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Home My WebLink About20107-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20184 Date AUGUST 29, 1991 THIS CERTIFIES that the building Location of Property 10 HICKORY ROAD House No, Street County Tax Map No. 1000 Section 54 Block 6 Subdivision Filed Map No. ADDITION SOUTHOLD~ N.Y. Lot Lot No. Hamlet 14 conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26, 1991 ~ursuant to which Building Permit No. 20107-Z dated AUGUST 28~ 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING TO CODE. The certificate is issued to JEAN C. SWEENEY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL A UNDERWRITERS CERTIFICATES NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ·// B~ilding Inspector FOIlM NO, ~ TOWN OF $OUT~OLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~_ 20107 Z Permission is hereby granted_ to: ~,-..:.-~. ..,.~ ....... :...~: .................. ............../o ~/~-~ ~......~.........~..~.~. .................. ~ ..... ~-..~..~. ,~.~/.~..:...~.....~ ..'..~.Z'..~:; ........ C/J :,, , , ,o.~/T.,~......~.~.../.~. ........ ~~....~..~..'x-~ ........................................................ ............................................ ~..~~ ................................................................................. ¢o,,n~ To~ ~op No. ~000 S~c~on ....... ~...~ ..... B~ock ...... ~ ......... 'ot No.../..~. ........... pur~uont to oppll¢~tion 6ot~:l ...... ~./..~.. ..................................... , 19. ~...., and oppro¥~t blt Building Inspector. Rev. 6/30/80 FOR CERTIFICATE OF!OCCUPANCY i. This application must be filled in by typeuriter 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~ '~' , · bulldzngs, 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 stat'ement 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 C~pliance from archiuect or engineer responsible for the building. 6. Submi~ Planning Board Approval of completed site plan requirements. ;- ~or existing buildings (prior to April 9, 1957) non-conforming uses or buildings and 'pre-existing land uses: , 1. Accurate survey of property sbo~ing 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. 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 BuildSng - $i00.00 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, Comanercial $15.00 Date ..... .... eu Construction ........... Old Or Pre-existing Building ...... .. Itouse No. Streec ' '' ' lunty Tak Map No I000, Section...!~:V ....... Block ..... 0 ......... Lot ......... ~..~. ........................... Filed Map ............ Lot ............. . · · .... Dare Of Permit ......... Applicant ............ alth Dept Approval ' ' ' ...... ' ............... Uuderwriters Approval ....... arming Board Approval est for: Temporary Certificate ..... Final Certicate ........ THE NEW YORK BOARD: OF FIRE UNDERWRITERS ~L0_01093 : BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 O.,e APRIL 20,1989 Appli~.t~o. No.o./ile 504A8087/87 N 067813 THIS CERTIFIES THAT '' only the electrical equipment az described b~low a~d introduced by the applicant ~med on the a~ve application number in the ~RS. S~EANY, CHESTNUT ROAD, POLE $8, SOUTHOLD, N.Y. in thefollowingl.cation; ~ Basemen~ ~ Ist FI. ~ 2nd FL Section Bl~k ~s exa.t~ned on APRIL 0 3,19 8 9 and found to be in compliance u'~zh the req.ire.~entz <~f this Board. FIXTURE FIXTURES RANGES ~OOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES iNCANDESCENT FLUORESCENT OTHER i 1 DRYERS OTHER APPARATUS: G.F.C.I:-i S E NO, Olde ~CC~CON D, R I OF CC. COND C E GARY DOROSKI LIC. #2941E , :' 420 MONSET,L LN. :;; GENERAL ~AGER CUTCHOGUE, NY, 11935 Per 1i ~/ This certificate must not be altered in any manner; return to the office of the 8oard if incorrect. Inspectors may be identified by their ~redentials. Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 .......... ,19 ?..~ermit No....~.~...~.~...?/'~ BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. NOTIFY: CALL ................... HAIL TO: Disapproved a/c ..................................... ................. . .......... , · APPLICATION FOR BUILDING PERMIT rote. ~.TT.-~'~ .... . ..... 19q/. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 5ets 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 cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~hall 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 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspections. ..... .............. (Signature of applicant, or name, ifa' corporation) (Mailingfiddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~!~h%~. ~ .(.~ .~..~..~-?~7.~?~..~'.).c~7.~ ............................................. ' ~ · ,. (as on the tax roll or latest deed) If applicant is a corporati6n, signgture 9f duly authorized officer. (Name and title Of ~o'rp0rate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... OCCUPANCY OR USE IS UNLAWFUL VITHOUT CERTtF]CATE OCCUPANCY Other Trade's License No ...................... Location of land on which proposed work will be done... ]~'~..~t.I.(} ~. C'.)[)~[~..[~'.~_~. ........ ' House Number '~ Street ~amlet County Tax Map No. 1000 Section .... '$.¢ ........... Block .... .~ ............ LO[ ..... ~5 ........... 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 Nature of work (check which applicable): New Building .......... Addition .. eration .... Repair r, emoym ............ Demolition .............. Other~W. ork~ .............. 4. Estimated Cost ..... 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 ears ..... ; .................................................................. 7.6' If business, commercial or mixed!occupancy, specify nature and extent ofeach type ofuse, ..................... Dimensions of existing structure~ if any: Front .... '.1,~: Rear ~,.z & .~.~ Depth Height Number of Stories ............................ Dimensions of same structure wiih alterations or additions: Front ................. Rear .................. Depth ~ Height Number of Stories 8. Dimensions of entire new construction' Front , Rear Depth Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ........... i .......... Rear 10. Date of Purchase ........... ~ ............... .'. ..................... Name of Former Owner . Depth; ...................... 11. Zone or use district in which pre~nises are situated.. ...... r'~W~'5 .............. 12. Does proposed construction violalte any zoning law, ordinance or regulation: ....... [,,,~ ........ , ............... 13. ,W, ill lot ?e,,regrade~d ....... ~i .2...c~.?).. 'c~ .......... Will excess fi!~ be removed from premises: _Yes Name of Contractor .~...c¢3~4... I htCC2vL/~ . Address c~ ..... ~ h ,-~ ~ -~ ~,~ - ' .... 15. xs tn~s property within 3U0 feet of a tidal wetland? *Yes ...... No..~. .... *If yes, Southold T~wn 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 n~ ~rfiber or descriptio~ according to deed, and show street names and indicate whether interior or comer lot. ~,,a/PP~OV~D AS ~OYED MOTIFY 8Uf.kf~lNG Di~PARTI~T~AT 765-1802 9 AM TO 4 PM FOR THE Or. LOWING iNSPECTIONS: ~. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ~OUGH ~ FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. Alb CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ~TATE OF NEV~¥OR~ I (~ :OUNTy OF...~C..iA)..~. ?..t..~ ~.~ being d ly sworn, deposes and says that he is the applicant (Name of individual signing ~ontracO bore named· le is the ........................ ,i'......(~..'.(~.... . . .~7-_~ .?... ............................................... ' (Contractor, agent , corporate officer, etc . ) f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the · 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this ............ .... ,RE .... ............ Xotal¥ Pu.b. llo, State of New Y~ , (Signaffire of applicant) ~o, 4879506 , Commission Expiree December 8, jlg~.~.~'''-