HomeMy WebLinkAbout19911-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20331 Date NOVEMBER 7, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 150 SEAWOOD DRIVE SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 88 Block Z Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application far Building Permit heretofore
filed in this office dated MAY 28, 1991 pursuant to which
Building Permit No. 19911-Z dated JUNE 4, 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 SCREENED IN ADDITION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to EDWARD & ELLEN WILLIAMS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-207838 - OCTOBER 11, 1991
PLUMBERS CERTIFICATION DATED N/A
f-' - ~ _
Building Inspector
Rev. 1/81
roam xo. t
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
RHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N 19 91 1 Z Dnte .......~,1,~ 14..~,~
Permission is hereby granted to: ~
,~9!~.~~..~. .
.%~a....~.
fO Sn%~~1'~l'Z.'.
.~......r~.... ...rPln'RQi°. r~..... ..YY .:J ......:~'Ery
at premises located at ........~~Q....q..?... ........i
................................................~4~24.~r.
~.••4.'~~.,~...............................................................................
County Tox Map No. 1000 Sectioen,~.......~~........ Block Lot No....~..............
pursuant to applicntion dated ....,yl... 14..~.~, and approved by the
i
Building, Inspector.
Fee S..
.1.x(.._.3..........
~~Buil I for
Rev. 6/30/80
Form No. 6 ~ 7 cr'
[~~RrG;~,~;~, ~
TOWN OF SOUTHOLD +
BUILDING DEPARTMENT ~ ' S 1J91
TOWN HALI, pp
765-1502 L~~..~,,a._
' BLL'C~,. i?t-1''f.
' YQW[V CJF fiCYe.§TtiC7L.K;
~ APPLICATION FOR CERTIFICATE OF OCCUPANCY ,r,..,M,..,.~,,.w..~.w_.u...A>....~,
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 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' 0$1'5-.00, Commerrcial $15.00
Date V.:.+.. ~.~....4.cr.
New Construction........... Old Or Pre-existing Building......
Location of Property.. ~ f? .........5~~.GUbrIY).... ~ ~ SQC~(~191: 4..........
House No. treet Hamlet
Onwer or Owners of Property.........li-~.'.~... .......v.:!4!C,!;;e.:~X:~?!/
County Tax MapCNo~/,1~0,~0,0~, Section.... g......Block..... Z:........Lot.. ~
Subdivision.. r~.:Nw V~;!...!4~;~,,,,,,. !!.//Filed Map.......... .Lot........
Permit No.~.R ~~~,2',,,,(D((~~at Of Permit. ~./7~~I....Applicant.~ .
Health Dept. Approval..,?:.~~ ................Underwriters Approval..?~:/~.................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate... Ci
Fee Submitted: ~ ~ ~ ~
C~P,c. N~91~ -ee~k~.........
~0 ~a~~3~ APPLICANT
. <z.
.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1 Q6(1+11 A •UREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
tx:'1'OBE;R 'lS,a99] 79A~b~9U/sJCI N 7.Oistif",
note f~'41~°'kPS°' ^~~f~~:~.lrq:>
THt3 CERTIFIES THAT
only the electrlcd puipntent a. deecrlbad 6elors end introduced by the epplioewt ttemerl on the abore epplicetion number in the promises of
RDMi1Ri) itlLt,i'pMS, 1.50 SRAMARD f1R'!'ae:, Pi,.~~, 3Utl'PHC){,0, N.Y..
GAR SErtion Bloek Lot
in the follouinA loco0a0.= ~~~as~~trr99.~ I et Fl. ? Ynd FI.
tcos examined on JGG tt''1t andJound to brin compliance Eeith the requirements of this Board.
AXiUlE XTIlRlS RA COOK111D DECRS OVENS DISN W S EXNAUST FANS
OUTLETS ACIES SWITCHES INLAND!%EM PIWKIeCFNT OTHEn NAT. K. W. AMT. K. W. AML. K.W. AMi. K. W. AMT. N. P.
DRYERS RNNAC! MOTORS lIITUM AN'UANCI INFERS fMC1ALMC'fT ryA1E~gOCKS EEIL U1Mi NEAlEK tAUlT40UTIRT DIMMERS
fYSTYK AMT. wars
AMT. K. W. dl N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANf. AMT. N. P. p IRlT
{
SERVK>E DISCONNECT HOOF S R R V I C E
ttETER NO.OP CC. COND: W. A. W. G. NO. Or NEUTRALS A. W.G.
