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HomeMy WebLinkAbout21063-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22185 Date MARCH 94 1993 THIS CERTIFIES that the building ADDITION Location of Property 600 GROVE ROAD SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 6 Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 28 1992 pursuant to which Building Permit No. 21063-Z dated NOVEMBER 5 1992 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 AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLIAM & KAREN HAGEN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-033651 - MARCH 2, 1993 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORK NO. a 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) NN? 210 6 S Z Date 19. r z-- Permission is hereby granted to* ~...~f~.....fr~.......... a 1197 / to . r~92...... &/I'A 1-4.... P~ la 7-- tea.... . at premises located at ...*Q.Q.... y r./Scad/5~....... Q . .ww'/ ww County Tax Map No. 1000 Section .....L.3'1........ Block ..........cae......... Lot No...La............ pursuant to application dated .........ld/ IQ5712, and approved by the Building Inspector. O'D Fee $.Q. Id ng Inspector \ Rev. 6130180 Form No. 6 TOWN OF SOUTHOLD~ r BUILDING DEPARTMENT j TOWN HALL j MAR 199 765-1802 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 00, Commercial $15.00 5. Temporary Certificate of Occupancy - Residential fiA?) $15 Date : Add/l-yw New Constructi.on........... Old Or Pre-existing Building..1..... Location of Property..6.Y a 1a........ House No./~ Street / Hamlet Onwer or Owners of Property... Gt?~'lC. ~n? ! . J./// . J. lfel..a County Tax Map No 1000, Section.... V .......Block... 6 ..........Lot.... _,~_7 Subdivision .Fined Map............ /Lot...................... Permit No. f~ 10/63-.7....Da e Of Permit ...,~~~fJ.,C~.2...Applicant , / ~?d~ZfP?d.751~f7 ``JJjj z2,~jj77 G > Health Dept. Approval.. N . ...............Underwriters Approval.J.7../ ?.l~r `.G Planning Board Approval.. lv/A Request for: Temporary Certffificate........... Final Certicate.~..... - Fee Submitted: $..s'.~rG71G~~ ~~Ca~SS~3 e o a a i s s APPLi' T I THE NEW YORK BOARD OF FIRE UNDERWRITERS 8037362 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date 11ARCA 02,1993 Application No. onfile 79446392/92 11 033651 THIS CERTIFIES THAT PERNIT NO. 21063'% only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of WILLI`AN Cc KAREN HAGEN, 600 GROV11 11040, 1t}11EU9, SOUTHOLD, E'Y, in thefollowing location: ? Basement © 1st Fl. ? 2nd Fl. .Section9l• Block6 Lot 29 was examined un 1''EER(IAR L 1' 5 r 1993 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS RECEPTACLES SWITCHES AMT. N P. OUTLETS INCANDESCENT FLVORESCENi OTHER AMT. K. W. AMT K W AMi K.W AMi K. W. 2 12 2 2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS ~R AML K. W. OIL H. P. GAS N. P. AMT NO. A, W. G. AMT. AMP. PMT. AMPS TRANS. AMT SYSTEMS cc H P NO. OF FEET AMT. WATTS N SERVICE DISCONNECT NO. OF S E R V 1 C E PMT. AMP TYPE METER 1 q ]W L ,e' 3W 39 3W 3q dW NO.OF CC COND A W G. NO OF HI LEG A. W G NO. OF NEUTRALS 0.M' G I 11 I PER .OF CC. COND OF HIAEG OF NEUTRAL OTHER APPARATUS: a iHQKC3 DEA 7'FICT0Rt..1 z S W1:LLIAY HAGEN 600 GROVE ROAD St1U'Pllpl,l), NY, 1197I GENERAL MANAGER i 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. INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton SCOTT L. HARRIS, Supervisor lF Senior Building Inspector c~a b ; Southold Town Halt Thomas Fisher Z: ; Building Inspector P.O. Box 1179, 53095 Main Road Southold, New York 11971 Gary Fish Fax (516) 765-1823 Building Inspector Telephone (516) 765-1800 Vincent R. Wieczorek ~rx Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD FEBRUARY 24, 1993 WILLIAM 6 KAREN HAGEN 600 GROVE ROAD SOUTHOLD, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of occupancy because of the following reasons: _ggg An application for Certificate of occupancy is not on file. (Enclosed) X_ No Underwriters Certificate on file. K1X The check is not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT 21063-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. .i::::. ?4LNTf H (fv,-OUNDATION (1st) c =OUNDATION (2nd) 0 ZOUGH FRAME & I q `PLUMBING y H m ENSULATION PER N. Y. I ,--3 STATE ENERGY CODE I ' ' I a Az~ FINAL I p • I M1 owe ADDITIONAL COMMENTS: t*J • H H \n m~ H H 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ) ROUGH PLBG. FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL REMARKS: eta ` DATE l INSPECTOR) M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. F NDATION 2ND [ ] INSULATION [ FRAMING FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST { ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE L~ INSPECTOR JL M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. SULATION FOUNDATION 2ND [ ZFINAL FRAMING r. REMARKS: tJ ` r' DATE [a3 INSPECTOR ~i s'' la BOARD OF HEALTH I;~ ? FORM NO. 1 3 SETS OF PLANS • • • • ' 9 Ii BITT~WN OFSOUTHOLD SURVEY 19L (3U'CDING DEPARTMENT CHECK _ TOWN HALL SEPTIC FORN SOUTHOLD, N.Y. 11971 . TEL.: 765-1802 CA rlY~ Examined . , . , 19 AIL T 0 Approved , 1 /9~. Permit No. . . Disapproved a/c ilding c tor) APPLICATION FOR BUILDING PERMIT Date MIZ.