HomeMy WebLinkAbout19788-z ' FORM NO. 4
TOWN OF SOUTHOLD
BtffLDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20305 Date OCTOBER 25, 1991
THIS CERTIFIES that the building ALTERATION
Location of Property 3506 PINE NECK ROAD SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 12 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
' filed in this office dated APRIL 15, 1991 gursuant to which
Building Permit No. 19788-Z dated APRIL 18, 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 RECONSTRIICT ROOF & ENCLOSE PORCH AREA AS APPLIED FOR.
The certificate is issued to RICHARD PEDDLE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTA APPROVAL N/A '
UNDERWRITERS CERTIFICATE NO. N-207947 - OCTOBER 15 1991
PLUMBERS CERTIFICATION DATED N/A
uilding Inspector
Rev. 1/81
IPOISM NO A
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N°- 19788 Z Date 1941..
Permission is hereby gmnted to:
to ~5.~!~,:::A:i!?:U:~:........s~.!Y.k.~....r.?wt~~:~:r....:v!a......af?-Qf?4. i,
s.~.~......~~ .~C?:~..
n c
at premises locoted ot .....r.a......~..~::...~.R~.(~...~.:........~..?..
3,S ~O
County Tax Map No. 1000 Section/........~.~....... Block Lot No.....~.3...........
pursuant to application doted .......1.~~.....~.~~ 19.~..~.., and approved by the
Building Inspector.
Fee S.. ~.V..:..
~.~.-C~L 0.-.........
Building Inspector
Rev. 6/30/80
. FORM N0.6
TOWN OF SOUTHOLD ~ ~~~~"~,ac~~r~,^~y~~
Building Department ~ ~
Town Hall 07~a~°~?~ , ~
Souxhold, N.Y. 11971 J y ;
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUP ' r ~ ~ 1~,} a~
'J~i, r .
Instructions ~5,
A. This application must be filled in typewriter OR ink, and submitted s~ueisa~to the Building Inspec-
torwith the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unuwal
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
r land uses:
1. Accurate survey of pYOperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner asto use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy onpre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 10.00
4.Vacant Land C.O. $ 20.00 r c,
S.Uodated C.O. $ 50.00 Date ~.7. `.1~.-.
NewConstruction,,,,,,01dorP~r-e~-existingtB/uilding VaceantLangd~/
Location of Property !°7.~'..r~!N.~.~.. • • • • .4.+~t- y!? .41.9..... .
House No. / / Street / / Hamle[
Owner or Owners of Property??7,/~.~.~":s..~`.-.~C!? !~.4.. !.4.N ~.C P.
County Tax Map No. 1000 Section Block ~°Z Lot .
•Subdivision ................../...Filed Map No. ......Lot No. .
Permit No ~ 9.?°. ~ Date of Permit '~/~~,/1i~~.Applicant .~~.?~.2 c , /P h ,
y........
Health Dept. Approval ...............Labor Dept. Approval ...i................. .
Underwriters Approval :................Planning Board Approval .
Request for Temporary Certificate .......-............Final Certificate .
Fee Submitted $ r~..3.~ .
Construction on above described building and p it meets all applicable codes and regulations.
'~j
Applicant L.•.. ~ .
Rav. 10~10~7a
C~ ~ aoaas
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1 fi rYt c 1 i
_ BUREAU OF ELECTRICITY
b 86 JOHN STREET, NEW YORK, N~ ~VI(.YO~K 110038 3V ~ tf,~+!>,7
_ Date APPlicafiott No. on file
THIS CERTIFIES THAT
only the electAcal equipment as described below and introduced 6y the applicant rsomed on the above application number in [he premises of ~
Shit, Kit:H p1{i1171d~;; 1"7,9L7 it'?"Nt; 11N',t'9{, ItiJ~;i, t;OIS'Plgitll, {v,Y.
i~fit; (P7i
in the followinK loco, iq)V' p~ #!fF1¢f ? ixt FI. ? 2nd FL. Sertion Blcek Lot
AP
L 1. I iJ~i.v
ti mas examined mL and found to be in cornpfianre with [he requirements q(this Roard.
- FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTIET$ ECEPTAGLES SWITCHES tNCANDESCFNT FWORESCENi OTNEH AMT K W AMi. K W. AMT. KW AMT K.W AMT N P.
