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HomeMy WebLinkAbout19442-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19778 DATE: March 8, 1991 THIS CERTIFIES that the building ADDITION Location of Property 1675 PINE NECK ROAR SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 70 Block S Lot 42 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 2, 1990 pursuant to which Building Permit No. 19442-Z dated OCTOBER 5, 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 2ND STORY ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to JOHN & DOROTHY DIETZEL (owners} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - MARCH 7, 1991 PLUMBERS CERTIFICATION DATED 3/5/91-JOHN E. WALTERS PLUMBING & HEATING Building Inspector Rev. 1/81 lOBfi N0. f 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~ 1 9 4 4 Z Date 19.~.~... i Permission is hereby granted to: ~ q,~ ~..t~°..:a... ...y,~..o ~..G~~,!~...... ~ at premises located at ..~....l~fGU,~......... .....11..~..~ t .............................r......................................... County Tax Map No. 1000 Section Biock Lot No......J..'~°~.--.'.. pursuant to application doted ..........,/.l/.,/..~ 19~C...(?, and approved by the Building Inspector. Fee 5....~~..r`l. . Iding for t Rev. 6/30/80 { i FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter 0R ink, and submitted in duplicate to the Building Inspec- torwith the following; for new buildings or new use: 1. Final survey of property with accurate location of a{I buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"_ land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling ~r land use ~tS/ $5.00 3. Copy of certificate of occupancy $1.00 r - Date ~ . New Buildi~ Old or Pre-existipn~g Building/ Vacant Land Location of Property .110.~.(~1........../,-.i°.~~°..(~~°.~iF~~~.•. ....:S.~~k7'"~p.l".~ House No. Street Hamlet 99 ~-~j~ Owner or Owners of Property ~ ?..~1 .'7..f'1. Rr.4 ~ ~ . County Tax Map No. 1000 Section Block Lot ..:7.~-....... . Subdivision ..................-..............Filed Map No. - ......Lot No. . Permit No.~. Date of Permit ~ a.:3-.~ ~?Appficant .~G.n ! , ,(ti,2R y'. Health Dept. Approval ...............Labor Dept. Approval ....Y'................. . Underwriters Approval ,fit n a~/n,~. , s / ;jo,~, ,planning Board Approval . Request for Temporary Certificate :.............Final Certificate . Fee Submitted$??Z;.S„',-';^,,,,,,,,,,,,,,,,,,, Construction on above described building and rmit meets all applicable codes and regulations. Applicant, ...!.C.....~....... Rev. 70-1078 C~uc• `I13~~ C©~ Iq~~B' TEL. 7G5-1802 ~oc,~FFOLS'c0~~ TO'4Y~N Or SO~JT~Ob,D ~~ll ~ ~ L:C' < OFFICE OF BUILDIPIG INSPECTOR' ° • P.O. BOX 728 {,J°-1 ~n~ 3:~u TOWN HALL 0~~01 ~ y ~ 10~ SOIJTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date 1~~i2cl~ ~ I Building Permit N~~occ.~~ ' Owner_ ~~cu~- (please print)n P1usWzr 3^a~~• ~~-1~(S V'~~?