HomeMy WebLinkAbout20113-z
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22529 Date AUGUST 17, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 1780 GREAT PECONIC BAY BLVD. LAUREL N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 145 Block 4 Lot 2.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 28, 1991 pursuant to which
Building Permit No. 20113-Z dated SEPTEMBER 3, 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to WILLIAM & HELEN CHILDS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - AUG. IO 1993 -
PLUMBERS CERTIFICATION DATED AUG. 13 1993 - LAWRENCE J. LISO
B ldi Inspector
Rev. 1/81
1tO16M 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)
N o 2 01 13 Z Date 19..1
Permission is hereby granted to:
to ~
.
of premises located at ~.7G~~~.....L.~: ~~i~l~.(..ls~......~^...........
..............................................~G~~~~rxrf•••••........................................................................................
.
County Tax Map No. 1000 Section../....~~17: Black Lot No........~~
pursuant to application doted .....:'/.7'U 19........, and approved by the
Building inspector.
Fee 3..~0.°.~./..JG~0
. . .
' ng Inspector
Rev. 6/30/80
l
j . R - Form No. 6
TOWN OF SOUTHOLD } ~
BUILDING DEPARTMENT
TOWN HALL M 0 14s~`_ia
765-1802 `
I~~~,~ ~,.r_~, ~ v.
APPLICATION FOR CERTIFICATE OF OCCUPA Y TpvVN G6~ ud+lJ~!`~~~~°~"~°"'"°'
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 17 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.
~B. 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 $15.00
Date .....~1: ~ ~9'~
New Construction........... Old Or Pre-existing Building...."!~..........
Location of Property... ~?cfd /~.2g`onlir;,. ~~_„~d,LUr~
..............~:!g`L,~eG..............
House No.,f Street ~ Hamlet
Onwer or Owners of Property... ~?.EL~N..;~_..df/r~f(e9!vt...~~e(cf.$'
County Tax Map No 1000, Section ..............Block................Lot...,................,.
Subdivision ....................................Filed Map............Lot......................
Permit No.:~~,~~~ .Date Of Permit ................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval .
Request for: Temposr7ary~-'C'ertificate.........., Final Certicate.~:........
Fee Submitted: $,~Y`3-~!•,~? d
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APPLICANT
c~oxaasa~
~VF~(](k TEL. 7G5d 802
z ~ . . Cam 'I'ON SUQJfi~t~L~l '
o>:r+rc>; r~~ ~t~tLb~NC ii~srir;cr~S~
,r ~ P.b, ub~c 72r;
~ ~tA TOiVNHAtL ~ ir' C`~~'~~ '
`f' SOUTHOLb, fr.Y, r i9~i ~ ~ ~ '
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Building hermit No. ~CJ~,~
owner ~ ~4.n1 ~
(please print
t
plumbd~ 3
Imo; aC~ H lnC ~ ~ ~ ~i')
~tpleas~ print
i~'6a'~';G yr E
i S° k`
I ~ ~ ~ ~j Y3 < ~~sn Lk
. , ~ - t " °3s a , r wax to ~ ,
3 der~:3.f~' that the ~ait~~r' ir~~t1 ft~ try wtet~~' supply system
contains i~ss than 2/id of 1~'."Z~ad,
c
(plumber's gnature)
Sworn to beforn_ me this
~ day of 1~G'ti? T
Notary public
Rotary public, .~~tk County
OOLORES 1. lISO
NWry PubB;., Sua of Nei Yak
Bulldk Count' • No. ~8410~
Comm4don Fxpim Oa. 31,
765-1802 16193 {
BUILDING DEPT.
INSPECT 1 O 1~1'~`~1~:4~~~~~~~T~ ~
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMARKS: _
DATE U INSPECTOR ~
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] IN ULATION
FRAMING FINAL
[J [
REMARKS:
~~r
DATE ~ _INSPECTO
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
FRAMING [ ]FINAL
R MARKS: ~ ~-~,r~~~ ~....,~4
`n !l"d
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DATE ~ / INSPECTOR
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765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION i5T [ ROUGH PLBG.
[ ] FO NDATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMARKS:
4
DATE c~'~~INSPECTOR
THE NEW YORK B0~4RD OF FIRE UNDERWRITERS PAGI: I
~~J9911 BUREAU OF ELECTRICITY '
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date Al)CUS`t' 13,1)93 APPlicotionNo.unfile 80501993193 0.3G~}J5
THIS CERTIFIES THAT "
only the electrical equipment as described below and irotroduced by the applicant Homed on the above application number in the premises of
HLLhI:APS Ct{LLg9, 1.'780 EY,C0N3:C UA4 RQlJGt';VB.ftCI, LAURt;L, N. Y.
in the following location; ~ Basement ~ /xt Fl. ~ 2nd Fl. GAR/Ax'i'sCf011T .Sertinn Block Lot
teas examined un AIIG 17S T 1@ , 1, 9 9 3 and found to be in compliance with the Narional Etecirical Code.
iIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTlE7$ ECEPTACLE$ SWITCHES INCANDESCENT FIUORESCENi OTHER AMi K W AMT. K.W AMi K.W AMT. K.W. AMT. H P
52 42 :t5 X38 4 l L„~1 1 k'
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEll UNIT HEATERS MUlTI~OUTLET DIMMERS
AML K. W. Oll H. P GAS H. R PMT NO. A W G AMT PMP. PMT. AMPS. TRANS, AMT p SYSTEMS O.ML WATTS
NO.OF FEET
1. P 1 8 600
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC COND. A W G. A. W. G. A. W G.