Y dT ~ ~ tt
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ggLL UNIT HEATERS M SYSTEMS T DIMMERS
AMi K. W Oll M. P. GAS H. P. AMT. NO. A W G. AMT AMP AMT. AMPS. TRANS. AMT H P NO. OF FEET AMT WAiiS
SERVICE DISCONNECT NO.OF 5 E R, V I C E
AMi. AMP rypE METER t ]W ~ ~ 3W 9 9 3W S,a 4W NO Of CG COND A. W G NO. Of M4LEG A' W G NO. OF NFUTRAlS A. W G.
EOUIP. PER .e' OF CC COND. Of HbIEG OF NEUTRAL
OTHER APPARATUS:
- 1,{1~l"r( itilRCL„(1lYtty°i.
_ `I'(fC}I+fA;i ,f_ i9hfd, I~'ii..itiE.i'?,0)-~Ma ~
$UUI'ffOYlfi, ld~l, 1. s. r37 t, GENERAL MANAGER
_ S.f
"
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,
~~F
F
p~X~4 TEL. 765-180"'
oo oG To~rr OI' SOUTIIOLi~
:5a ~c OFFICE Or BUILDING INSPECTOR
o P.O. BOX 728
~~~y{ ~ 'tO1VN FIALL
O~OI ~a~ SOUTIIOLp, N.Y. 11971
AUGUST 7, 1991
GEORGE TERRY CUSTOM BUILDER
P.0. BO% 41
SOUTUOLD, N.Y. 11971
RE: PEDDLE
To Whom This May Concern,
We are unable to complete your Certificate
oL- Occupancy because ,of the following reasons.
An application for Ccrt-ificate of Occupancy
is not on file.
$R/ No Underwriters Certificate on file.
The check is (outdated/not on file.}
No Itcalt-h Dept. Approval on file.
No final inspection has been made.
Please coriL-act our office on this matter.
'Phank you for your cooperation.
Buildi.nq Permit it 1 9 7 8 8 Z
[luildi.nq Dept.
No Plumber So.ldcr Certificate on file. ,
( all permits involving plumbing being
issued after April 1,19II4 )
I
~~2~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU TION
[ ]FRAMING [ F~INyAL
REMARKS: `'~S
DATE ~ INSPECTOR
rss-sso2
BUILDING DEPT.
INSPECTIt)N
[ ]FOUNDATION sST [ )ROUGH PLBG.
(]FOUNDATION 2ND [)INSULATION
[ ]FRAMING [ INAL
REMARKS:
~f
}
DATE INSPECTOR
4. _
iELD II:S:'cC:iUIJ ~~Un:E ~ ~OMMLNTS
1 . ~ m ~
. y ~
FOUNDATION (1st) ~
a ~
FOUNDATION (2nd) _ _ ti~
m
c
2.
o /1+
P,OUGH FRAME ~ ~
O
PLUMBING
H
3. ~
m
IIISULATIOPI PER N. Y. y
STATE ENERGY
CODE
x
r
4 . y
~O
FIiJAL U
/ I ~
z
ADDITIOIIAL COMMENTS • m ~
t
m
' x
_ ..o .
H
~ ~
H
O '~O
Zr
x
y
x
' z d
_ _ _ ro
H
'
< E
SwuY.ano. _
u,... +.w.w. ~'h;u~+ec'7C'i~e~+9x.p¢.ik6..~......esv.•.'rwwAa:S~N
.na...,rew..~~s a+UN.c~di.
,c~-;~~',f~~~'j~~+`I!. ,i.. C.Pt.4F'Qio).P4~r~
~ ~ FORM N0. 1 a
~,r Ii66 TOWN OF SOUTHOLD
BUILDING DEPARTMENT
L~n,..~.....,..m~._...,,a~.,.-...~ ~ TOWN HALL
BLDE3. 136:{^7.
T01n,~fv c~~ ~oai~r€~sCrP..k7 SOUTHOLD, N.Y. 11971
~ TEL.: 765-1802
Examined ..Q.~.L~.P.. ~.g.., 199 j. Received.......... , 19 • • .
