HomeMy WebLinkAbout19573-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20472 Date JANUARY 13, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 10725 OREGON ROAD CUTCHOGUE NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 83 Block 2 Lot 16
Subdivision Filed Map No. Lat No.
conforms substantially to the Application far Building Permit heretofore
filed in this office dated DECEMBER S, 1990 pursuant to which
Building Permit No. 19573-Z dated DECEMBER 12, 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 AGRICULTURAL STRUCTORE AS APPLIED FOR.
The certificate is issued to FRANK McBRIDE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-134905 - JUNE 12, 1990
PLUMBERS CERTIFICATION DATED N/A
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~ Building Inspector
Rev. 1/B1
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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)
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Permission is hereby granted to: / /
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ro ....~.cQs~....Z~.2.......°.~....,~R~y(r!M.~......~.~..Icd~.H,~..~.Ce~2.u~x.......a~X1~h~:......
I .~.~i'..~i."..u., a • „ l.u u,.................,......,..,..,..,,..,.u.,.,,u.«.\
of premises located at .....~.v.~ ~ y ~ 1..~~!~' q.
O'rti........................... 111
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County Tax Map No. 1000 Section Block .......Q Lot No.....~..~R
' ursuant to a Iicatlon doted ....h.~a?:.?¢:::~ 5 19..t'1..~, and approved by the
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Budding Inspector,
` Fee 5...4?~
Building Inspector
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Rev. 6/30/80
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Form No. 6
TOW[J OF SOUTIIOLD
BUILDIIJG DBPARTMGNT
TOfJCJ H:\LL
765-1802
APPLICATION FOR CLRTIPIC:ITC OP OCCUPANCY
This application must be Filled in by typewriter OP, ink and submitted to the building
inspector with the following: for new buildinh or new use:
1. Final survey of property eaith accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply cmd 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 le lead.
S. 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.
3. 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 cariting to the applicant.
C. Fees
1. Certificate of Occupancy - PJew 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 ..q
::cw Construction........... Old Or Pre-exQisting Building ~ 4¢-~.~' LELE~LtiLC
Location of Property..~.Q...~l..y~i~.C/.
House No. ,~`C~~~j/~ Street Haml.•
Onwur or Owners of Property.... ~~iiA~lr22': Y• • • • .
County Tax Piap PJo 1000, Section.....R..,l.....Block.....~:+........Lot....Ckl
:subdivision ....................................FileC~d/~Ci;ip............Lot......................
Pcrml[ No. ~.q. tS. ~,3,Z. ~ f a/ ~ .°~./..l.t!..Applicant. I V a/~ I~~~L(C ~YI ~e
Date Of Permit....... .
ifealth Dept. Approval ..........................Undenariters Approval.~./..,/.~..~~.~ `5~-
:Tanning Board Approval
~:equest for: Temporary Certificate........... Final Certicate...........
`~ce Submitted: r\/1/~,~~~,,[[~ ~y
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THE NEW YORK BOARD OF FIRE UNDERWRITERS vary I
7 ?11017.9 BUREAU OF ELECTRICITY
BS JOHN STREET. NEW YORK, NEW YORK 10038
Date Jl)Nh 1~„799Q Application No. on file ~2u52Qf{~~AS N 7349Q5
THIS CERTIFIES THAT
only the electrkal equipment as deacri6ed 6ebw and introduced by the opplicont named on the above applicotion number in the premiaea of
[tTCH tA1~ARIUE:, gREGON kD.; FOLF-1.97, rU`l'~'Hi~sGllkl. N.Y.
in [kefollouinq locatianq ®Baaement ~ lat Fl. ? 2nd Fl. p11T .Section Block Lot
una eromined on APR 7II 7.n , 7.990 andfound to 6e in compliance with the reyuirenrenta of this Board.
FX7UR! ECEITAGIEi SWI7CifE4 RXTURES RANGES COOKING DECKS OVENS DISN WASHERS EXNAUST FANS
OUTlE7S INCANDESCENT-FLVORESCENi OTHER AMT. K.W. AMT. K. W. AMT. R.W. AMT. K.W. AMT. H.P.
17 ~1 ~ i f~
DRYERS FURNACE MOTORS FU7UR! A/KtANCE iEEDERS SPECIAL REC'?T 71ME CtOCK4 BEII UNIT HEATERS MULTFOUTLET p1MMER5
AMT. a. W. Oll N. P. GAS H. I. AMT. NO. A. w. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS AMT. WATTS
NO. I)F FEET
- 5lRVICE DISCONNECT NO. ttF 4 E R V 1 C E
AMT. AMP. rypE M!7!R t R iw 1 / Jw 3 A ]w 3 / Aw NO. OF CC COND. A. w G. NO. Of MLIEG A. w. G. NO. OF NEUTRALS A. W.G.
EOUIP. PERK OP CC COND. OP HIiEG OP NEUTRAL
~t1~ X ~ .1 ~11 1 .~II~
O7NER AMAl1ATU5: '
/
ftOX 76,ST{LdTWnT6'R AvF,.
t;UTCHOGUE, NY, 77935 ~ OMNRAI MANAWR
77
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~crot7antials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGITE MUST NOT BE ALTERED IN ANY MANNER.
=1coD Ii: S:EC:'_u:7 ~~lln:~ ~I :;ONMGNTS
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FOUIJDATION (1st) W
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FOUtdDATIOtJ (2nd) _ _ mS 1
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PLUMBING y)
3.
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INSULATION PER N. Y.
