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HomeMy WebLinkAbout19854-z FORM N6. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20930 Date AUGUST 12, 1992 THIS CERTIFIES that the building ALTERATIONS Location of Property 38910 MAIN ROAD ORIENT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 015 Block 8 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 7, 1991 pursuant to which Building Permit No. T9854-Z dated MAY 14, 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 ALTERATIONS TO SECOND FLOOR & INSTALL BATHRQOM ON FIRST FLOOR AS APPLIED FOR. The certificate is issued to MARTIN BANCROFT JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-206509 - OCTOBER 3, 1991 PLUMBERS CERTIFICATION DATED AUG. 10 1992 - PERFECTION PLUMB.&HEAT. ui ding nspector Rev. 1/81 tOEM 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°- 19854 Z Date ~.f.~ 19. Permission is hereby grouted to: _ at premises located at ....~.~.~.~.lQ.....~r~~..-.GC!f...... / ...............................................~.Y~.~:~~~.............................................................................. County Tox Map No. 1000 Section 6/~.P..`..+/.,.r..... Block Lot No....`..-~~..~......... pursuant to application doted .........::r~...,l.:~f..~ 19./.,1, and approved by the Building Inspector. i Fee 5.........°~.dl. - Buil g Inspector Rev. 6/30/80 r Form No. 6 CT~~`~~~-~~`~~~ .tii1 ~ r,: E~~ TOWN OF SOUTHOLD AUG3;11992 ~,y¢¢i, BUILDING DEPARTMENT ~ { t:, TOWN HALL _ _ _ y,4~~~~ 76s-laoz ~....._........~z--~ ' 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, street:;, 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 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. 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. Zf 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 $1Q5'.00, Com//{nercial $15.00 \x/ Date U./~ ~ . New Construction... J.l. gO1ld Or Pre-exist~ji~nfg Buildin Location of Property.. .116............1.~~1.~...~.,~'...........~~.~.~~~........... House No. Streeet T Hamlet Onwer or Owners of Property,.~~1.~~1,,.~:..~A;VCR~~,!,,,~,~~~~ County Tax Map No 1000, Section..~.~ :~.....B1ock........~......Lot....:~ Subdivision ....................................Filed Map............Lot...................... Permit No ................Date Of Permit................Applicant............................. health Dept. Appxoval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: $ eo ~a~y~o - .APPLICANT SUFFDU- ~ TEL.7G5-1802 o~l!-~ C~l~ TO~1N OT'' St~iJTIIOI.PJ • l.,:" `~,,ry;.I. OFFICE OF BUILDIIQG INSPECTOR ~ r•. . c°n ~ ~~~~k; P.O. BOX 728 e`+ TOWN BALL °!o`b0~' SOUTHOLD, N.Y. 1 1971 C E R T I F I C A T I O N , Date ~/d 9Z Building Per/mit No. ~9~5~/ Owner / l! ~~(p~ (p tease print) ~,,c P1u.;.ber~~~~fo,~ ~~Uryl6/179~~1~FC!/i//g (please print) ~ I certify that the solder used in the water supply system contains less than 2(10 of to lead. • ~ (plumbcr''s siynaturc) Sworn ..o beforo ~ this ~ ~ tlotary I>ublic, ~ k Notary Public~"- _ c~~_County ClgIRELGLEW Notary public, State of New York No. 48'79505 QuallRed in Suffolk Cou tt~~ Commission Expires December 8 19L.~~ THE NEW YORK BOARD OF FIRE UNDERWRITERS. A {Ij1i11~1ri BUREAU OF ELECTRICITY " 8S JOHN STREET. NEW YORK, NEW YORK 10038 Date QC9'OHl'. {2 f11 i'I N9J APPlieation No. on file '~'$~4:2p?