HomeMy WebLinkAbout19174-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219352 Date SEPT. 12, 1990
THIS CERTIFIES that the building ALTERATION
Location of Property 260 HORTON RD. CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block D1 Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application far Building Permit heretofore
filed in this office dated JUNE 29, 1990 pursuant to which
Building Permit No. 191742 dated JULY 2, 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 ALTER & RAISE CEILING IN EXISTING ONE FAMILY DWELLING.
The certificate is issued to LOUIS S. BOURGUIGNON & ORS.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H01791B SEPT. 5 1990
PLUMBERS CERTIFICATION DATED N/A
.
Bu lding Inspector
Rev. 1/81
~osx pro. s
TOWN OF SOUTRiOLD
BUILDING DEPARTMENT
TOWN FIALL
SOUTFIOLp, N. Y.
BUILDBNC PERMIT
(THlS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF 7HE WORK AUTHORIZED)
Na ~ 9 ~ Z Date 19.`~b
Permission is hereby granted
..~...:y.:..........~.,.9.~:~...........
to ..~.Cc:SJ.~:~:.~...J.l...sl-1e4-:4r....... ..J?.k;....,~!~~!~'.... ..Q:?:4,4....,..
tel... ..u~......
of premises located at .................~it~::!!`:!Jtl....~-':!..t........ .t1~!-.=^.~.............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No. 1000 Section ......~.O..d....... gBlock Lot No....1.~
pursuant to application doted .....~..:~~'.'.:?'.R..•••a,••1•••••••..•••••..••••, 19.9.x?., and approved by the
Building Inspector.
Fee 3.!>~..:./~~
Building Inspector
Rev. 6/30/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS FACE a
9.195].1"? BUREAU OF ELECTRICITY
BS JOHN STREET, NEW YORK, NEW YORK 10038
Date SEFTt MB EH (17, 1990 APPlicotion No. un file 71i I1A6o90J~10 N 1b ;'5ri'i
THIS CERTIFIES THAT
only the electrical equipment as described belorD and introduced by the applicant named on the oboce application number in the premises of
-HAWN kl'NU, 2b1J HORTUN ROAD, C:UTl NO1bOF, N. Y.
in thefollominq location; ? Basement ~ Ixt Fl. ? 2nd Fl. A r i I ~ 3ertion Block Lot
una eromined on AU6US1 1:,1940 ondfoundto be in wmplioncr with the reyuirementx of this Berard.
RXTURE HXTURES RANGES COOKING DECKS OVENS DISH WASNERS EXNAUST FANS
OUTLETS LCnTACLES SWI7CNE5 INCANDESCENT fIUGRESCENT OTHER AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMi. H. P.
G
WIYERS FURNACE MOTORS N/TURE AFFUANCE REDHK SFECIAl0.EC'FT TIME CLOCKS Rll UNIT NEATFRS MUlil-OUTIET DIMMERS
AMT. N. W. Oll H. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMi. AMPS. 7MNS. AMT. M. P. SYSTEMS AMT. WATTS
NO.OF R!i
SERVICE DISCONNECT NO.OF 5 E R V 1 C E
AMT. AMP. ME 1 J ]W 1 B 3`n' 7l 3W 3 F 4w GPER BCOND. Of CC
COND. ~ MI-LEG a' H
'IEG NO. OF NEUTRALS A'tllVlaNAI
OTHER AMARATUS:
ROOM RFNOVA710W-t
EL FC'.. ROfiM HfAt"F'h;9:2'3..". N,.W.
SAIsE h LA(.i Fi f1ANN INC. Ll~:. ft3t~t5F
Y.O. BOX 1768
.5OU7H01.1? ~ NY, 1197 t ON~RAI MANAO~i,
1 ~ -p
Per
i
This certificate must not be altered in any manner; roturn to tM office of the Board if incorrect. Inspectors may be identified b fh~eii credentials.
