HomeMy WebLinkAbout19215-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27512 Date: 01/16/01
THIS CHRTIFIHS that the building ALTERATION
Location of Property: 2715 NASSAU POINT ROAD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 104 Block 13 Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 3, 1990 pursuant to which
Building Permit No. 19215-Z dated JULY 20, 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 ENCLOSE EXISTING OPEN DECK TO SCREENED PORCH OF EXISTING ONE FAMILY
DWELLING "AS BUILT". NOTE: THIS CO IS ISSUED BASED ON AN INSPECTION DONE
BY CURTIS W. HORTON ON JAN. 8, 1991.
The certificate is issued to ANN B. WALL REVOCABLE TRUST
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H-019507 12/04/90
PLUMBERS CERTIFICATION DATED N/A
Auth riz d Signature
Rev. 1/81
lYDHffi HO. ~
T®WN OF S®U'TNOLD
BUILDING DEPARTMENT
TOWN HALL
SAUTH®LD, N. Y.
BUILDING PERMIT
ffHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
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Dore G~%'~.~UG%~........G~ t 9.:/...~
Permission is hereby granted tja~ ,
.
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ro . ...E%~~~
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of premises located at L7 f~!
.
County Tax Mop No. 1000 Section ........1......~.,. Bieck ...~~...~~....~.jL~o't No.....~~...~.
pursuant to application dated )9..1..(r.; and approved by the
Building Inspector,
Fee $..J.~.rdi...~O..'..
Building Inspector
Rev. 6/30/80
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TOWN OF SOUTHOLD VV
BUILDING DEPARTMENT 11
TOWN HALL Vv
SOUTHOLD, N. Y. ~ { la
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 16'G"2~ z Date ...gig.............., 19.A.7
Permission is hereby granted
4ra:!~.....~ J~'
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of premises I«ated atat
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.~.....1.?.. ~ .
County Tox Map No. 1000 Section ........1. ~..7..... BI«k .......~..1~....... Lot No.......~a...8.
pursuant to application dated 19~..~., and approved by the
Building Inspector.
Fee S..'~•
..iS.f~~!.:.
.
Building Inspector
Rev. 6/30/80
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Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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-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 17 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.
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 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $1pp5.00, Commercial $15.00
Date ..~~h':'~:.A:..~~G.l
New Construction........... Old Or Pre-existin Buildi g......
,~I ~ / ~
Location of Property..~.7~d~.... f :
l~~s f~
: .A/.~/! . l.`.°~"~. ~9~~~ !~Y~..ll y3~ . ,
House No. Street Hamlet
Onwer or Owners of Property../~,~/,v.~°„.~.::.:GFt~/i/7~„/~:,~1~;", 4; 4';
County Tax Map No 1000, Section ..............Block................Lot......................
Subdivision ....................................Filed Map............Lot......................
Permit No..~.F~~.~.~.....Date Of Permit..~I~.Q!Q.~.....Applicant. .~?r.h~.
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $ l '
C Q ~a 7SI2 APPLICANT'
THE NEW YORK BOARD OF FIRE UNDERWRITERS ir.a4"=k' ~
%Sy]N1?fi$ BUREAU OF ELECTRICITY •
65 JOHN STREET, NEW YORK, NEW YORK 10038
Uate t72';c"~Fa1'T+~;N (7 di. "t`~y0 APPlicotionA'o.onfile `Lf*i'~~7^4C1f°~(7 H f,7~~3°°~t,1"1
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the opplicont named on the obooe application number in the premises of
7?,A, tt~iftE~. ~Yf45 N7#55:4t~J f"v;T.PS'!' I~d~t1, CPPPhd§c)(;'tI'k~, t:3.°t'.
in the foUowinq location, ? Boaement ? IRt F'1. ? 2nd Fl. i11)f Sertion Btock Lot
iW~%Vf~'P4F1N'(f .f 6~r?l) and found to be in compliance with the reKFuirernents q~ this Board.
uas examined ort
FIXTURE ECEPTACLES SwtiCHES FIXTURES RANGES COONING DecKS OVENS DISH WASNERS EXHAUST FANS
OUTLETS INCANDESCENT FIUORESCENr OTHER PMT K W. AMi K. W.~ AMi KW. AMi K W AMi. H P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCN$ BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMi. K. W. Oll H P GAS N P. AMi. NO A. W. G AMT NAP. AMT AMPS TRANS. AMr. H P SYSTEMS AMT. WAIIS
NO.OF FEET
I
SERVICE DISCONNECT NO.OF S E R V I C E
PMT. AMP. TYPE METER I tW I % 3W 3,9 RW 3,0 4W NO OF CC. COND A. W G NO OF HbIEG A W C' NO OF NFUiRAIa A W G'
EQUIP. PER% OF CC.COND OF HbLEG OF NEUT0.AL
OTHER APPARATUS:
*tdfl Vf:ffgr, dfk:P'h;r°T2,: "~tt e~.lEpl'ft-ir~l.
