HomeMy WebLinkAbout19821-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 2-20050 Date SULY 3, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 5650 BERGEN AVE. MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 113 Block 7 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 26, 1991 pursuant to which
Building Permit No. 19821-Z dated APRIL 29 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 UNHEATED SUN ROOM ADDITION TO EXISTING ONE FAMILY DWELLING
WITH NO ELECTRICITY & NO INSULATION AS APPLIED FOR.
The certificate is issued to NICHOLAS LOBASSO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
N~°V
B ilding Inspector
Rev. 1/81
i
>ro~xo.,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDINC~ PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°- 1 9821 Z Date ......ra'?..`.1.............., )9.~.!..
Permission is hereby grouted tL~o: _,oQ
c~- ...J~.t:~~:e.~s-~. ..4?~. ~ ...~:f.....
n
of Premises locoted at . 5?o Sa.......f~'ll:~r.~?:ri.....~.~!!ti?.:........~..
County Tax Map No. 1000 Section Block .....Q. ~.....p. Lot No.. D.Y
` pursyant to application dated ......~r~~.....t?~..~ )9.9.~.., and approved by the
' Building Inspector.
' Fee S••.i~~......^.~_
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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, 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.
l4} 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 P1anring Board Appraval 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 $15.00,~C°o//~mmyercial $15.00
Date ........~~~~1.f.'s.~
New Construction...x.. Old Orr~Pre-exi`st,,i/ng B,~ui,,lding..........f.~},
Location of Property..:
~.~.:S.Q..~JG~~~IY...~J f.'."?~;7~777/~/~-~.........
House No. Street Hamlet
n/ r
Onwer or Owners of Property.lY ~.e~'.~®®~~'..~~~~~'C~
County Tax Map No 1000, Section..l~~........Block....~..........Lot
Subdivision ....................................Filed Map............Lot..
Permit No. ...Date Of Permit..:s~ .L L.I~....Applicant..
Health Dept. Approval ..........................Underwriters Approval.................,.......
Planning Board Approval "
Request for: Temporary `Certificate........... Final Certicate...t!.......
Fee Submitted: $....1!J ~t~~r~il_(n'V
C~.ec,• ~~®c~,3 ~v
o a D, 0 S b ~ ~ . ~ APPLICaNT ~
o. _ tvcud,3?Y„Fi a„uRa?5 _ massra ttAfmSvtY i'
~l
THE NEW YORK BOARD OF FIRE UNDERWRITERS `'i"~'~' `
l;;nl,rl~all
c BUREAU OF ELEGTRIGITV
` ~ 85 JOHN STREET, NEW YORK, NEiW YORK 10038 '
ql°roftra? .i 19, 1991, fig s.~~f~~J!`~~! i*x ;>.,I~,f~~s'i
Date APPlicatiort No. on file '
7H45 CERTIFIES THAT
only the electrical equipment m deacrihed below and introduced 6y the app/icont named on the shove application numher in the premises of
~ lUiCf[i)1~A,5 IIOHA,;,t1, "fy$0 fSiS{tGAllti ilV'?[J(;Fl, i~A'("t'I'Pln:i<, 1~.W.
in the following hrcation• ase,m n ~ lst FI. ? 2nd F'1. Section Block Lot
Isr rtua~,~ t~~l F , ~~~+f
was exornined on and found to be in compliance uilh the requirements q(titis Board.
_ FIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COONINO BECKS OVENS DISHWASHERS EXHAUST FANS
_ OUTLETS INCANDESCENT FWORESCENi OTHER pMT. K W, AMi K W AMi KW. AML K W AMT. N P.
{ ; ~1 ~
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ggLL UNIT HEATERS MULTI-OUTLET DIMMERS
pMi. K. W. Oll H. P GAS H. P AMi NO A W. G. AMT AMP AMi AMPS TRANS. AMT N p SYSTEMS qMi WAiiS
NO. OF FEET
SERVICE DISCONNECT NO.OF S E R V 1 G E
AMT. AMP rypE METER I A, 4W L ~ 5W J 3W 3,e' 4W NO. Of CC. COND A W G. NO OF H4tEG A W G' NO OF NEUTRALS A. W G
EQUIP. PER .6' OF CC~CGND. OF HblfG OF NEUTRAL
C
i•.
