HomeMy WebLinkAbout19906-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20320 Date OCTOBER 30, 1991
THIS CERTIFIES that the building ALTERATION
Location of Property 310 ORIOLE DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 6 Lot 15.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 24, 1991 pursuant to which
Building Permit No. 19906-Z dated MAY 31, 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 ALTERATION TO FART OF SECONB FLOOR OF EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
4'he certificate is issued to ELEANOR WALDHEIM
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-207945 - OCTOBER 15, 1991
PLUMBERS CERTIFICATION DATED OCT. 3 1991 - K & K PLUMBING & HEATING.
uilding Inspector
Rev. 1/81
>rOH,M N0. i/
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°- 19 9 0 ~ Z Date .....:~";f:~/ 19.L1
Permission,s,,h~r by g~r~ant~ to:
~d
s
....~..~j .,..,...~9.
at pre ises locat d at
.
County Tax Map No. 1000 Section .....,,.'.f.~,.~........ Block Lot No.........,1+.~
pursuont to application doted .......Y./~}r...1~ 191., and approved by the
Building Inspector.
1 O~
Fee
f.G.~:..... ........:li.
L.,r
i/ Buil g Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTIiOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
t1. This application must be filled in by typewriter OF, 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 1~ 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, eeCommercial $15.00
Date ~a.:.~.R:
:Jew Construction.........qq.. Old Or Pre-existing Building..
Location of Property.....L ! p Q..~. 1 .~.L. ~-S 0 U ?'l;i;a L l~
House No. Street Hamlet
Onwer or Owners of Property.... ~:.4 ELI ;J.4.~ . . (~%.L l~//./-l L /H
County Tax Map No 1000, Section...:5.~r......Block......5~:........Lot....~5/.?-~............
Subdivision.pN,IC~.I,-f,PO fn'%. ,M~;9~D1-c)S/..,Filed Map........... .Lot...J.~
Permit No..~.tq~~.Z:...Date Of Permit.:~l:~!/~{.....Applicant....~.J.~~.~. ~e~
4tealth Dept. Approval ..........................Underwriters Approval...~.~.U..7 S
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...
Fee Submitted: $..,.~,v,/ U
U
'a.4R.. N 2 g F'~ 71
LO %~'aO~J'~,,~ f APPLICANT . .
._.....~.,_~...~......a..,~.....~....:.~.~ ~ ~
~ ;
I
,
h,~ i
~
~ TEL. 7G5•t802 ~
O ~ ~s
Ol. TORN qI' SO~JTIIOILD ~
< p~ y
~at
~F ~ ~ OFFICE OF BUiLDI1dG INSPECTOR '
w ~ 'r z TONN HALL ~ ~ "'w
SOUTHULD,N,Y.11971
~'01 ~
a~''`:
yv. ~m~p„s`1
x
3
aiyr ~ y,~r'~.1
C E R T I F I C A T I O N , Bpi
l: r~~ a.
r ,,.,1
'H~9'~~
~~~x;,
y fip~~
1 ,2~~,
Date ~O~'J~~~ ~°av
t':l
m
~F ,
Building Permit No._~~1'9O~ Z
.
Y• Owher
~`~cc~ Cock ~ '
T~~~ Y "
(please print) ~~3;
11~~
PlurSer ~ ~ ~vm~c~~ c>~c~ ~o:S~n~
(please print) ~
3
V~C(~se. x.35 ~
J
~ d
d -
~ ~ iAA.
S` ~ '
Y certify that the solder used in the water supply system ,4~.
yj~'' ~r ski
lQQ j~~
~COhthlhg ],egg than 2/10 of 1'~ lead.
Y~rre r l A .~c
a a.
~ `'~4
t;F
Y ~f/1''~~ py' .l
r r q i4,t
~ ~ Q,53°.
{plumber's signature)
:r,;E'
..,z Swor~ to befor^_ me this
.~,~day of ~o~-P.G~ i ,
19~, ~..t ~ L°D~-e-
-,f ~ c `:r`
e~.
