HomeMy WebLinkAbout19367-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219823 Date APRIL 2, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 7195 MAIN BAYVIEW RD. SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 078 Block 07 Lot 43
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPT. 5, 1990 pursuant to which
Building Permit No. 193672 dated SEPT. 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 ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to PATRICK & BLASE STIGLIANI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OE. HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N179793 MARCH 22, 1941
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
]PORN NO. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAIL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
f N ~ ~ 3 ~ Date ??~:.~!-L-... 5:.........., 19.~
E
Permission is hereby granted~to/1:/~~ ~ • 1~~~~1///y~~~)))j
1}/'~1A p
f ......T•.'~sil......X]NT.TViZ .e.•.• .l..ii _iGTR 15..{......•
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y at premises located at X.M:~!~...!!~~ ...................1~.............................
County Tax Map No. 1000 Section Block Lot No...~:..,, .
0. - .
Pursuant to application dated .....~.~.:`.::t:V~~::...Jr 19..e1:~?., and approved by the
Building Inspector. ` V
' Fee S.•~~'•~• f
'r
r Building Inspector
Rev. 6/30/80
a
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN FiALL
765-1802
• APPLICATION FOR CERTIFICATE OF OCCUPANCY '
i
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the fallowing: far ttew 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 Apptavai from Health Dept.~of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installaCion from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that Che solder used in system contains
~ less than 2/10 of 17, lead.
S. Commercial building, indusCrial 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.
H. For existing buildings (prior to April 9, 1957) non-conforming use6, 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
i. 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 huilding $25.00. Businesses $50,00.
2. Certificate o£ Occupancy ort Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
Updated Certificate of Uccupaney - $50.00 ,
5. Temporary Certificate of Occupancy - Residential $15.00, Commerci/a]/, $15.00
al!'~A _ ~ - Date ~I••
acw Construction.G,,,,,, Old Or P~rOeY-he'x~i-sting Build~tng... ,
///jam r
Location of Property. • ~4~1a.. ,.,,,;',~.s.....
.House Na. .Street Hamlet 1.
Onwcr or Owners of Property..
County Tax Map No 1000, Section..b./.~,.~.......B1ock.......~~........Lot...
Subdivision....../
..............................Filyed^M~jahp.........././. Lat...........~'•,"':........
Pcrmit No..f~,~(Q,7~;,Date Of permit.'.~~:~~.,Z./,I.UAPP13cant.~iY~~~~(C~':F9.T..
({ealth Dept. Approval.....,,:.::'; ,,,,,,,,,,Underwriters Approval.. ./..b,...............
Planning Board Approval........+.~,,,,,,,,
LequesC for: Temporary Certificate.,,,,,,,,,, Final Certicate..(.:r,.,..,
1`~"-' ~ 1 ( APPLICANT • ,
=TEED ICS:'EC;IU;J ~~Un:E ~ COMMLNT°
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FOUtJDATION S 1st) a ,J,
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ItJSULATION PER N, Y.
STATE ENERGY
CODE '4l
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FINAL
ADDITIOPJAL COMMENTS: m
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1
7 7 ?.506!i
a ~ BUREAU OF ELECTRICITY
83 JOHN STREET. NEW YORK. NggW YORK 0038
MARCH "12,1991 7233$891~9t N 7'797Tt3
3 Date Application No. un file
THIS CERTIFIES THAT
_ only the electrical equipment as described 6eloto and introduced by the applitront nomad on the eboce opplitetion number in the premises of
ST7GL7AN7, BAYYIFW ROAD, SOUTHOLii, N.Y.
in thefdlouinR luco~~17~.Ba~mfq(37_ ~ let Ft. ? 2nd FI. Section Block Lot
tAna examined on and found W be in compliance with the reyuirernenra of thia Ruord.
AXTURE RXTURES RANGES COOKING DECKS OVENS DISH WASNlRS EXHAUST FANS
OUTUttS ECBTAClES SWITCHES INCANDESCENT. RUOIIEXENi OTHER AMi. K. W. AMi. K. w. AMT. K.W. ANT. K. W. AMi. N. r.
11 11. t0 7. F
- DRYERS RJRNACE MOTORS WTURE AMLANCE 1ElDERS fFlCIAI REC'FT TIME CLOCKS pu UNIi HEATERS tAUITi-OUTLET DIMMERS
ANT. K. w. aL N, v. cAS N. r. ANT. No. A. w, c. AMT. ANr. AMT. Arms. TRANS, ANr. N. r. SYSTEMS ANr. wATrs
NO.Of IEET
- i i0
SERVICE DISCONNECT NO.OF S ! R V 1 C E
AMT. AML. T]PE ~ 1,I ]w 1 ,e ]`M ] l 3\v 3 / ~W ~R
% ~D~ OF CC. COND. a NI-LEG ~ ~ H NO. Of NEUTRALS at NEViNAI
OTIIEE AF?ARATUS:
SMOKE DETECTOR:-7.
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LAKE ELECTRIC LIC.A1845-E
17 F'ORY;5'1' TRAIL
RLDOE, NY, 7.7.961
GEEIMAE MANAEiER
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Per
Thit nrfificats must not be altered in any manlror; return to the office of the Boord if incorrect. Inspectors may be idaMifiad by their credentials.
COPY F BUILDI DE IS AtT ED IN ANY MANNER. r
T65-1$fl2
p~ ~ BUILDING DEPT. ~ ~ ,
lNSPECTlt~N
FOUNDATION 1ST ( ] RQ?UGH PLBG.
[ FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ]FINAL
REMARKS: ~ ~ ~a.~~
. _„w .
