HomeMy WebLinkAbout20639-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22271 Date APRIL 21, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 3495 HAYWATERS ROAD CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 111 Block 11 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 13, 1992 pursuant to which
Building Permit No. 20639-Z dated MAY 20, 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 ALTERATION TO EXISTING TWO CAR GARAGE AS APPLIED FOR.
The certificate is issued to RICHARD & CAROLYN VON SEELEN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - MARCH 25, 1993
PLUMBERS CERTIFICATION DATED DECEMBER 30, 1992 - OWNER
it inq Inspector
Rev. 1/B1
I
I
FORM 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)
N_J~I.a Date 19.9..
NN? 206392 ~a° y
Permission is hereby granted to:
.
to
. r...
at emises located of ....~lT.....G../
{Y............Y..6?1.ACC
I
County Tax Map No. 1000 Section Block Lr........ Lot No
7- 0
E pursuant to application dated ................J1 19./.. and approved by the
i
Building Inspector.
Fee
i
uil ing Inspector
Rev. 6/30/80
f0LAr C TEL. 765-1802
@0 TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 1179
.~E cp j ~c TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date . - L
Building Permit No.Q~C'~
Owner'
C.E-fv4-2~
(please print)
PL:mke-t
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
JAN- 7.
t}}
A Sworn to before me this
_3:~~day of IE
19,
otary Public
t10tary Public, MAssA1) County
• KIRSTIN' L. BINDLEY
NOTARY PUBLIC, State of New York
No. 01614942607
Commis ionlL Aires Sr ep embe2fi /99
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INSPkm t(5
Victor Lessard ~r
Principal Building Inspector ,13f Fr)(/r 0
; Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector o 1 `
Thomas Fisher Southold Town Hall
Building Inspector P.O. Box 1179, 53095 Main Road
Gary Southold New York 11971
Fish 'f~O~ t,Y yv~ yi' ax (516) 765-1823
Building Inspector F
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
SEPTEMBER 21, 1992
61
RICHARD E. 6 CAROLYN VON SEELEN
71 WHITEHALL BLVD JAN 7
,i GARDEN CITY, NY 11530
RE: PREMISES @ 3495 HAYWATERS ROAD,`CUTCHOGUE
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
XXX An application for Certificate of occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
XXX The check is /not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
R%% No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).'
BUILDING PERMIT # 20639-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector a 4J - r~
en ( Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector 14 "
old, New Gary Fish d 1>Ol `~X ~~ia~ y0 South
Fax 5 6) 765-1823971
Building Inspector
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
SEPTEMBER 21, 1992
RICHARD E. s CAROLYN VON SEELEN
71 WHITEHALL BLVD
GARDEN CITY, NY 11530
RE: PREMISES @ 3495 HAYWATERS ROAD, CUTCHOGUE
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
1X% An application for Certificate of Occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
1t%X The check is /not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
XXX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20639-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
I1 LD T;: i ijDA7-- it C;XMLNT~
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ OUCH PLBG.
[ } FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE / 2-- INSPECTOR
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Form No. 6
~i
TOWN OF SOUTHOLD
i
BUILDING DEPARTMENT
TOWN HALL JAN - 7
765-1802
PJ5
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.
8. 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 FJ•!•-..~
New Construction..... Old" Or Pre-existin Bu'i`lding..........
j Location of Property.. , I • ~ W,,~ • • ~ • • • ! • ///~J ~ '
House No. S reet Hamlet
I Onwer or Owners of Property. L S
~.Y.....Ua,..
'County Tax Map No 1000, Section... Block •.®..cr
.......Lot.. Y.
Subdivision #03
Filed Map............ Lot...
Permit Noxo..~.3`).J' .....Date Of Permitlfy. M'2...... • • •
`....~x....,
j Applicant
Health Dept. Approval.........;
~ ...Underwriters Approval....
;Planning Board Approval........
Request for: Temporary Certificate.........., al C ticate...
Fee Submitted: $ „ •
6~.
C ~oZ a~ APPLICANT
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST OUCH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
i
REMARKS:
DATE INSPECTO r per,
7
aOAnO OF HEALTH
FORM NO. 1 - ~
7 SETS OF FL A77S
t~j1l1'~,TOWN OF SOUTHOLD SURVEY ~
NI UILDING DEPARTMENT CHECK
lid 19~ ~ .
,1 TOWN HALL SEPTIC FOn-I
OUTHOLD, N.Y. 11971
HLO~•Ot11. TEL.: 765.1B02 :.-OT ILL
F7;
117D,tMd(),`xt3 J:{'i.!f 3L19 A 1.
Gxamincd 19ppC MAIL TO: • • .
'approved . .1i. . . . . . . 19/ y-Permit No............ .
Disapproved a/c
.,AB ilding Inspector)
APPLICATION FOR BUILDING PERMIT
Date o......... 19 9~
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
cts 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
)r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation,
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
'tall 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
:tall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance'°bf a`Building Permit pursuant to the
luilding Zone Ordinance of the Town of Southold, Suffolk County, N York, and other applicable Laws, Ordinances or
:egulations, for the construction of buildings, additions or alteratio , o for re oval or demolitio , as herein described.
'he applicant agrees to comply with all applicable laws, ordinances b ' din c d ~Oqng code, nd regulations, and to
dmit authorized inspectors on premises and in building for necessa ect ns.
ie ature of app~lic~ant or'~rjame, if a corporation)
(Mailing address , applicant)
state whether applicant is owner, lessee, agent, architect, engineer, general contractor, el9r, iah, plumber or builder.