~ Notary Lic
;z4 NOtar;r l~UbilrCr . GL Count ~4~i'l9~i~lw J. P; •~,Ic,C.NE ~;,,i
`~~i' , N6YAI3Y PU]LIC, 5fotn of Nmw Ymk ~ r.;;i
~ No. ABB2744
" tdualified to Suffolk County
' Caoa»1eeSOn F,xplnrs Jan, 20, 98
'i i
y, r
- ,
;y
THE NEW YORK BOARD OF SIRE UNDERWRITERS
,ioti~~.2
BUREAU OF EI.ECTRICITV
_ ~ 85 JOHN STREET, NEW YORK, NEiW YORK 10038
OC4"f)fi~IN :iP;,7?4i Jh1t,,ph9'?/c1 Ri S:F(')`•l~:`,
Date Application No. un file
THIS CERTIFIES THAT
only the electrical equipment as deacrihed 6e/oto and introduced 6y the applicant named on the ohove application numher in the premises of
it ii Pl c:i?., 4Yanb;t, ~!~Hb;sJ+~: }t 11it s, t(.I, tul'1'41,tn{I, n:, Y..
s
tdi'1H (I a,'P
- in tke follouinp loc~d}t'on~t~ii~ t~4Ae~~'7~ ? !st F(. ~ 2ru{ F'1. Section Bork Lot
- was examined on aged found to been curnplianee ceith the requirenteats u(this !Board.
HXTURE ECEPTACLES SWITCHES RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT fLUORESCENi OTHEq AMr K W. AMi K. W AMT. K.W AMi. K W AMi. H P
- K d "7 fi I~.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ggLL UNIT HEATERS MULTI-OUTLET DIMMERS
AMi K. W Oll H P GAS H. P AMT. NO. A. W. G. AMi AMP AMi AMPS TRANS. AMT H P. SYSTEMS AMi WATTS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMI AMP. TypE METER I RW I S. 3w J 9 3W 3,e 4W NO. OF CC. COND. A. W. G. NO Of NI-LEG A W G NO OF NEUTRALS A W G.
EQUIP. PER A OF CC COND. Of HFLEG Of NEVFRAI
OTHER APPApATUS:
~'!'T'flti AlC Fi k'~„AIT+, titilVl?)li°;It-~,
G.i'' !'.I:-2
c
S1lC;lti d~ iJAf14`n($NlV 'i'fd(. ~ 71 i : , ,y
€ T'. O. S(i>t 17fi 23
S(?U'i,'({(,fit, {,7; it+Y, 1,T 97i. GENERAL MANAGER
4 T
Per T ~
' This certificate must not be altered in arty manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
i
INSPECTORS
PrincipaltBuilding Inspector O~pSUFFO(~COG
Curtis Horton y~ SCOTT L. HARRIS, Supervisar
Senior Building Inspector o
va 2 Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector ~ • ~
d p! Southold, New York 11971
Building Inspector ~ Fax (516) 765-1823
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
September 10, 1991
DBM CO.
P.O. BOX 2130
GREENPORT, N.Y. 11944
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
XX No Underwriters Certificate on file.
XX The check is (NOT ON FILE) $25.00
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 19906-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
_-1::LD ZI:Si'~C:iu,J ~~l)niE ~ COaKMENT° ~
ro
1. ~ ~ ® 9/ ~ ~
H
~ J Q
_ H
FOUNDATION ( t)
c
FOUNDATIOIJ ( 2nd ) ~
~ / ~
2.
zo ~J
ROUGH FRAME &
PLUMBING
ti
y
3. ~
m
m
"3
I1dSULATION PER N. Y. 7 ~
STATE ENERGY
CODE
x
a
4 . ~ Cc+ . j
FIIJAL
o~ V
z
ADDITIONAL COMMENTS: x
x
H
~ UJ
77
9
H
H
O \
z
. ~
cn
• r\
H
O.
H
_ boys _ ~ ~
rs chi
b
~tC'rnn ~ ~U .
~ ~r
C Om ~ ~ ~z CJtJ~J"
o n ~ ~ ~ d ~ N `I
'CVm ~r~ y, rp
p~~ ~~0 ~ L ~~n
~ , v ~ ~
o ~ ~ ~ l7 t1i
~ x
t N ' T
I ~ ~ ~
N O -S
x~:a~ PLO U o, i ~
4~ 3 _
O. I~
„,,.w 3-0-
x ~
-t~
w~
m
I
l ~~o~
T6S-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
~ vu~~~
REMARKS: ~ ~
' DATE ~ INSPECTO ~~L',i'1
_
~O~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ]FOUNDATION 2ND [~~LATION
[ 1 FRAMING [ ]FINAL
REMAR S: ~ C~
~-'~-sly-~'~/ -
~ G
DATE ~ INSPECTOR
i
765-1802
BUILDING DEPT.
INSPECTION
[)FOUNDATION i5T [ ] ROUGH PLBG.