~,{~T#~ }Y ~(3 {'i?:13 Ti THIS CERTIFIES THAT only [he electrical equipment as deacrihed below and introduced 6y the Applicant rwmed on the shove application numher in the premises of I~~'d'"1'tti )3t\~iGR.ON"P Tf~, 3it9,4,n N(At.i ~<tAll, O4?1'.kN'S`; Yet Y.. k ? /xt F'l. ~ 2nd F'l. Sertian Block Lot 3 in thefollowinq locption; ?Basement t~}}7th was expmined on and foundW he in compliance with the reyuirements q( this Board• FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH ASHERS EXHAUST FANS OOUTLETS INCANDFSCENi RUORESCENT OTHEn AMi. K W. AMi. K W AMT. KW. AMi. K W AMT. H P 1 I ~ I (I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS AMT K W. Oll H. P. GAS H P AMi. NO A. W G AMT AMP MIT. AMPS TRANS. AMT H P NO. OF FEET AMi. WATiS SERVICE DISCONNECT NO.OF 5 E R V I C E " AMT. AMP. TYPE METER I PW L a. 3W J.e 3Yk ~A' dW NO. OF CC COND A. W. G. NO OF HbLFG A. W G NO Of NEUTRALS A. W G EQUIP. PER 9 Of CC. COND OF HbLEG Of NEUTRAL OTHER APPARATUS: , Ci,F.(:.7:~:~ 1. _ r~ 5. ~~~~~~~`;~l~ t ~i'I'P;V?~'S Pad';CiS.p~LNRR7,'4(7N 1,LC.#.il`~~°"P; P.O. RL)X 7?.GM € C<H('i'f((1T,tl, 4d~', 1'{97'1 GENERAL MANAGERf ' '.l Cy 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 ANX MANNER. i ~1c;LD II:SP~C,i01J ~~llAiE ~ i;OM NT° ro ~ m t. " ~ FOU47DATION (1st) c m FOUNDATI0IJ ( 2nd ) - (/~.a 2. < z p„ O W ROUGH FRAME & O PLUMBING H ~ ~ 3. 'y c~ m I1ISULATION PER N. Y. y STATE ENERGY CODE x~ a . ~ ~ `°__._i y FINAL y ~ _ ~ o z ADDITIONAL COMMENTS: ~ cn x ^o R m \ H H O Z 1 . ~ m A • r H \ • x d ' [7 b H C~~~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ SULATION [ ]FRAMING [ ]FINAL REMARKS~:,/ c~~.~,, y,~ DATE C~' / ~ INSPECTOR ~ - Pf VVV 765-1802 ~UILDING DEPT. INSPECTION [ )FOUNDATION iST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: © R k I I ft ~ { f i, E C DATE O ~ INSPECTO BOARD OF HEALTH FoaM NO.t 3 SETS OF Ph1NS SURVEY ,l TOWN OFSOUTHOLD CHECK BUILDING DF,PARTMENT SEPTIC r•oarl TOWN HALL $0UTHOLD,N.Y.11971 NOTIPY~ TEL.:705.1II02 CALL Examined.~.,l.'.~.......,19.~~./ MAIL T Approved 19~~ Permit No. ~ , ' A 93~ Disapproved a/c . ~ a"-~ _ 1 ' ~ MAY - 71991 , r,~ ~t uild~ nspector) ~ ,f~ - , APPLIC TION OR BUILDING PERMIT ~~l`_~~~`'~.~' i ~'r>i Date ...i`IAX. ,7.........., IrA.l. - INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Bui]ding Inspector, with ~ 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 areas, 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 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 Rcculations, 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, housin; code, and regulations, and to admit authorized inspectors on premises and in building for necessary i gpections. ~v:^.~3 .1R• ~~a. (Signature ot""applicant, or name, if a corporatton) P.tD.BOx 1033 7675 Cox Lane,Cutchogue,NY (Mailing address of applicant) 1 1935 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Consulting Engineer Name of owner of premises Martin Bancroft, Jr. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ' ALL CONTRACTOR'S MUST BE SUFFOLR COUNTY LICENSED. Builder's License No . . To be selected Plumber's License No . . . Electrician's License No . Other Trade's License No . . 1. Location of land on which proposed work will be done; ,3~p~® Main Road (NYS Rte 25) Orient, NY 11957 Elouse Number ....Street,................... .Hamlet County Tax Map No. 1000 Section 15 Block . , , , , , , , _ . , , , , Lot . 