HomeMy WebLinkAbout20318-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-21171 Date NOVEMBER 23, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property 2305 GLENN ROAD SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 1 Lot 31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 3, 1991 pursuant to which
Building Permit No. 20318-Z dated DECEMBER 9, 1991
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 ONE FAMILY DWELLING WITH ATTACHED GARAGE PORCH WOOD DECK
& BRICK WALKWAY.
The certificate is issued to LARS & ASTRI TORKELSEN
(owners}
of the aforesaid building.
SUFFOLK/COUNTY DEPART'P~NT OF HEALTH APPROVAL 91-SO-95-NOV. 19, 1992
UNDERWd~ITERS CERTIFICATE NO. N-256114 - NOVEMBER 6 1992
PLUMBERS CERTIFICATION DATED APRIL 6, 1992 - MIKE SACOBI
Building Inspector
Rev. 1/81
1'08~M NO.
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)
NO ~ ~ 31 $ Z Date ....I~..U~~F.tl:».Y.1h.
1...... ~ 19...1.
Permission is hereby granted to: p7~'-~ / -
!.~-35
.w~,~l..r~-~, ,
o .~~5.[.......~'A......!n1~41:..a~ ~ ..'~..'D......
of premises fixated at a ~ D$;......~......fC.Rf..:.........~~~:~$:ye~.{~1..ISt!~
i County Tax Map No. 1000 Sectio~n~....~..~.~......... Block Lot No
pursuant to application doted L„~i-.RA.^.:w4~aa.~.....~ 19.g.~.., and approved by the
Building Innspector.
Fee S..`~..~s.....-~
.,~.GI.•O.d:
Building Inspector
Rev. 6/30/80
•f ~ Form No. 6
~'`a ~ (`?C'~~,r ' ' TOWN OF SOUTHOLD
BUILDING DEPARTMENT
• TOWN HALL
• ~ ~ ~ ~ 765-1802
APPLICATION FOR.CERTIFICATE OF OCCUPANCY
This"applYcat~ion 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 }:sed in system contains
less than 2/l0 of 19. lead.
5. Commercial building, industrial building, multiple residences anc~ 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.,
j• 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.
• Fces •
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 •
/ 7~'' ~
Date
:w Construction....... "
Old Or Pre-existing Building,,,,,,
-cation of Property...... ~rJ
. House •No....... L~~~......... 1 4-Ea L .
• Street
,,Hamlet
vcr or Owners of Pro ert ~~~-S r S?6C~.
P Y............~...........ti ~~«-~'E•7d
:nty Tax Map No 1000, Section....1.•Y......Block....~•••••••••••••
...........Lot..........
division. ~ ~i.S l'... C C~
Filed Map............Lot..
mit No••••,•Date Of Permit..~~~~,/~,/•,
~31 SS2 ..Applicant. ~ . 2~ ` l'~~.
lth D PP 'P•
ept. A royal.......... ..Underwrite
rs Approval........
nning Board Approval........
:est for: Temporary Certificate...........•Final Certicate.•
Submitted: $
APPLICANT
~~FFD(/~ C TEL. 7G5-1802
0~0 -v, O~~ TORN OF SOYJTB[Ob,ID
1-..
1 OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
.r co ~ 'e TOWN HALL
SOUTHULD, N.Y. 11971
Ol ~ y,
+jk
~ t~3 C E R T I F I C A T I O N
APR - 6199 ;
i 3,
ti~~~..~,..r.. -
~~t.~,~.~.°~; , s
1ov~aa ~<,~f?r,~ ~
Date
Building Permit No. -2('~ ~ I
L c-i~5 9'
Owner !Uy>- Ic ~ ,/.S" C~6V
(please print)
Plumber ~ '
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
S
(plumber' signature)
Sw~n to before me this
day of II ,
19 ~ vl~/~~_
No ary Public
t7otary Public ounty
fin'
P~i+b State ~ New York
No. 4952246, Suffolk Coun
Term Expires June 12, 19~j
,T,.. , ~ , 4,. ~ _ ~ ...a:~.,.,.
