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HomeMy WebLinkAbout19815-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUFANCY No Z-19867 Date APRIL 26, 1991 THIS CERTIFIES that the building ALTERATION Location of Property 55415 MAIN ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 62 Block 1 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 25, 1991 pursuant to which Building Permit No. 19815-Z dated APRIL 26, 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 PROFESSIONAL OFFICES/RETAIL BUSINESS ON FIRST FLOOR OF STRUCTURE AS APPROVED BY PLANNING BOARD & ZBA #3896 The certificate is issued to GERALD GAMBONE & KESTUTIS ZAPKUS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-051524 - DECEMBER 22, 1988 PLUMBERS CERTIFICATION DATED N/A Q~ -0 CiY WL. Ot,! Gam,. Building Inspector Rev. 1/81 roses xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF 7HE WORK AUTHORIZED) ~~~p N ° 1 9 815 Z Date .........Q~ru`~"'......~.~ 19.9 Permission is hereby granted to: ; ......~r..~. .Si~!:~:~9 .....~.~..~~~.~.~~....u.:y....t.aa.~..... r of premises Ixoted at ....~Hs~S..':~....~`~.........~4'^'.~...P-:~?.:........~1 .....1.~1..:.~.,.... i County Tox Map No. 1000 Section Block Lot No....~.:~-- 19. ~ pursuont to opplication doted ~ ~ and approved by the building Inspector. Fee 5..~..4~....... ~l' it U`.te...... Building Inspector Rev. b/30/80 E `~F Form No. V D ~ ~ ~ I+ TOWN OP SOUTIfOLD ~Y6~ U BUILDING DEPARTMENT TOWN HALL gI,DG. DEPT: 765-1802 TOWN OF&OUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. 4. `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. 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 Euildi.ng - $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 - Residentji~al $15.0~0y, Commercial $15.00 Date J~.(~~.~.~`! Iew Construction..... r... Old Or Pre-existin Building q ,ocation of Property.. J S Mf~~N, , , l Stl~~~~t, t ~ p J..... House N/o~--y~ q-~ ~ /~~5, t~re,,e{t~ ~mlet 4 7nwer or Owners of Property..4~~.-I: y:.~^}; , , ,j~-~,~-! ; Via`; \Vd 2~ :ounty Tax Map No 1000, Section...~.F'.P°~......B1ock.....~. .........Lot....... a.... ubdivision.rnrn ..................................Filed Map............Lot...................... ermit No..~.`~,~,,..,Date Of Permit ................Applicant............................. ealth Dept. Approval ..........................Underwriters Approval......................... lanning Board Approval equest for: Temporary Certificate........... Final Certicate...C`'...... ~O . a ~ ee Submitted: $ 0 ~`~9I~~ ~ ....APPLI~ T~lf 1~7A1 YORK 1lCtARD OF FIRE UNDEI!RN'RITL=R5 "A<:F ' i.Ono1.?.1. EuFEEnu OF e~ECTRRCm Et5 JOHN.STREET. NEW YORK, NEW YORK 10038 Date [JK;CFMAI'':R `1,~,1gNR APPlicetian No. on file ~i$()4()(ifiR/$Ft N (1515'l,Q THIS CERTIf1E5 TXAT only the slectrJeei ytkipmant w deecrthed 6elote end JntnKaluted hY the applicant named en the akooe applieetien wumMr iw thepromiese 4/ dY:RRY (iAMkSC7Dik; k RS:S'SI7T(S. MA7N