30 , _ Subdivision Filed nlap No. .Lot . ~ (Name Stzte existing use and occupancy of premises and intended use and occupancy of proposed construction: A. );xisting use and occupancy..,,~~ne family residence One family residence'" B. Intended use and occupancy / ~ . . interior, 3. Nature of work (check which applicable): New building Addition Alteration . . Repair R~mov~l Demolition ..............Swimming pool............ . Tennis Court Accessory Building..........Fence .......Other Work:........... 4. Estimated Cost ~ 12 , 500: 00' Fee I (to be paid on filing this application) 5. If dwelling, number of dwelling wits ,one , , , , , , , , Number ofdwelling units an each Cloor • IC garage. number of cars . 6. If business, commercial or mixed gccupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures,,if any: Front . 62.'........... Rear . ~2.'.......... Depth :tfz'. 2.&', , , , , , Hei_ltt ..1~:.......... Number of Stories . 1i'z . . Dimensions of same structure wit}} alterations or additions: Front Rear , . Depth ! FIcight ......................Number of Stories . H. Dimensions of entire new constnt~tion: Front Rear Depth , Height 4.:... ' . Number of Stories . 9. Size of lohi"'Front , 215 .:10' • , • • ~~a,...212• ,51 ! • • • • , • , , , , , , Depth 3Q~•.,7,2 ! . & .335.•.Q'.. 10. Date of Purchase Ogtpte>v , 19~~89 , , , , , , , , , , • ,Name of Former Owner . . 11. Zone or use district in which premises are situated , R, ;200, , , ,Low, ,density, ,r~s,i,d~riti.al . . !2. Does proposed construction violate any zoning law, ordinance or regulation: , NO • , , , , , , • • . . . . . 13. Hill lot be regraded N~ 1Vi11 excess fill be removed from premises: Ycs , No . . 14. Name of~t~e~~~remisesMartil> n Bancroft JRAddress ............Phone No............... , . Name o IFiE Warren ,Sa,mbach ~ , , • , AddressEQ$A7C .1Q33. AutchoRhm~E No..73A--7492• Name of Contractor ~I ......Address ..Phone No..... . IS.Is this property locat'led•within 300 feet of a tidal wetland? *YES....NO.S.. *If yes, Southold Town',Trustees PLOT DIAGRAM a required. Locate cleazly and distinctly all buildings, whether existing or proposed, and•indicate all set-back dimensions from property lines. Give street and block Number or description according to deed, and show street names and indicate whether interior or corner lot. I ~ ~ t0'fa'~~~ To G~~ ~ ytJ 25~ 21s,to' i ~~yl~ fiCl/3'D ~N u ro2`_* II o M I (~oRLN ~I tzXt5'tlµb~ t'~2 b-CY ~ . KIZRn16 2k5{DPE&G` 1 S[V I ( y tell ~ i N i~ ~ 0, a i v ar V\ I'{ I _ ~ I 'COUNTY OF SUF~,OL~{, , , , , , , , I~S•S • •Warren •A; • Sambach , ,'I being duly sworn, deposes and says that he is the applicant (Name of individual si;n~ng contract) above named. Consulting Engineer Fleisthe (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed tltc said work and to make and Gle this application; that all statements contained in this application arc true to the best oC ltis knowledge and belief; and that the work will be performed in dte manner set forth in the application filed therewith. _ Swom to bcCorc me t us .....day of . M.A'P 19 .91 Notary Public, . S-: S-.~~Ia-!."•~ ~ ~~'•'~j~~~~ounty , ' ~ ~Q HELENE 0, NipRNI: ~Wl/U-t~ 1:L Notary Public, Stat@ of Naw York • • • • • • • • • • • • • • • • • • • • • • • No. 4961,364 (Signature of applicant) Qualified in SufP,olk Coon Commission Expires May Z~ t~ ~ •