THE NEW YORK BOARD OF FiRE UNDERWRITERS ~Rr'N
~L}I~`~"` BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 1003!# ,
Nb'tir?{(3k;R °S ''tJi "efbll^6F~:.d('3l ??rg{.l~l
Date ~ APPlication No. on file
THIS CERTIFIES THAT
only the electrical equipment as described 6eloso and introduced Ly the applicant named on the above application number in the premiaea of
?~Ch;f;GtiH,PV :ierTP,~h'P,€ °fr't9 G[~Gldil T±t •~l ~tel~}{C^f,171 Bi..
in the follouinq locationl Basement ~ Ixt Fl. LJ 2nd Fl. ~ `I i - Section? Block i' Lot
uns examined mr andfound to be in cornplianre with the requirententx u/this Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT ftUOREECENi OTHER PMi K W. AMi K W. AMi KW AMi K W PMT. H P
3? ~'i 1e? ~ I. I _ i~
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELL UNIT NEATER$ MULTI.OUTLET DIMMERS
SYSTEMS
AMT. K. W. Oll H. P. GAS H. P. AMT NO. A. W. G. AMT. AMP AMi AMPS, TRANS. AMi N. P. NO.OF FEES AMi. WAtiS 'Tu'
•s P ~ -
L SERVICE DISCONNECT NO.OF $ E R V I C E
METER NO.OF CC COND A W. G. A. W. G A. W G.
AMi. AMP, TYPE EONF 1,9' RW 1,a' JW ],6' ~W 3,6' 4W PER % OF CC COND NO OF HbLEG OF HbIEG NO.OF NEUTRA45 OF NEUTRAL
OTHER APPARATUSI ,
c.f~,c~,"r: t
gr~=rf~ nf,~e~rx~i>.,-I
c' e.Trarrl~t<~::
l;ICYAF.G V;Gf;t;t7F"130T ?,Tf,^ ~~65" E
I1~ ~,`'a.G)Ofl Ali,
OENERAI MANAGER
C:~LJ;r+ '!'ttRP. , N3', I ta5... 1;.
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.
_'Z-Lt~~ i;:S:'cCT1U:7 'Jn:~
II I ~O~YMENT~ t
1 . m~
_a0
r
FOUIJDATION-... (1st) ~ '-ip`6
C ~ ~
FOUtJDATI0IJ
(2nd) cn`
2 ~ ~ ~r~~ L m
P,OUGH FRAME $ ° Q~~
~ O
•PLUMBING
n
3 . ~ L- a
m
ItJSULATIOPJ PER N. Y. y ]h
STATE ENERGY (1~
CODE •
4. L-
m
Eq ~ 3
'~G(
FZ;JAL
ADDITIONAL COMhfEtlTS:
x
•
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INSPECTORS _
Victor Lessard ~ yGFO(,~f~'~
Princi al Buildin Ins ec[or ,pt~.'j~ •
h g p ~ d,
Curtis Horton ,E ~~y SCOTT L. HARRIS, Supervisor
Senior Building Inspector o ~"`te'a"` rt ~t
w ; t"' Southold Town Hall
Thomas Fisher , ~ P.O. Box 1179, 53095 Main Road
Building Inspector O ' a,~ 4 ° ' 'r
Gary Fish ' ~ •~O~'-f'' ~ Southold, New York 11971
Building Inspector 1 "`Y Fax (516) 765-1823
Vincent R. Wieczorek °~'-z'~r~-`f"r Telephone (516) 765-1800
Ordinance Inspector ,
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
OCTOBER 29, 1992
LABS 6 ASTRI TORRELSEN
2305 GLENN ROAD
BOR 1475
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)
BR% No Underwriters Certificate on file.
RxR The check is /not on file.)$25.00
xRR 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 # 20318-Z
Please contact our office on this matter. Thank you for
cooperation.
50UTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] F NDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ] FINAL~,A `
REMARKS: ~L~
-
~ `
DATE ~ INSPECTO
r
~Q~`~
~eS-iso~
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMARKS: C~~
DATE ! ~ INSPECTOR ~;'z~„
~ _ r~
765-1802
BUILDING DEPT.
! NSPECTlON
[)FOUNDATION 1ST [ ] ROUGH PLBG.
]FOUNDATION 2ND [ ]INS TION
[ ]FRAMING [ FINAL
REMARKS:
DATE 7 C~ INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: _
~ ~
DATE ~ ~ INSPECTOR
BO,1n0 OF HEALTH
FORM N0, 1 1 SETS OF PLANS .
TOWN OF SOUTHOLD SURVEY . . .
BUILDING DEPARTMENT CIICCI: _ .
TOWN HALL SEPTIC PORN
SOUTfIOLD, N. Y. 11rJ71
TEL.: 765 1 II 02 t: oT I r-'t
p CALL
Examined t....lg~/./ MAIL TO:
:1pProecd I . ?!µs~. 19 9 ~ Pcnnit No.oZ,O.~ ~ ,L. . .
Disapproved a/c ~ "`°""y~ .
. ~ q
................................V ~ 1k~~~
p-~-~..... ~ = 3 8991
~ ,
(Bw ding Inspector) ~ - ,
j3.1 I_w.,_,._
APPLICATION FOR BUILDING PERMIT
_
Date 19...
