HomeMy WebLinkAbout19935-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCC[1PANCY
No Z-20425 Date DECEMBER 23, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 3780 ORCHARD STREET ORIENT
House No. Street Hamlet
County Tax Map No. 1000 Section 27 Block 3 Lot 3.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NNE 5, 1991 pursuant to which
Building Permit No. 19935-Z dated JUNE 7 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 isDECK ADDITION TO AN EXISTING ONE-FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MICHAEL LOPEZ
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
• ill~nspector
Rev. 1/81
101dJtf 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 ° 1 ~ 9 ~ ~ Z Date ~!.1...~.7 19.1..
Permission is hereby granted to:
to ....lt.~' r~.......~~11....-..~al...~~~~'..~...¢tt~I......
of premises located ot .....:~i'~~.7.1.t11
.................................................G~'~
County Tox Map No. 1000 Section ~.7..... Block .......a..~.......... Lot No....:~a?..........
pursuant to application dated 19.~ and approved by the
' Building Inspector.
Fee S.~a~.
~~~~~~~~•:G.... ~i.:...`~
. .
B ng I for
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD D
BUILDING DEPARTMENT ~~f'+~
TOWN kiALL L
765-1802
APPLICATION FOR CERTIFICATE OF 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.buildings, proper[q'liges,
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,
d Alterations to dwellin
g $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 $1500, Commercial $15.00
Date ...~~./a,G, ! y'
New Construction........... Old Or Pre-existing Building.
Location of Property.. ,7 , . Q~-~hr~K,~s~-'_ ~ ~ ~ ~ ~ ~ ~ ~ • • ~y P ~ ~
..1.1~..
House No. ~ " " " '
Street Hamlet
Onwer or Owners of Property, m,tc..y~,l'~ 2~1 , ~p(J . • • • • •
~~77
County Tax Map No 1000, Section...~.1....,..Block..~ „~,~,5,,, •
...Lot. ,
Subdivision ......Piled Map.........
y~ ...Lot
Permit No.~ { ~,Z; , , ,Date Of Permit..... l ~ ~ , , ,Applicant ~!~?~RQ~.~f ~~,~1~ST~JJ
.1....
Health De t. ~ 1, ~ ~ c~ ~ r • •
p Approval... .................Underwriters Approval.....
.~21~-..
Planning Board Approval. ; '
Request for: Temporary Certificate........... Final Certicat
Fee Submitted: $.c~ sal ~
6
F.C. L~3~c~~ 2eS•C~Pn~"•APPLIC•
~o ~ao~a5 ~ •
THE NEW YORK BOARD OF FIRE UNDERWRITERS ?ac,'•, ~
I /Y(lOt^' BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK 10038
= Date i?F:!'f:.Mt1 F'H .13,19`+}. Application No. un file 71d921ay1 /97 td ii f; }i~IQ
THIS CERTIFIES THAT
only the electrical equipment a• described 6ebrs and introduced 6y the opplirnnt named on the abode opplicetion number in the premises of
idT<,Hr~kd: I,OFF'L, s'%k10 i1RCHARL l,:Adf:, i)RIEPi'{': N.Y.
in thefollouinK hrcation: ? Basement ?x /se FL ~ Ynd F'l. Ol[I~ .Section Block Lut
una a:ermined un UF(~F.MRP:k 03,.19YJ andfoundtu br in curnpliance with the requirenrenta of this Buord.
- RXTUIE RXTURES RANGES COOKING DECKS OVENS DISK WASHERS EXHAUST FANS
OUTLETS ECBTACIES SWITCHES INCANDESCFNi. FIUORESCENi OTHER AMT. K.W. AMi. K.W. AMi. K.W. AMi. K.W. AMi. N.P.
-
- DRYERS WRNACE MOTORS NTUEE ARM1IANCE RlDEK SFEGAI EEC'?T TIME CLOCKS YU UNIT NEATEK MUITI.OUTIM DIMMERS
srsTEMs
AMi. K. W. dl N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMi. AMPS. TRANS. AMi. M. P. ~ AST AMT. WATTS
SERVIC7 gSCONNlCT NO.OF S E R V 1 C E
AMi. AMI. TYPE ESE. 1 A ]W i A ]W 3 A ]W 3 / AW NO. PER eCONO. Of CC. COND. ~ MI~LFG Of' N '~G NO. Of NEUTRALS Of NEU MAl
OTHER AMARATUS:
PAU11 R. HURI~iS I,iC.#:?f12-1':
/
2'15 TONN HARBOR LAIdF!
