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HomeMy WebLinkAbout19463-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF OCCUPKNGY No M-24114 Date JANUARY 11, 1996 THIS CERTIFIES that the building Location of Propert~ 480 GRISSOMLANE House NO. Street County Tax Map No. 1 Lot Subdivision Lot No. ADDITION 1000 Section 78 Block Filed Map No. SOUTHOLD, NEW YORK Hamlet 10.3 conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 10, 1990 ~ursuant to which Building Permit No. 19463-Z dated OCTOBER 16, 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 GARAGE WITH DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. ELSIE D. YOUNG (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - JAN. 10, 1996 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOV~'H HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS pERAAIT AAUST BE KEPT ON THE PREMISES UNTIL PULL COJ~PLETION OF THE WORK AUTHORIZED) N~ 1946D Z Dote ../...~.~.Lb. ........................................ ,9.Z~ Permission is hereby granted to: at premises located at .................. .~..~...~......1~/~ ......................................................... County Tox Map No. 1000 Section ....~....~.. ............ Block ..... ./... ............ Lot No..../- .~...:,...~.... ..... pursuant to application dated ......... ./...~..././...~.. ............................ , 19, ,~/..~.., and approved by the Building Inspector. 7~ Pee Rev. 6/30/80 ~ Form No. 6 TOWN OF SOUTHOLD ~ ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY, ~"'gT"A-~-~---.~_l This application must be filled in by typewriter OH ink and submitt~'~2~ing 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. 5. 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. 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~ate ~~.~ ~. 1.0..,.. 1.%?. ~. ........ Locatmon of Property..,.~,.~-(~-..~c*-~S''~r~' ''~)~''~ ..... ,~t~. ~r~'~.~ ._ .......... House No.~/~~.~tr~t Ha~et Onwer or Owners of Property ...... ~.~(~...~...~k.~.~ ............................. ectlo~ .'~.. Block .I ~.. Lot. County Tax Map No i000, S ' · ..................................... ~v~s~o~ ...... ~.~...~,.~ ........ ~ ~ ............ ~o~...' .......... ~..~ ...... ~,rm~, .o J.~ ~.~., .~-'~ .~ o~ ~ ................ ~ ~.. ~s.~. ~.. Planning Board Approva% ........................ Request for: Temporary Certificate ........... Final Certicate ........ Fee Submitted: $...~ .~..~ ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~S2~'~ BUREAU OF ELECTRICITY j~- 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date JANLIARY :t. 5,1996 /Jpplicatio, No. on file 10963696/96 H 048384 THIS CE~IFIES THAT PE~iIT NO. 19463-Z ELSIE D~ YOUNG, 48~ GRISSOM LANE~ $OUTI,IOLD, in thefoBowlng location; ~ Basement ~ Ist Fl. ~ 2nd ~3. G~ / OU'I' Section Bilk Lot ~sexaminedoa JANUARY 10~ 1996 and found to be in compHance with the N~onal Elect~cal Code. FIXTURE FIXTURES RANGES C~KINGDECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS rECEPTACLES SWlTCflGS survey has been made of the exposed electrical equipment in the premises ~ndicated. "No obviotls [lnsatisfactor~ ~.oDd~t. lLn WaS 1380~ PI,~OSA I'~SON, FL, 34667 GENERAL ~AGER COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIG~T~ MUST NOT BE ALTERED N ANY MANNER Town Hall, 53095 Main Road P. O. Box 1179 Southoid, NewYork 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 21, 1995 Ms. 480 $outhold, Grissom Lane NY 11971 To Whom This May Concern: We are unable to complete your Certificate of because of the following reasons: xx An application for Certificate of Occupa~'~ ~x_~x No Underwri. ters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT 19463-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 7own Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 21, 1995 Ms. Elsie Young 480 Grissom Lane Southold, NY 11971 To Whom 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. (Enclosed) xx No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 19463-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INS~JLATION [ ] FRAMING [//] FINAL []FIREPLACE&CHIMNEY REMARKS: ~/~/~ ~ DATE INSPECTOR, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J/~dDATION 2ND [ ] INSULATION [/~ FRAMING []FINAL REMARKS: ~~,, ~///_~ DATE INSPECTOR 7G5-1802 BUILDING DEPT. / JNSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ FOUNDATION ( ls t) FOUNDATION 2. ROUGH FRAME & .PLUMBING (2nd) INSULATIOn! PER N. Y. STATE ENERGY CODE FI~AL .] ADDITIONAL COMMENTS: T©\;J?,~ { .'- · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ./,~/,~ TEL.: 7{35-1802 Examined .......... 19 Approved ........ 19 ?crrnit No. Disapproved a~ .................................... BOARD OF HEALTH . ~.~7.' ........ : SEPTIC FORM . .., ............ NOTIFY~ CALL MAIL TO: ,/('13 u il d~ In~pecto'r) APPLICATION FOR BUILDING PERMIT ~ Date ............... 19... INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building I/~speetor, with s~-ts of I~lans, 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 street~ Or areas, and giving a detrdled description of layout of property must be drawn on the diagram which is part of tiffs appD- cation. o. The work covered by tiffs 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 appl/cant. 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 ~:emoval or demolition, as herein described. The 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 necessary. ..ini~~. .~.. 'I .... o'.l..~2 ............ ~ .... ~ .......7J (Mmhng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. o e o£premises .~,,L~ ~_ ..................... I[applican,. is a corporatlon,... . slgnat~r~duly aut,~or~ze~.officer. ...................... ~4 ......... (Name and title of co.orate officer) "'lV~t~",' ~ ...... ,r I. Location of land on which proposed work will be done: ', ~ . . ............ 57~ 5~ A~. ............ ~, ............................... tlouse Number Street, Hamlet ....... .... ........ ............. Subd v s on ' ........ ~ .............. ~iled Map No. (Name) ' ......... t ....... -.~ SI~ie UXlStmg" ' use a~d occupancy of premises' and intended' use and occupancy of -ro"o~ ~ · ,' .. ~...~ .~ ~., o~.,=~ .................... .......~...=,~ ...................... B, ~ntended use c~ occu?c.qt:', ~ ..... ....... 3. Nature of work (check which appllicabie): New Building .......... Addition .......... Alteration ......... '. ..... S~im~ing pool. ..... Repair ........ i ..... R~mov~i .............. Demolition ........ · · .~.. ACcessory Building .......... Fence '. ...... Ot?er Work; ........... Tennis Court ~Z ~, ~. 4. Estimated Cost ./..~A~. :.. v,..v.! ........................ Fee ................................... ' i ~. ,d]~..i.~l.~ (to be paid on filing this application, 5. If dwelling, number of dwcilmg u~n,~ts ....... Number of dwelling units on each fl. o:~ ............... If garage, number of cars ....~) .Z ~ .b~l~. ..................................... I~'/~ ............ 6. If business~ commercial or mixed Occupancy. specify nature and extent of each type of use .... J,.~F ............ 7. Dimensions of exist.)~, resi if any: Front ............... Rear ................ Dept ................ Hmght ........ . .~'-~TF -~2AJ4~ her of Stones ....................................................... Dimensions of sam~vith alterations or additions: Front ................. Rear · · ~ ~I ............ Depth .......... ?~~. Height ...................... Number 9f Stories ...... '~ ;t l,' ....... 8. Dimensions of entir~ construction: Front...~./. ....... Rear,..~.~.( ........ Depth .~.~/...t4.~. .....~.,.... "" ' '~ Date cf Purchase Name of Former Owner 1 1. Zone or use district in which prer~ises are situated ......................... ~.,~ .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....1.~ ................ 13. Will lot be regraded ......... ~. ..... x.! ......... Will excess fill b~e remo~d£ram premises: . Y .... 14. Name of Owner of premises .~-r.~SCe..-r~).: .,~. ~j.. Address .q~:~.~'~f~ .~dys...~.~hone No..7.6~"-'-~-t~V-~- ..... Name of Architect ...... ~.~,/~. ........... :... Address ................... Phone NO ........... Name of Contractor ..... ~ ~Je/.J~ ...... ; ........ Address ................... Phone No ....... qS.Is this property located within 300 feet of a tidal wetland? ~YES .... NO~.. mIf yes, Southold Town[ Trustees Permit may he required. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property tines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or comer lot. N O ' STATEOF* E~VY RK,, COUNTY OF.. ?{g ~Fbil/~ ...... S.S ........... . .~'.f.. ~. J..~...¥.~...~..tl;J.. 5 ............ being duly sworn, deposes and says that he is the applicant · . (Name of individual sigging contract) above named. I t3e is the ' ' ' ! (Contractor, agent, corporate officer, etc,) of said owner or owners, and is dt!ly authorized to pe,rform 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 perfomaed in the mann er set forth in the application filed therexvitb. Sworn to before me this ....... ....... day ........ ~L .......... ,,.. CountE ~ , ot.w P,, lie, · d ..... .............. I:RA~IClI~ M. IIALCZA~ , 'l, ' ......... "'(Signature of applicant; Ne. 48g8780, 8t . ' r ' ~"' ";", 765~1802~!9..~AM TO 4 PM FOR THE i~ ~'~.~%, ' .... = 'rFOIZ,~OWiH~ ING~ECTIONS ', ~. FINAL - CQNSTRUCTON ~UST , , . ~ CO~PLETE FOR C.O. :',, ';~.:. TION SHALL MEET .... '" '"" I'~E' REQOIREI~ENTS OF THE NY,'"' ?~4[E CONSTRUCTION &~ .ENERGY.' "i