HomeMy WebLinkAbout20291-z
~ FORM NO. 4
TOWN OF' SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20647 Date APRIL 15, 1992
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 52550 MAIN RD & 45 OAKLAWN AVE. SOUTHOL? N.Y.
House No. Street Hamlet
County Tact Map No. 1000 Section 61 Block 3 Lot 1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application far Building Permit heretofore
filed in this office dated NOVEMBER 13, 1991 pursuant to which
Building Permit No. 20291-Z dated NOVEMBER 22, 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 & ALTERATIONS TO EXISTING ONE FAMILY DWELLING
FOR COMMUNSTY RESIDENCE AS APPLIED FOR.
The certificate is issued to INDEPENDENT GROUP HOME LIVING
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-228464 - MARCH 20 1992
PLUMBERS CERTIFICATION DATED MARCH 25 1992 - G.SCHOEIVWAELDER
' di g Inspector
Rev. 1/81
108M 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 0 2 91 Z Date ....1.~~'~.~ 19~/
Permission is reby grunted o:
r P ~ ,
~ to ..1~~~. ~.u... . u.... ....a~>~P
:~:~e...... .
of premises located ot ..~sz~.c'j.--r`..~~1....1.1~.~,~...~Yy.~..,.~
' County Tax Map No. 1000 Section Block Lot No.....f...................
pursuant to opplieation dated 19.x./..., and opproved by the
- Building Inspector.
Fee s..~.~..33<.
uildi nspector
Rev. 6/30/80
~
Form No. ~i (.a,(,Q_, ~P_~2~J'~
l tOVW~ V 44JJ
~C11~'ij~'~~';
;tp ~ TOIJN OF SOUTIIOLD
~ HUILDZPIC DEPARTMENT
E ` APR I Q 1992 ~ Tol•,M lIALL
76s-lsoz
i 6 i'
lr"''`• ~ ` . APPLICATION POR CERTIFICATE OP OCCUPANCY
This application must be filled in by typecoriter OP, ink and submitted to the building
inspector caith 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 C~;mpliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 19s7) non-conforming uses or buildings and
„ o ,
pre-existing" land uses:
1. Accurate survey of property stiocoinry 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 Luilding Inspector shall state the
reasons therefor in writing to the applicant.
~ Fees
1. Certificate of Occupancy - New dwelling $2s.OO, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $2s.OO. 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 - $s0.OO
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial 515.00
Date ~v..
ew Construction........ Old Or Pre-egxisting,B~ui~lding.. ~ IJ n
ocation of Property....,~,°?:SS(~,,.,,,.(V`Ol.!;`:,.J~l,',^. ,,,,,,.,,,,5'uu~`,o/Y
House No. >1 /Street{ /i , Hamlet
ewer or Owners of Property...~'L;,~,~~,L`!.,;~'~d-e~4'^d~ ~YOOY..~y':S. ~lU/~~..........
,unty Tax Map No 1000, Section....(' I,,,,,,Bloclc...... 0:3......Lot..... ~.r
~bdivision......0O Piled i`1ap............Lot........
~rmit No..2 ~.?:![.~...Date OC Permit... ~~~.~~~(..A
pplicant.,
:alth Dept. Approval ..........................Underwriters Approval.........................
inning Hoard Approval
nuest for: Temporary Certificate........... Final Certicate...
Submitted: „
Q-er, y 3 ~ .
e 0 a 66 ~ ~ APPLICAtv'T
826 SUFFOLK AVENUE
BRENTWOOD, N.Y. 11717
BK ENGINEERING Phone (516)273-2010
- DIVISION OF EMDI LTD. FAX 1516) 273-2939
March 16, 1992
Borruto Contracting Company
446 North Windsor Avenue
Brightwaters, NY 11718
Re: IGHI.
5255 Main Road
Southold, NY 11971
To Whom It May Concern:
This letter certifies that the smoke and fire detection system with
all related component parts (lncluding main fire alarm control
panel, smoke and heat detectors and fire alarm, pull stations,
magnetic door holders and fire alarm bells) was furnished and
installed in accordance with the plans and specs and following NFPA
72A, and NFPA 72E. System was tested on Monday, Mareh 16, 1992.