4!Wrl~- n /
.
lame of owner of premises ?l~tn r ~O ? V~~!
(as on the tax roll or latest,
`applicant is a corporation, signature of duly authorized officer. s ( A
9 mAI
(Name and title of corporate officer)
Builder's License No . . .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
Location of land on which proposed work wil be done. , . , • . , •
H/1 -Y W
[louse Number Street
JJ Hamlet
County Tax NMap No. 10000 Section ..o. V........ Block 0 a Lot. Q b o o
.
Subdivision N('~.*q&1YE. L Filed Map No. I ...f.... Lot
. . .
(Name)
State existing use and occupancy of premises and„iiJnt~e7ndeed' use and occupancy of proposed construction:
a. Existing use and occupancy ..~l9 ?~tt !j , F rl!NIL Ae7-(Aowq,. •
I c - C~ • , ~,1 t .
b. Intended use and occupancy 1
.,r~,znr
3. Nature of work (check which applicable): New Building . Addition .
Repair Removal . Uteratio i'
Demolition . Other 1
4. Estimated Cost .V,4?, (Description)
Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor. . 6 .
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures,,~if any: Front . . Rear
Height Numbcr of Stories , . • . • . ' Depth . .
Dimensions of same structure with alterations or additions: Front • • • • ,
Depth.. Rear.........
Height . . Number of Stories . 1
8. Dimensions of entire new constriction: Front .Rear . . Depth
so,1fiffrf o27,3
Height in
9. Size of lot: Front hear , . .
y!lmbcr of Stories " " "
. l ....9l
l0. Date of Purchase j~ j YR Y Depth f~ t
• • . • • • • , Name of Former Owner ,~,f 4s,?vl7/1Alto
11. Zone or use district in which premises are situated to 0 0 ' ' '
12. Does proposed construction violate any zoning law, ordinance or regulation: . Q, , , , , , , , , , • .
13. 14. WNameill
Owner o d ` ~ • ~ ~ • . ' ' Will excess fill be removed from premises: Yes No
premises • • • • • . • • • . Address . . Phone No. .
Name of Architect . Address . Phone No.. ' .
Name of Contractor j Address . • . • • • • .
LS. Is this property within 30'0 feet of a tidal wetland? * ~ " one No .
, y
*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.
j
UNDERWRITERS CERTIFICATE
REQUIRE
APPROVED AS NOTED
DATE: & E,P,
f~~ f R COMACARUN
--ON L CONVENT BEFC)R NOTIFY BUILDING DEPART ENT AT
CERT, ,;>1TEOFOCCUP'ANCY' FO LOWINGIMSPEC IONS FOR THE
SO,_..` i `•'R USED INWATF FOR POU ' GONCRETEREQUIRED
S(P ' Y SYSTEM (I'ANEi'O T 2. ROUGH - FRAMING & PLUMBING
r='_D 2110 Of 1 V LEAD. 3. INSULATION
4. FINAL. - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHAW,,. MEET
THE REQUIREMENTS OF THE N.Y.
KUM STATE CONSTRUCTION ENERGY
CODFS: NOT RESPONSIBLE FOR
ALKWAMOVW RESIGN OR CONSTRUCTION ERRORS
OCCUPANCY OR
USE IS UNLAWFUL
rarsoF ) Y K WITHOUT CERTIFICATE.
)UNTY F . S OF OCCUPANCY
. ' ' ' ' ' ' being duly sworn, deposes and says that he is the applicant
( c of ndivid l signingicontract) ove name .
is the
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
)lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
rk will be perform in the manner set forth in the application filed therewith.
om to before in ii „
L I .....da of.. , 19 V
:ary Pub .
"rrv61 .County
tibUt#A C Fa1A$ ,JII
NAtary PU61 St?ijeo Nyw Y9vk • •
001JOI.Le I
Nr ^
Now
t (Signature of applicant)
' " `ti8' IIIIYl~65lm
I
D } n
MAY 13 19R
BLDG. DEPT.
TOWN OF SOUTHOLD f
I
RE avf. ~ ~ t Tl~
(
~EBw,,p Porz~rt ~ I I
i kG$fc%5 41 1?0511
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
ALA~ OF OCCUPANCY I
f
APP OV D AS NOTED
-DATE: J!B:P. 4 --26
/OY• FEE: BUILDING DEPARTMENT AT
766-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS:
1. FOUNDATION',.- TWOREQUIRED -
FOR POURED.tQQNNq,RETE pF NEyy y
2. ROUGH - FRAMI C•~ & PLUMBING PZE~t 0
< ti 3. INSULATION 5`~'.jO 4- 4. FINAL - CONSTRUCTION MUST
BE COMPLETEFOR C.O. u
r J ALL CONSTRUCYIdN SHALL MEET 1 ,xL -
THE REQUIREMENTS OF THE N.Y. `O ~ a5
STATE CONSTRUCTION & ENERGY 032251
CODES. NOT RESPONSIBLE FOR AAOFESSWA
1A7M,'F'iSH'~~'•. ~MAINS'i' 1JEtJ5V~f0[.~
PLU BERCERT/FICAT/ON EK~sCi~~ Cppsp?fID67a
ON L41D CONTEINTBEFORE
olvno L)
CERTi /CATE,OF OCCUPANCY ~~M
- j ~ ~ SO ER USED /N WATER li
Sl/ LYSY$TEM CANNOT
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