HomeMy WebLinkAbout19551-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.f.
CERTIFICATE OF OCCUPANCY
No Z-19947 Date JUNE 5, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 6760 PECONIC BAY BLVD. LAUREL, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 11 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 28, 1990 pursuant to which
Building Permit No. 19551-Z dated NOVEMBER 29, 1990
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 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to WILLIAM & DOROTHY GRANNEMAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-183935 - APRIL 19, 1991
PLUMBERS CERTIFICATION DATED MAY 23, 1991 - WALTER L. DOHM
B ilding Inspector
Rev. 1/81
i~
~N®..
TOWN OF SOUTHOLD
BUILDING DEPARTMEN4
TOWN HALE
SOUTNOLD, N. Y.
BUILDING PERMIY
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 1 1 5 1 Z Date ........l..f..(CL'Zl............?..'.. 19.,f...~
Permission is hereby granted /to:
.~'11~ ....4.r...•....~./.
..(..7.~0.../' . ...t..~.........
of premises located at ..................L?....~GP.~...........1.:r~~..CN ....~1.... j.4/ t
i~~-
County Tox Map No. 1000 Section ....f.~.~••••• Block ........1.[........~~rrLot No.....~
pursuant to applicotion doted ........:.r.l....!!:"?/..•••~•••~••••••••••••. 19.,/..1, and approved by the
Building Inspector.
Fee S.•!Si!.I..a.l/...
Building Inspector
Rev. 6!30/80
~ Form No. 6 `'+P~ ~~?~1.~?~~~f7\`~~L'?[i~`~F
TOWN OF SOUTI[OLD ~
~ BUILDING DEPARTMENT ~ f~
TOWN I1ALL
765-1802
V
APPLICATION FOR CERTIFICATE OF OCCUPANCY
1. This application must be filled in by typewriter OP, 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.
h, 5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance fzom archi'_ect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
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 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, Commercial $15.00
Date ,.~lL`/ .:~L~t.7.,~~~
ew Construction...... Old Or Pre-existing Building
ocatian of Property... ~~?~........~C;[,v~7~G.:
c-n~.~:~...~lY.~ 1~K~'rr.
House No. / Street Hamlet
ewer or Owners of Property... ~Q!?o7(/~! ...(r... ~ :°,.~j;,(f ilJ~!°!/~!;}
aunty Tax Map No 1000, Section..t:~.~'........Block..... ~~........Lot.....'3
+bdivision ....................................Filed Map............Lot......................
~rmit No. ...Date Of Permit... J. ./....Applicant..
~alth Dept. Approval ..........................Underwriters Approval...'.
anning Board Approval
quest for: Temporary Certificate........... Finul Certicate...........
e Submitted: $ ~ o/~y~
@~sDC. ley # .
Q _ ~
(+0 ~ '9q(,(~1 APPLICANT
~,,,r„Tt~l,~ THE NEW YORK BOARD OF FIRE UNDERWRITERS "'i``'"'
BUREAU OF £LECTRIClTY
85 JOHN STREET, NEW YORK, NEW YyORK '10038
AI~RLi~ 9i1 L`I151 72t7~,(~J1 ~7 Ai 1~'~'A,3~,
~ Date Applicotion No. on file
I~ THIS CERTIFIES THAT
z
'''r only the electrical equipment os deaerihed helow and introduced by the applicant named on the oboes application numher in the premiaea of
Iz ~r.)~`~}ly t;RAPF'P11id+tA'f~, 4,7~,ff I'!fa't?kltt~ I~AY Yi's,VU.., l,~.fitdi~3,, hi.Y
(e
44 ~j I-~ t7CI"T`
is in the fallowing Ioca¢i . B nt LJ lst Fl. ? 2nd FT. •Seotion Block Lot
aK'k'f `Y'3,4'~t'tf
Iv was examined on artd found to be in cohepliance with the requirements of this Board.
i-
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1 FIXTURE ECEPigcLE$ $wI7CNE$ FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIVDRESCENT DTHER AMT. K W AMT K.W. AMi KW AMi K W AMT, H P
j 14 8 t Ia 1 ~ ~ P
i
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'Pf TIME CLOCKS EELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. N. W. OIL H. P. GAS N. P AMT NO A. W. G AMT. AMP AMT. AMPS TRANS. AMT H. P SYSTEMS AMT WATia
i NO.OF FEET
SERVICE DISCONNECT NO.OF $ E R V 1 C E
AMT. AMP. rypE METER ~ 4W ~ ~ 3W ~ b" 3W 3,a' 4W NO. OF CC COND. A W. G. NO. OF HbLFG A' W' G NO Of NEUTRALS A. W G.