COPY FOR BUILDING DEPARTA~NT. THIS COPY OF CERTIFIGTE AN1ST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE ~
801,9t]84 BUREAU OF ELECTRICITY
83 JOHN STREET. NEW YORK. NEW YORK 10038
Date SEPTENBF.R 05,1990 APPlicationNo.onfile 70280790/90 H 017918
THIS CERTIFIES THAT
only the electrice! equipment os described 6ebw and introduced by the applicont named on the shove appliation number in the promises of ~
LOUIS S. BOURGUIGNON. 260 HORTON Rt?AA, C.[JTC,HOG[IE, N.Y.
~~77ryry ~~--yY,~ OU'f
in thefolloming locotion• LJ ment LJ /xt Fl. ? Ind Ff. .Sertion Block Lot =
AUt;UST 28,990
mss examined on and found [o be in complianrr with the reyuirementx of this Beard.
NXTURE RXTURES RANGES COOKING DECKS OVENS DISN WASNERS EXNAUST FANS
tIVT~, $ E?TACtE$ SWITCNE$ INCANOESCFM FWORESCENT OTNER NAT. K. W. AMT. K. W. MIT. k. W. AMT. K. W. AMT. M. P.
DRYERS FURNACE MOTORS FUTURE AMIIANCE gEDER$ SFKIAI REC'FT 71A1E CLOCKS EEII UlRT IIEATER$ RAItli1.0UTlET DIMMERS
AMT. K. W. Oll H. P. GAS H. P. AMT. NO. A. W. G. MIT. AMP. AMT. AMPS. TRANS. AMT. N. P. ND. ~T AMT. WATTS
SlRVIQ dSCONN[CT NO.OF S E R V 1 C E
AMT. AMP. ME ~M 1 / tW 1 ,e ]W ] H ]W ] / AW OVERCACOND. OF GC. COND. OF HI-LEG ~'HI'~G NO. OF NEUTRAL] Oj NEUTGRAI
O711ER Ag11RA7U5: •
'ENO VIS[JAh DEFECTS: "An electriral
survey has haen made rif the FxpasR~d
electrical equipment in the
premises indicated." "No obvious rE
uusatisfactary condition was fated.
-t'~ ¦
LO[liS S. BOIIRGUIGNON G/~~~
?1 GRAND AVR.
SHIRGEY, NY, 1.1967 gR1ERAl MANAGER
17
Per I '
This nrtificate must not be altsrod in any manner; return to the office of the Board if incorrect. Inspectors may bs identified by their credentials.
COPY FOR BUILDING DEPARTMENT. TNIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER. ~
Form No. 6
n
TOWN OF SOUTHOLD 11 Lj
BUILDING DEPARTMENT U ~@""""~~
TOWN HALL _ ~ S f
~bs-1BO2 1990 ~ ,
1.~ i=
~,,~~e ~
a~~D~. ri~Pr
APPLICATION FOR CERTIFICATE OF OCCUPA CY 7'piry~y UFt~Lf7t~CiLCJ
< .,.„~,b
.1. 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 3lealth Dept, of water supply and sewerage-disposal (S-9 Form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement £rom plumber certifying that the solder used in system contains
~ less than 2/10 of 1R lead. '
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Gode Compliance from architect or engineer
responsible for the building.
b. Submit Planning Board Approval of completed site plan requirements.
B. 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 o£ 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 huilding $25.00. Businesses $50,00.
2. Certificdte of Occupancy on Pre-existing Building - $100.00
3. Copy of Ce-rtificate of Occupancy - $5.00 aver 5 years - $10.00
4. Cpuated Certificate of Uccupancy - $50.00
S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Bate
::ew Construction....... Old Or Pre-existing Burillding......
Location of Property.,,.L~~.,....~„~U~TUIJ... l~,D~,rl•......... ~t.:'~~:I~.~J~ t.