~f~~Ti U (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. " (plumber's signature) Sworn to before me t4:is day of ~~'J~1r6~__ _ 19 ~I Q No ary Pu lic Notary Pub.Lic, > County ' Notary Pu~bl~ ~t~ e ~ lt~t Na 4822568. Suffolk Cputmr Term Expires December 81. t8 ~ 2 ~~~z THE NEW YORK BOARD OF FIRE UNDERWRITERS i o,~o.i ~ i BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, NEW YORK 10038 NAR(~Y l:,laul 77hRZ?9~J'+'1 P~ 1?R~#26 Dote Application No. on file THIS CERTIFIES THAT only the electrical equipment m deacri6ed 6ehrto and introduced 6y the epplicont homed on the aboENt application number in [he premises of )'CtBN D:L;ET7.EL, :6"i5 i"idE ;V6;i'f( 2i'i~b iC1iY".'Htit[,J?. ld.Y_ fi~tt--~, A'P"i'1C/iiU; _ in the follouinp htcationk B e ant ? lst F'I. CJ Pnd Fl. Sertinn Block Lot una examined on ondfound to 6e in cmnplianre with the requirements q(this Boord. NxiulE EPTACUiS SWITCNES FXTURES RANGES COOKING OKKS OVENS DISH WASNERS EXHAUST FANS CrItTItTS n INCANDESCENT FIpdIESCENT OTHER AMT. K. W. AMi. K. W. AMi. K.W. AMi. K.W. AMT. H.P. C. Y% j DRYERS FURNAC! MOTORS FUTURE AMLIANCE REDERS SFKIAI RK'?T TIME CLOCKS Ott UNIT HEATERS MULTI-0UTIET DIMMERS AMT. K. W. ql N. P. GAS H. v. AMT. No. A. w. G. AMT. AMV. AMr. AMPS. TRANS. AMr. H. P. SYSTEMS IunT. WATTS NO.OF RET - ,:(1 = 5lRVICE DISCONNECT NO.OF _ S E R V 1 C E c AMT. NAP. TYPE 1 / ]W 1l 3W l.e 3W 3 $ AW t''O' RER COND. OF CC. CONp. NO. OF NbLEG L~'H LEG NO. OF NFUTRAIS ~ ~~L i OTHER APPMATUS: F10T~:(i>~2~-1(2 B.P. G.e_f.Tc- ' F'Allh F.. }{IiRfd'i i~iC'..#?$-f:. _ J Z''.`, TO}tti NAkwOR t,ANF, SCIUTBCt.J), ?JY, 71'17"I ONEidtMA1UGlR .i Per ~16s Thi[ 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 ANY MANNER. `J~fO~K~~ TEL.7G5-1802 p5 ~O~` TOWN OI' SOUTIIOLD O' . ' . t, :-c UPPTCL' OP BUILDING INSPECTOR y ,_r~ ,-r P.O. BO\ 728 ~ TO1VN fIALL ~yf, ~p~" SOUT?IOLD, N.Y. 11971 41,~,~ March 6, 1991 Mr. & Mrs. John Dietzel 600 Highwood Road - Southold, N. Y. 11971 - To L^7hom This May Concern, We are unable to complete your Certificate of Occupancy because of the following reasons. /Xx/ An application for Certificate of Occupancy is not on file. /Xx/ No Underwriters Certificate on file. /gg/ The check is (oxi~txl~~/not on file. ) $25.00 No ticalt-h Dept. I~pproval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Bui]di.ng Permit )f 1 4 4 2 2 Building Dcpt. ***/Xxl No Plumber Solder Certificate on file. ( all permit-.^, involving plumbing being issued after 11pri1 1,19II4 ) vz:formll6 'IELJ is:.`;.c .i:::i ~{J;,:.. I{ :;~Mi•tF.t7T~ -v ~ m ~\}w` ~ R ~ ~ H _ ~ N 'OUI7DATION (1st1 Y~~ ° ~`CVN I - L~. ti 'OUNDATIOt7 (2nd) _ - m f ~t o ?OUGH FRAME & PLUMBING ' • ( ti v 3. ! t m H 0~ y IIISULATI0;1 PER N. Y. / STATE EPlERGY II ~ /}C~~-S'.S ~ I CODE ~S . a. y ~ ' ( FI;tAL ~ G~-a-H ' ~ _ ADDITIOPIAL COMMEP7TS: ro • x . 