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HomeMy WebLinkAbout19701-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 . Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20517 Date FEBRUARY 3, 1992 THIS CERTIFIES that the building ADDITIONS Location of Property 885 ORCHARD STREET NEW SUFFOLK, N.Y.y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 5 Lot 41 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 28, 1991 pursuant to which Building Permit No. 19701-Z dated MARCH 8, 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 ADDITION & FOUNDATION UNDER EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to UBALDO GONZALEZ M.D. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-212503 - NOVEMBER 11, 1991 PLUMBERS CERTIFICATION DATED JAN. 31, 1992-PERFECTION PLUME.& HEAT. ~tiv ,l/./~..i Building Inspector Rev. 1/81 rows xo. 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) 0 N_ 19 7 O 1 Z Date .........3~~' 19..9.1. Permission is hereby granted to: ..........~:~-~...-~r...~~,.. ....~1.: ~ . . .........~-,~~:,.::~.:..J.:. pa j . „j of premises located at ...............Q..A County Tax Map No. 1000 Section ...f1.7........... Block ....JA.~ Lot No.......~'!........... pursuant to application doted 19..1.., and approved by the Building Inspector. Fee 5...~SP.J~.d : n~: ~ 7s, o-d ~3) rrl9 ~ r wilding Inspector Rev. 6/30/80 a~~' l 5 L I ~pry~ TOiJN OP SOUT[IOLD ~Cl1~(~ ~3.01OYf. "r, BUILDING DCPARTCICNT 1't~" ~ x,.~9 TOWN HALL r~'t.~t1~~._.., s °..-~^._...E 765-1802 APPLICATION FOR CGRTIPICATC OP OCCUPANCY 1. This application must be filled in by typewriter OP, 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 L'oard 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. G. Submit Planning Board Approval of completed site plan requirements. .i. 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 sCate the reasons therefor in writing to the applicant. 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 J. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00,r~Commercial $15.00 Date .....v;{F~:i..2-: •!•t.~.~ '%cw Construction........... Old Or Pre-existing Building, /-},QJr~Cj;f7`~ „ ' Locacion of Property...~~.?-.. ~':~.?n-~..:f:~:~....~aw, ,r~l~L~....~1 ~d House No. S trcet Y El;imlet %n4cr or Owners of Property........~~.'. n y~ Limp ..~Q:,.~..rei~..) ~,1 %:uunty Ta:< Map No 1000, Section.... 1~.~......Block..., ~;~,,,,,,,,Lot..... ;ut~divlsiun ....................................Filed hE;ip............Lot............... ;'crmlt ::0...1.~3.~,~~;Date Of Permit ................Applicant... U7.~?~„70~t~~....... 'ic.~lth Dept. Approval ..........................Underwriters Approval......................... .'1.inninB Iioard Approv:il •%oqucst for; Temporary Certificate........... Final Certicate...~...... ~'cc Submitted: GZ~ee,' 433 0 ® i,~(x~ , . . en X05 i ~ AP LICAN~' ~ ~T rr _ _ d , - ; 45 MAW YORK OF ~ l#N~ERWRITERS F.ttlltiiF:!yl /KNIi/tU OR R{kECT14CFTY ~ JCMN $TREt"t. NRYV YORK. lIRMt YORK f003H Nt?V F;~MH$R 1:1.t 4H~i ~PPJkk~No. onfi4 iti:: ~t~ t/y~s « ..