 mixed.occ.upancy, specify ature and extent of each t e of use .
.
7. Dimensions of existing stru Lres, if any: Front . ,P Rear 41 , , , , , • Depth , , , , , • , • ,
3 bof Stories
with alterations or additions: Front ...6,11 • • . • • , d
Dim Rear
e ensrons of same structure ruction: Front .
Depth , Q . . . . Height Number of Stories , . , .
8 Di oht Dimensions
of . .entire new construction:
Rear . . . Depth
H N
umber of Stories y..:...... , , „
9. Size- of lot: Front ~o Rear Depth ,J far ,
10. Date of Purchase • • ' ' ' • •
11. Zone or use district in wb.irh + ..................Name of Former Owner .
premises are situated ...........................X/..
1... Does proposed construction violate any zoning law, ordinance or regulation: , .
13. Will lot be regraded , . • • • • • , • , , • , , , Will excess fill be removed from premises: Yes
14. Name of Owner of premises /~!q , , • , , Address . . Phone No. Z9B°.9 ~~3
Name of Architect Address Phone No.
Name, of Contractor . . Address . . Phone No. .
15. Is 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 from
property tines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
A PR 11 AS NOTED
1:1ATE: a.lt #P~___,
NOTIFY BUELi l 1G DE PA AT
765.1802 S AM TO 4 P FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - T%fV0 REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. iNSLit.ATION
4. FINAI.. • CONSTRUCTION MUST
P COMPLETEFOR C.O.
ALL CONSTRUCTION SHALL (MEET
'THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION t& ENERGY
CODES. NOT RESPONSIBLE FOR
DF-SIGN OR CONSTRUCTION ERRORS
i
STATE OF NPV-Y
OR
COU Y pF u... n1
~ •~r'•If ~ • • • • • • being duly sworn, deposes and says that he is the applicant
((Name of individual signing contract)
above named,
Ile is the . . . .
(Contracto, agent, orhorate 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 will be performed in the manner set forth in the application filed therewith.
Sworn to before me his
...day o 519
Notary Publi r • , ,
` County
CLAIRE L GLE1N.. .
Notary Public, State of New York (Signature of applicant)
No.4879505
Qualified in Suffolk County''.
Commission Expires December 8,j18
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Z. MANUAL OF STEEL CONSTA u67-1011 ( NINTH rD/rlo,v)
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