STATE ENERGY Q,
CODE
x
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ADDITIONAL COMh1EPJTS: x
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,,,,,„,..+.r~:•.+a B0.1RD OF HEALTH ,
~~L~,~~'~,~ I" 3 SETS OF PLdYS
h~ t ~ FOAM NO.1 SURVEY
$ ~ ~ 4~! TOWN OF SOUTNOLD C11ECt: . . . .
i I BUILDING DEPACtTMENT SEPTIC FORM
~ ~ TOWN HALL
BLDG, DEPT. ~ ~ $OUTHQI~. [~1.Y.11Q71 tiOT i FY s
TOWN OF:tOUTHOLD TEL.:7G5~1B02 CALL
cI rtAIL T0:
Exatttincd .1-1~--:??^"^t. ~2,.. 19 ~.4 q .
Approved L?~caw~~'~4-..~~-. 19~ P. Permit No. J.LS~.~.tiZ.- . .
Disapproved ale
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(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .l~~J~J..._...... IS~G
INSTRUCTIONS ff
a. Tltis application must be completely filled in by typewriter or in ink and submiticd to the Building Inspector, tuitk
sets of plans, accurate plot plan to scale. Fee according [o schedule.
' b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stye:
or areas, and giving a detailed description oC layout of property must be drawn on the diagram which is part of this apF
cation.
c. The work covered by [his application may not be commenced before issuance of Building Permit.
~d. Upon approval of [Iris application, the Building [nspector will issued a Building Permit to the applicant. Such perry
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 fot any purpose whatever until a Certificate of Occupant
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 t:
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
Re=ulatians, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describer
The applicant a:~rees to comply with all applicable laws, ordinances, building code, housin, c?~ofdje,~and regulatio~r sr and t
admit authorized inspectors on premises and in building for necessary inspec / ~"K/
r.:2~!Y~•
(Signature o[ applicant, or nom rf a coy or on)
1.S.I`.:
. (Maiiin~ess of aPPlicant) .
State whether applicant is owne ,lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
....................................J~....y.~...../~...........................................
NameafowneroCpremises ..~!~...V.~....'.%C!fy
(as on the tax roll or latest deed)
IC applicant is a corporation, signature oCduly authorized officer.
(Name and title of corporate officer)
Builder's Liccnsc No.... 1~~.~'~.
Plumber's License No. "
cr
Elcetrician's L.icensc No . '
N
Ot(tcrTradc's Liccnsc No .
1. Location of land on which proposed work will be dorc;
_~n ~
!louse Number . • • •StrccQ~.. .........Hamlet
County Tax Alap No. 1 t700 Section • • Bluck , , • • , , 2, _ • • • , , Lot ' • _
Subdivision 1`Iic~ Atop No. Lot
..IN:unc)
State existing use and occupancy of premises and intended use and`~occap nay f roposed onstr ct n:
A. Existing use and occupancy... .....r~r"f°.\'1..~~ ~~•f~-~~
C~~~~~Grrlxx~yyrw~~f~~ ~ G!/
B. Intended use and occupancy.~...+SC~Y~~~•••••
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3. Nature of work (check which applicable): New building Additicn\ • • • • A)teration
Repair , , , . RFmpval , Demolition ..............Swia~~~~• , , ,
Tennis Court. , (,Accessory Building.......... Fence ..Other Work:........ .
4. Estimated Cost ......~._.~~.d~.d Fee . , .
• 4ta Lc paid on fi3ins-this applicatianj
5. IC dwcllin„ nutnbcr oC dwelling Ilunits . Number of dwelling units on each floor .
ICgaracc,numbcrofcars
6. If business, commercial or mixed occupancy, specify pature and extent of cacti type of use • . • • • • . .
7. Dimensions of existing structurds, i(any: Front . Rear Depth .
Hciaht ...........NunjbcroCStorics..........
Dimensions of same structure with alterations or additions; Front Rear . • , , , , , , , ,
Depth Height • Number oC Stories .
8. Dimensions of entire new constrtction: Front . Rcar ...............Depth ,
Hcigltt Nurtjber of Stories .
4. Size of let: Fiona Rea • Depth .
10. Date of Purchase , . .........Name of Former O~vncr ,
1 1. Zone or use district in which pri miles arc situated .~r
12. Does proposed construction vio(atc any zoning law, ordinance or regulation : .............R/.~. • • •
l3, 1Vill lot be regraded 1....•....... ....1Vill excess Cill be removed Crom premises: . Yes • • • • • •
lh, Name of Owner of premises , . , , , . , , , , - • , ,Address • Phone No .
Name of Architect , .......Address ...................Phone No.............. .
Name of Contractor . • • • .Address ......Phone No..
IS.Is this property•loc~ted within•3p0 feet of•a tidal.ve.tland? =YES....210.....
*IE yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAI~1
Locate cleazly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimen;ior.•.:r
property lines. Give street and blocklnumbcr or description according to deed, and show stree[ names and indicate w;:c::.
interior or corner lot.
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srn'rcoF~ewYORI;, ~
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si~ ' • • • being duly sworn, deposes and says that he is the applit::
' C ^ .'ping contract)
about named.
Hcisthc
(Contractor, agent, corporate officer, etcJ
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl:
application; that alt statetnents cont'aincd in ibis application arc true to the best of his knowledge and belief; and that t:•.
work will be perl'omted in the mannc,r set forth in the application filed lhcrcwith.
Swom to bciorc me this ~ •
..day of K/;P;~r........, 19 `!•4. ,
Votary Public, .....G~~• • ~"Q• County ~j/ ~
NEIEN IG DE VOE
N07AKYPUBI1C,StateofNer)York (Si;natnre of appbcan
No. 4707878, Su}Ioik Cougty
.Term Expires Msrch 30,19
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