DATE ~
~~.~'--~_(~---INSPECTOR
r:a. PHONE 516/734.6681
• L'VYYL. ~E£.LTE
B U I L D E R
I3ew Suffolk Lane
CUTCHOOUE~ L. L, N. V.
11935
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OCCUPANCY OR
U5E UNLANIFUt,
W~TNOUT GERTIF#CAT~
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rl Ir .r~r'~~Llyr'rd'~'>%~ COOES. NQT RESPONSIBLE FOR
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D^'~ f7t117f_,~`~~ BOARD OF•HEALTH.•.•.•-.••.••
l1 V l.~ 3 SETS OF PL.~;IS
FOtitvi NO.1 SURVEY
~,.5~~ ~ ~ TOWN OFSOUTHOLD cNccK
7 BUILDING DEPARTMENT SEPTIC FORK
TOWN HALL
BLDG.DkPT.OtD $OUT{iOLD,N.Y.11971 NOTIFY;
TOWN OF SOUTH 'TEL.: 7G5•1II02 CALL ..GOG' y
•~T•
Examined.~~. $.4.~.., 19... PlAIL T0:
APProved ~.~j 9 D., !9 ...Permit No............ .
Disapproved a/c
(Building Inspector)
APPLICATION FOR BIJILDING PERPi1IT ,p
Date`./.~ „ 15~~
INSTRUCTIONS J
N.'
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 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 pan 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 h1ADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~v York, and other applicable Laws, Ordinances or
Rc;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heaein described.
Tlie applicant agrees to comply with all applicable laws, ordinances, building code, houstnG code, and regulations, and to
admit authorized inspectors on premises and in building for necessary. inspecti ns. , ~~y qs
(Signature of applican~me. if a corporatwn)..
' Mailing address of applicant)
State whether applicant is~ow'ner~,
lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .
(as on the ta:c roll or latest d d)
If applicant is
a~core~r
~ion~jgnatur of duly authorized officer.
(Namesnd title o7f corporateQofficer//) '
Builder's License No. ~ ~ /1. lT
..G .
Plumber's Liccnsc No . .
Electrician's License No . .
Ot)tcr Trade's License No .
i. Location of landpon which proposed work will be done; /
Rouse Number Street Hamlet • •
County Tax ~\faP No. 1000 Section . ~ ~ • • . • Block . ~ , , , , , , , , , , , , , , Lot . 1~........
Subdivision Filed t\tap No. Lot .
(Namcj•
State existing use and occupancy of premises and intended use and occupancy of proposed construction: - ~ - ~
A
a. Existing use acrd occupancy • • • •
b. Intended use and occupancy ~-p '
• . . G~E~G~c~~'j.~ .
I
3. Nature oC work (check which aPP,icable): New [luilding • • Addition ,111eraUOn s.,: , , •
Repair R[=modlnl Demolition ............Swiatrlin poab. .
Tennis Court Acce~ ry Building..........Fence .......Other tJork....
'4. Estimated Cost i..
l^°~^ Fee
/ (to be paid on filing this application)
5, IC dwcllin„ number of dwelling u I its , ' , , , Number of dwelling units on each floor ; . .
ICgaragc,numbcrofcars F6-~D1~-x•
6, If business, commercial or mixed Qccupancy, specify nature and extent of each t pc of use ~ .
7. Dimensions of existins structures; if any: Front , ;3~~ • , Rcar ...~.i~.t....... Depth , , , , , ,
Hci_,ht .dl.,~.~ Nurnb~er of Stories .
Dimensions of same structure wit~t alterations or ad itions: Front Rear
Depth . . I. IIeight . Number of S[orics . ! ,
3. Dimensions of efttirc new constntktion: Front , •~3; ! ~ , , Rear, f': Depth .
Height . ~~g, , , Number of Slorics .
9. Size of lot: Front , ii Rear ~ ..~-3 Depth e~ ,
t 0. Date of Purchase ~ ! ~ ' D. • t
....Name o~Former Owner . .
l 1. Zone ar use district in which premises arc situated .
t Does proposed construction,viola e any zoning law, ordinance or regulation:..../.(,/,(.~ .
l3. 1Vi11 lot be regraded .:.LII.~y~~~~ , , ; , , , , Nill excess fill be rc~Qv d from premises: . Ycs No~
(4, Name of Owner of premise 7.~7L',,~t ~jf~'(y:~Address ~A:4t 4l<ku ..9.GG~.... Phone No. ,
Name of Architect , , cAddress . ...Phone No. ~~.r~.~./~Q.~ r : .
Name of Contractor ~,dkl.~t,~~._7l~[/elY!-l.~k. Address rt.N ~ri`71~ ~J~ .Phone No.
IS.Is this property located within 100 feet of a tidal wetland? *Y);5....NO.~I..
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
?roperty lines. Give street and block n~rmber or description according to deed, and show street names and indicate whether
interior or corner lot.
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sTnTe or• ~Ew YoRI:, ~ s
COUNTY OF .
• • . • (1\amc of individual si~ni% ~ ~ ' ' ' • • • being duly sworn, deposes and says that he is the applicant
• ' ~ Itg contract) ,
above named. i
Fkisthc
~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dulyl'~ authorized to perform or have performed [hc said work and to make and file Utis
application; that all statements contai~ncd in this application arc true to the best oChis knowledge and belie C; and that the
work will be perl•omtcd in the mannerl,sct forth in the application filed therewith.
Sworn to before me this
...day of I 19
Notary Public ,II , , ,
.~~...~i ~-Q-.t!1:~ .County
N6TARYPUBLIC 5'~e
to~NewYatk • ~ • • • .
No.4707878,Su1taikCaa (Si^nature of applicant)
Tenn Expires March 38,18
•