AMT. AMP. TYPE ERIR~. ~ / 7`M 1 / DW t / SW 3 / AW PER t NO. OF N4lFG Or NFIEG OF NEUTtAI
OTMR AM'MATUS:
l't,i~C tIN'FT R/C-
!~~/~~t'
NI1,lAEY H. HOLI,RQRAi & tiUtdS 6tC.i}2,567k
.102-5 CBR1~i;TUN AVk:.
i.31,IP TFSRR. , NY, i t.'14r OREIRRAL RAANAORR
Per ~
Th ificMe mutt not M oMered in airy mpmia; rNUrn to 1M office. of the Board H. incorntt. Inspectors may be_ idenYdied by tMir cnnleetiah. a
~ IN ANY Mi?NNlR.
- r
9 ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS vars. "i
457.1,'? EUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK f003H
Date CH:TOHY.N 11 , J 997 Application No. on filr 745 ~ 7091 / 97 N ::.1"i'i Yi l i3
THIS CERTIFIES THAT
s_ only the electricd equipment a described 6skrto and introdtesd 6y tlu appNcawt nortESd on the shore appBcation numher in the premises of
~;nrra~n r~z),t,z;~MS, t5o senwrim>~ nkrvr;, sol~T~ot,n, N.v.
in theJdlowinA kxotiong ~ne~s4 17UT
Si;P'PF.IIO ~3t1 19Y1? IatFl. ? 2nd Fl. Seetian Block Lot
rroa exomined on and found to 6e in cornpliancr rritk the reyuiremend of this Board.
gXTUR! RXT{MK RANGES COOKRI6 MCKT OVENS DISN fyi1SNER5 EXHAUST FANS
OUTURS ACIK SWITCIIfS INCANefSCEM FlUg1EXENT OTNEa AMT. W. AMT. K. W. AMT. W. AMT. K. W. AMT. N. P.
~ ~
DRYERS 1URNAC! MOTORS g1TUMAFKIANCE IEEDNf. fNC1Al MC71 1tMEflOCKf ~l UNIT INATlfS MULf4011T1ET DIMMERS
AMr. x. w, ar N. r. oAS N. r. AMT. No. A. w. a. AMT. AMr. AMr. AMn. TRANf: AMr. N. r. NO
~
~ unr. wxrrs
SERVIC! gfCOFBACT ttO. OF S E R - V - 1 C E
. MAT. AMP. 1TPE ~ 1 / 1\V 1 / aW ~ / t\V 7 / AW Or tC. COND. OP CC. COND. NO. OF N4LFG a NO. Of NFUl11A15 pj NEUTML
OTt1ER AFMRATUS: NR
x
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SIIC,E & I~ADF.MANN TNw'. I:IC.~36"t5-F.
l?.O.BGX 77b8
SQUTHOLq, NY, 1. i.977. OEFIERAI MANAGE!
I7
~ Per
Thit cartificaq nwsf not be alNrad in any manner, rNwn to the oNinof tlEa Yoord if incorrect. ndpacfors nwy M identified by their crod~ als.
COIFY Fdt lUILDUIG DE?ART?A6iT. THIS CERTYfIGTE A)MlST NOT 6E kLTERED IN AIAf MAlNER.
rrrrrr~ TE~I,. 7G5-1502
~05~~FOlXCOG TORN OI~ SOUTIIOL~
~ Of~PICE OP BUILDING INSPECTOR
~ ;N~
.~•r: ~3' .z [ .O. BOA 728 . .
~ TOIVN fIALL
~~Ol; ~a0t' SOUTIiOL~,N.Y.11971
7~a q~Y/
To Whom This May Concern,
We arc unable to complete your Certificate
oL- Occupancy because of the follotioing reasons.
An application for Certificate of Occupancy
/is not on file.
C70 [Jndcrwritcrs Certificate on file.
The check is (outdated/not on file.)
No 1lcalth Dept. T•.pproval on File.
No final i.ns.pccCion has been made.
Please contact our office on this matter.
Thank you for your cooperation.
13uildi.nq Permit 1 ~ ~ ~ ~ Z ~o~~
Bu.ildi.n<J Dept,
Dlo Plumber Sel.der Certificate on file. ,
( all permits involving plumbing being
i:sucd aft:cr April 1,19II4 )
r'1cLD I::SPEi.iiU~: ~~Unir. ~ ~OtKMENT° ~
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1. m ~
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FOUtJDATION (1stJ p
"1
tn~
FOUNDATIOtd (2nd) -
_ - ~
2.