'v O H C.., Hi • t*1 r H . x - - - o , m -o - H ~ i ~c~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. J FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL RE'M/ARKS: ~ ~ _ ~1 ~ , DATE ~ l~ INSPECTOR ~ 765-1802 BUILDING DEPT. INSPECTIQN [ ]FOUNDATION 1ST [ ]ROUGH PLBG. (]FOUNDATION 2ND [ ]INSULATION [ RAMING FiNAI REMARKSm DATE ~ C~ INSPECTOR ~7-/~ 65-1802 ILDING DEPT. C ~ INSPECTION [ ]FOUNDATION 1ST [ ] ROUGN PLBG. [ J FOUNDATION 2ND [ ]INSULATION [ 1 FRAMING [ J FINAL REMARKS: ~ ~ DATE ~ C) INSPECTOR b~ ~ l 9 ~~Z ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [~SULATION [ ]FRAMING [ ]FINAL REMARKS: DATE ~~~_INSPECTOR~~P/ 4 3. Nature of work (check which applicable): New Quilding Addition ~ • • • [eratio . Repair Removal Demolition ..............Swimt~~o441 Tennis Court Accessory Building..........Fence ..,,.cc~~..Other Work 4. Estimated Cost , FeeT'~~~W.? ¢o be paid onefiling this application) 5. If dwellin„ number of dwelling units Number of dwelling units on each floor ....f........... If garage. number of cars 6. If business, commercial or mixed occupancy, specify natyre and extent of each tfype of use • r . 7. Dimensions of e~xistino structures, if any: Front . Rear Depth .l-~•-~, • , , • , , • , • , Height .c~,,~.... . Number of Stories v.~........... . . Dimensions of same structure with alterations or ad}itions: Front Rear , Depth a.l~ Ilcight C. 7...........: Numbc7r of Stories . ..i.......... • Dimensions o entire new constntction: Front Rear ~.,7........... Depth . , Hei~ltt ~,5. Number of Stories • • • • . 9. Size of lot: Front''../. J>:.7 l:ca_~• • ~2 Depth .~G2c.~ • • . • • • • [0. Date of Purchase , ~~9 hklme~ of rorm~r Owner • • . 11. Zone or use district in which premises are situated A.K P,1./ Niz 2-........ . 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.rJ • • • • • • • • • • • • • • • • • • • • • • • • 13. 1Vi11 lot be regraded /~CJ...,,.,. ......Will excess fill be removed from premises: .Yes Nc 14. Name of Owner of premisesJ~~'!7.~`~"V2~i~~•~•e•~, Address ...................Phone No.............. . Name of Architect ...........................Address ...................Phone No................ . Name of Contractor .Address ...................Phone No............:... . 15.Is this property located within 300 feet of a tidal wetland? *Y);5....NO_... *If yes, Southold Town 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 lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. Jo c%a7 C-a2rr /L ~ ~~~y ~ yJ' ,~~77, ~ . vA2~ ~ {z vc~~ ~/cL~ STATE OF NE1V YORK, S.S COUNTY • • , , , , , , Pl. being duly sworn, deposes and says that he is the applicant (Name of individual si uig contract) about named. Fk is the ~~i~.~c~ 2. c,.'~,.7 e2._.. . (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 Gle this application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swom to bciore me this dayof....~~ .........191.~~. ~ Notary Public, (~:~'!'Y. • ~ • ~L v•~- County NftEN K. DE VOE • NOTARY PURIIC, Stote of New York No.4767t47R,SuPtotkCounty ~ (S~ ture•ofapplicanU Tana Expires March 3D,19...~• i ;;p 11 ~ __L~ f5 i1~ ~ ~i BOARD OF HEgLTH , , , , • I! D i I 3 SETS OF PLd,.1NS • , , . FORM NO.1 SURVEY ` TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORr! BLDG. DEPT. TOWN HALL WN FSO LD $QUTHOLD•N.Y.11971 NOTIFY; e ~ ,~j TEL.:705.1802 CALL Examincd~~~~....... 