+i'•~)? r~ Tins C®RTIFIES TNA? otJy the ehrteiwl ~ 1iucribotl6elRte ewd JMtrrre~l6y the epplic~wt wowtod ew tAe show orpliadaw wutw6or iw elt.rtetwi.w o UN.. ~(it47. Si{r}P/.; tf'L$ .)KC N~a kl. fi 4 ~ K0.i~;'f'. iu ;•;N tiE~,+M'U hn ry ~ ~ is thefetferinR location; ®Bwement f?' lAt FI. ®fnd Fl. Section Rrloeh Lot Ni)VN:MHN;fi 04, 1.941 teas examined on aadfound to 6e in canep(fence Leith the reyuirementA of ehiR-'Beard. f AC{Rt fM1TCNlS M FMIf aV~OC:eM OTNEM AMT. K. W. AMT. K. W. AMT. R.W AMT. R. W. AMT. n I. :i 4 is 1,t ri rerMS t1~thC! RM10Ri Iwur.RUeneswwwc RRC'?t1IIfflgOCltfYU tNd111M ~iWMMC- AMT. K. W. dl N. t. GAR N. I. AMT. NO. A. W. G. AMT. AMT. AMT. AMIt. AMT. N. r. AAtt. WATTS y - flMeC4 RMCCWMCf M9.:p f [ R V I C -l.. - _ _ ~ AMT. AAV. me T / m ew a i tw t.e ew a. eeoNO. ~ A.+ ~ NO. w N41lfi A.. ua a NtNMLS ~1 i 71Uii Ckl "1 ,fi ({u </.il 01168 AN'hRATUS: - MU 1')RS. i.--i).'l5 N.r', t ~ 7,'RLpNG;~Yti ~~F;C'r8li; ,_..;3iy;l,. y.o.~s«x ht oN~~ r+wrw Per Thit a M tiny fir; rMwn to ~(fiut of tha N.. . ~juFFO~'~+ TEL. 7G5-1802 .a o., Totvrr or sou~~o~,~ ~ •'t' : < OFFICE OF IIUILDI2~IG INSPECTOR o • ~-}r~ cn Ems'' :;I~~~~k, %T P.O. BOX 728 c?, r z TONN HALL %bQZ' SOUTIIOLD, N.Y. ] 1971 C E R T I F I C A T I O N Date Building Permit No. /~17G~ Owner G~C3/jG(~O C->on za JrS' (please print) Plumber c,~~eT~ ,~~~~6h~/~~~;n~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. ~ (piumbcr's signature) Sworn to before me this day of I9~. ~ ~ tlotary I>ublic, tar`I Public ty p~y.ICYCH M. WILKINS Term Expirp,JuM f$~ INSPECTORS T~"`tt'`~z PrincipaltBuilding Inspector ~ ~~q~~~Ta[~~~~ Curtis Horton ~ V ~ SCOTT L. HARRIS, Supervisor Senior Building Inspector d ' v~ ~ ~ Southold Town Hall Thomas Fisher w• , ~ w P.O. Box 1179, 53095 Main Road Building Inspector ~,ys ' ~ Southold, New York 11971 Gary Fish ~ ~~'1 ~ ~ ~A~ Fax (516) 765.1823 Building Inspector ~~r~ Telephone (516) ?65-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD JANUARY 13, 1991 UBALDO GONZALRZ, MD 885 ORCHARD STR&RT NBW SUFFOLK, NY 11956 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: 1QCX An application for Certificate of Occupancy is not on file. (Enclosed) gRg No Underwriters Certificate on file. gXx The check is not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. x%x No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 19701-Z Please contact our office an this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Wit= ~ F:'1~I,J I.: S:'°C:iUIJ ~~UATF. ~ COZv1MENT° 1 1. % ~ ~ O s r-i ~ FOUfdDATION (1st) c ~ ~ b FOUNDATI0IJ ( 2nd ) _ ~ p 2, j 1 ROUGH FRAME & ~ ul PLUMBING s1r~.,r ~ .f a H 3 . ~ ~ ~ IIJSULATIOPI PER N. Y, ~ • • STATE ENERGY m CODE F' x >r FIiJAL p~ L A z ADDITIONAL COMMENTS: _ x ~ ~ ~ ~ _v . .~.3 ~ ~ x ~ ro H b z olc, ,l x m O A y r C H~ Z d.~ R7 ^o H r~~~~l rss-lsoz BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ) ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION ~RAMING [ ]FINAL REMARKS: ~ 1 NSPECTOR DATE 1 '~"~-I ~~70~ T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: c DATE / ~ ~ INSPECTOR 765-1802 BUILDING DEPT. f NSP~CTiON [ OUNDATION 1ST [ ) ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [)FINAL REMARKS: Q, ~ o ~oryy?