AMi. AMP, TYPE ggUlp IA']W l,e 3W 9,a'3W 7X 4W PER .9 Of CC.COND. NO. Of HLIEG OF HbIEG NO. OF NEU1RAl5 OF NEUTRAL
OTHER APPARATUS:
MO'POIi5:~-S~ IJ.P„,i-~fi II.P„7-'fi SI.P.
G,P.C.1::-7
st~axe nr~~rc~~aa:-z
' 'FRACI(' LIGH1'TNGI-1?,
YfLLI,1:AP! C1I1:LJ9
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P.U. IlO.X ti6
I~AISRRIt, NY. , '1199fl OENERAI MANAGER
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Per ~~1~
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ideniifiecj by their credentials.
f C®P~F F~Bi 63U@~®88Vw ®~E~EIV~TFJS~b31"B'. VC"94~ ~®~1P ~~~~&t°'~~t~1"~ R9~I9~V 649"~u l~~ GAp_'ifC6~~® 99@Y LSE99~J ~f9.4d~9SU~~.
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAt>fi 1
1000378 _ _ BUREAU OF ELECTRICYTY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date S>;P'PEMBS'Ct Ca4111493 APPIicaNonNo.onfile 75E1495~31/91 N .2A$41~0
THIS CERTIFIES THAT '
only the elctricol equipment as described 6ebm and introduced 6y the applicant named on the ohove opplication number in the premieea of
WLGC,IAN CI#EGO3, 1790 PECONI;C BAY BLVp., POLE;#84, LZtBftEL, @l, X.
in thefollotcinq location; 0 Basement ? let Fl. ? 2nd FY. t}1tP .Sertion Block Lot
A UG U $ T y J , 14 4 and ound to be in com hence with the National Electrical Code.
ubs examined on f P
fl%TURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLFS SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K W. AMT K W. AMT. K.W Ami K.W AMT. H P
DRYERS FURNACE MOTORS FUTURE AWl1ANCE FEEDERS SPECIALREC'PT TIME CLOCKS RELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. K. W. Oll H. P. GAS N. P. AMT. N0. A W. G. AMT. AMP. AMT. AMPS TRANS. AMi H. P. SCSTEMS M1i WATTS
NO.OF FEET
SERVICE DISCONNECT NO.Of 5 ~ E ~ R' ~ V ~ ` ~ I - C E -
M1T. AMP, TYPE METER 1,e'tW I ,e' 8W 3 $ 3W 3,e' dW NO.OF CC COND. ~ A. W. G. NO. OF HHLEG A. W. G NO OF NEUTRALS A. W. G.
EOUW. PER % OF CC. COND Of H4lEG /Of NEUFRAL
1 200 CB 1 R 1 210 1 2lft
OTHER APPARATUS: '
F'RCUER$11-3 B 2 BASEMENT TO BASEMENT
PANES~BOAB15E:1-24 C:f.R. 200
®
;3TGVE'5 ELEC(S.ALBERT$GN G~~~~
P,O. BOA 126'8
$OUxHOGbr NY, 11471 6ENERAI MANAGER
1.1
Per
This ceniticata 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.
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' B0~\FD OF HEALTH
FORMN0.1 3 SETS OF PL.\NS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT C11EC); .
TOWN HALL SEPTIC FORCI
( SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t70T`iFY:
CALL
Examine ~~-......,19~~ P1AIL To:.•._.•..-.•'•.-
App oved .~,/.3A , 19 /f Permit No..~~.1.
~~`..1.~ . . .
Disapprove a/c •~%d~~47>~C-- (~Zr~'?!.. J....... . .
I~ ~ G~~.~ G~.~......p .....4.....
i ~ uild' Ins ector)
~11
31',~ 8 0~~~ APPLICATION FOR BUILDING PERMIT ~ ~ r?
~I~'s; Date . 19~~
t~ .')N OF ta?3;1'fhri'rf.i'J '
~_„e-.. .n......,..m..w._~..,...,_.~,......~ INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of pans, 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
;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
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.
Che applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspectio '
. ~?~-:i~ .
- - (Signature of applicant, or name, if a corporation)
2
(Mailing address of applicant) ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises..~^!~:??7..~..~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which propo d work will be done. r~/:Z! u .
Mouse Number Street ~ Hamlet
County Tax Map No. 1000 Section . ,~7.".5 Block Lot l....... .
Subdivision Filed Map No. Lot...............
(Name)
3. State existing use and occupancy of premises and intended use a~nj occupancy of proposed construction: '
a. Existing use and occupancy ! ...'S~ ~ , , , , , , , , , , , ,
y////~/y~~y MQ 1 tff~ ~ "R)te~
b. Intended use and occu anc ~ ~ ~ , .
