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HomeMy WebLinkAbout20169-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20653 Date APRIL 16, 1992 THIS CERTIFIES that the building ALTERATION Location of Property 595 FIDDLER LANE GREENPORT N.Y. _ House No. Street Hamlet County Tax Map No. 1000 Section 36 Block 2 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 19, 1991 pursuant to which Building Permit No. 20169-Z dated SEPTEMBER 26, 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 ENCLOSE PART OF ATTACHED DECK (UNHEATED) ON EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GEORGE W. & DOROTHY I. GILLMAN JR. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-027950 - APRIL 2 1992 PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 P08M NO. A 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 ~ 2 016 9 Z Date 19.x/. Permission is hereby granted to: :~~~2.'~-~~.... ~ .......~1.-~~... ~ ~ at premises located at ....a~.~~..v`.~/...7t<aa2cur.....~ i/d~~............................................................. . County Tox Map No. 1000 Section .......c~..(~...... Block ..........r2.......... Loot No............~......... pursuant to opplieation doted 19.1., and opproved by the Building Inspector. da Fee 5~~~. ~uildi nspector Rev. 6/30/80 Form No. 6 ~ ~ ~ ~ TO[JN OF SOUTIIOLD BUILDING DEPARTPIINT TOWN HALL 765-1802 APPLICATION FOR CfiRTIFICATE OP OCCUPANCY 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 building's, 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 Plauning 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 ew dwelling $25.00, Additions to dwelling $25.00, Alterations to dcaellin X25.0 Swimming pool $25.00, Accessory building $25.00, Additions to accessor 'bu' ing $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 $159.00, Commercial $15.00 Date .....~.1..~ ~ New Construction......., Old Or Pre-existing Building.. Location of Property.... ~~J~....... I=sI~~G~~^~-, ~ fj'~lJ~'. _ . _ ~ ~l. 7--'. , House No. Street Hamlet ~ l'. , Onwer or Owners of Property.... ~~~?~~x~., lc:~„ ~~~~,~r~~' ~ .~/,~~~"~1.~~ County Tax Map No 1000, Section.... 6 :.....Block....~:..........LoC.....~ Subdivision .Filed Mnp............LoC......... Permit No.. ...Date Of Permit..?~~Q?,4./I....Applicant.(,,~'~'~t~~,+,a~',w~,l~'~~i/N~~.~W~P-~ IIea1Ch Dept. Approval ..........................U~idcrwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Pi ali Certicate. I'ee Submitted: $.......~.'JtlO /\/'~~1 ~r~~r~~ ~1~' ~ , CD ~ ~d~ APPLICANT ' THE NEW YORK BOARD OF FIRE UNDERWRITERS rAt1r 7. BN37,'7'v}7, BUREAU OF ELECTRICITY BS JOHN STREET. NEW YORK. NEW YORK 10038 Date ARf:TL tn1r7991 APPlicationNo.onflle -/C479Efr32/92 ~i ~'J,795f7r THIS CERTIFIES THAT PERPIL~P Nd' `071x97 only the electrical equipment as described below and introduced 6y the applicont rwmed on the obove opplication number in the premises of fi~~ft~i is fs ~.II L~M.Il1a .1,. y J95 ~T p7f lefi~ Ir(1.~ r 6s [l ~1'i ki l'f}I*i'~Ir L`1.~. in thefoUouinq locotion; ? Bosernent ? l•tt FL ? 