EGUIP. PER .6' Of CG COND. OF HPLEG OF NEUTRAL
OTHER AAPPARATUS:
IT.I' Isx l.~ .f
~?.C, 1±1I,i~i"Pi<'(C :Ctdf[. lr1t~ ~)$l.J-F«
P . f1 . N(~}: 5:I. k
T~~#i,SC{i~ar, @IYr ~'I 2~I$ GENERAL MANAGER
id
Per # ~ i ~ .I
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 UILDING DEPARTMENT.-THIS COPY' OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TEL. 765-1802
~oc~~FFOC/~COG TOWN OF SOUTHOLD
~c OFFICE OF BUILDING INSPECTOR
c .z P.O. BOX 728
u' TOWN HALL
O ~ SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date Mav 23. 1991
Building Permit No. 19551 Z
Owner D. GRANNEMAN
. (please print)
Plumber WALTER L. DOHM LIC. #453-P
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
(plumber's signature)
Sworn to before me this
23rd day of May, 1991
19 91 -i/~f-(~ :dotary Public
Notary Public, Su€folk County BARBA.IADIACHUN
Notary PubBc. State of New Yadt
No. 4635190, SuNotk County
Cammisslai E~!res Oclaber 31,1992
I
tmlrr TEL.,7G5-180"_'
~~S~FFOLI{ O `T'OWN OI' SOUTIIOLi~
~ y
_3? t,~;,Z,,,! ~c OPF~ICE OF BUILDING INSPECTOR
~ ~ P.O. BOX 728
v' ~ 'COIVN (FALL
"Oy~ ~ao~ SOUTIFOLp, N.Y. f 1971
1 ~
MAY 31, 1991
DOROTHY C. GRANNEMAN
P.O. SOR 651
LAUREL, R.Y. 11948
To whom This May Col~cern,
we are unable to complete your Certificate
of Occupancy because of the following reasons.
% / nn application for Certificate of Occupancy
is not on file.
P1o iJnderwritcrs Certificate on file.
The check is (outdated/not on file.)
No f(calth Dept. P.pproval on file.
/ / No final inspccCi.on has been made.
Please contact our office on this matter.
'lhatik you for your cooperation.
Building Permit I) ~ 9 5 5 1_ Z
Building Dept.
/ No Plumber So].cier Certificate on file.
( all permits involving plumbing being
.issued after April 1,19II4 )
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IJSULATI0;1 PER N. Y. .3
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ADDITIOtIAL COMMENTS: ~
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765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION i5T [ ]ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ RAMING % [ ]FINAL
REMARKS:
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DATE / 3 ® IN8PECTOR
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INS TION
[ ]FRAMING [ FINAL
REMARKS: C~~
DATE ~ INSPECTOR G" ~
T
D BO.1RD OF HEALTH /
.
3 SETS OF L.11JS Y..
FORM NO. 1 SURVEY .
Qy~„ TOWN OF SOUTHOLD CHECK :
f7R~/ BUILDING DEPARTMENT SEPTIC FO[tt•1
TOWN HALL
TQWNO°Fg°EpT• $DUTHOLD, N.Y. 11971 NOTIFY
~y OUTgFtO~p TEL.: 7G5 tII02 CALL .
Examined°./.'.~'!~ ~ 19 ~G ~.e. TOE p ~ ~ ~.~.p~ ~
/y~ .6S~.A.~.iW .
Approved 19,1.®Pennit No. 1..~[/. ~1 .
Disapproved a/c
Y (Building Inspector)
APPLICATION FOR BUILDING PERDi11T
Date 15...
INSTRUCTIONS
a. ~ Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~
sets of plans, accurate plot plan ttrscale. 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. Ho building sha1L 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
Buildin; Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Reculations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Tlie 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 necessa specii ~s.
(Signatur of applicant, or name, if a corporation)
(Mailing address of applicant)
Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.........................n............................'.'./.,,.//......~n/...............................
':ame of owner of premises ~~?,~/~'~S!.. C:. ~.~~.1~!!I!.tf~ia'~ .