Approved 199 j. Permit No. 9. 7 8
Disapproved a/c
....................................ti........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT j
Date 1~./
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 arias, 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 i ections.
(Signature of applicant, or n2rhe, if a corporation)
(Mailing address of applicant) 9
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber ~`ull e .
Name of owner of premises F C h a k. /.-t. C/ L4 .
(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. 1.3 f7`~•9
Plumber's License No.
Electrician's License No. .
Other Trade's License No. .
Locatio of land on which proposed work will be donee ~.l.Q....!YJ. ~..l~~e , , , , ....v ~ v
House Number Street Hamlet
County Tax Map No. 1000 Section Q Block ~ Lot .
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premise/s and intended use and occupancy of proposed construction:
a. Existing use and occupancy ::bG'S..! G? P.~/. G.y ~p{y~_,~ .
/ >OraY'w~~ t~ ,~t~~~ .oH::_,~1 slt~c,W
b. Intended use and occu anc ~~°S. [ CYf h ~ q`: ;,,.g .
~ ~ ._a~.~,,~~ , .
~
Re air ~ Re pplicable): New Building Addition , Alrera '
3. Natpure of wo check which oval . . Demolition , Otl~~'(r)~ .
~ QQ p,! (Description)
4. Estimated Cost Fee
5. If dwelling, number of dwellin (to be paid on filing this application)
units . Number of dwellin units on each floor , ,
If garage, number of cars g... g
6. If business, commercial or mixed occupancy, specify nature and extent of each~t}'pe of use .
7. Dimensions of existing structur ,
Hei ht ..c~5~. Nu es, if any: Front Rear tiS.`I Depth . ~ .
g 3nber of Stories ~ ..,2:~.. , . , .
Dimensions of same structure With alterations or additions: Front~~.' a-1'.'~: e•....... , , ReaF '.??.."T t:........ .
De th.`J~.~.~t..........
8. Dimensions of entire new const 'Height Sz-.wF.,~ , , , , , , , , , , , , , N~mber of Stories . ~ .
ruction: Front r:~, , Rear Depth .e....... .
Height Number of Stories . .
~
9. Size of Iot: Front ~ .w~.°J Rear . 1.`7.x............... Depth . i 5:~...:.c,5:.`........ .
10. Data of Purchase .........P ~"'1 . , , , . , , , ...r~ Name ggf Former Owner t}Qr.ej. ~Z , ~?a .~t~Y, ~.L P,h.~.
11. Zone or use district in which temises are situated , t.•4e s. r dc. M . ~ i ~ .
12. Does proposed constructiop viglate any zoning law, ordinance or regulation: , G. c~ . .
13. WBl lot be regraded . , , , ~ ..Will e~ceS~s fil~~~n~ve~ premises: Yes No
rYj~ini 3'. ~.ec,,.. ~.r~... .z v i ee
14. Name of Owner of premises .e~ld•lr....... Address . .Phone No. ~(,S-,Q,~,3,'. . .
Name of Architect . .d. ~lC.r~, , , , , , , ,Address !??fit !4!7 ,Phone No.~i'.7. ~ : ,
Name of Contractor ~ e i e iz2 7 v oo y• /,.fi~ wood' 'Rol - S- z
.........Address ~oit~ryc 7l(,Gf, ...Phone No. 7('S.:. . .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and bloclf number or description according to deed, and show street names and indicate whether
interior or corner lot.
I- ~ 1y~ YL~C-C f< ']2cy fa ~
1'3 C~
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a ~ ~I' ~~h
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I ~ ' it F Me nex ` yd
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12e-wortk
J7~,d'
~i
STATE OF NE i`OR ~ S.S
COUNT F.
.t
~
~ I • • • being duly sworn, deposes and says that he is the applicant
~J/~ (lvame of individual s~ g contract)
above named. ~ j
He is the ~ ~ ` To / ; ,
a».. r. c~.G...
(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 sat forth in the application filed therewith.
Sworn to befOr~ e this
......,.da ~ l.r......, 19~~
Y
Notary Pu is . C,C.~,P County
Notay Pu
Ib I~State ofiwYb~k .~.~1?~~r . L . ^ . .
No. 4878606
Qusliflad in Suffolk County (Signature of applicant)
Commission Expires De~6er t~,16
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