House No. .Street Hamlet
Onwer or Owners of Property.....L:~:~OS•. `,•Y•~O~'~"•~'-.UJ~i-•~!~ SRS
~y )
County Tax Map No 1000, Section....l.,~ •L.•••B1ock.....1..........LoC... 1 ~
Subdivision ....................................Filed Map............Lot.............:........ -
Permit No ................Date Of Permit................Applicant...........................•.
Health Dept. Approval ..........................Underwriters Approval.......................
• ~ i
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate....4:..... ,
fee Submitted:
.y..~:~.
91 f 3! yD APPLICANT
Coziy.~s~-
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
8019684 BUR@AU OF E4ECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 70038
Date SEPTEMBER 05,1990 Applica[ionNo.onfi[e 70280790J90 H 017918
THIS CERTIFIES THAT
only the electrical equipment as deacrihed helow and in[roduced by the applicont homed on the afwve app[icotion numher in the premises of
LOUIS S. BOURGUIGNON, 260 HORT~ON ROAD, CUTCHOGUE, N.Y.
in thefoBowinq location; X? Bosement GX' /xr F'l. ? 2nd Fl, OUT .Section Blork Lat
was examined orL AUGUST 28,1990 and found W he in compliance with the reguirernenrs q(this Buord. '
FlxiuRE FIXTURES RANGES COOKIND DFCK$ OVENS DISH WASHERS EXHAUST FANS
OUTIET$ ECEPTACLE$ SWITCHES INCANDESCENL f1UORESCENi OTNER AMi K W. AMi. K W. AMT KW. AMi K.W. AMi. H.P.
DRYERS FURNACE MOTORS FUTURE APP[IANCE FEEDERS $PECIAt REC'PT TIME CIOCK$ gEll UNIT HEATERS MULTI-OUTLET DIMMERS
ANT. K. W. Otl H. P. GAS H P. AMl NO A. W G. AMi. AMP AMi AMPS TRANS. AMi, H P SYSTEMS AMt. WAiiS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V 1 C E
PMT AMP npt METER 1 a, DW ~ ~ 3W 3 $ 3W 3$ 4W NO.OF CC COND. A W G NO OF HLIEG A, W. F'' NO OF NfViNAIS A W G.
EQUIP. PER 9 OF CC. CONp OF MFIEG OF NEUTRAL
OTNER APPARATUS:
*NO VISUAL DEFECTS: "An electrical
survey has been made of the exposed
electrical equipment in the
premises indicated." "No obvious
` unsatisfactory condition was found.
LOUIS S. BOURGUIGNON
71 GRAND AVE.
SHIRLEY, NY, 11967 ~ GENERAL MANAGER
Per11(~ • ~L '
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.
r1ELD I;:S:`EC:IU;: ~~UATE ~ COMMENTS
b ~
1. ~ J
H ~y~
FOUNDATION (1st)
c
ti
FOUNDATION (2nd) m
2. ~ ~C J
o N
P,OUGH FRAMF/$ o
PLUMBING
H
3. ~
t»
I;JSULATION PER N. Y. y
STATE ENERGY
CODE
x
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4. a' ~ W it,.? y~
FI;JAL
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s~--m
ADDITIOP7AL COMMENTS:
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~Y ~ 765-1802
~9f j'~ BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ]ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS: ~
~r ~9~ _ .r~'
DATE ~ INSPECTOR
~y
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( } ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
~M1NG [ ]FINAL
REMARKS: _-~~~'~`'~,,Z~° " -
_
DATE ~ ~ INSPECTOR
4 ~
rr~ TEL. 7G5-1802
oO5UFF0t1(~OGy TOWN OF SOUTIIOLiD
~ OFFICE OP' BUILDING INSPECTOR
~ ,zT, P.O. BOX 728
~O • ~ ~ TONN EiALL
,~Ol ~ ~a~<- SOUTIIOLp, N.Y. 11971
August 29, 1990
LOUIS BOURGUINON
71 GRAND AVE.
SHIRLEY, N.Y. 11967
To Whom This 'May Concern,
We arc unable to complete your Certificate
of Occupancy because ,of the following reasons.