(as on the tax roll or latest deed)
.C applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer),
Builder's License No . /~~.~~.'.Hr
Plumber's License No. ....~t .
Electrician's License No . '
Otttcr Trade's License No . • .
Location of land on which proposed work will be done; -
House Number Street. Hamlet •
~ 1
County Tax ~11ap No. 1000 Section • • , • • • • • • • •
,r~.l........: BI'ock ....~1........... Lot.
Subdivision Filed nfap No. Lot
..(Name) .
State existing use and occupancy of premises an~dpintended use and occupancy of propOSed construction: .
A. i;xisting use and occupancy..../Cnr\ ~~~•~~~"~t ~..........~e~ t~ ;,S•a;l}I,1~~• • • • • • • • •
Y.'•. X11 W~t<t #!~'llra: rs `«i4tts0'$Y4fPC~+I '
B. Intended use and occupancy.. • • • • • •~;~;~n•4~'''.,'.;it~;~:'d#ift7,i}I'$ • • • • • • • - • •
rw+.~~ <ir 'SiYtlPoxFb'~xi^~u Q~'t1!,lk'~ #YP,f{~E}N4ffY~•k~
.
',i n.
1. Nature'of work (check which applicable): New Uuilding , Addition . ~q,4m~F'AJEeratton . .
Repair R~moval'i . . . Demolition ..............Swimnin~ poo .
Tennis Court Accessory Building.......... Fence ..OthQ,ot'r .
i. Estimated Cost~)a/d!~.^:....... Fec ~Qi ,
(to be paid on filing,this application)
t. IC dwcllin number oC dwcllin umt •
g ' s Number of dwelling units on each door , , , , , , , , , , , , ,
Ifgarace.numbcrofcars
Tf business, commercial or mixed occupancy, specify gature and extent of each type of use .
7, Dimensions of existing structures, if' any; Front Roar .'(.7:4......... Depth .:Y.7, , , , , , ,
,,.tj Hci;ht Numbcrlof Starks . .
Dimensions of same structure with a
r Iterations or additions: Front .39.4 Rear : . . .
Depth ...~7 TIcight . Nuntbcr oC Stories
q, Dimensions of entire new constntct~on: Front ..1.4 Rear . /4 Depth ?,0~,"
Hei;ht Numbenof Stories .
9. Size of lot: Front Rear.. Depth .
J. Date of Purchase ..............Name of Former Owner
1. Zone or use district in which premises arc situated . .
Does proposed construction violate';any zoning law, ordinance or regulation: ....1t~4 . .
3, Hill lot be regraded : . . ..Will excess fill be removed from premises: Yes ~ . No . .
1. Name of Owner of premisesM~FP+,ts f«)•,~rYbN;«; Address Y=; c gle¢,,(q,,; r;.(, Phone No. ^??~':`,'~k'~{, , 9 . , • .
Name of Architect , ; . , Address ......Phone No.. . .
Name of Contractor 4A«,Prv~;
v, ;r;,;
; a~., • • (~v2ot7Y..~~ Address 1:•:<~:':: ?':~~t•~ ~g•. t~-C ..Phone No.~, ~Y: ~ I
S.Is this property loo,~ted within 300 feet of a tidal wetland? *YGS....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
zterior or corner lot.
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• • • • • • • •~Qw• • • , • • • Y ~ •~~•rnCC.ti... , being duly sworn, deposes and says that he is the applicant
(Aamc oC mdtwdual signingi contract) ,
bove named.
k is the L4-~k1-Q.~........ ~
(Contractor, agent, corporate officer, etc.) • • • • • • '
C said owner or owners, and is duly ;iuthorizcd to perform or have performed the said work and to make and file this
pplication; that all statements contain4d in this application are true to the best of his knowledge and belief; and that tl~e
rack will be performed in the manner sat forth in tltc application Glcd therewith. ,
~wom to before me this~~,,BB
1~~ . 1
7otary Public,~,.Q , ~~'~~~/,C~ , , , , County
CLAIRE L OI.LW
Notety PuWla Stets of New Ybtlt • • . • • . • -
No.4879608 : (Signature of applicant)
QualiRed in SuHdk Coumy
Ctanmlakan Enpkas Dawmlba 8,15 '
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f ~ S1} i 1 ~ ~ f 7 E ~ TO THIS SURVEY IS A VIOLAitON OE
'F 'T D n' SECTION T109 OE THE NEW YORK STATE
EdiCATiON IAW,
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