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HomeMy WebLinkAbout20090-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPAN6"f No Z-25235 Date SEPTEMBER 4, 1997 THIS CERTIFIES that the building Location of Property MONTAUK AVENUE House No. County Tax Map No. 1000 Section 10 Subdivision ALTERATION FISHERS ISLAND, N.Y. Street Hamlet Block 8 Lot 1.2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 9, 1991 pursuant to which Building Permit No. 20090-Z dated AUGUST 14, 1991 was issued, and conforms to all of the requirements of the applicable provisions cf the law. The occupancy for which this certificate is issued is REPLACE WINDOWS & ALTERATION TO EXISTING OWE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. LISA REALE (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-229221 -MAR~H 23, 1992 PLUMBERS CERTIFICATION DATED OCT. 11, 1991-F.Io PLUMBING & HEATING Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_~ 20090 Z Permission is hereby granted to: ...... 13~...1..~..~ ............ ~._.~.., ..... ...... ~.~......~/..~.~y ~~ ............................................... ~~......~/.._~..~_ ............. County Tax Map No. 1000 Section ........ /....~.. ......... Block .....,~.. ............ Lot No .....l.,...,~. ...... pursuant to application doted .............. ~,',~. ......... ~ ............ , 19..~./ and approved by the Building Inspector. uuildlng inspector ! Rev. 6130180 TOWN OF SOUTHOLD BUILDING DEPARTHENT TOWN HALL SOUTHOLD, NEN YORK 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-gXISTING BUILDING.X..VACANT LAND ........ Location of Property ............... m.~'..~..~.~ .... ~.~ ..................... HOUSE NO. STREET HAHLET 0-.er or o..ers of Property .... '.L.',~..o. ..... O.!k.:~i ......................... cou.~y Ta~ Hap No. '000 se~tion~l~'.gPHlock ~:.~.. Lot Subdiv£sion ....................... Filed Map ........ Lot .......... Per~:t ,o..~.9?.9.O....ate of Fermit .<a./.:'~./.~.t.Appl:~an~ .e..a~.O.~i?..~..,... Health Dept. Approval .................. Underwriters Approval .............. Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate ~. ............. Fe~ Submitted: $.. 19.9-fl~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY E5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT DRYERS FURNACE MOTORS iAPPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUT/ET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R OTHER APPARATUS: I C E NO, OF HI-LEG A W G, A W O. OF Hi-LEG OF NEUTRAL 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 BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 Date OcJ- j\ ~,qql Building Permit No. ~OO Owner ~[~(,~ O/I IJ ~ ~ (please' print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Swo~n to before me this /','/s day of C)o.~ . ,. Notary Public, ~~County No. 52-9509J85 Notary Public FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. If copper tubing Is used for water distributing system; pipi~ Shall be of types~ UNDERWRITERS CERTIFICATE REQUIRED ~OTIFY BU1LD;~G ~65-1802 9 ~ FOLLOWING 1, FOUNDATION FOR POURED ROUGH - F FINAL BE COMPL ~: THE REQU~P'~,~ STATE C0¢~ , CODES. NO r DESIGN OR '%, ~'L~.ki OF P~.Or'E~,'FY TO ~SE ¢OMVEYED To If ~opper mbin~ i~ used for water distributing ~,~em; piping shall be ~ ~pes ~ UNDE~RITERS CERtiFICAtE AP~OVED AS NOTED,. :~§5-1~O2' 9,-AM TO '4 PM ~oR ~TH,E t',, RO~H - F~MING & PLUMBING ~ FINAL 2 CONSTflUCTION".MUS~' 'THE REOUIREMENTS' OF ~THE N.~. , ~TATE CONST~U~'iON[~' E~ERGY- DESIGN OR" ~STRUCTt~N ERRORS PLUMBER cERTIFIc,' ON LEAD cONTENI CERIIFiOAFE OF 00 S.OLDER USED ~gUPPLy SYSIEM, EXCEEZ) 2/10 of FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ................ ,19... ^pproved Permit No.. Disapproved a/c ..................................... BOARD OF HEALTH ......... SETS OF PLANS .......... SURVEY ................... CI1ECK .................... SEPTIC FORH ............... NOTI ~Y = CALL ................... MAIL TO: APPLICATION FOR BUILDING PERMIT / Date... 3l / 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 Buff,ding Permit to the applicant. Such permit shall be kept on the premises available for lnspectm~ t~,r®~ghout tl~e work, :,, ,,-.¢, , .~, ,.,-,, ' e. No building shall be occupied or used in ~'fiOle or ~n part for any purpose ~¢liatevffr broil a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION, IS~,HF~R,EBY M,~DE to the Building Departr~en[~or.