2nd Fl. 7)11'T .Seftion Blork Lot u~as examined on P1AttC1l 3'n , 7.9 and found to be in conrplianee with the requirements y(this Board. FIXTURE FIX7URE5 RANGES COOXING OECRS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLE$ SWITCHES INCANDESCENT RUORESCENT OTHER bNi K W AMT. K.W PMi KW PMi K W AMi H P 2 I DRYERS FURNACE MOTORS FUTURE AP%IANCE FEEDERS SPECIAL REC'PT TIME CLOCXS REIL UN17 HEA7ER5 MULTI-OUTIET DIMMERS SYSTEMS AMT. K. W OIL H. P. GAS H P MIT. NO. A W. G AMi AMP qMi. AMPS TRANS. AMT H P NO. OF FEET AMT. WAiiS SERVICE DISCONNECT NO.OF 5 E R V I C E AMi AMP. rypE METER i EW 1 A JW 3.9 3W 31d' 4W NO OF CC COND A. W. G. NO OF Mb LEG A W G NO. OF NEUTRALS A W G. EQUIP. PER 9 Of CC COND OF HI-tfG Of NEUTRAL OTHER APPARA7U5: G.1~,C.Ys-A - s 595 ;:';fpElll~[~B LA. GI?13FN71Q1i 1' f NY f 71.994 GENERAL MANAGER s Per! 1 _ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentiols. • COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. _ lELJ is:.°.: _ .1~:i ~IJnin I~ Ci..`4i9e NT.". ~C •-o O ~ i OUI7DATION s t j ~I Y, c OUNDATI011 (2nd) m - o OUCH FRki~IE & PLUMBING H • ~ 11SULATION PER N. Y. y STATE EPIERGY I Y~l,\ CODE I - ~y ~i.~° ~ m H c f FI:lAL • I ADDTTIOPIAL COMMEPJTS: ~ - x~~ ~ ~ • x v H 21 `}V`I 9 H ~ hi O \N r H Z • - O I m H • ~ a t ~~~c ~ ~rVia ~ ~ ~ ~ ~ ~ ~ w T/4v~7 S~p - , .Q ~ _ ~ p,~~ca~.~taR~a;~~r.` ~<~jslrfs o N ~ ~~C ~ • ~V ~r ' / p. ~ / . ~ \ , / ~ j, ~ , , ~ 2~ l ~ ~ i ! ~ a o ~ ~ I ~ ~ I ~ u r , ~ ~ ~ ~ ~ j S ~ ~ ~ ~ ~ ° a~ -~f I G.P. ' - ,~j I ~ ~ ~ p'e o"° a m ~ ~ ~ ~ 1 - 'g'o - ` ~ _ . ~ ~ - 3~ ~ ~ 2 ~'4NE ~ ~ rfl I° i r II , ~ j w f'' - -I ~ CYacarrf~ ~ ~ i ~ I/ r ~~77 , I N,~TES~~ "hX/5T/NG~7~RR D~CKppA'S 57i~U1th/TEn /N t9Ri6/NfJt PL/jNS 7'//~e~ W/TN SOV' TNO L1~ ~J L.D I.-. DEp F ~PPh~I~~D E1N C/©Z~ ~6 ZG, ~i /pl~i~~ , •,13~- h.XlST/~/G l~2o~`n,/~' ~~cK 1~-S .S7"~/~U4ATED lti DG-tGrn>v}c PL1iNS -~i ~e~ wrrH S~v~i©~o l~L~G. J7ePt~~`/~Wp~mvrD eti Z /~Z~G /O`g/E7 ,r q,, / n ,l G - /K©PDSG .D F1NC~r7StJ1"E O ~ /~®2 }''7 CNb 0 ~~~/~12 U~~~ I • ~ao,~ao of xsn7.rx _ FORMN0.1 f3 SETS OF PLd775 11~ r`' ~_r~rv'~"! TOWN OFSOUTHOLD SURVEY •::;:::::i:;:: A ~ '"'-i~~ BUILDING DEPARTMENT /SEPTIC PoRM i~~ TOWN HALL S~P ,2 ~ l ~tl1~ ~ SOUTHOLD, N.Y. 11971 ~~~11~ ~ TEL.: 765.1802 , CALL Examined ~p..... ~ 19`. , . M TO Approved . f~`~/.~/....., 19 Permit No. • • . • - . Disapproved a/c / kf~~~~ t_`~ .~~/~pp-{{ . /~'~(ffB//~, SSA ! 91991 ~ y~ [J ~ ii uil g Inspector) ,may= ~;_,s et.t~~. DF~r. YO WN OF .^kOU7F{Ot.C1 APPLICATION FOR BUILDING PERMI Date 9.., 19 ~ / INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. r b, Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ,F areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 5tion. ` 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 `;call be kept on the premises available for inspection throughout the work. e. No lauitding 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 iss a of a Building Permit pursuant to the ;uilding Zone Ordinance of the Town of Southold, Suffolk County, New ork, aai~d other applicable Laws, Ordinances or regulations, for the construction of buildings, additions or alterations, r for fnoval or demol' ' n/as herein described. he applicant agrees to comply with all applicable laws, ordinances, uild' ~de, housi g c e, d r gulations, d to dmit authorized inspectors on premises and in building for necessary i s. . ..~ti .............p. " (Signature pplicant, or name if a cor ation (Mailing address of applicant) / I ~i!