1;~`. MAIL TO t Approved . /,a~~.'.. • 19'v. Pcnnit No..~~~Y' e~~ ~ . Disapproved a/c 'i tPL c=-e Ins ctor i APPLICATION FOR BUILDING PERMIT Date 15'!.O INSTRUCTIONS a. Tltis 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 sdale. 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 descrjption 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 Buildt~tg Inspector. APPLICATION IS HEREBY MgDE 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 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 laws, ordinances, bull g code, housin; code, and regulations, and to admit authorized ins ectors on rem p p ~ses and in building far necessary ins ct' ns. ~ ~ ~ (Signatur of"applicant, or name, ' a corporation) ~a ~~w~~~:~,.~ah~!r.-~~ fit. y..~~ 9.7, (Mailing address of applicant) Stat~~e++whether applicant'I/is owner, lgss e, agent, architect, engineer, general contractor, electrician, plumber or builder. ..C~.Prirra4~. C:err'VJ,act',~~BCef/N,~n/~/ Name of owner of premises J~~~~~,~.~1: o:Yh,y• c;4~~.F'.1 . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. /.~/.a ...............~I. (Name and title of corporate officer) Builder's License No,.~~.: ~ ~/1. Plumber's License No. • . . _I~i Electrician's License No . : . Other Trade's License No. } . 1. Location of land on which proposed work will be done; ..1~.~.5' :...............~'~~.e..1.L1.~~~I~..... s~~~:f-~~.1~1.......................... (louse Number Street, ~ Hamlet County Tax ptap No. 1000 Section • • • • • • • • • • • • Block • • 5. • • • Lot . ~ ~ • • , Subdivision ° Riled ntap No. • • Lot . ..(N;une) State c~isting use and occupancy o~f premises aJn~nd intended use and occupancy of proposed construction: A• lxisting use and occupancy. l••••••••••••••••°••••••••••" " " " ' .~~.S.r. S-.`.P!7. ~1 c7~. f g• Intended use and occupancy. " ' „ ~.^hT-..f'+.1•_r~RY 191 W1~1~ I i Ne-. i i r J . ry lZ [c r~ J l! k u d{t: f>. ~ i7 1 ~ V _ 1 ~ I, oS;tlg'+r ~ ~ ~t ~ ' _ . v is , I 0. , y+ ,4 1 ai y _ N ~ ~It ~ L 4i al~.r~. I. V tU 15 1 .w ~ \I+ ~ t I f) -i wl " f's • f:..l: M" _ ~ C_ f{ ~ ~ ~N I.TT NU.iAt°~::i",`_ ~I'IC~Cv'N RE;''E:11'~,:7 ''„'~C~.j' C)I,. Z .a C~ ~'h,~>[~c's*.'t"~ ~.,r~ ~Lw~:_~-._. r,rl,._:. >'~;~~,..I:;. ;r.~r,~l:: ~ A SUf'-w-C.1C.1•; 4: L;"atJIJT`~ CLE°f~,:~.,:a ~•p-~•-l~wf~ r'~S I.. CJ L u , z J~ ?G F-S=nt- K C plt W -j ( -j"p, x ;-'N'.:.'..: i::.: t~ G U - %O - • 1. C. ~ ' I•c~ut.' .t I~ 4 etn..ntborn.:d cltrlretlon a: eG?itiml V~ :o th~•i ;urvay is n vio!]4iun of . ;.~.nan n1 ffin Nrtw York £>x9o Fnaautinn Lrv C41'l,~" „Y 4n1^ Cnnl: f fl1t'il flal ~]dY((~'i •n~ cunmtyn irprP as:Aa cr,}r::,:;.s w: :xn! chtl; rnn: ba oonMcFxeB ro bur -rt,6c r, ve covp. G uradnlCB^ in~SicatOd YkfTGVBt OIInA ryN Orly n> th? p<6i Sun foY Ufh,Uni 4h tr &JfUm rrcns: st:. end on hin Lshuil Ya Yha 7 ntlt rornrr.":ny. Pov!nnmuntnl adancy pnU I,+^~'~r%e m,cn utinn Ilatud hoaoon and ' In rb• •„y„a,~ cA thu Isndmy Inati- ' u:n t.to[rlrofrtwus YtY nOt ninY'Wn6li lAON N ti6'$C)tC)C)"\~/. 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