OTHER APPARATUS:
t
` ~
i
t 'Pt~~i.C~I F"r)12K ,tlu;i"!'K;tl i,a;r;,#~>~~`~-Ni ,
J01MS~,SPOItT', IL<4`, 1.'I'~~i'7 6ENERAI MANAGER
t L ~
Per
This certificate must not be altered in any manner; return to the office of the tbard+f incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPAR MEN .THIS CO CER F CA E'MUST NDT'BE ALTERED IN ANY MANNER.
c1ELD '1GSP~CiiU27 IIUni~ ~ %OMMENT° y-
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FOUNDATION (1st)
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FOUNDATION) ( 2nd ) _ and ~
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PLUMBING
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It1SULATI0A1 PER N. Y.
STATE ENERGY
CODE
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FINAL Q
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ADDITIONAL COMMENTS: ~ ~
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' ~ B0,1RD OF HEALTH
FORM NO. 1 SETS OF PL.\NS .
TOWN OFSOUTHOLD "-~SUAVEY
BUILDING DEPARTMENT Ci1EC1: . . .
TOWN HALL SEPTIC FORCI
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 tt 7f-''G1.--~-y~~~~
,
Examined. ..,a°~,,1991. L}~TD:•
,
Approved . r.~.~., 199 .I. Permit No. ! . ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Disapproved a/c _ .
.1. h ~~t.. .9!~'v..
(Bui 'ng 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
seas 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-
cdtion.
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 TS HEREBY MADE to the Building Department 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,g
c~~d~~a~'d regulations, and to
admit authorized inspectors on premises and in building for necess nspe io
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is,owner,-lessee, agent, architect, engineer, ggneraY contractor, electrician, plumber or bui, Idcr~
Name of owner of premises . ~1 L~..4/Y.~~~ .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corponrante officer)
Builder's License No. ..~~~VV
Plumber's License No . .
Electrician's License No . .
Other Trade's License No .
I . Location of land on which proposed work will be done .
House Number .Street Hamlet
County Tax Map No. 1000 Section Block Lot .
Subdivision Filed Map No. Lot..,............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
,~~,,,A
a. Existing use and occupancy . ~U;M.VN . fl'cN~?. (~()1;~"lC GN, DS ,
b. Intended use and occu anc N ~ ~5 P
Repatt Removacable): New Building Addition Y....... Alteration .
3. Nature of work (check which applll Demolition Other Work .
~ ,,,~-"1 (Description)
Estimated Cost 1...~ ~ . ~.v .v
. . Fee , , , .
(to be paid on filing this application)
5. If dwellin , number of dwelling url'its . . . Number of dwellin units on each floor , .
g g
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature end extent of each t,1'pe ~ use , .
7. Dimensions of a 's 'ng structures, ~f any: Front .....(~i C>. , , Rear ~?.4...... Depth ~.5 , , , .
Height , , , Number of Stories P.n/.'.4r
Dimensions of same structure with alterations or add ions: Front ~
.....~p.4....... Rear
Depth
8. Dimensions of entire ~}ew construe Height . Number of Stories , . .
tion: Front .....~~.r..... Rear Depth
Height Number of Stories..........
9. Size of lot: Front ......../..O.p.,~......... Rear ld~~. , Depth ~ (?O .
10. Date of Purchase , , , , /~(Q, , , , , , ,Nam of Former Owner ...W F S
:4!!h':
1, . ~-!!~!~?rS;t~'~Y, , ,
, Zone or use district in which prem
12. Does proposed construction violat~ses are situated ~~~~~cc,~?~
G any zoning law, ordinance or regulation: ~Y . .
13. Will lot be regraded . I`(~Q, , , , , , , , , , ,,,,,Will exce s fill be removed from premises: Yes
14. Name of Owner of premises t~~~FQ~F1-3 ~?3 o, Address ~ Phone••~~o. Z~r,~.~.~.9.
Name of Architect ...Address ZZO. ~UC`s r, Sf'.~ ~~~ion~'IQd"~• ! I zz~, , , , , .
Name of Contractor ecy~n~S.4~ 3~~i-'~;o , , ,Address ,,{7gT0.~~v`:fS/, ~ ,Phone No. ~~;~.S~i4; , ,
15. Is this property within 30Q feet of a tidal wetland? *yes........ No..:~..... k
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block nu#nber or description according to deed, and show street names and indicate whether
interior or corner lot. I
ill
;
I
~~I
STATE OF NEW YOI~{{,
'OUNTY OF .........F~?SK S.SiI~
, , , ;cf~;o \aS ~0 0 kss ~ I , , , , , , , , , , being duly sworn, deposes and says that he is the applicant
(Name of individual signing•',oontract)
bove named. ~
[e is the . ~ `u`e!? .
(Contractor, agent, corporate officer, etc.) ~
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
pork will be performed in the manner set forth in the application filed therewith,
worn to before me this
'otary Public, Y..~, ~ e 111_, County 1~.
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