-~ sate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......@?t.c?G~I Er2 game of owner of premises . (.~/'~-~2G E . ,~r, G,`/?!? f3-!~, C/ ,!!O~p~1f 1., s L..L/y~71~ (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. /I/~~ , . Plumber's License No . . . d~ Electrician's License No . . h Oilier Trade's License No . Location of land on which proposed work will be done. !,C!.CvIJ.. d. j , ~O t9 ~iJ fl Ll~..... . ...............4.r....... Ilouse Number . Street Hamlet County Tax Map No. 1000 Section .1~........ Block ~.L........... Lot . Subdivision Filed Map No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed con/struct~on: a. Existing use and occupancy ..~~:?l?~G Al,~,~, D Nt .7 ~l9~1 i L~ l{W~ C ~/x/~, ~ f~ b. Intended use and occupancy (Q~/JC~, +;?~.7Z7` ~,tJC/OSir'/' UN /z 1~1~~~', p/U ~Qdf-C~ ( 3. Nature of work check whiRemoplicable): New Building Addition Alteration Repair...... 'Ival Demolition . Other Work . ! (Description) 4. Estimated Cost Q~ Fee . . g (to be paid on filing this application) s g g nits Number of dwelling units on each floor , . 5. Ifdarallennumbebofc dwellin u!,•.•••••..••..,••.•............•....••• 6, If business, commercial or mixed',occupancy, specify net re, yin extent of each ty of use . 7. Dimensions of existing structures; if any: Front .`t',7... Rear , . ~ ( ff'Z Hei ht Depth ....1..l......... g •~.....NumberofStories....~,,,,••,,,,, Dimensions of~s me structure with alterations ar a ~tions: Front . Depth JI.~~.......... Height ~ , Rear 8. Dimensions of jntiro new construe Number of Stories ~!`?i=, Cm~/,°iV~~uD, I ~ tion: Front ....,5".' Rear Depth ! j't?:...... . Height Number of Stories . . • 9. Size of lot: Front .....~.r-Q .`~~i'i Rear ......z-~,~a........... Depth ..L~D . 10. Date of Purchase 11. Zone or use district in which rem ~ • ' ' ' ' ' • • • Name of Former Owner . . . . . p p uses are situated . 12. Does ro ose~ construction violate any zoning law, ordinance or regulation : . 13. Will lot be re raded , , .Will excess Pill be removed from premises: Yes No 14. Namo of Owner of remises • • p • • • • . • • ,Address .Phone No. . Name of Architect ! . .Address • ~ • • • • • ........Phone No............... . Name of Contractor . .Address . .Phone No. . 15. Is this property within 3001 feet of a tidal wetland? *yes„• No.. *If yes, Southold Towri Trustees Permit may be required. ~ " ~ PLOT DIAGRAM ' Locate clearly and distinctly al] bui~dings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nurrjber or description according to deed, and show street names and indicate whether interior or corner lot. G~%~%~ i I II' „ j TATS OF NEW YQ~ S:S OUNTY F . ! (Nnm~f individual fining ont ac~~ Y • ' ' ' • being duly sworn, deposes and says that he is the applicant >ove named. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authori~cd to perform or have performed the said work and to make and file this plication; that all statements contained in t~tis application are true to the best of his knowledge and belief; and that the irk will be performed in the manner sat forth', in the application filed therewith. +orn to before me this ~t-~... ....day ! ,;r,^~ ,]9~t~ SU~~~_ rY .Count to Public ~ ~ ~ J, ~ t I ROBERT I. SCOTT, JR. / f~. NOTARYPUBIIC,StateWN.Y. (Signature ofap licant) NT tm FxPires~~A Y 91