~the issuan,c?~¢f a ,~!digg Permit pursuant to the Building Zone Ordinance of the Town of SouthOld, Suffolk tZofin~yl New York, a~ld other applicable Laws, Ordinances or Regulations for the construction¢of buildings, additions of,,alterations or fgr removal or de~molition, as herein described. The applicant agrees to comply ~it~,.a~ ap~ab!e laww~!,rdlnances,:~mlhl~i~'g code ~!~u~ih, g ¢o~e, an¢~r~.~lations and to admit authorized inspectors on preilli~se~ ~nd 'in, buildin~t~r necgssar~ ifi~p~Ot!6ns/ ') ~ ' )~ ! "' .' ' - -- ; ' ' ",, ',"~ -,: ' :, ~ ~'~ , ', '~ ', , :(-gignhtur~ of:apfil~ant, ~r name -if a,co~poratJon) 7 ' ,, ~, ,, ~, (Mailing address,of ap,~'l,iq~ant) x State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ 9..~..r.k.~. .................................................... :: :.. :..,..:....- ............. Name of owner o f premises ..... .~'~C~z~a 0.(.. · -~ ~. · ,0 [~. V.~. V.i ........................................ (as on the tax roll or latest deed) If applicant is a corporation, si~n~t~re df ~t~ly; ~th~riz~d.officer. ................. ~,~. ~,~ ~?~'.~.''~'~'/~' · Builder' 's hcense' No. m~'~5~}f'~J~;'~ ~C~O ~'~' '"' ~ ' '> · . ~;. ,. ~,,,~: ~: · Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... .~. 9..u~?.~.., .% .... -.~.~%.~ ~ ............ ................... .~...0 ~.+..c .~a-.. 1<.....~..vx., ................... GM .~r.s..Z.~ House Nmnber Street Hamlet County Tax Map No. 1000 Section ...... I.~ .......... Block ...... ~. .......... Lot /. Subdivision ..................................... Filed Map No ................. Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed cbnstruction: a. Existing use and occupancy .... .bq/.O.j.'... iP:~ .... ~. ":- Ur) 0 C ~ ,c?~.,/. ~ ,,, .~... ' ....... b. Intended use and occupancy {9~ ;,Vy~,k w .L~...W.~ X [ 4 .'¢-)9. ~;0,2 .... O, .~..-~- .... (,t._....~..~.' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..... Repair .............. RemOval .............. Demoli:tion .............. Other Work .............. /~/ /../ i ' ' /~ ~0 ©0 (Description) 4. Estimated Cost ........ .~..C~.~..,..Q~...., ............ 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. business, commercial or mixed occupancy, specify nature and extent of each type of use,. 7. Dimensions qt;exlstin~, structure~,if any: Front... f.~..../~...T... Rear . ./~....~:77'.... ~. v.~pth . .,.,~ .7.....~.-.'./-:... Height .../~....f':~... Number of Stories .... ~..A(..~. ......................... .-. .... ,. ...... Dimensions of same structure with alterations or additions: Front .. ~.~.>..~. ....... Rear ...,.~.~.~.~.~.~.~.~..*.7>...~.. ........ Depth...~.~-..: ....... !.. Height .... $.~..,./77..~. ......... .Num?er of Stories .... ~:O, XD..~. .......... 8. Dimensior~. o~f entire new construction'_ . Front .... . .~..~./97~ . . ..... Rear ~ f/-/'O/-~ .... Death~ . . .,~ .o-YA-., ....... ~-- Height . .~k'l.~... ,..,. Number of St, ories .. Ofl~,-.. ' ......... 9. Size oflot' Front ~ ~ Rear ' ~; ~ ....... &"L" "<5'~5 "~M ..... ~. ' ~ ...... ,'~ .... ,'_2' ........... ', .... t.: ...... IJeptn .... o.-z>,, .~1 .......... 10..ate of Purchase .J.U~&... I. 7. ~.. I.c] .~.l ......... ~am? qf Former Owner .. I~ .~lp.c~.~,~.../~rr.o.w~..... 11. Zone or use district in which premises are situated .... ~..S1.d,~..q~'~x.~ ................................. 12. Does proposed eonstruction violMe any zoning law, ordinance or regulation: ....A?O. ......................... 13. W/ll lot be regraded ..... g4'~ ! .......... ' ......... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~(¢~q~M'.' .~...O[iX~.r./. Address .~X>X../.O f....~.,Z::.,.~y. Phone No.-.%'l.~.."~g..7 Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ................ 15. Is th±s property w±th±n 300 feet of a t±dai wetland? *Yes ........ No..[.'~.. .... *If yes, Southold Town Trustees Perm±t may be requ±red. PLOT DIAGRAM 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. OCCUPANCY OR USE IS UNLAWFUL , WIIHOUT CERTIFICATE , OF OCCUPANCY STATE OF L S ..i..'~mtq...~'.t~ ~.. ~)f¢'O~,O? .................. beingduly sworn, deposesand saysthat he is the applicant (Name of individual signing contract) above named. He is the ................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 manneriset forth in the application filed therewith. Sworn to b.e,l~re me' this ~,~1~I (Signature (~t~ app}icant)