HomeMy WebLinkAbout19425-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY'
No 219561 Date DEC. 5, 1990
THIS CERTIFIES that the building FOUNDATION
Location of Property 16995 MAIN ST. & 770 THIRD ST. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 08 Lot OS
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPT. 26, 1990 pursuant to which
Building Permit No. 194252 dated SEPT. 27, 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 FOUNDATION UNDER AN EXISTING BARN.
The certificate is issued to JOAN ROBBINS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N161502 NOVEMBER 19, 1990
PLUMBERS CERTIFICATION DATED N/A
Bu lding Inspector
Rev. 1/81
roses xo. ~
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 9 4 ? Z Dote ....y~'.~~.. ~ 19.90
Permission is herebyymnted to:
_/yG~
ro . ..~~7....... .~r~~......GhX.~.~~....... ~..~?'tt~"l~
...Q~..... G~~/D~
at premises located m .~P.9.~~.J`.......~~,!"`.:::'{...~?i!~....~..~./..~ A
County Tox Map No. 1000 Section ......./,~,7........ Block Lot NO.....C~
pursuant to applicotion doted .......:/..,1.~ 19~'~., and approved by the
Buiidfng Inspector. ~
Fee S••,-~j~~~~.:
uildi Inspector
Rev. 6/30/80
THE NEW YORK BOARD OF EIRE UNDERWRITERS }'ktit~ ;
lt~t711i.`'l BUREAU OF ELECTRICITY P " ?
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date 4d'fJC/n11kX1~iR -4 rDr;l dt )f} APPlication No. on file ~)~.1:'~~)F)'~Q,(~117 {Ij :~~".5',"CJ
s THIS CERTIFIES THAT
only the electrical equipment os described below and introduced 6y the opplicont Homed on the above application number in the premises of
iue~i3`1'l7DI RtlNllgl~i, 1~/1': f'£~kt.liATDT S`C, d'z 1'i#'1#{f! ;i"C, IVN~I+f 'v'flN"~%ljL1~r 7vT.Y'.
in thefollowinq location; ? Basement d /,st Fl. ? 2nd Fl. Sertion Block Lot
75l>Vx:3fT,htkt '1 ;d, 199n
uqs examined on and found to 6e in compliance uith the regoirenrenLS q([his Board.
FIXTURE ECEPTACLES SWITCHES flXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIUORESCENi OTHER AMT. K W. AMi. K W. PMi N.W AMi K.W AMT H P
I ~ I
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT NEATER$ MULTI-OUTLET OIMMER$
AMi K. W. Olt H P GAS H. P AMi. NO. A. W. G AMT. AMP. AMi AMPS TRANS. AMT H P SYSTEMS AMT WAiia
NO.OF FEET
SERVICE DISCONNECT NO.OF 5 E R V I C E
AMT. AMP. TYPE METER ~ TW ~ a. JW 3 A3W 3,e' 4W NO. OF CC COND A W G NO OF HI-LEG A W G' NO OF NEUTRALS A W. G'
EQUIP. PER % OF CC. COND OF MI LEG Of NEUTRAL
OTNER APPARATUS:
>,~rt~:r n~ , 4'~na ~r.e~r al'll~~r -'x
4~u~re,r:>;t,axn;;a..~, •"~ftt. ~1~1n
- LC~:L~c.ti.~ .t~~-C
r~i3frfL a. r3ffxns 4,f.c.~ar4:x4~'
`i'~W.N 4fARflCalf 4rA]dE:
SUtJ'I"Nc~IL17, dl k'. 1,"Z `all GENERAL MANAGER
Par
This certificate must not be altered in any manner; return to the office of tfie Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
1~. o . n~,~, 14 ~
J ~ Form No. 6
D ~ ~ ~ TOWN OF SOUTHOLD ~ /
BUILDING DEPARTMENT
5 ~ TOWN HALL
7es-laoz ,,~~n~a
BLCJSi.
DENT. ~ iGs
~TOW~(y
(^P SOUTNOL~'~ ~„~,~PLICATION 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.