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o
ROUGH FRAME & O'
PLUMBING
ti
3 .
m
ra
H
I1ISULATIOP7 PER N. Y.
STATE ENERGY
CODE
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4 . _
FIidAL
ADDITIOPIAL COMMENTS:
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ I~TION
[ ]FRAMING ` [ INAL
REMARKS:
DATE INSPECTO
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7
~~~,,2; FORM NO. 1
j ~ '4FFS3
~-=~4 ~ TOWN OF SOUTHOLD
S BUILDING DEPARTMENT
R~ ~ s MAY Z $ i991 ~ TOWN HALL
s ~ ~ ~ , ~ SOUTHOLD, N.Y. 11971
Y~ l~s_ ~ ~ TEL.: 765-1802
s.:.2;~-,.
,
Examindd° je%` 19 Appli tion ~i[o....
Approved ?~/L~~/....., 19 Permit No.. ~-O~ ~ ~ ~i)
Disapproved a/c ~ ` ~ ~
.g...
(B din Ins ctor)
APPLICATION FOR BUILDING PERMIT ~/~~p,~
Date . !K l~"..4... 2: ~ 19 ~ .
INSTRUCTIONS v
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 DepaztmenT 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 inspe ns. n~~Q.~ _
~~.~~?~.11h!J .
(Signature ofgap~pl~ic~ant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Q. 9--......:.Q.~.~~.,.....................................................
Name of owner of premises ~w c~ - " ~ ~ ~ ~ 1
(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 proposed work will be done . .
Jn~
. ~ . S.0 S ~ W O O n...,.V'~.~............. S~ U~ OL .
House Number Street Hamlet
County Tax Map No. 1000 Section/~ ~ g Block Lot ~ .
Subdivision lV Filed Map No . Lot .
(Name)
2. State existing use and occupancy of premises and intended use an-dnocncupancy of proposed construction:
a. Existing use and occupancy ...L 'L"!4 ~.~...~.W.`~!~C~r~... .
~II~ZJI~~Ie%11
b. Intended use and occupancy ~ ~ ~...SC~ ~A
I~ .
.~.lBF.~g'Nl~`al~ ptrsl
i k
3. Nature of work check which a ' ?
( pplicable): New Building , Addition Alteration .
Repair Removal Demolition ..............Other Work .
d~ (Description)
4. Estimated Cost ..~,C•'', oth~ ;Fee . ~'.4s.,~~ .
! (to be paid on filing this application)
5. If dwelling, number of dwellingunits 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 existin structures rf an Front .
g Y: Rear Depth...............
Height ...............NumberofStories.............,'..........................................
Dimensions of same structure with alterations or additions: Front Rear .
Depth ! ..Height Number of Stories .
. , ~LL.lf~~......
8. Dimensions of entire new construction: Front . 3. .Rear 3.~. i. Depth . ~ ~..T....... .
Height NurrFber of Stories .
9. Size of lot: Front Rear Depth .
10. Date of Purchase ..................Name of Former Owner .
11. Zone or use district in which premises are situated .
12. Does proposed constructiop violate any zoning law, ordinance or regulation: ~ .
1-.~... ~
13. Will lot be regraded f • ' N-k~ Will e ~ ess fill be remove from premises: Yes
14. Name of Owner of premises . Address So , 5 £aurtn~A. ,phone No:7. Ei~" .~~?'.'O... .
Name of Architect .........:.................Address ...................Phone No............... .
Name of Contractor .................Address ...................Phone No............... .
II' PLOT DIAGRAM
Locate clearly and distinctly all'~I 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.
i
it
I
I~
i
STATE OF NEW YOR,~r. ~ IIS.S
COUNTY OF , , ~ bein
~ e..~ C l~ ~ g
I1.~ l 4 . ~ ~ .Q,~ . . . . . . . . . . duly sworn, deposes and says tha5he is the applicant
(Name of individual si ning contract)
above named.
SHeisthe........~?t!~!`-Q-~rI',..
(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 manne}~ set forth in the application filed therewith.
Sworn to before me this I
...day l 19
1
3u ~
Notary Public, ~I.%~"'. Count
~ x (Signature of applicant)
~°mn