P Y : ?2-: L.. Inc-.~;ti ti. itS,;:.. .
i'r," 's a', .
3. Nature of work (check which app' licable :New Buildin V
P ) g Addition Alteration .
P emo
Re air ~ val , , , Demolition Other Work .
4. Estimated Cost ,
I~ (Description)
Fee......................................
(to be paid on filing this application)
s
5. If dwelling, number of dwellin units • Number of dwelling units on each floor . • ,
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 Depth
Height Number of Stories .
unensions of same structure with alterations or additions: Front . Rear .
Depth ....................i Hei t..........
r • gh • • • • • , , Number of Stories .
8. Dimensions of entire new construction: Front Rear ...............Depth , , ,
g Num
9. Size of lot: Front ~er of Stories : ; , ..?.~',`s .
Rear Depth ,.........:.:_~y,.........
10. Date
of Purchase ~ , . , , .Name of Former Owner .
one or use district m which re
12. Does ro osed construction viola ises are situated . .
P P to any zoning law, ordinance or regulation:
13• Will lot be regraded ..................Will excess fill be removed from premises: Yes No
14. Name of Owner of remises . .
p ....................Address...................Phone No.
Name of Architect
Name of Contractor ~ • • • ~ ~ • ~ • ~ • • ' ' ~ • Address ...................Phone No............... .
• .Address . ..............Phone No..... . ,
15. Is this property within 300 feet of a tidal wetlands ~ "
• Yes........ No.........
*If yes, Southold Tgwn 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.
~
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STATE OF NEW yyO)~I4,
COUNTY OF S~ e~~.+~.. • • . • S.
• • • • • • • • • • • • • • \ ~ ~~~.4~ being duly sworn, deposes and says that he is the applicant
(Name of individual sigmn~ contract)
rbove named.
i'~eisthe .......................~c~.'~~~e~!~.........................................................
~ (Contractor, agent, corporate officer, etc.)
~f said owner or owners, and is duly ahthorized 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
vork will be performed in the manner se,t forth in the application filed therewith.
iworn to before me this ; -
fay of. ~ . /-~t~o ~4~, 19.~.~
Jotary Public, ~~Q`: , • "F~q~,' County / ~
~ . , ~ ~ ~it'~--C 4t~aJ
TNRt~ E1A111 .
4 (Signature of applicant)
N
PECON/C BAY BLVD.
rr~Nr e~aun+N N 69° 13~E /,i/O' ruN,~ a~~umN
oni~
F2~li nl N
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~ LOI / c LOT 2 3 n~ 'n~A
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38 42' 235- ~ ~
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~ CIRCI/LdR DRIVE S<dTE ~
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RAE ES ~ A I ~ R ,
o ~ ~'/'o o/~/e o ~ V
N CLgB~ I ~ ~ ~ l
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uL 35A _ _ ~ ~ Ng,S~l4'2d~E
/Fd/ NoarR l r,=/ ~ lO.l3
~ 2ZaT
End 2 ra,l BUL KNEAD
~Ene Fecce 2RO/fe ce.,7r ~re~~e N as' P/O LOT 3 509°44"4/,E ~ .
zd /o l,ne [,°e 375°gg'40"W 23.97'-- 0 0
oL o/d wire fence PK NA/L FD ~ ~
o~"\ 20B B7' 2B Br
°sy`c°o _ ~-Ene fevrce
~PU'S~PL N/F JOHNSON / S /O±
cF,
FM#l3B/ SURVEY OF
p ~~jj SUR VEYEO 2 FEBRU4BY ;99/
F/LEO JAN l6, /993 LOTJ G, ~ P~O 3 SCALE VC''
ny /000-/45-4 02.00/ MAP OF PROPERTY OF ELIZABETH MESROB/AN
AND FOREST HILLS /MPROVEMENT CO., /NC
S/TUA7E
LAUREL, TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY.
SURVEYED FOR : W/LLIAM 7 ~ REL EN K CH/LOS
GUARANTEED TO ~ SURVEYED BYE
WILLIAM T ~ HEL fN K CHILOS STgNL EY ? ISAKSEN, ?R
FIRST AMEF/CAN TITLE INSUFANCE CO PO BOx 294
TOWN OF SOUTNOLO NEW SUFFOLK, NY, I/956
5/6-x3 /4//n//5~835~
Guarantees indicated hate on shall nm Copies of this survey map nol heanng [ t~ A .
only to the parson for whom the survey the Lond Surveyors embossed seal shall NYS _ N 77--SU~~P,
VE-"YON
is prepared, and on his behalf fo the not ba considered to be o valid true
LlC lV 442T3
title company. Govermental Agency, ev
lending instiNfion, if listed py"
hereon, and
to the assignees of the lending institution.
Gunrantees are not kansfera6le tv Unauthorized alteration or addition fo this
additional institNions or subsequent ownarx survey is a violation of Section 7209 of
the New York Siate Education Low.
{ ~ ~ - ~ s r 9/R449