Yours truly,
/ j ~
Tracey KamSn ~~e~' ;tj',a `~i,,
BK Engineering
4
- LASS PREVENTION ENGINEERS -
THE NEW YORK BOARD OF F[RE UNDERWRITERS 1
l,~~i1 ~ yr EiUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038 ,
Date 1$P`ff ~}I LB°~'~~~ Application No. on file I~.~1~4~r~~(~1 ~ ~2~a{?~
THIS CERTIFIES THAT
only the electrical equipment as described below aru! introduced 6y the applicwnt nomad on the above applicwtion number in the premises of
T.G.H.I,., 52.ri5 4tATtC Ri374.iJ, £tpCl2~'HUTIIJ, ~.w.
in thefollowing location; ~ Basement L'J /st FL ~ 2nd Ff. '~~~~r 9ertion Block Lot
P~1lSRC;H 1G,1992
was examined art wnd found to be in contplianre with the requirements (this Roard.
e FIXTURE ECEPTACIES SWITCHES FIXTURES RANGES COOKING DECKS OYEN$ DISHWASHERS XHAUST FANS
OUTLETS INCANDESCENT FLUOREECENL OTHER pMT K W, AMT. K.W PMT. K,W, PMi K W AMi N P
5S la ~3 ~2 1~ 50.1 ~ 7.3. 1 C;.ES 1 102 7 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RK'Pi TIME CLOCKS ggLL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AML K. W. Oll H P GAS H P. AMT NO, A W. G AMi AMP qMT: AMPS TRANS. pMT N P NO. OF FEET AMT. WATTS
~ L' 1
SERVICE DISCONNECT NO, OF S E ~ R V I C E
METER NO. OF CC COND q W G. A W G. A. W G
AMT. AMP TYPE EDOIP IA']W 1,6'3W ~%3W 394W pER .e Of CC COND. NO. Of NIAEG OF HI-LEG NO OF NEUTRALS OF NEUTRAL
- 1 24~(~ Cll :t x 1 3!@ 1 8/0
OTHER APPARATUS:
,y
t"i. lr. G. 1!'•I.~
aaex ~u~u~~xl z.~c.~l~z~l-ia
1;88 ICARSk3ICR Sr1tN!iwT
GENERAL MANAGER
Bf~HHM:1.h, NY, L17't.G ~ 11
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.
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AF'R I Q 1:392 e2ssuFFOucnvENUe
1~ BRENTWOOD, N.Y. 1171'1
F;9 , , Phone (516) Z73•Z010
BK ~NGINE~RINa
FNC(51b)273-2939
~ ~ DlVIS10N OP EMDt L7D. TOINIV ~ ~ '
tc~att~di TIME IN: TEST DATE: /
/~(9a--
~ monthiy quarterlq
AI)DR `S \S• e ~ ~ ~ em -annual annu
L~y~ o \y - ~-'~~j~c~Q~ ~+Tc
~5~: STATB: 2IP:. new install other
.IUit NAM . ~
C()NTRUL PANEL NAMB: TYPE: SSRIAI'/c
SYSTEM LOCATION:~~~\ _
NO. OP NO. OKAY ~`~`~~-y~.-• NO. OC NO. OK.
DEVICES TESTEllSEE BELOW DEVICES TE5TEDSLI'
CONTROL PANEL(S) ' } ~ TROUDLS DEVICES
PULL STATIONS ~ ? BATTERIES ~ ~ t/
5MUKS DETECTORS ~ (:HARGER(S) riATTERX 1 ~ ~
I[EAT DETECTUItS ~ q / CENTRAL STATION
SIGNAL BELLS IIURNS ~ ~ V? EMERGENCY LIGHTS
DOUR IIULUERS/MAGNETIC ~ ? FIRE EXTINGUISHER
CAN EQUIP. SIIUTDUNN
ANNUM. PNL
HATER FLOH5
CODE TRANSMITTERS
bOCAL FIRE DEPT,/ CENTRAL STATION/OTHER SIGNAL RECD OPRIf
REMARKS: TIME+
ALL DEVICES AND EQllIPMENT FOR TIIIS SYSTEH TESTEb ANb FOUND TO RE FULLY OPEAATIONA
EXCEPT AS NOTED AROVE IN REMARK5t
CUSTOMERS SIGNATURE: _ TITLE: DATEt
INSPECTOR'S 3IGNATUREt j ____DATE: ~3~/~~1,~~_._.
~~~~G LOSS PREVENTION ENGINEERS-
765-1802
BUILDING DEPT.
INSPECTION
[)FOUNDATION 1ST f ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[)FRAMING ~ ~ [ L
REMARKS: ~r
_ '
G
ti ~
A C
DATE ~ -INSPECTOR ~
765-1802
BUILDING DEPT.
