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Home My WebLink About21146-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, CERTIFICATE OF O~CUPANCY No Z-23730 Date JUNE 23, 1995 THIS CERTIFIES that the buildin~ Location of Property. 440 GRANGE ROAD House NO. County Tax Map No. 1000 Section 78 Subdivision ADDITION SOl'f HOLD NY Block 1 Filed Map No. Lot NO. Street Hamlet Lot i conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 7, 1992 pursuant to which Building Permit No. 21146-Z dated DECEMBER 15, 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 A DORMER ON EXISTING ONE F~/4ILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD & PATRICIA RICHARDS of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N354383 PLUMBERS CERTIFICATION DATED (owner) N/A JOq~E B, 1995 N/A Building Inspector Rev. 1/81 FORM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMtT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N? 21146Z Permission is hereby granted to: ~'"~"~"L"~'"F;7~ , . .... ..(....~.~....~.,...~..~......, .............. ,/, , - at premises located at ... ,~,,.~.~....f..~2,.~.....~.~,...~ ....................................................... County Tax Map No. 1000 Section ..... .~..~.. .......... Block ..... ./.. .............. Lot No ........ Z ............. pursuant to application dated ...... ./....'~..../~.. ............................... , 19..~..~.., and approved by the Building Inspector. Fee $~......~. Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING D EPp. RTHEi'IT TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in hy typewriter OR ink and submitted to the boilding inspector with t}m followiug: for new building or new use: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or topographic features. 2, Final Approval from Ilehlth Dept. of water supply and sewerage-disposal(S_9 form). 3. Approval of electrics}, installation from Board of Fire Underwriters. 4. Sworn statement fromfplumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences an ' ' aud ~nstallatious,~a certificate of Code Com~li--- = . . d s~mziar buildings respousibie for t}' ' · ~. re, ce ~rom arcnmtect or engineer ~e mu~ldzng. 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 '.~re-existing" land uses: l. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic ~eatures. 2. A properly completed application aud a consent to inspect sigaed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasoas therefor in writing to the applicant. C. Fees 1. Certificate of Occupaucy - New dwelling $25.00, Additions to dwelliug $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 Buildin~ - $i00.00 3. Copy of Certificate of Occupaocy - $20.00 4. Updated Certificate of Occupancy - $50.00 5, Temporary Certificate of Occupancy R ' ' - es~dent~al $15.00., Cmmercial $15.00' .................. . , .... ...... ................. llouse No, Street Hamlet Onwer or Owners ,.,f Property... { + , ~ ~ ~ co . y 000, Se on.. UZ /. ............ Bleck ...............Lot ........ oubd~vmsxon ................................... Filed Map ............ Lot ...................... · - · ~ ..... Dat~ Of Permit..J. ..Applxcant ~ qealth Dept Approval ' ' .................... Underwriters Approval ~lanning Board Approval.. . request for: Temporary Certificate ........... Final Certicate..~. .... Town Hall, 53095 Main Road P. O. Box 1t79 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 2, 1995 Mr. & Mrs. Edward Richards 440 Grange Road Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is < . not on file. (Enclosed) xx No Underwriters Certificate on file. xx 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 # 21146-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. OUNDA'TION 'OUNDATIO:; (2nd) '~OUGH FRAME & .?LUMBING [NSULATION PER N. STATE ENERGY CODE FI;IAL ADDITIO~A'L COMMENTS J.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] IN//SULATION FRAMING [¢~ FINAL 76~-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [~NSULATION [ ] FRAMING [ ] FINAL ~ ~ 76S.180Z ~.~ ~.~/~ B/UILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] F/~UNDATION 2ND [ ] INSULATION / FRAMING [ ] FINAL DATE /' INSPECTO Y / // -" THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 ~[0t~418 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 O,~e JUNE O8,1995 ~pp]ica,ionMo. onyi]e 84345394/94 N 354383 THIS CERTIFIES THAT only the electrical equipment as d~scrlbed b~low and introduced by the applicant named on the above application .umber in the premises of EDWARD & PAT RICHARDS, 440 GRANGE ROAD, SOUTHOLD~ ~.Y. in the followint; locution; [] B~sement [] 1st FI. [] 2nd FL OUT .Section Block Lot 3 ,~s examined on JUNE 0.5,1995 and found to be. in compliance with the National Electrical Code. FIXTURE OUTLETS I: c~N FIXTURES EPTACLES SWITCHES IN DESCENT FLUORE~ENT OTHER 4 DRYERS I FURNACE MOTORS t FUTURE APPUANCE R~EI~R~ A~T. K W.I OIL H.P, GAS H PI AMT. NO. A.W.G. RANGES" ;PECIALREC'PT SERVICE DISCONNECT I NO. OF I S METER OTHER APPARATUS: COOKING DECKS OVENS DISH WASHERS TI=~ CI~OCj: T:AELN[s'~UNIT HEATERS V I C NO. OF CC. COND pER ~' OF CC. COND NO OF HI-LEG OF HI-LEG EXHAUST FANS DIMMERS AMT. WATTS ~O OFNEUTRAI. S A.W.G. OF NEUTRAL SMOKE DETF, CTOR, -- 1 ALEFJ~NDER G. HUBBARD BOX 222 AQUEBOGUE L.I, , N-Y, 11931 LIC. #304-E GENERAL MANAGER 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 BUILD~NG DEPARTMENT. THIS COPY OF CERTiFiCATE IVlUST NOT BE ALTERED iN ANY MANNERi d,.