SGUTHtJLb IVY, 1.297'1 ou~reuMANAOu
_ it
Per
This certificate must not be akered 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.
1cLD T~;~7c~:lU~i ~~Jn'i:. I~ „U.`1ME:NT~ ~
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FOUNDATION ( 1st ) a lYl
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FOUNDATION (2nd) m
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ROUGH FRAME & 0
PLUMBING
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3. ~
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H
IIJSULATIOAI PER N. Y. `
STATE ENERGY
CODE
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F I;J A L
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ADDIT IAL COMMENTS: x
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~rc~ IIOdItD OF HEdLTH
~L~a~~~JL`.~i41y\`~L.,a'~j;~~`I~~ FORMN0.1 3 SETS OF. PLANS•••.•,•,••.••
SURVEY
TOWN OFSOUTHOLD CHOCK
5 ~9~~ r i BUILDING DEPARTMENT SEPTIC FORM , ; , , ,
`S TOWN HALL
~b.~=--.a-•~~~- SOUTFIOLD,N.Y.11971 NOTIFY
g rr.;,~: ~ TEL..765-1802 CALL
:amincd . la ~7 19 MAIL T 0 . .
pproved /,,~7 , . , 199l. Permit No. , •
sapproveda/c
(Bui ing ectod)
APPLICATION FOR BUILDING PERMIT / '
. Date lO.l~~~f.'. .'..,75.
• ~ INSTRUCTIONS
' a. Tlus application must be com letel filled in b ~ ` ~ ~`t,,~d
P Y Y typewriter or in ink and submitted to the Building Inspector, with 3
s of plans, accurate plot plan to scale. ree according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship [o adjoining premises or public stets
areas, and f~iving a detailed description of layout of property must be drawn on the diagram which is part of this appB•
:ion.
c. The work coveted by this application may not be commenced b~•r~re issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Pcnnit to the applicant. Such permit
ill be kept on the premises available for inspection throu~ltout the work. 4,'
e. No building shall be occupied or used in whole o: in part for any purkS~ose whatever until a Certificate of Occupancy
dl leave been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the ~ nuance of a Building Permit pursuant to the
ilding Zone Ordinance of the Town of Southold, Suffolk County, New Y~k, and other applicable Laws, Ordinances or
gulations, for the construction of buildings, additions or alterations, or fq~ removal or demolition, as herein described.
e applicant agrees to comply with all applicable laws, ordinances, buildinh, code, housintt code, and regulations, and to
nit authorized inspector on premises and in building for necessary inspcct~~s.
(Signature of applicant, or name, if a corpotatton)
~C)?5:~h~~~,=,~J 1J(~CfC
• ..~..e.~o.~~.s:...l~?~L.li~s~
(Mailing address of applicant) •
ite wftethe applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
~ ~-c,~ ~ ~ .
me of owner of premises .~.1C~:1G~:?:\,. ~~,r~'j",~,~,,,
(as on the tax roll or latest deed) ~ ~ •
ipplican cor i n i ature of duly authorized officer.
e and title of corporate o tcertt)''
Builder's License No. ....~.~~~~..4':~.~....
Plumber's License No .
Electrician's License No . .
'Other Trade's License No . .
Location of land on which proposed work will be done. , , , , , , , , ,
House Number Streets Hamlet '
County Tax Map No. 1000 Section ...~.e7..~... 1.. , BI ck , , , ,
Q Lot.. ~.t
Subdivision~~.'(.~.y~.~11. (~:(S. ~~r~5......... filed tlap No."~,~, Lot
(Name) ~
State existing t~se and occupancy of premises and intended ,use(L(alInd occupancy of proposed construction:
a. Existing use and occupancy a..~7A:~i ~ ~ • ~K-~.l ~ , , , , , . , . , , , .