1 NSPECTION
[)FOUNDATION iST [ ~ ROUGH PLBG.
[ J FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
i REMARKS:
ill /l'' y,L ~a~,. iGLZO ~i'~.~~t~'0 /s
i
r
DATE _INSPECTOR
~~~~i
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[)FOUNDATION 2ND [ ] iNSULATYON
[ ]FRAMING [)FINAL
/ f~
REMARKS: _L__, --R~~~
DATE ~ ~ INSPECTOR `~~-`l
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'r'OUtIDATION (1st)
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PLUMBING I
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IIJSULATIO;! PER N. Y. I . , y
STATE ENERGY `
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MARTIN GOODMAN AIA f~ r~
Architect ~~44fs~j°~ QO ~f v~Q~~°~[~
95 Commercial Street
Plainview, IJew York 11803
(516) 349-8808 DATE JOB NO
FAX (516) 349-8826 November 12, 1991 9135
ATTENTION
To Town, of Southold Building Department, Buildin De artment
PE
53096 Main Road I.G.H. L.
Southold, NY 11971. 5255 Main Road
Southold, NY
WE ARE SENDING YOU ~7 Attached ? Under separate cover via the following Items:
? Shop drawings ? Prints ~ Plans ? Samples ? Specifications
? Copy of letter ? Change order ~ Annl it fnr R1 rig Dormi t ?nri Survey
COPIES GATE NO. DESCiiIPTION
3 Drawings: A-l;thru A-7, PH-1 thru PH-3, and E-1 thru E-3
sets (Signed and Stamped)
3 Survey
) ..Blank Check (made out to Town of Southold)
1 (0 iginal) Building Department Application for Permit (Signed and Notarized)
THESE ARE TRANSMITTED as checked below: J
? For approval ? Approved as submitted ? Resubmit copies for approval
~J For your use ? Approved as noted ? Submit copies for distribution
? As requested ? Returned for corrections ? Return corrected prints ~
? For review and comment ?
i
? FOR BIDS DUE 19_
I
REMARKS
The contractor's information will be submitted as soon as the project
goes out to bid and a contractor awarded the bid. I realize that no
I
permit will be given until that information is submitted but I do hope
you will begin reviewing the project.
COPY TO SIGNED: ~ ~'~r^'~'~'sa`~~~
tl enclosures ere not as notee, ammy notuy us et once. MARTIN GOODMAN, AI'ChlteCt ,
MARTIN GOODMAN AIA nn IImo~,
r 5
r I~ I~ ~r n ~c m n
Architect Il~-LS l] 1J ~W ~tt' ll Ull ~'JWLI~~~tl,~~,
95 Commercial Street
Plainview, New York 11803
(516) 349-8808 GATE JOB NO
FAX (5ts) 349-6826 November 12, 1991 9135
ATTENTION
To Town, of Southold Building Department Buildin De artment
- RE.
..53095 Main Road I.G.H.L.
5255 Main Road
,Southold, NY 11471 Southold, NY
WE ARE SENDING YOU Attached ? Under separate cover via the following items:
? Shop drawings ? Prints (%I Plans ? Samples ? Specifications
? Copy of letter ? Changa order ~ ~pplic'~0]"~1.d9-- pprmi t anti SlirvP~
COPIES DATE NO DEECRIPTION
3 Drawings: A-1 thru A-7, PH-1 thru PH-3, and E-1 thru E-3
sets (Signed and Stamped)
3 Survey
) Blank Check (made out to Town of Southold)
1 (0 iginal) Building Department Application for Permit (Signed and Notarized)
THESE ARE TRANSMITTED as checked below:
? For approval ? Approved as submitted ? Resubmit copies for approval
~7 For your use ? Approved as noted ? Submit copies for distribution
? As requested ? Returned for corrections ? Return corrected prints
? For review and comment ?
? FOR BIDS DUE 19-
REMARKS
The contractor's information will be submitted as soon as the project
goes out to bid and a contractor awarded the bid. I realize that no
permit will be given until that information is submitted but I do hope
you will begin reviewing the project.
COPY TO SIGNED: y~r~-•ti
u enao=~.=, nor es norea, x,~mr noon ,I one=. MARTIN GOODMAN, Architect
r
{Ir°cG~e?5(t,:r'~i`"'"~1~+'~''' BOARD OF HEALTH
FORMN0.1 3 SETS OF PL\NS
~,E ~ t
4I~~~`t~_}~"_" TOWN OFSOUTHOLD SURVEY
'I I'1 NDV I ~ I99I BUILDING DEPARTMENT CIIECI: • • • " " " " "
.