~, ~, OEPT, ........ ~? ~J,~,~ :.~?.U~H O L~ ............. ' TEL.: 765-1802 Examined / .......... , 19Q~ Approved .. ~/¢~ ........ 19~Pemit No ...... Disapproved a/c ..................................... . (~ldin~pector) ~PPklC~TIO~ FO~ BHIkDI~G FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH l~ ...... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC PORH .............. CALL ............ HAIL TO: 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- *~'~"*~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 w6rk. 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 authotized inspectors on premises and in building for necessary inspections. A ~ ~-' ~ ' -- (Signature of applicant, or name, if a corporation) .. t. ....... (M~i'ling address of applican0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ C .......................................................................... Name of owner of premises .' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License No .... ~..h3...&.~.. Plumber's License No. t I Electrician's License No. [ I Other Trade's License No ...... [ I ............... Location of land on which proposed work will be done .................................................. ........ .v.o ....... ........................................................ House Number Street Han~let County Tax Map No. 1000 Section ...(~. 7~.'.0.~. ....... Block ...~..].'.Q¢. ........ Lot..~.O!~:~.Q.q ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... 'l ...................................... b Intended use and occupancy ~ Locate clearly and distinctly all property lines. Give street and block interior or corner lot. .- 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remdval .............. Demolition Other Work ~,~ ~OE) ' (Description) 4. Estimated Cost... ~ O O ........ ? ........................ Fee ...................................... i (to be paid on filing this application) 5. If dwelhng, number of dwelling units...~ .......... Number of dwelling units on each fioor If garage, number of cars ..... i 6. If business, commercial or mixe6 occupancy, specify nature anl~ extent of. each type of use ................... 7. Dimensions of ex. isting structure~ if any: Front .[~.~.'3.Qf.6f~..~. ~'. Rear I~.~O"'.'.~."Jcl' Det~th~!Of. ~Co- Height .. ~0~./Ju~ .... Number of Stories ....... ;[.V..o> Dimensions of same structure wRh alterations or additions· Fr,~,; ' il~;_~;~J~'~,~'~'' '~ ~'d~' ~a~*~/] ~o;-d~. ;,} ';" · ................ ' 9. Size oflot: Front ...].O?;,,rr~,.), .......... Rear· ~ Depth :.jK.,~f...^ ............ 10. Date of Purchase .... J I..~Yi-.~,, .~. ...... . ......... Name of Former.Owner . JDC. ~.].</~z~e. lo~.){-~ .......... 1 I. Zone or use district in which pre~nises are situated·, f~-P~'~C~.tk~.~ .................................. 12. Does proposed construction violate ally zoning law, ordinance or regulation: . Ik)~ ........................... 13. Will lot be regraded ...... .. :~ !~'} ~. .......... .,... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ,,t~iOlg,)jlt~.D..4r.'P..r~?.:r,.t,.~.~l{'gAddress .~.~...~.q.~...~.. Phone No./05- ' Name of Architect ...... .x. ............ '. Address " .... '/.. Phone No '7.3.t Name of Contractor \X. ~ ~ ........ ~ ........... ~.. .... Address ................... Phone ~ .... '!.. ? ....... 15. Is tM.s property w±th±n 300 feet of a t±dal wetland? *Yes ........ No...k- ..... *If yes, Sou±hold T~wn Trustees Perra±t may be requ±red. ... i PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions fr~ umber or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY ?F .......... ~ ....... ... ............... (Name of individual signin¢ contract) above named. ·.. being duly sworn, deposes and says that he is the applicant i (ContractOr, agent, co~porate offic;;, of said owner or owners, and is duly Cuthorized to perform or have performed the said work and to make and file this application; that all statements contair~ed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner slet forth in the application filed therewith. Sworn to before me this Notary Public, .)~. ................ County LINDA J. COOPER ..... ' '" .... ' ....... Notary Public,, State of N,ew York (Signature of applicant) No. 4822563 Suffolk Cpunty~,~,.-" T~.rm [.:×pims December 31i, 19.~.Z_ '% x