, •.,e t P . .
b. Intended use and occupancy ~ • .I ~ ~ ~ (r . , , Q. ~ •
I
3. Nature oC tvork (check which a'pplicable): New lluilding ,
Repair Removal . , , , • • • • Addition Alteration , ,
• • • Demolition . . Other IVork . , , s ,
k. Estimated Cost ....~Y~,~~, • • , , , ~?il' , , • • . , • • , • . • (l~bscription) •
' tto be aid an 61in this a
P g PPlication)
5,. ]f swcllin number of dwellin ,units ......i... , ,
g' 6' • • • • Number of dwelling units on each floor . , , , , , ,
If ara~e, number of cars , . • •
6. If business, coaunercial or.mixdd occupancy, specify nature and extent of each tv~c of use , ;
, ; , , , , ~ ~ ~ ~
7. Dimensions of existing structures, if any: .Front ,Rear 6t,~S •
Huight ...,,.,,.,:,'.,.Nuipbarof5torles, fC Depth
Dimension$ of same sttuctura ~1ith alterations or additiene Front ~ ~ ~ • ~ ~ • • ~ ~ ~ • ~ • ~ • • ~ ~ ~ • • • ' ' ' ' ' ' ' ' ' ' '
Deptlt„~.-~.,,. ~ ..1luikht. liugr~~~~~~~~~~~~;
8. Dimensions o entire new const}~tction: Front ~ ' • ' • ' ' ' ' ' • • • • Number of Starks LgZ.-.. . , , , , , , . , ,
Height ' Rear............... Depth
• . Number of Stories
9, Size of lot: Front ~
10. Date of Purchase ~ • ~ • • ~ ~ " " " " " • Rear . Depth , •
1. Zone or use district in which } • • ' • ' ' ' ' ' Name' of FomLcr Owner . . . . . . . . . ' •
pr mises are situated , ~ ~s,,,~+;~;..?'j-t ta; • • •
2. Does proposed cons[ructiat vio~ate any zoning law, ordinance or regulation: ~.2C~.. ' • ' ' •
3, Will lot be regraded ..h1,~ ,Will excess fill b~ }~mnovcd from premises: yes) ~ ~ No
4. Name of Owner of premises(~.~4~!~?~ , , , , ,Address '7.>rQ,O,nff-h~i,SY;
Name of~Architect 3 C~~z i ~'s.~- • ..Phone No~/.~r,.~~Z~ ,f„~ Jg;
Name of Contractor, t3?~(37~~ • • Address Phone No. , ,
't~~l' rn t . rtr"~?C. cri~iJ i,~nilfec~Lp~jt
IS.Is this properCy located within •Address3.~P~dY,~~etland?n*YES.f.'?N~O•..7~7/i•
'100 :feet o t~`
*Iti yes„ Southold Town Trustoes Permit maybe required.
~ ~ ~ PLOT DIAGRAM ~ ~ ~
Locate clearly and distinctly sill, buildings, whether existing or .proposed, and, indicate all set-back dimensions from
roperty lines. Give street and block Number or description according to deed, and show street names and indicate whethef
rterior or corner lot.
Ste. 4~'-l'.YCQ~~ ~ ~ ~ ii~
a!
~ ~ ~ , ,
i,
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•
-
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y. ,
I
:1TEOF,A'EIVYOR', ~ ~ ~ ,•~,a''!
being duly sworn, deposes and says that he is fire applicant
(Name of individual signing contract) ~ • , t ,..,t;.,..
we named.
is the ~ i too ~ -~i~ ',!1 ,i
................I,..
.tor nt, corporate officer, etcJ
.aid owner or owners, and is~duly~authorizcd~to p form or have perfonncd the said work and to make ond~tile ~tltis
licafion; that all statements contained in this application arc true to the best of his knowledge and, belie f; and that the
k will be performed in the,manner set forth-in the application pled therewith.
rn to before mc'this
, ~.:..,~.njdayj~of~ . ~~,a~(!':':e-.......... 19 C~/.. , , •,t,~
iry Public.~~l4:":e~!:P2V.®/~~`'~-~ . s;
•y• Cougty
HELENS b. HORNH
Natary Publia, State of New YoHt ~ • • .
Duai(iledln3uHolk~C,ounty (Sig turcofapplicant)
Commission Expires May 22, 1 gl~
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FilroA~ CONSTRUCTION MUST f s' `'"'i~ ~
U £tE COMPETE ~ +'~'`}"~F ,o~ ; s
FOR C.O. "~~~11Fo##)) a,.
~!°I• CONSTRUCTION ltF~ IE~'1k 1 l`e r
T WE REOUIRENIENT SHR~I' MEET s ° i
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