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HomeMy WebLinkAbout19289-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219331 Date SEPTEMBER 4, 1990 THIS CERTIFIES that the building REPAIR Location of Property 744 OLD PASTURE ROAD CUTCAOGUE House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 11 Lot Zl Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 27, 1990 pursuant to which Building Permit No. 192892 dated AUGUST 2, 1990 was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is REPAIR DAMAGE CAUSED BY FIRE. The certificate is issued to SAMES P. WICKHAM (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A T7NDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 rossi aro, s TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUIL®ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) I Y N ~ ~ ~ ~ ~ r Z Dote .......~G.'~~.~~~~ 19.~~..~/ Permission is hereby grunted ta: pJ,~ .......C/~~ ....6~.Y...... ..............(~...1.1.....Q~....~:~.~..................... to ......fd~......... . .....G.~.. 4 .e../o,?l~...u.u.uu.u u.u..eu.uu...... u. t of premises located at ~G~1%~~..... .......~.~y.....~.......... ..........................................~......::~........s. ~.......~.~t..~................1..........::. County Tax Mop No. 1000 Section ~ Block .~...1........... Lat No...~~1....t............ i ...(..t~...... /y ~ pursuont to application doted .C~/~~~~........d.•`...~~......., 19y1...rf, and approved by the f ~ Butlding Inspector. f Fee S.••~/••1..~.~.. I i Building Inspector f Rev. 6/30/80 i t - s_:_ Form No. 6 _ TOWN OF SOUTHOLD ~J ~ - BUILDING DEPARTMENT TOWN HALL ~ ~ 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ' ' ~ 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-4 form}. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn staCement from plumber certifying Chat the solder used in system contains ~ less than 2/10 of 19, 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. 8. 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 inspecC 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, A1Cerations Co dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory huilding $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 Upua[ed Certificate oY Uccupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date :;cw Construction...........~O1ld,O~jr Pre-/~exisCing Building...n Location of Property ~l!l~ % .SX-~~..V,~'::t'~°-~c~ ~J ~"ee~-C •'~H~•-•_••••••• •ouse•No. ,,,Street, a e Onuet or Owners of Property...~/~t.x4'~:`~••~~•e~c`= ~•'r~~•°•=~'%•-.•.•••••••••••••••'•••••••••' Coun[y Tax Map No 1000, Section.. f.©. ~......Block..l~............Lot...' Subdivision. pp ..................................File9d Map............Lot.............':........ Permit No,.~.`.~~(. ~ .,.Date Of Permit.~:`:::~: F.~•.ApplicanC ~A:'l::~g, Wi: K ~9•~. Health Dept. Approval ..........................Underwriters Approval......................... i Planning Board Approval Re nest for: •Tem rar Cer ifica e. Fi Fee Submit $ y nal Certicate......... ~d: 1 ~ . 9~y~90 APPLICANT r n z~ 9331 ` 1• u ~l:n JHa ~ i ~ r '"--1 I~ ~ [T7 1 . ` an0 r'OUIIDATI0:1 (1st) - 1 • m ?OUIIDATZ0;1 (2nd) - 2. I o ~OUGH FRAI•!E & V PLUMBING yam. H 3, ~ n\ y V IIISULATIOM PER N. Y. STATE EPIERGY ~ • CODE • -~r m H 4, ti F Z;1 A L I • ~ ~ o as 0.DDITIOPIAL COMMEt1TS: x x H ro~ 3/ 9 • K O~ 7 • r ~ a v m b N~ C.o,_____ THE NEW YORK BOARD OF FIRE UNDERWRITERS= ~ `,~,r;~.`'"' 1~C~7 ~l iS'~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10088 Date NCl~tlf?I48i;.N th,'19a4) APPlirationNo.onfile ~i!)i?t~i.!3O/°~!(b AP 7C~1a3$N i THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of ,rlhl >~r~i~x~~n>~. l''~zTrt~')'~i.:: xt,~,ji, in»'x;rfrfsrtl~;,, fa-K,. in [he following /ocation• ? Basement ? 1.4t F'l. ~ 2nd Fl. .Sertion Block Lut was exmnined on and found to be in contpliancr wif.h the requirements q~ this Board. FI%TURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS MCANDESCENT RUORESCENi OTHER AMT. K W AMT. N.W PMi KW pMT K.W pMi. H P. DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT T{M4 CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W Oll H. P. GAS H. P AMi NO A. W. G. AMT. AMP. AMi AMPS TRANS. AMT. H. P. Sy$TEM$ pMT. WAtiS NO.OF FEET c SERVICE DISCONNECT NO.OF S E R V I C E pMT. AMP, rypE METER I YW I % ]W 3 JW S~ 4W NO OF CC COND. A. W G NO OF MbLEG A' W' G' NO OF NFUTRAIS A W G' EQUIP. PER% OF CC.COND. ~ Of HIiEG Of NEUTRAL OTHER APPARATUS: SC4Qf~S~; llk7l"k:C'PC)~+~-fit }3(3X 16,5'I`t1,f't4TA?'i?~ft f1VN;., (OY'Cftt~GfTM;, PYY, i.7 93fi GENERAL MANAGER 2.k Per 1 t ~ 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 BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. . ,~,r BOARD OF HEALTH 3 SETS OF PL<\tJS FOftM N0.1 SURVEY ' TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORPf TOWN HALL $DUTHOLD, N.Y. 11971 NOTIFY o , TEL.:765-1II02 CALL Examined • 19 MAIL TO \pprovcd ~ 19q~Pcrmit No..~..L . f! / f-.-- . Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIIT y Date „ 15~~ INSTRUCTIONS a. Tl1is application must be completely filled in by typewriter or;n ink and submitted to the Building Inspector, with 3 .:s of plans, accurate plot plan tbascale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets :;cos, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- .::on. 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 ::1 be kept on the premises available for inspection throughout the work. No building shall be occupied or used in whole or in par[ for any purpose whatever until a Certificate of Occupancy ::i :;ave been granted by the Building Inspector. ',:'PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ' .:.;:n~ Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~;,ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ficant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to .authorized inspectors on premises and in building for necessary inspections. ignature of applicant, or name, a orporatton) ~ ...5:~?~..J~.~~:~..1....~-~.~.~•~J-,w:~ V.~. (Mailing address of applicant)) ~ J~ ..;ether applicant is owner, lessee agent,^%architect, engineer, general contractor, electrician, plumber or builder. ~ 2V~2g.....~.....~~'...~ . ,;f owner of premises . (as on the tax roll or latest deed) _~nt is a corporation, signature of duly authorized officer. (Name and title of corporate//officer) :;idcr's Liccnsc No. (rG./.-.~~P(!:'1.._. ..:rnbcr's License No . icctrician's License No. . • .~.:-f~~ , Other Trade's Liccnsc No . . ' :cation of land on which proposed work will be done; - :(uuscNumber Street. Hamlet l ? l r'cunty Tax Dlap No. 1000 Section J....... Block ....~1 Lot . , o~ .l • Subdivision , Filed r\fap No. Lot . (Name) =rate c~istin~ use and occupancy of premises and iii~ ten/ded use and occupancy of proposed construction: A. Existing use and occupancy.......t~ ?•"~t`::~ .........o........ B. Intended use and occupancy ;....i. :.s ~.IY•9~s,~.. _,..a. , Ret air odi` $~1. (c;~i4`~: h Rpmovlal able): New Ouilding Addition Alteration . Demolition •Swimnin; pool............ . Te~nis Court Accessory Building....... enc{e- Other [fork........... . Estimated Cost t~ ~ I~.D~f Fee . ?..r!+. ~~..1~....................... ( (to be paid on [i]ing this application If dwellin;, nwnbcr of dwelling unit's .....I.......... Number of dwelling units on each t7oor If garage. number of cars if business, commercial or mixed ocFupancy, specify nature and extent of each type of use . Dimensions of existing structures, iCany: Front ~ Rear Depth . . Hei_ht Numbcr,of Stories . . Dimensions of same structure with alterations or additions: Front Rear . . Depth blcight ......................Number of S[orics . , Dimensions of entire new constntction: Front Rear Depth , • Height Number,of Stories . Size of lot: Front . .I........ Rear Depth . Date of Purchase . Name of Former Owner , . , Zone or use district in which premises arc situated Does proposed construction violate gny zoning law, ordinance or regulation: . . . . • . \Vill lot be regraded ............................Will excess fill be removed from premises: ,Yes No . Name of Owner of premises . .............Address ...................Phone No............... . . Name of Architect ,Address ...................Phone No................ . Name of Contractor ....:........Address . .Phone No.. . S.Is this property•loc„~ted within 300 feeC of a tidal wetland? *Y);5....NO.... *If yes, Southold Town TYustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly,all buUdings, whether existing or proposed, and, indicate all set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. ' ~ ~i ~ _ i ~1TG OF NEN YORK, S.S~~~' OUNTY OF . .i................. being duly sworn, deposes and says that he is the applicant • • • • • • • • •(Namc of individual signing contract) ~ovc named. I ' .isthc (Contractor, agent, corporate officer, etc.) ' ' said owner or owners, and is duly adthorizcd to perform or have performed the said work and to make and file this ptication; that all statements contained in this application arc true to the best of his knowledge and belief; and that th c irk will be perl'ornted in cite manner set forth in the application f led therewith. vom to bciorc me this ! ~ ...............a.~. ..day oF. ( ........,19 g~ Mary Public, , , , , , . t!!4 : ~ • • • • • County , ' HELENKDE~E tp~,gypp edNewYorN (Signature of applicant) . _ - k TEL. 765-I 802 5~F F °~c o~1Q OGy TOWN OF SOUTHOLD < OFFICE OF BUILDING INSPECTOR ~ ~ P.O. BOX 728 `f' ~ TOWN HALL y0 ® SOUTHOLD, N.Y. 1 1971 Cpl ~ ~`a C E R T I F I C A T I O N Date_ ~ ~ 9~ 7 Euilding Permit No._ f ~ Owner ~ ~p t `'i ~ ~ c~ T~ C , (please print) Plumber ~ ~ ~ ~..C; w (pleas print) r.' I certify that the solder used in the water supply system contains less than 2/10 of 1$ lead. (plumber's signature) BARBAiiA S7EPNONVSi;t Notary Public. Stat® of ha:~ 'Mork Sworn to before me this ivo.4ga47s2 Qualified in Suffolk County r, day O f , - L`'- ~ ~ ~?~ission Expires iYiarch 3 .18~ 7 v i 9 . Notary P li Notary Public,. ~~,~y-~"~ County