, s
TOWN HALL sErTic FoRrf .
t,j':- - SOUTHOLD, N.Y. 11971
~ ` t7pL LFY
7c:,~~_'r,~ ~ ~ ~ TEL.: 765-1802
- ~ ~ c~ CALL
Examined 19 MAIL T0: • • • . .
Approved I~~Permit No...Q 9.%~ . .
Disapproved a/c
(Buil ng Insp t r)
APPLICATION FOR BUILDING PERMIT
Date ...1~./O1/ 1991. .
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 Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in pazt 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.
The applicant agrees to cornply with all applicable laws, ordinances, building code, housing c e,((((444~nd r ulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
95 Commercial Street, Plainview, NY 11803
.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Architect
Name of owner of premises Independent Group Home Living (IGHL)-Ex. Dir., Walter Stockton
(as on the tax roll or latest deed)
If appl' ims'`a~rpo 'o sfgna ~e of duly authorized officer. •
..r. .
' •(N.ame and title of corporate officer)
Builder's License No . .
Plumber's License No . ~-d~V
Electrician's License No . ) ~ ~
Other Trade's License No . L-~-~
1. Location of land on which roposed work will be done. .52550, Mai n, Road r ,Southold; , NY , , , , , , , , , , , , , , , , , , ,
?
. a-~~
~ .
House Number Street Hamlet
County Tax Map No. 1000 Section , 061, , , , , , , , , , , Block 03 Lot ~ 1 .
Subdivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Resi dence(Off i ce, , , , , . • • • 1 ~ , , , , , , , , , , , , , , , •
Residence rv,r.,,`:,,„.,:_:=,Y,a.
b. Intended use and occupancy .
^`..Q". .e
\t
I
3. Nature of work (check whiRemoplicable): New Building Addition ~ Altera~on
Repair val Demolition Other Work , ew fence ~ •
Sp inItT2N'SVStem
(~escrlpt$on
4. Estimated Cost $~•`~0.,000.. Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units Fami ly• , • , , Number of dwelling units on each floor .
If garage, number of cazs ?
6. If business, commercial or mixed occupancy, specify nature and extent of each~ty, a of use . ~ NA- r • • • r
7. Dimensions of existing structure, if any: Front . 45Y z?~: ear 44:8 ; G0:2 ,8:3Dcpth .54,1 ,20 ,12.3
27 ,12 ,10 2 1 1
Height Num~er of Stories 7.. P................................................. .
P h alterations or additions: Front 45; 2' jhousel • . • • , Rear .44;8'
• 54 j .Height 27.... 7 Num~err of Stories (house • i r • • • • •
8. Dimensions i5ent resnewtconstnYction: Front i......... Rear ...............Depth , .
Height per of Stories . ~ i , .
9. Size of lot: Front g5... um, Rear 74: • . Depth .ZOO . . .
10. Date of Purchase
1 1. Zone or use district in w}iich pre ' ' ' ' ' ' • • • Name of Former Owner .
...........raises are situated . R-O .
12. Does proposed construction violate any zoning law, ordinance or regulation: No• • , , , • • • • . • . • • • • • • • •
13. WIlI lot be regraded 'NA'. ' ..................Will excess fill be removed from premises:) Yes
14. Name of Owner of premises IGJi~.• , , , , , • , , , • , , ,Address 62• Pi ne• St; ~ • E; . Mor' g 516-878-9000
artinGoodman .,.Address 95 Commercial St.,P~~O~e~~.516-349-8$08...,
Name of Architect M. , , , • , , . ,
Name of Contractor .
15. Is this property within 3 • • • " " " " • • Address Phon~ No.
p0 feet of a tidal wetland? *Yes........ No.........
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all ~uildings, 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. i
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PCiUNL1rT1ON. .~R >ILW.F I"',PO'-px ''T,
STATE OF NEW YORK, S SI
COUNTY OF • .
• , • Martin Goodman, Archi tECt • , , , being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the......Architect
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly 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 manner sgt forth in the application flied therewith.
Sworn to before me this
....da f..!.~(/r~:2n?~1,-!.!tom...., 19~/.
Notary Public, ~~~j • • • •
~<:(i ' P'~' .County ~
SUSAN C. POIANSKY
Notary Public. State of N0W York ' ' ' ' ' '
*~o. 4639124 (Signature of applicant)
Quali?i11~1 in Nasaeu CoMnty
CommisslouL-•,nresJda ~,1 ~ '
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