/,t/! An application for Certificate of Occupancy
~ //1s not on file. (ENCLOSED)
1.S L .i~/_+~/~No [lndcrwriters Certificate on £ile.
r N'~, / Tlie check is (oT[~k~~E~~i/not on file. ) $25.00
No Ilcalth Dept. ltpproval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit 1 9 1 7 4 Z
Buildl.nc,i Dept.
No Plumber Sol.cter Certificate on file. ~ .
( all permits involving plumbing being
issued after npril 1,19£34 )
I
rizmsr~ TEL. 7G5-1802
S~F~.a~x~
~p Op TOWN OF SOUTIIOLD
''a, ;.n! ~ OFFICE O[' BUILDING INSPECTOR
o v+~'i z P.O. BOX 728
y ' ~ ~ T01VN HALL
O~o! ~ ~a~`t- SOUTIIOLp, N.Y. 1 1971
August 29, 1990
LOUIS BOURGUINON
71 GRAND AVE.
SflIRLEY, N.Y. 11967
To Whom This May Cok~cern, -
We are unable to complete your Certificate
of Occupancy because of the following reasons.
/-~An application for Certificate of Occupancy
~~s not on file. (ENCLOSED)
No Underwriters Certificate on file.
/ ~/J 'flic check is (~[~li[3~ci/not on file. ) $25.00
No tlcalth Dept. Approval on file.
/ / No final inspection has been made.
Pleaae contact our office on this matter.
'(hank you for your cooperation.
I3uildi.nq Permit fk 1 9 I 7 4 Z
Buildi.ncl Dept.
/ No Plumber Soliier Certificate on file.
( all permits involving plumbing being
.i_,sucd after April 1,1984 )
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U 3 SETS OF PL.1YS .0:~..
FOtirA h10, l SURVEY Q• I.....
g~ TOWN OF SOUTHOLD CHEGK • . - • • - • •
BUILDING DEPARTMENT SEPTIC FOatf
BLDG. DEPT. TOWN HALL
jQN/N OF SOUTHOLD $OU7HOLD, N.Y. 11971 NOTIFY
TEL.:7G5~1II02 CALL
,r,~q.~. t~9.~ r1nIL To: •7/ ~p~C;"-~-
Examincd 1 , , .
APProvcd.... V•?;..,199b?PcrntitNo.L9,l?~~ ..x~ CJ~~.~lr~6.7..
DisaPProved ale .
(Building Inspector)
APPLICATION FOR BIJtLD1NG PERMIT
2
Date ...:!~"•''.'i'-C`_=.... 15 ~G
INSTRUCTIONS
il:
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Builditg 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 adjoinin; premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which ispart 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 applicatlan, the Building Inspector will issued a Building Petmit to the applipnL. Such permit
shall be kept on the premises available for inspection throw pout the work.
e. Na building shall be occupied or used in whole or in part for any purpose whatever untli 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
Re;ulations, for the Construction of buildings, additions or alterations, or for removal or demaiition, as hcrin described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and rcoufations, and to
admit authorized inspectors on premises and in building For necessary inspections. /~i ~j
•(Signa[ure or applicani, or name, if orpa ;wn) • •
-7~.,~r,Rol-Nt?_/~u~~:.SH~~'~.~.~:.~!_`~...1.<~~T~.
, (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••rs U a 5 , $ r . J3,b U d2 !s, U f G, /J•b D•b{' S .
(as on the tax roll or latest deed) •
if applicant is a corporation, signature of duly authorized officer, •
• • • • • • ~ • (Name and title of corporate officer - • • •
Builder's Liccnsc No. ~ • • • • • -
Plumbcr's Liccnsc No.
Electrician's License No . y
Olltcr Trade's License No . .