kf)_ . iOi7K<}t,t). N. Y. ~ in thefdkrteinE ktcatbn; t fli l'T © ? /At Fl. ? End FI. Section Block Lot OK,r, N;ltBP.K 1. fi~~kR 11 ~ Trot exomined on ondfound to 6e in compliance with-the reyuirementa q/th,u uueM. N7tTUl! R MMS RAMDEi CODRRI6 DEWIS OVENS Dlfll R%MAtKT FANS OUTtETf A~'tES NCANOlSClNT P1110NtClN7 AMT, k. W. AMT. K. W. AM$' ' .C.W. AMT. K. W. AMT. N. P. DRYERS MENACE M07~S 111TIIE! APNtANq IrMf SMdAL EECFT TEN! IXOfKS EMl UNIT NMTEES IEtST4011TIR DIMMERS _ AMf. K. W, ql N. P. OAt N. P. ~ AMT. NO. A. W.O. NAi. AMI. AMT. AAMb. TEAKS. AMT. N. P. ~ AMT. WA715 SERVKiR lIEODFYi1LT lIO. p S E R p~ V 1 C E AMT. AAV. Tl4! ME1tl 1 / tw ~ tW 1 ~ TN ].I AW No. W lRC COND. OF GC ~ OND. NO. q NHF6 a~w:~ No. q NeYIKAU a 'NWIVT~IIAI 7 ,140 CB 7 X i "t/o 1 ~/i) otter APPARATUS: ~ PAIII, K. NIJI2Nti -?75 'Ph6lH::5AKH(JK f~14l4F: ~ SAI7THOLS)~, NY. a'd 971 O~AI MANAW! Ii ' L7: r"p:N?N: NO, '1,>i E Per ~ i This mutt not M edhlrod in a montlerl tMwn M fhs office f the Eoord if intwntl. Inspetbrs ba idenHffed by cndaMbh. - y~E~ ~i6R'f Of T! /~T NOT ~ AL1~ pA riELD I1:S:'~CTiOiJ ~~Un:~ ~ COMMENT° _ C 7 , m ..O a o0 ' H A H FOUIIDATION (1st) v~ ~ ~~..=.,,~~v FOUNDATIOt1 (2nd) _ 2. - - z 0 P,OUGH FRAME & ~ PLUMBING yQ~p 3. ~ mF. m Ii1SULATI0P1 PER N. Y. y STATE ENERGY CODE x a m H r FIiJAL O z ADDITIOPIAL COMMENTS: m x • ~ v~ N - ~ . m - x ro.~ ' H `~t' ~ 9 y ~ O N z ~o -f 'x m . A • - H IT1 ~ H ,a3s; htiky e;s z uM1:C~ A.~. s. A ~ 'Ni^° C3 ,t ens ~~f;.u..~Ena~.. t. ...v ;1 '+^ro ~"dP,a'+.b.~.e~'s~ Ls ,oeaw+lur a.u ?exs ..xw a,r..ri+S1X+,..cstw`tt,>s.'.. . BOARU OF HEALTH ' FORMNO.7 3 SETS OF PLA:iS TOWN OF SOUTHOLD SURVEY _ . BUILDING DEPARTMENT CIICGI; . . • TOWN HALL SEPTIC FOa:1 SOUTHOLD, N.Y. 11971 TEL.: 765-17302 1:OT I FY ; CALL Examined 19 9 ~ hfA I L TO : ' • . - . • • - • . APProved .`.-'.~t4,xlX....~~P.. , 19q~. Permit No.i y~ '1,~.., . . Disapproved a/c _ . ate.. . ........(Bui ding Inspector) ~ ? ~ ? ~ . APPLICATION FOR BUILDING PERMIT Date 19~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 hall 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 hall 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 ;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ,:egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. n~ ~ ..~V~~ (Si ture of applicant, • name, if a corporation) ~~-~r~~essq.~~~t) ~ state whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Jame of owner of premises~S~.'C'r_~~...~~~. ~S~~!'~~bVJ~....c~- ~j\u~ ~S ~ ~ t~i~,~l~ (as on the tarX roll or latest deed) ~ • ~ ~ "6• f 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 . . Location of land on which proposed work will be done. . , , ~ ~..i.~o v\"Oa ~r ~ ~.f 1 ouse Number Street Hamlet County Tax Map No, ] 000 Section Block 1, , , , , , , , . , Lot Subdivision Piled Map No. Lot . (Name) State existing use and occupancyy off premises and intended use and occupanc of proposed construction: a. Existing use and occupancy !