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HomeMy WebLinkAbout19612-z 1 \ FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19862 Date APRIL 19, 1991 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 3605 MINNEHAHA BLVD. SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 3 Lot 13.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 28, 1990 pursuant to which Building Permit No. 19612-Z dated DECEMBER 28, 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 & ALTERATION AND DECK ADDITION TO EXISTING ONE _ FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SOHN & KAY BRASSIE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-182840 APRIL 11, 1991 PLUMBERS CERTIFICATION DATED APRIL 16 1991 - MICHAEL DAWSON ~A !d?,/~ / ~t `'COL; Building I pector Rev. 1/81 meal xa s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDINd PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTiL FULL COMPLETION OF THE WORK AUTHORIZED) N 19 612 Z Date ......1 ~,~?.8 19.9...a Permission i hereby gro ~ to: (/JL~~ .fR.. .....;.....~`.:fl... . ~...7.~......... ' ro.Gams"y..t?nln~~....ltr..?~......G.ZL~^.sAI••/.~D!:~~R...S~.k~e~~ ./r17.?:{r.2r......~....... at premises locoted ot ..~~..Q...~.......'...~..{!G'/~~*'~~.....~.e.Orel.`.~..t ...............................................~aE~6*G~Si..,.~.......................................................................... County Tox Mop No. 1000 Section Block Lot No.......~~.r..~?. pursuont to applieatlon dated ..1~"..',1..?:~ l ~lJ.., and approved by the Building Inspector. ~ 00 ' Fee 5~..~a ..,al~° . . .t.. Bull g Inspecto Rev. 6/30/80 Form No. 6 a TOW[Q OF SOUTHOLD ~Q~ 6 BUILDTOWNDHALLTMENT V// N1t ~ V ~9t w.., 765-1802 ' APPLICATION FOR CERTIFICATE OF OCCUPANCY _J .1. 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), 4. Swornvstatementcfromaplumberlcertifyingmthatrthefsolder0used intsystem contains i less than 2/10 of 1% lead. S. Commercial building, industrial building, multiple residences and similar buildings and installations, a ceztificate 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. 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. Upuated Cer~ificate of Uccupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15/.00, Commercial $15.00 Date ...~~~7/ .~1....... _ _ ::ew Construction........... Old Or Pre- existing Building..... Location of Property....... ...05.......... /.L/ta.nrh~la..t; ..:~~~~o/~ House No. ' ~ " " " Street Hamlet Onwcr or Owners of Property...Y.41?n 2no( ~ f~ ~ ' .............:Z ..rr/~. ~1:3.tiFt~............. County Tax Map No 1000, Section.... .,,........Block.. ..............Lot......... Subdivisian,,,,,Blj/fir GUa~~CY7" ........................Filed Map............Lot.............:... /9~ia Z Permit No ................Date Of Permit.. /.Z .~L®/}0.....Applicant...'/.l1lJJ4~~. ~/Sf12C/` stealth Dept. Approval ..........................Underwriters Approval.':~~//9~ Planning Board Approval . Request for: .Temporary Certificate........... Final Certicate.~..,,,,,, Fee Submitted: 0 ~ 9 ~ ~ APPLICANT ' , lELlj It:sr•EC.IUt1 ~~uA.E ~ ;;orrc~~rrrs 1 . ~ 3p / - d~- n2a r ~ 4\ _ '~-r9~.'' _ H ~ FOUIIDATION ( 1st ) ~ _ ~ ~ FOUNDATIOIJ (2nd) _ _ 2. 