~ ?,,^D DATE ! ~ j INSPECTOR /v ~,i C 765-1802 BUILDING DEPT. INSPECTION [ ] FOWNDATION 1ST [ j ROUGH PLBG. [ • ] FO ATION 2ND INSULATION FRAMING [ ]FINAL 'REMARKSs ~ - f - DATE ~ INSPECTOR i l9~©/~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: Cdr i f r f k! I DATE INSPECTOR f I 765-1802 BUILDING DEPT. INSPECTION [ )FOUNDATION i5T [ ) ROUGH LBG. [ ] FOUNDATION 2ND NSULATION [)FRAMING [)FINAL REMARKS: a ~ f~ -~~u`_`7-_ rte' ~ d ~ Gf r_~- a DA ~ ~ INSPEC 3 r ~ x m ~ n~ r,: ° ~ 'C 3 Q 0~ ~ CD ~ ~fJP~~ l "`)~fJ O T 1' ~ G.',~r ~'A.{d.~~ S 3 lJ ~ ~ 3 ~j ~tv.~r ~ .-r ~.a~... ~ Al ~ h ~ ~ ~ ~"~~"~~-~~`~~~~%;y , O SU ~ ~ ~ CD n ~ N (Q 7 O - n ~ C ~ N O n ~ ~ • N N ~ ~ O ~ ~ O =''~~CD Qom m ~ E N O n~~ O z `°oc~n~m~~ mCD as ~ ~ ~ o m ~ < ~ m ° o-°~ x hm~ -G a m~ ~m ~ O z O n~ n .~'cn ~ T ~ c~~~ ~ r+ ~m~'cC~~ C7 m CD ~ ~ '-r ~ ~ ~ ~ ~ ~ C7 ~ ~ O fA ~ ~~~~rcn O o ~ ~ ~ O ~ CAD ~ ~~:~~~Q i , L~ ~ B0.1&D Of HEALTH ~9A~pe/ ~'~3 J SETS OFjPL.IYS•.?••••••• frG~~##~~ii1l ~ FORMNO.1 SIJRVEY ? TOWN OF SOUTHOLD CIICCK ~.l BS,.• _ _ _ BLDCi.DEP7: BUILDING DEPARTMENT SEPTIC fOR:I • • • • • ~ ~ • . ' TrWN OR SOUTH04D • • . . _ TOWN HALL • SOUTHQLD_ CLL.Y_ 1t~7i t70T I FY ; 1 ry / TEL.:705~1II02 CALL Examined ..5-!//........., l9 91, PIAIL TO: S')S.d~~-r~ • • . z7 f~' C~ / ~ ~ A Approved Y~°, 19 / Permit No.. [9~®~~; . .~~?ir/,~y~J~L . Oisapprovcd a/c . ( uG'eling Inspector) • • • • • • • APPLICgT10N FOR BUILDING PERM (T Date °'7.~~'----..... 259 INSTRUCTIONS a. This application must be completely fiIIcd in by typewriter or in ink and submitted to the Building Inspector, tviL` sets of plans, accurate plot plan to scale. Fee aa;ottling to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public strc: ar areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt :anon. 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 appacartt. Such perr. hall be kept on the premises available for inspection throughout the work. e. N~'building shall be occupied or used in whole or in part for any purpose whatever until a Certi[icate of Occupant hall have been scanted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building pe^it pn:rsant to t: 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances 2c.ulations, Cor the construction of buildi~ss, additions ar alterations, or for removal or demolition, as herein describe: fl:e applicant a__^rees to comply with all applicable laws, ordinances, building code, houstn, code, ana rcgu:auons, and t dmi[ authorized inspectors on premtses and in building for necessary inspections. ~gay9.rCe • •(Signature of applica~t, oY name, if a corporation) • .h'fs_ 8~-off~~~•S7• /1!¢w;fuFF~~iz/1;.Y._I15,t6 (I.Iailing address of applicant) hate whether applicant is otvnet, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .0w Ker' dame of owner of premises , V pd,/}eDO• • C.~ onlzR G;= 2. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. ' • ~ • • • • • (Name and •title of corporate officer) ,~do36 H~ Suildcr's Liccnsc No_Z.1L~.1~ • ~ Lys ~tri"4; , v O $Sy {{Z. Plumber's Liccnsc No. J'c ~t~e~„ o~l ~~19 Electrician's Liccnsc No~~~~~,~j~t. ; ;'J• c~~g7~ - ~ Outer Trade's Liccnsc No . . Locat~~iyyon o(IanJ on which proposed work will be done; ....9.~s O R:.~!~:2.9.. S r2£L'~. Ill `c' u~ J'u FFOL ............./1 Ilousc Number ~ "'"N"~`' Strcct Hamlet County Tax \tap Na. 1000 Section ......f ' Bluek ...,5 Lot.. 4 ~ Subdivision • ..............(N:uttcj F.il~d >\1ap No. Lot 0 Stzte ccistin^ use and occupancy of premises and intended use and occupancy of proposed construction: A. Existing use and occupancy..... ..Q k: .