-~t.~~`.~~ ~~f C~~O~~b~~ b. Intended use and occu anc / ~r~l vv.~lF ~ ,~i'•Ivr+~ss+~14 P y ~tr-d~,',-SSiCi^.~Fk~..~~~e~..l~~s ~ ~~p~-.2 s,AtiPIvS~6~..crSR ~QSi~~rv1~6k~ ~F~ti(ff-Lpti~ ~o2n~iDr~~O~~~m~!~..:~....... 3. A'ature of work (check which a plicable): New Building • • • • • • • , Addition Alteration . Repair , , , • , , , Removal . . . Demolition Other SVork 4. Estimated Cost . /.t} , 5. Ifdwellin number ofdwellin .u Fee.~~.•.,',.,,,,,,,,,,,,,••••••••,.••, g (to be paid on'filing this application) g,nits . . . Number of dwelling units on each floor , , , . , , , , , , , , If garage, number of cars 6. If business, commercial or xc .ioccupanc specify nature and extent of each type of use . , , , , , • . . 7. Dimensions of existing structures ~ any: Front ..~3. ~2!! , , , , , ,Rear a!.~'-. Depth .~a,~, ~r, , , , , , , Height r~.br.~!!.......NumlieroCStories..~..........., Dimensions of same structure with alterations or additions: Front Rear.....,............ g . ..Numb. Height Number of Stories . Hei ht • • • • • • • • • ',ction: Front . Rear , 8. Dimensions of entire new construer of Stories . . . . . . . ......Depth . 9. Size of lot: Front 7.~...... L Rear . ~ . . . 10. Date of Purchase Depth ,1$Z5,!,,,,,~,,,,,,,•,• « • • • • • • • • • Name of Former Owner l~a S ~ 1 1. Zone or use district in which premises are situated :ftFY7M~ , , RUS` weSS, , , ~ c, , , • • ....t. ~:c.ST.~r.tT 12. Does proposed construction violate an zonin 13. Will lot be regraded N,Q , • i y 6 law, ordinance or regulation: . Q, • . Will e~~°~~s~s till be removed from remises: Yes 14. Name of Owner of premise iZ. °~'~Addres~~`~,~;y0e~'~~~~ PT. ~ P ~ Name of Architect 1 ~V~ ~ ~.'~'-c.Ptl21'~ ^ • Phone No. `.f 71- , , , , , ~ t 5~ Addre '~.\•l• .ivvv:~,..S"-t^y ...Phone No. 7.i.k+. . Name of Con Yactor . . . . .Address , ,~s.~+;??r:Q?~T 4 Ny ,Phone No...... . pro ert w thin 30, 15. Is this p y 0 feet of a tidal wetland? ~ i " " " Yes............... If es Southold Town Trustees Permit may be required. ~ PLOT DIAGRAM Locate clearly and distinctly all bl'uildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block n~imber or description according to deed, and show street names and indicate whether interior or corner lot. ~iQv-~~~ 1~il~tr~N~,..~ C~~~o `{~3o~~lb T i TATS OF NEW YORK, ~ OUNTY OF S.SI, ~1~~ y PP ~ f~~'~- l,~ al~• • " • • • • • • , being duly sworn, deposes and sa s that he is the a licant (Name of individual signing contract) >ove named, is the .....C~.:' G.JN, ~I . . (Contractor, agent, corporate officer, etc.) ~ ~ ~ • ~ • • • • • • • • 'said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the nk will be performed in the manner sets, forth in the application filed therewith. corn to before me this i .....day of..., ....19 ~ ~ Mary Public, , . ,\Q,/ • "~•~r•~:-County JOYCB M WIt.KINB • ' p~ Publb, 8tsU of NewYak • ' / ~ ' ' ' . No. ~67t?i~. BuHaH<t fbu ~J (Signature of applicant) Tam EMpIrN JuM 12,18.~r