3 z o ~ ROUGH FRAME & ~ % PLUMBING 3. ~ ~ m I1ISULATIOPI PER N. Y. ~ H STATE ENERGY CODE n ~ ~ q FIiJAL © c ~ z ADDITIONAL COMMENTS: . ~J~ ,r 7~ f .Q ro H \-a H~ H O 2 _ ' ~ CiJ _ H x d m ro 4 e ~ O ~ > ~ O~ C a O w ~ G1 m ~ b ~ S Y ~ ~ O s ~ ~ ~C y q ~ O ~ ~ 9 ~ n N Hm } ^ ~ ~ m ~ ~ yy RR N ~ - Y 3 O £ F-' m R Fi V1 tf 1 ~ N O_ H ~ O C ~ N n' ~ ~ ~i c a O o : a r c p J~ ~ Z n `n ~ UI f ~ m y' o x H r m y ~ Z b e ,d pox 9 s ,Q E x? d D H 2 r ~ ' m ~ r ~ ^ m d m~ o x C ~ y d N o? F,. p k ~ o ~n m ~ 3 ~ r - ~ ~ r• a m 3 ~ ~ d n L ~ C+] £ ~ ~ ~ r ~ ~ ~ ~ Q m ~ 1 m ~ ti r fn 0 = T 1 ° ~ Z ~ m £ D m m t. $ N ~ y U1 ~ y z y x » y W ~ P Z O ~ Z mC o f m ° r O a ?d ~ mm ~ Z N ~ a fv "1 ~ ~ O ? mo n ~ ~ a ~ ~ D o r mo f A ~ a a ' m~ ~ ~ ~ ~ a c ~ ~ jm N r o ~ z~ a ~m~ m N m' n m ] O ~ .T` n~ m 1 O ~ A f n C C ° ~ ~ ~8 ~ A ~o< rn o < n o ~ z m a ~ a F a 1-+ 7c C o ~ y N f~ x ~ ~ 0 4 N- ~ W ~ ~ $ ~ m = ~ o ~ Z m ~ ~ ~ 3 0 ~ x H C _ ~ a ~ a F ~ `a P r~ ~ 'b ~f ~ ~ ~c a z ~ O ~ c F F', _ ~ ~m0 x H C] ~ n N N 2 m l mhy £ m ~ 7 ~ s ~ ~ ~ m fL o H rt 2 R7 _ ~ 9' ~ o y n G~ 3 ~ 3 ~ ~ ~y m s ~ c£ f m ~ k F-' + ~0 y N v A 0 O ~ ~ 'L ~ N ~ _ n TEL. 765-1802 ~O~VFFO(k~~G TOWN OF SOUTHOLD y~ OFFICE OF BUILDING INSPECTOR P.O. BOX 728 ~ ~ TOWN HALL Q~o~ ~ ~~0~ SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date ! ~ f Building Permit No. Owner ToffN jj0(pSS/L (please print) Plumber r1/c/~RyG- O~`~-~°"~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. ~~i, cu..i~,-.,z (plumber's signature) Sworn to before me this day of ~ ~ ._.f`s~ .L - 19~. Notary Public Notary Public ~ GFn ~iL County NotaryP~ubnc StateoSN wr°,~ Quaotl a°i 4ssr ossc°un 7arm Expi:®s March 30, 79 lg~~z~ 7s~-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ]ROUGH PLBG. (]FOUNDATION 2ND [)INSULATION [ ]FRAMING [~NAL REMARKS: ~ I ~ 1111_ ~ C' ~ ® f DATE INSPECTOR G~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~ FINAL REMARKS: ~ ~ ~ ~ _ ~ r DATE~~~~INSPECTOR rss-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: %~J f i DATE ~ /I INSPECTOR ~9G ia- '65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMING [)FINAL REMARKS: DATE .J ? INSPECTOR ~ - ' 7s5-1802 BUILDING DEPT. 1 NSPECTION ' [ OUNDATION iST [ ]ROUGH PLBG. [FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~-yv-~e, DATE ~ ~ -6 ~ INSPECTOR F -'T ~;J ~ aA~A~4 }j~'I '1~'fi'` Z H3 ~1' 3 '"fi't' 3 ~ If c a<3.. ~ ( ~ 3 ~,,s wn~'f Y~rF 3~},•~tif'<'rt11T ~}q.~~ ~Al '`'Y3v5fi7~*' a~~r f i~cV fa .rti ~L`'j`'* '~(w ir'f'Y t a5 "L "~c ~ n ~ryE;,,.i4+f ` t}.,u~ 5 t ty.3 ,...f ,ice ...7*~S~Jr. f A^Xa*; '!j'yC ;T`4'' M d .,r k'fyf,,.Y~ (~g~ '%~~.~°1S~ 1~" y i y „ k{ ~ +i n t"I" ¢ ~ h rt Y sue. ~ >1 ~ r ! w. ri ~ '1 S. 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I ~ M1 \ r 1 ~ 'tt'~~ ~ r ~ ~ -z ~ 4 ' Sri ~ ii ~ a RF f i t d ar Y ~ i r ..a llh,, ti t V'' ~i 'r ~7 ,1t -ti ' 1 Px } a . ~'t < i r, r a d Yac r 4i r.r+t r / - J r ~ ,y~ . , 'n. q z q s i rf titi9 syj ' it ~ BOAFD OF HEALTH ..y...... FORMN0.1 ~ SETS OF PLAYS TOWN OF SOUTHOLD SURVEY . BUILDING DEPARTMENT CIIGCh • • • . TOWN HALL SEPTIC r•oart SOUTHOLD, N.Y. 11971 ~I TEL.: 765-1802 r:oTIFY: ,x,23-3BG~ D Qp CALL Examined ~/Gl 19/~.r.~ q MAIL T0: Approved ...,/.L/,l Y.~.. 19/.~. Permit No..// ~ ~•Z ~ . • Disapproved a/c .II..................... II', ~ ~ ~ z e Aso Gam' r%~G:~i.. .l!~ . D uilding Spector) BLDG. EPT 1'~DWN OF S UTfiOLD APPLICATION FOR BUILDING PERMIT Date ..'`.'`.G.,Z~......, 191~.~. 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 areas, and giving a detailed descripl'tion 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 shill 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 Buildin'ig Inspector. APPLICATION IS HEREBY MA~E 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, er for remo al or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code housing code, d regulations, and to p p 'des and in building for necessary inspections. admit authorized ins ectors on remt I . • • • • • • • • • . • • • ~ . - - ' (Signature of ap99plicant, or name, if a corporation) (Mailing address of applicant) State wheth/e~r applicant is/owner, 12ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. (~'2 t2 G ram Lo ~ bra, ~~a j~ . . Name of owner of premises y!?.. e /1'ay..