~~vh1 ~ ;I~b. • . sE B. Intended use and gccupancy • _ ~ 3. Nature of work (check which applicable): Ncw ?uilJing , ~ , _ Repair RFmoVal • Addition +~t~r+~ . . Tennis Court • ~ ~ • • • • • • • • • • • • • Demolition ,Sai:nni poo ~ Accessor g 4. Es2imatcdCast,,,,,,••(• ,QcD,c7, y IIuildin .........Fence .......Other Work.., ,ti~'•"•`"$~ ' 5. If dn•cllin„ number of dwcllin^ units , , , ,U~, y e- J ~ (tn Uc paid on filing this avvlicauon) (A/"~~~ Number of dwelling units on each floor. <'J'ot~~, , , If garacc, number of cars . 6, if business, commcreial or mixed',occupancy, specify nature and extent of cacti type of use . , ,,'Yq , • • • ~ • 7. Dimensions oC existing structures if any; Front , , , , ,~,'z , Hci;ltt Rear ../~.7.......... Depth • Nuntticr of Stories , „"'cr., , Dimensions of s~me structure tvit)t alterations or additions: Front • , , • - ~ • ~ ~ ' ' Depth ~ Height ......7s• Rear . 8. Dimensions of entire new constnt~ction: Front , 2 • • ~ ' ' ' ' ' • • • Number of Stories , , Height , .`L'....... R~aar 2 :7:........ Depth , :zr.7,,.~3... -.,.,,NumtierofStorics. 9. $!ZC of let: Front It a.Q l o~ . `e% . 10. Date of Purchase ' ' • • • • • • P.car . Dcptlt .....,~y~t,•,~Ia ................Namc fPo c~rOwncr ...n`.~.4»:k~..gt~1.~~?^^."?r..... l 1. Zone or use district in w ticlt prerrises arc situated IZ. Does proposed construction violate a,ny Zoning law, ordinance or rc~~tian: • 13. 1Vi11 lot be regraded .......Y?ry'.. H~ • ..1Vi11 excess fill be removed from prcmisrs: Ycs . y~ 14, Name of Owner of prcmises• . _V b.a.~eGe .~,~•quj,s~ f g - _ Address tI o t;-"! t Name of Architect _ 7 II 1~--•~~`)~p• •Phonc No..?7.Y. •7. Name of Contractor . ' • ' • • • • Address ......:~°f:•';*".~j~f/<, , , ,Phone No . 15_Ls this ro • • • • • • " • • • • • • Address ..Phonc No.. p party loczt'ed within 300 feet of• a tidal •weCland? *YES....NO.~. *If yes, Southold Town~Trustees Permit may be required. • PLOT DIAGRAM Locate clearly and distinctly all tjuildings, whether existing or proposed, and. indicate all set-back dimcnsior. t: property lines. Give street and block number or description according to deed, and show street names and indicate tv::_::. interior or comer lot. ' • i • TnTeor-~e~or~~ 'OUNTY OF. 1~... S.S l3r} Do oivz ~ ~ Lit Z ~ ' ' ' ' ' • • • • • • • • . • being duly sworn, deposes and says that he is the applir_: (i\amc of individual si^nitto contract) love named. c is the , , , , , ~~~F.~? - (Contractor, agent, corporate officer, e[c.)• • . • • ~ • • • • • • • • • ~ • • • • ' said owner or orvncrs, and is duly authorized to perform or have pcrtormed the said work and to make and Gic tl: 'vlication: that all statements contained in this application arc true !o the best oChis knowicdgc and belief; a'nd ttta[ t:: ork will be pcrl•orntcd in the manner sat forth in the application filed therewith. °om to hciorc me this I • .day of . , ;f- 19~,J, • nary Public, v c~~QQ~~~~ unt ' CLAY{~ L" QLTW Co y Notary Publla State of New Yak n ~ Na.48796061 tY llualified)o Suffolk County G'2 ~j' • ' • ' ' ' • • • • • • • • • • - • • - Cemmiaslon Expirea December 8,16,.0. 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