INSTRUCTIONS
a, T}tis application must be completely filed in by typewriter or in ink and submitted to the Building Inspector, with 3
ets of plans, accurate plot plmtto scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
tr areas, and giving a detailed description of layout of property must be drawn on rile 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
fall 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
hall 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
luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Ze;ulations, for rite construction of buildings, additions or alterations, or for removal or demolition, as herein described.
°he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary~yssyrectlon
(Signature of applicant, or name, if a corporation)
.Po.~s~xiva,.f......~e~li~o~a
(hfailing address of applicant) 1 ~S~ ~
irate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......~':~~rvz;n/gc c_cnv~~C~lcTol'L~
y~.
~amc o(owner of premises .L f~ ~S 7a(~)CG~L..('e~^'
(as on the tarrc roll or latest deed)
I ap I' is a corpor ion, signature of dui authorized officer. •
(Name and title o/f c/orpor~alte offic1er) / J
Builder's Liccnsc No. 1. b. ,(~0~, ~ , l! , , , b
Plulllbcr's Liccnsc No . .
C•lcctrician's Liccnsc No .
Otllcr Trade's Liccnsc No .
Location of land on which proposed work will be done. , .
Ifouse Number --7 Street Hamlet
County Tax Rfap No. 1000 Section Block Lot . ~ ~ .
Subdivision Filed l.lap No. Lot .
(Name)
State existing use and occupancy ofpremises and intended use and occupancy of proposed construction:
Vl4c/9w ~
a. Existing use and occupancy .
,
b, Intended use and occupancy , ~ ~wG-L.C , . , . ,~,~+"h /C t( ~ ~
...........,1~..~.~....
(
3. R'ct~I of wort. (check whicRell aPPlicable): New Building / Alt '
P moval • " " " Addition cration
• • • • • • • • Demolition Other Work , ,
~,06U
4. Estimated Cast ..lU~ (Description)
p.
Fec
S. If dwelling, number of dwelli (to be paid on filing this application)
If ara~e ig units , , , , , , , , , , Number of dwelling units on cacti floor , . , , , , , , •
B , number of cars ,
6• If business, commercial or mixed occupancy, specify nature and extent of each type of use
Height ~res,ifany:Front....;..
o inbcr of Stories , , • ~ • • ' ' ` • Rear Depth ,
Dimensions of amerstructureuwith alterations or additions• • ~ • ' ' ' ' ' ' ' ' ' ' ' ' ' ' • ' • • • • • • • • • .
~ .front Rear............
ePth . . Ilcight Number of Stories .
g nrction: Front ,
.........'....Nu Rear Depth
Henthtstons of entaexnew const• . • • • • • • Rcar . , " .
rhbcrofStorics
9. Size of lot: Front . ~
10, Date of Purchase ' ' ' ' ' • • • • • • Depth •
I I. Zone or use district in which premises are situated , , Name of Pormcr Owner • • • • • . • • • • • •
12. Does proposed construction violate any zoning law, ordinance or regulation: .
13. 1Vi11 ]ot be regraded
14, P • ' ' ' ' ' ' ' •'Toj2lC(SZ.lf~ • . , , 1Vi11 excess fill be removed from premises: Yes No
Address ,~,~3o G~Lrwh• YCr,
Name of Architect remises ~ . , ,Address • • • • • ~ ' ' ' Phone No..~ 6,S ~ C~ • •
Nante of Contractor ' ' ' ' • • • • • • • • • • • • • .Phone No. .
15. Is this~~ """•••••••••.Address ~
property within 00 feet of a tidal wetland? ~ • ~ • • ~ • " " • • Phone No...... .
*If yes, Southold own Trustees Permit may be required. " No..~~',•
PLOT DIAGRAb1
Locate clearly and distinctly all ibuildings, 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.
~ 1T{~}C~~ SU1'ZUhx~.
I
~i
I~
n
~i
TATE OF NEW YORK,
OUNT OF
'i~"'""'....
(rN~a~me o~ivo~ r nrn So ~ • ~ ' ' ' ' ' ' ' ' ' ' • • • being duly sworn, deposes and says that he '
g g ontract) is the applicant
~ovc named.
(Contrn_
rtor 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
plication; that all statements containediin this application arc true to the best of his knowledge and belief; and that the
vk will be performed in the manner set fortft in the application filed therewith.
orn to before me thjs
./.......day of ~.2.;~?!~~!-~
tary Public, L~~r-~
~ • • • • Count~~--~
' HE4ENE D. HORNE /
Notary Public, State of N8W Yptk , •C Pnts~•
No. 4851364
Qualified in Suffolk COUnty ' • • •
Commission Expires May 22,'~ (Signature of applicant)
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