Location of land on which proposed work will be done; ' '
•
IiouscNumbcr ~ Stne4 Ilamict
~ 3
County Tax i\tap No. 1000 Section f ~ • - • • ~ BfUck ........J.......... Lot . i~•• ,
Subdivision . Filed t,tap No. Lot , , .
• (Name) •
State existing use and occupancy of Premises and intended use and occupjanc~~y~of-ap~r~o~p^osed construction: - . ~ -
a. Existing use and occupancy "~t~r
Jll ~
_ } • • • • • • • •
b. Intended use and -.S.C~n.2.'-.. ~e; ~G-;°Z,(L; ' .
occupancy
3. Nature of work (check which aPPlicnble): Ncw Ouilding • Additicn • • 5 ~.',t• •
Repair RFinavall........ Demolition ..........Swict., o j • . .
Tennis Court , . Acdessory building.......... Fence ...0[her tJork..-... # f.~} •
y4. Estimated Cost ~ Fcc .......J~Ar~.'~. ~
(!o' be paid on fifint; this application) •
5, IC dwcltin„ number oC dwelling uni~ (~''!`;e:::.... Idumbcr of dwelling units on each floor .....4'':R::
IC garacc, number of cars .....:Mstt+O'4~ . . •
6, If business. commercial or mixed o4eupancy, specify nature and extent of each type oC use
7, Dimensions of existing structures, i~' any: Front . .Rcar • • • • • Depth . .
Hcisiet . Number of Stories . .
Dimensions of same structure with ~~Itcrations or additions: Front . Rcar , .t.
Depth illcipltt Number oC S[oncs .
•
S, Dimensions of entire new constntct',ion: Front Rcar Depth • .
Hci~;ht , Numbe; of Stories .
9. Size of lot: Front ~ Rcar , Depth . .
10. DatcofPurchasc ,,,,,,,,,,,,,i,,,,,,,,,, ,,,NamcofPormcrOwner . ,
1 Zone or use district in which prcmi'ses are situated . • • • • • • • • • • • • • - • • •
l''. Dacs proposed construction viotatc any zonint; law, ordinance or regulation: ........./!'F•r~°•- • •
13. Will lot be re;radcd ~ ,1Vill excess (ill be removed from p[e~mises: Yes • • Na . .
1•l. Name oC Owner of premises ¢a,olsi,5,.. 1~ ouati,~vl,t~}' °~pddress 7.+. ~:~:'1.`~-• • P~i'one No.. •..39.Y:.`C`~~:~ , .
Name of Architect , . . .Address , .Phone No.. , .
Noma of Contractor ...Address . ..Phony No.._..;'....
tS.Is this property located r+ithitt•f00 feet of a~tidal•vetland? ^YHS....NO.It:-
*If yes, Southold Tocrn Srustees Permit may be required.
PLOT DIAGRAi~i
Locate clearly and distinctly all buildings, whether existing or proposed, and.indscate all set-back d'unensions from
property lines. Cive street and block number or description accordins to dyed, and show street names and indipte whether
interior or corner lot.
. '
r
-
I,
STATE OP\ENYORI:, SS
COUNTY OF .
• , being duly sworn, deposes and says that he is the applicant
• •(A'amc of individual signing contract)
above named. " `
FFcisthe
(Contractor, agent, corporate officer, ete.)• •
of said owner or owners, and is duly', autharizcd to Perform or have performed !hc said work and to make and Gle this
application; that all statements canta~ncd in this application are true to the best of his kno+vladgc and belief; and that the
,
+vork will be perforated in the mannersct forth in tltc application filed !herewith. ,
Sworn to bciorc my this • .y
i 1 ,
Votary Public, r~.. !7: ~ R
;((JJ//uf,~,~...... County - ~ _ ~ ~
NELEN ft DE YOE ' • • • •
NpTMriP118tIC,Ste1e ltnwYbdt ($i;natureoCa p(teantJ
No. 4707878, Suffolk
Term Expires Match 80, ,
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