~., 19 9.7- 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 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 and in building for necessary inspections. (Signatur f appli nt, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......4 D'L~1 Name of owner of premises JiV~(/. Jt°i{fY7 .1 / er, (as on the tax Z. ~ or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done . 6t?~ ....................C..................... 5?P.I G//................... House Number Street / Hamlet County Tax Map No. 1000 Section Block ...'b Lot ~ . 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 QYi . ~~Y.vz f, .p ¢!Cf ;!1 ! ?c?r!I 5e . . . . . . b. Intended use and occupancy ~ f-eu4, , (.t>J`Cf L tJ 3. Nature of work (check which applicable): New Building Addition . Alteration Repair . . Removal , Demolition Other Work 4. Estimated Cost /~Jf 50 (Description) f 0 Fee. . 504(!~ / (to be paid on filing this application) ' u 5. If dwelling, number of dwelling nits I Number of dwelling units on each floor If garage, number of cars I 6. 7.. If business, g structures, specify /a/~,~utre and extent of each type of use , . of commercial existin r mixed, ' if any: Front ~7......... Rear ....Y~/........ Depth ~Q. , , , , , , Height Number of Stories l................. . Dimensions of same structure with alterations or additions: Front . A? t . Rear I~X.~ Depth . . . . ( p . o. . . Height ! Number f/Stories 8. Dimensions of entire new construction: Front ~S2......... Rear C......... Depth . Z~ Height urryL rp Stories 9. Size of lot: Front ~J f Rear J-1 2 • . 7.1..x'...... . epth Y QO 10. Date of Purchase ~ . . y~ ' W11. • • Name of Former Owner D . 11. Zone or use district in which remises are situated,V,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 12. Does proposed construction violate any zoning law, ordinance or regulation: ..fl..0 , , , , , , , , , , , , , , , , , , , , 13. Will lot be regraded p Will excess fill be re oved om No Name of Architect premises: Ps 14. Name of Owner of remises ! Address .0Z~dX3r Phone No. Name of Contractor kQIfYC AddressEeP~rpvL° hone No.76;~`~... . t - t..... 1GY/r®r°~1~~F~rW.. Address ..Ph ony No.~ZZ 15. Is thi* 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 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 ICI I i ~I STATE OF NEW YOIkI¢ / / iS COUNTY OF. .~.U... 1. I l • • • • K..~ en . . g being duly sworn, deposes and says that he is the applicant (Name of individual signing c&htract) above named. He is the ..CWl (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 will be performed in the manner set forth in the application filed therewith. Sworn to before me this .''nnday o OC4:............ 19 9Z Notary PublicG .(Y,...... . ,c /ounty HELEEN NS D. HORNS S Notary Pu State of NEw' Yorh of applicant) (Signature Qualified In Suffolk Coun' 9,-* Commission Expires May 22, 9 f E aye 1 ~!}s R ~4 _ "1 y C rWti4j n. ~ Q k a etryH~ ~ ° spa gFj l1 { e Jot V3 L.v4J yiiiif)~VLI'r11J. A ' 2.2ax z - ~K8Rib~4.CV£NT~ a MR~cH piTcH PnAIO ° VENT C'c 9 v j i Alm I-IOu SE_ /LATCHING SI-fINGLES IcjFBxT cv. G am- 04 Q J O! 1~bc lz c% v _ 0 v "FjRi17G IN G, i O i R-oor1.----- _ COUr.pER oM N ; ~.2 2xla it TaTM SoF~ Ij 2Ax7A`FT' c. 3-2.~ N Q q R_I9 MATCHIN4 6n_-~ Na - PIER j R-I`~ ip TVvr~K J + i x v N~ 0I p~ ~iRlp[,If lL I 14 PjdC - % ~ ~J~rJRoon~ ,fix i SII:L C1 l }~,_~9 '3-2[b 2a8-I(voc. `JELL .-,BALI°R McTAL 5HI PLD 'L"cow-~~, W > 2 28 4 x, 2'couc. - s _Md FLOOg, ~LA~ C4(3 .r P, Ur3E IS Or- cn,~ccu,()Awcy U dwb DATEe~/ B.P.q FEE: Z% 0• crr_ BY.. N F~ ~V/-'lT O Iii NOTIFY BUIL I DEPARTW&WW ---_765-1802 R AM TO 4 PM FOR THE FOLLOWINL, INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED UNDERWRITERS CWFICAIE 2. ROUGH - FRAMINGRRTPLUMBING ,il~'JiN;wl P~~ti Foy REQUIRED 3 INSULATION q. FINAL - CONSTRUCTION MUST OLN Z'V I902 SCALE: APPROVED BY: DRAWN 9Y L F- BE COMPLETE FOR C.O. DATE. REVISED ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. ~ tRIPF. STATE CONSTRUCTION m ENERGY CODES. NOT RESPONSIBLE FOR HA6Md DESIGN OR CONSTRUCTION ERRORS CoN,-~•~~cYot~ ' -To VEi3FFY roVEi3FF ALLDfMENSrcnlS DRAWING NUMBER N AND- Cy0 otg 0 u A. •1on~s ~ ~r,T_. I G'K 2- <0' ApDrTIo N •~x:~ PRINTED ON NO IWON CD RPbxT.