~i-QSJi/ . . (as on the tax roll or latest deed) If applicant is a corporation, signatur¢ of duly authorized officer. (Name and title of corporate officer) Builder's License No. y3 ~~Z Plumber's License No. . Electrician's License No. . Other Trade's License No. ....'I . 1. Location of land on which proposed work will be done . . Street z Hamlet i 3 3 Count NTax Map No. 1000 Section Block .:-l Lot ~Z/,Pa!'?~a~" . . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy ~,of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...''~/v~ q~e . ~R?!~>.~! . rC>.~c Y/.4G..V4'~~.1$f,.,A ~4~:,1:x . J / ~ .IftoY+YnblNion,§eE.o+ttkrk~lggN b. Intended use and occu anc ~~?'m*"'z'~P~4f/~ 2de~if!oh •~t1 , , , , , , , , , , , , , , P Y ~ •~prar€~3•,^,•.r:.ri}+ai•i~srYil~iut,~. I •~m ~ P ,S wujs,~x =.3 uaugx 3, s~+`2.~lHNn~9 i 3. Nature of work (check which applicable): New Building Addition . Alteration . Removal Demolition Other Work Repair • • • • • • • ~ (Description) SO D - 4. Estimated Cost.......,. Fee...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ~ Number of dwelling units on each floor . If garage, number of cars ....!jO 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . ~ . 7. Dimensions of existing structures, if any: Front Y.''.......... Rear s!3........... Depth 3B . Height Aluty'bej of Stories ~ . Dimensions of same structure wi#t alterations or additions: Front .`f3 Rear'it3 . Depth ...5.°.~: 6:~ ..........-Height ....~.3 Numberof Stories 8. Dimensions ~tirelae~nstruction: Front Rear Depth Height ...............Number of Stories . 9. Size of lot: Front Rear...................... Depth 1,................. ]0. Date of Purchase !97.Z Name of Former Owner l?Gr•~?7Q'T.: • • • • • • • • 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: .!t'.4 . 13. Will lot be regraded tY~ . ......Will excess fill be removed from premises: Yes Io I4. Name of Owner of premises ?'oh.,,~ !(~+,y,!3ras{ ...Address ~l,,z~~ y?h~. d/.!, sty phone No. 7G5 , , , • • • , , . , , Name of Architect .......Address ...................Phone No............... . Name of Contractor . 1~a,.?!~~. }'s~~. • • • • • Address !P~B:+: ~y . ~rY4'??' • . Phon^ No.3.~.~:.•~8,6,8. , . 15. Is this property within 300 feet of a tidal wetland? *Yes........ No:~...... *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 number or description according to deed, and show street names and indicate whether interior or corner lot. /J ~lq.Je SGe Su.r?L~ fTCw add,+~~on Slna-4~ed ~n 9t-CGiJ i/GaY sC)t ~AC,{ notd.me.r~sionv~+f J~o~27`~Qlao-t? w~^e- you sec ed t. ,yam ° FP,oie slue , STATE OF N R ~ S.S COUNTY~~jjF~(.C~ • • Ck• .L//1N/.EL L, ~tSCf~F!~ • , , , , , , , • , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ~D .?7'K~Q To ft,. (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 se[ forth in the application filed therewith. Sworn to before me thi~s -E~ ~ .............C:.~'~(~ , . - .day of "~E~~-...., 19~ Notary Public, .~~~.,7~•` ,~~/c' ' '~7'\~i!~ County ~ CIANll4 t;lllW MMry tiblk, lass of NswVlelt : G2!~G-LAG . ~v ~'~`~f......... . ~ ~~606 (Signature of applicant) O~Ys6pns® ?lsssmbs l.tl~~ - I - 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 15T [ ] R H PLBG. [)FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE 3~ INSPECTOR IS~~~ 7ss-iso2 BUILDING DEPT. INSPECTION [ FOUNDATION i5T [ )ROUGH PLBG. (]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: c.~-..-~ c' DATE ~ 3~ INSPECTOR