[ ] FO ATION 2ND [ ]INSULATION
[ ~ FRAMING [ ]FINAL
REMARKS:
` _ _
f
l
DATE INSPECTOR
r
i
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]-FRAMING INAL
r -
REMARKS
^i~~d~~~
DATE INSPECTORS
r ~ i
II
N O
~
o rn
o
dot
to
i
19733 A s
1 1 y !1~ ~ " \ /C~
I 1 C ~ QC1. ~J
1 , 1
NT6 ~ '~o
ut
~1 m~ ' ' ''9 / \
'
q s ab O~ \
O
O '
O ' \
IW
IN ' \
w ,
N 1 \
'cMO Lot 3 p65 s 248b2
c~ - 22
~f80 "
_2 ~4AWN ENCBUAONfB ,
32 W '
~ ~ S.18°46
. n
4 n TW0
dot SBCtio
t MeodOWS,
H~9hG File N°•g911
' Subdivision 'guff. Coin
tPARTN1fiN'f OF fICALTH SERVICES SURVEY FOR ,
iMIEy F~luei uNC~ of'tt.Y D.B.M. COMPANY ~ Auo. 15, i99o
LOT N0. 3, " HIGHPOINT MEADOWS,SECTION ONE II MAr 9, 1990
;ILiF1.S. RC(. N0. ~C~'.SCc'.~ APR. 3, 1990
and dater supply facilities inr this AT SOUTHOLD DATE : SEPT, e, 1989
spsctedl•ythl;Uep-lrLnentand/or TOWN OF SOUTHOLD SeA~E~ 1"= 40'
>}Ind tp l1~_saii~Ciory. SUFFOLK COUNTY, NEW YORK No 69 - 1028 ~_ry
1 _l.a.•~ C
of Wastewai2r Mana ement • IRUUTNORI:EO 4liUAiION OR AO DI110N Tp rNl! GUARANTEED
SURV[Y q A v10l ATION OF Sf CTIpN 1201 Of iNf D.B. ('n. IVPY
Nfw YDRK STATE EDUCATION LAw 71COR
M COZIES OF MH 7URVEV NOT BLAR[IO TN[ IAMD
3UR VE YphS INKEO SEAL OR ENB03l CO SEAL SNAIL ~Q+~~ Er; jO 'lfe
' NOT BI CONSIp[RID TO RE A vAUO TRUE COPY
N 6UARAN TCES INOICA iEO NEREUN SNRLL RUN OMLY TO '~O
A f•'OR APPRON4L TO CONSTRUCT TNf FEA5011 FOR WHOM THE SUMET IS PREPARED T ~ {
ANO ON HIS 6ENALF TO THE ililf COMIPANY, OOVNN-
NlOVRCE OF WATER H11 V1T[ -PUBLIC MENTAL Apt NCY ANO IE NpINO INl TtiV TION LI lTEp ~ !
ECTION OIACK l0T P 015.1 NUEON, ANO TO THE ASlIBN ECS OF TNt LE NDI NB
PITNIN 100 FEfT OF fM1 ?ROP[RTV IMS t1TVTlp1 GUARANTCIf ARE NOT iRANSFERABLf
6REON l0 A001 TIOM Al IMS TITUTIONS OR lVB SCOUINT
VE pl[POlAL !YlTCAI FUR TNI[ RtlIDI NCL R ON lTA NC[7 SHOWN NCR[ON FROM PROPCRTT UNCI ~ g?3 q
IyyS OF TN[ SUfIOLR COUNTY OOMTNENT r0 [NISTIM6 lTRUC TU R[S ARf /OR A SR[CIfIC p9 /
PURPOlE RND ARE NOT TO BE USED TO ESTiBIIlN ~ (A A• yky
IROPfRFY LINE! OR FOR FNE ERfC TION OF fENCCf
i
BOARD OF HEALTH
~ .
1, ` ~ _ ' ~ 3 SETS OF PLANS
f;~.:,. 1-, ` fORMN0.1 SURVEY
1:j;
r'';~t~i MIaY 2~l991 ~fy BUIOLD NG DEOPARTMENT SEPTIC FORM
E~ ~p ~ TOWN HALL .
t F,t..s+, ~ , ; r~ .,OUTHOLD, N.Y. 11971 NOTIFY p~'
Tu1lw,~:P ,')~3~~t~fr zt TEL.: 765.1802 CALL ~~7..~%.~.~~.....
a~~. ~ MAIL T0: ~{7~_ Z 2
Examined•.~. 9~ wy
Approved .:'~~t3.~........, 19~~. Permit No. l f .