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 cr engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. Far 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.
9
v. 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 $)1t5-.00, Commercial $15.00
Date ...I ~:F,J .
':ew Construction........... Old Or Pre-existing Bui~ding /,~y
Location of Property.... 7.V.. ..............`Ir..
House No. Qtr4~[~ ))Street Hamlet
'lnwer or Owners of Property.... ~~~'~,~....~:~.b~lvt.~
County Tax Map No 1000, Section..~~ ~........Block.......'S~........Lot......
Subdivision ....................................Piled Map............Lot......................
i'ermit No ................Date Of Permit................Applicant.............................
!lealth DepC. Approval ..........................Underwriters Approval..
Planning Board Approval
Request for: Temporary Ce-rJtificate........... Final Certicate...~.....
a~ °
Fee Submitted:
~S
~yO `F~o ~ .APPLICANT ~
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ROUGH FRAi~1E &
PLUMBING
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IIISULATI0;1 PER N. Y. ~ ~`1;~s
STATE EPIERGY I h
CODE
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FI;IAL
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ADDITIOPIAL COMMEPJTS: x
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'sS-isos
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
(]FOUNDATION 2ND [ ] INSUL¢TION
[ ]FRAMING [~]'~INAL
REMARKS: ~
DATE ~ O l ~ O INSPECTOR
~t~~i ~ 765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: " ~ " G'_.-
l~ bc~
DATE ~ ~ 7rL' INSPECTOR .
• ~,R;;ziJ ~ TEL. 7G5-180
a5~~fo~",`~~o~~ T0~'N OIL 50UT~I0I,~
y). rc OI~fICI; OF fsUILDING iNSPrCTOR
g' ~ I'.O. I30K 1 1 7 9 '
~ ~ TOWN HALL
~~O ~ ~ S0UTII0LD, N.Y. 1 1971
~;yo ~~o
' October 19,,1990
' Pride Building
P.O. Box 1464
Southold, New York ]1971
Re: Robbins, Joan
'Po Pihom This, May Concern,
We are unable to complete your Certificate
of~Occunancy because,oi the Yollocving reasons.
An application for Certificate of Occupancy
is not nn file. (BNCLOSSD)
/_j /NO t7ndcrwritcrs Ce.rti£icnte on file.
l ! 't'he check it: (cXt%4L3L9L4IdT<Y/n~>t ott ti1C.) $25.00
No flc:al.th Uept. Approval. on file.
/ / Nn final insl'~ect:ion has been made.
Plea:;c contact our office on this matter. -
Thank you for your cooperation.
Ilu.ildincJ Perm.i_i-. i! I 9 4 2 S Z
I3uilc3inc{ Dept-.
*.+k/YJ tlo i'lumhcr Solder Cert.lficate on file.
( al.l pertnitc involvi"ng plum2~ing being
i:;sucd after 11pri.'! 1,1984 )
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BOARD OF HEALTH
~ 3 SETS OF PLANS
FORM NO. 1 SURVEY ~ ~
SEP G ~~O TOWN OF SOUTHOLD CHECK . ~ J , , , ,
2 t~ ~ BUILDING DEPARTMENT sEPTiC FORM
f $OUTHOLD, N.Y. 11971 NOTIFY c
rawNtpGSO!il~oi_t7 R TOWN HALL
TEL.: 7G5.1802 CALL ..~J?p.~".~Q~~. ~+ut. , ,
Examined..~~..°~,O•.,,.,...~,~ 19~~ MAIL TO:p~ ~~'1L ~~~.I..
APProvcd 9,/.?~......, 19J~. Permit No.. - 9 ~J• .
Disapproved a/c
e3-i O c~ f~'~%C.a...
(Bring ctor)
APPLICATION FOR BUILDING PERP/IIT C~/'1
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 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
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 ]aws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building For necessary it~y`~ections.
Signat e of applicant;°ror name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises l.Q~.....~~.~ ~/~J• . ~ .V ..~0 ~.~t•~. .