Disapproved a/c
(B dingy Spector)
APPLICATION FOR BUILDING PERMIT
Date May 24,......., 15 . 9.l
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 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.
The 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 inspections.
(Signature of"applicant, or name, if a corporation)
P. •U.• •Box 2130, Gneen~rant,..N•.Y:...9..........
• (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
bu,i.2den
Name of owner of premises D B h4 Co.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title o/f corporate office/r) T
Builder's License No. ! 2~ . ~ 7~ ~ • • • • • • •
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. , , .
. ...EJ.l.O Q~V•~e. i7jiLve..................... S~t~tha2d
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot ~.r': 5.
Subdivision N:i-9ht~p:%t~:t• MQad{riN4 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
b. Intended use and occupancy .........~tti1'~h. llr~i~"rt•C !51?u,e,e tiw a• one ~jam~i,2y hau~e• • • • . • • , , • • , , , , , , ,
• I i
3. Natpure of work (check which a' plicable): New Building , , , , , , , , , .
Addition • Alteration X
p
Re air Removal Demolition ..............Other Work .
• .
®o ~ ~ , ; ; ~ 4 (Description)
4. Estimated Cost 000 ` . . Fee .
~ (to be paid on filing this application)
g, g,
5. If gdwellin number of dwellin lumts . Number of dwelling units on each floor , , , , , , , , , , , .
If arage, number of cars .
6. If business, commercial or mixe p y, p y
7 Hemhtsions of existing stru Nur s,~f an anFront ecif nature and extent of each type of use . .
gg Y~ Rear Depth .
g rlSberofStaries.......
De th........ s: Front Rear..................
DupensJOns of same structure µ'Ltctionr Front or addition, Rear De th
8. Dimensions of entire new constru ~ ' ' ' • • • • • • • Number of Stories , , , , , , , , , , , , , , , , , , ,
P
Height Nw~}ber of Stories .
9. Size of lot: Front Rear.. Depth
. .
10. Date of Purchase ,I ..................Name of Former Owner .
11. Zone or use district in which premises are situated......i,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
1 Z. Does proposed construction viojate any zoning law, ordinance or regulation: .
ill lot be re raded .
g p ' • • • • • Aa ill excess fill be removed from premises: No
14. Name of Owner of remises ~~13.M. GQ........... dress 443 •Mpi,vt 5~., • ,rih~~.. phone No. ;
~77 _~~~3
Name of Architect ................Address ...................Phone No..... .
y
~ ..Phone No. .
15.Is this property located within 300 fe 0,,,,
If a es o Southold Towrl• Addetsof a tidal wetland? *YES.... •
* Trustees Permit may be, required.
PLOT DIAGRAM i
Locate cleazly and distinctly alll, buildings, whether existing or proposed, and indicate all set-back dim nsions from
property lines. Give street and block number or description according to deed, and show street names and indi~ata whether
interior or corner lot. I
AP AV p AS N07ED II
II DATe: ®.R a 9 40'
FEE: D BY: T.
NpTIFY U NG DEPARTM AT
785.18Ol 9 AM Tp 4 PM FOR THE
FOLLOWING lN5PECTIONS:
1. FOUNDATION - 1W0 REQUIRED .
I FAR POURED CONCRETE
2. ROUGFI - FRAMING ~ PLUMBING
3. INSULATION
aR, FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.t7.
ALI. CONSTRUCTION SWALL MEET
THE REQUIREMENTS OF TFIE N.Y.
~aTATG CC3N5TRUCTIpN d'r ENERGV
f:CYI"lI'S. NOT RESPONSIBLE FC3R
~ r~FS1GmN pR CONSTRUCTION ERRORS
I
i
STATE OF NEW YORK
COUNTY OF ,$y~yu~kl?, , , , • S.S
....U.tta. SCho.Gvtb,~v;%n , , , , • • ,g _ . • . , • . • , • • , , ,being duly sworn, deposes and says that he is the applicant
(Name of individual si ning contract)
above named.
• Indent '
He is the ..........1~b ~scy~etr;e;n~~ • • • 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 conta{ned in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner. set forth in the application tiled therewith.
Sworn to before me this ~
.........24~h...........day of :l. ~y ..............19..91
Notary Public, , ;I Courjty U~y Su~j{oRIL
CP:Gl~tIG(71~f1;• •
NOTAR'! PUBLIC, S afu o~F PtleW York ~~~/U"~^C :
q 'r."Y~ . .
hlo. 4871?799, . .
qualified In SuNolklI County (Signature of applicant)
~ommisslon Expires Jgn. a0. 19 °~Y