(as on the ta, roll or latest deed)
IC applicant is a corpor do Signat of duly authorized officer.
a e and title of corporate officer)
Builder's License No. ~ ~ Q~~ J .
Plurnber's License No . .
Electrician's License No . .
Otltcr Trade's License No . .
I. Location of land~n which proposed work wil! be done; ~(,'~y',~ ,~i%t//U s0°
ffouse Number >Street. ~i Hamlet ~y
County Tax Map No. 1000 Section ~ ~ . L . • • • • • • • • • Block • • . • Lot P......,.. .
Subdivision Filed pfap No. Lot
(Name)
Stale existing use and occupancy of premises and intended use arrnd11occupancy of proposed construction:
l~
A. Existing use and occupancy....,(/tl~:~
B. Intended use and occupancy....t~?{,~.rb~}.•••••••
3. Nature of work ~c~¢k whicft applicable): New Quilding Addition Alteration
Repair .:"ra~,:w R~mov~al . Demolition ..............Staimming pool . ,,:t .
Tennis Court Rccessory Building..........Fe e ..Other Work::.
4. Estimated Cost:~,.l(~1~,L?:r~1 Fee
' 1 (to be paid on filing this application)
5. If dwelling, number of dwelling t+ its Number oC dwelling units on each floor .
If garage,numbcrofcars
6. If business, commercial or mixed', occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structure if any: Front . Rear , , , Depth .
Hcigitt Num~}cr of Stories . .
Dimensions of same structure wi h alterations or additions: Front Rear
Depth ' ,Height ......................Number of Stories
g, Dimensions of entire new constrS ction: Front Rear Depth .
Hcigitt Num er of Storics ,
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner ,
11. Zone or use district in which pro' .ices are situated .
0 0 ~ to any zoning law, ordinance or regulation : . .
13. Will lot be~ a waded truction viot, ,Will excess fill be removed from premises: ,Yes , No . .
l~3. Name of Owner of premises ...............Address ...................Phone No.............. .
Name of Architect ...............Address ...................Phone No................ .
Name of Contractor . .I~ .Address ..Phone No.... • : • . , .
15.Is this property local!Led within 300 feet of a tidal wetland? *YES....~••••
*If yes, Southold Towr} Trustees Permit may he required.
PLOT DIAGRAM
Locate cleazly and distinctly all', buildings, whether existing or proposed, and indicate all set-back dimensions from
property fines. Give street and block' tnmber or description according to deed, and show street names and indicate whether
interior or corner lot.
1'R ED AS I~OI'ED '~5`
/i~,,~
DATE:~~~ 'd B.~! ~
BY:
FEE:
L
NOTIFY BUILDIyC7 DEPART^-- IVI~
76Ev-1802 9 AMI YO ~ PM FOR THE
FOLLf)V'JHNG INSPECTIONS:
t. FOUNDATIOtJ - TWO REQUIRED
FOII POURED CONCRETE
2. ROUGH -FRAMING I]< PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.U.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERfiY
CODES. N171' RESPONSIBLE FOR
DESIGN OR P,ONSTHUCTION ERRORS
STATE OF NE1V YORE, it S.S
COUNTY OF
. being duly sworn, deposes and says that he is the applicant
(Name of individual sig ing contract)
above named.
1-k istltc
(Contractor, agent, corporate officer, ctcJ
of said owner or owners, and is duuly authorized to perform or have performed the said work and to make and file this
application; [hat all statements co~tained in this application arc true to the best of his knowledge and belief; and that the
work will be perforned in the man',, er set forth in the application filed therewith.
Swom to before me this
.............~.F. 6.. ~..da~y f ..,i l/ . 19 9~
Notary Public, .....r!~c:~:?~!.. .-...~L.:!~. County G~~ _
NELEA K. OE I~ ~ .........CJ ~'c'en~_ .
NOTARY PUBLIC, State~New York
No. 4701878, SuIfoll~CountyG' (Signature oC applicant
Tenn Expires Merch ~r 19_,.~cr
STREET
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