;~ut'r~q han h;3c~"H tn~tler o."r. rrii+, asx~L~::er~
F~lelr,trir.a.f. equi~sta~iTi, i.tt t.ia+^
lat°I~~u-~i;rsc~s ti~rl'i~'at;~Tl.a nNEy <>f>c~.+~xt~t
uu„atias4'~rtc>r•y a[and.tf"itm wr~~ ~nRttt~,
'
~:°l!5 NT14;~i7~lf Y'O.(f~`i' tfl).
11'€'C`}N11t(St`„ fslY, "I M1,a 1t, OENERyA~I MANAGER
Per i t ~X~~~~
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.
CGPY FGR o;UILDING DEPARYMENT. TIiIS C®PY ®F CERTIFICATE MUST N®T-BE ALTERED IN ANY MANNER.
::;,D l:: ca,. i~'i: ~I~e.:.. I~ .;UMMENT~ ,R~ ~
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NSULATIOP! PER N. Y. I ~ • •
STATE EPlERGY ~ ,a
CODE II
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BOARD OF HEALTH
~ SETS DF PLANS
FORMN0.1 SURVEY
TOWN OFSOUTNOLD CHECK
6UILDING DEPARTMENT SEPTIC FORPf .
TOWN HALL
$OUTHOLD, N.Y. 11D71 NOTIFY ;
TEL.:7G5.1802 CALL
Examined 19 MAIL T0:
APProved `a.Q., 19~dPermit No. 1..~. ~ l~z , , , , , , , , , , ,
Disapproved a/
(Building Inspector)
APPLICATION FOR BUILDING PERPo1IT
Date ~i-;, • . 15
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~
sets of plans, accurate plot plan tb~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 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 ptuy.apulipo~~~'t+~~a`~t~~?eiz`i~hil a Certificate of Occupancy
shall have been granted by the Building Inspector. ~,llt~ gpty,,jt t~~r<22°sat `ti~a
c.. ,
~t'YE,z.A.
APPLICATION IS HEREBY MADE to the Building Department fbrifl4 ssnai~c~ of a;,B,fwlding Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, N~~t11'drk~,~. an~~fier~pplicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for,removali:qr ~g~tyolition, as herein described.
The applicant agrees to comply with all appiicab~e laws, ordinances, tiui118inIS ~gzl~~~~usin~ code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inape tiojs. '
(Signature of"applicant, or name, if a corporation)
%P! o~ox 7p5', ,~vCfG.fa'P.~~."df~~. ~1~..!0~5' S.... .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Pa c~ J ~`2....................................................... .
Vame of owner of premises . c~, . .
(as on the tax roll or latest deed)
IC applicant is a corporation, signature of duly authorized officer.
OCCUPANCY OR
(Name and title of corporate officer) C
Builder's License No. .USG's UNLAWFUL !
Plumber's License No. l.Y.~-rM.'.e:........ WITHOUT CERTIFICATE.
Electrician's License No. 0~ OCCUPANCY
Otltcr Trade's License No . .
Location of land on which proposed work tvil! be done; -
house Number Street. Hamlet
,
County Tax Dtap No. 1000 Section Block O !,3, Lot Q;?~. , , , •
Subdivision ....:?i? 5,.9q , lPi.»'; . . . . Filed Map No. Lot .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,
A. Existing use and occupancy.... , ......~,t44, rv„~,E3..~.;,,:. .,p.,f ~,t
B. Intended use and occupancy... ~~'.~.L~~~~•~`•` ~'~f': . .'sr`'''''
'.I?c,#li~~t'.'., 's'
3, Nature'of work (check which applicable): New Building Addi~n . Alteration .
Repair Removal', Demolition ..............Swimming pool........... .
Tennis Court Accessory Building..........Fe'rlce~•-•.......Other Work...........
t. Estimated Cost /4:440 Fee ~ ~ .~~.U , •
! (to be paid on filing this application
If dwelling, number of dwelling units Number of dwelling units on each floor . !
If garage.numbcrofcars z': •
5. if business, commercial or mixed occupancy, specify nature and extent of each type of use , , , , , , , .
1, Diimcnsions of existing structures, i~ any: Front / . Rear Depth . .
Hci~ltt Numbct of Stories / ~y . .
Dimensions of same structure with Alterations or additions: Front Rear , .
Depth licight Number of Stories .
3. Dimensions of entire new constnuction: Front Rear ,Depth .
Hcigltt Number of Stories .
9. Size of lot: Front ~ Rear Depth .
0. Date of Purchase ......../1.': j5; ,7,7 , .......Name of Former Owner Frl:'4`i'FPr!CK.?r. HE;«:~: ~.,G?o,$;~ ,
1. Zone or use district in which premises arc situated .
Does proposed construction violate~i,any zoning law, ordinance or regulation: .
3. \~ill lot be regraded , .....will excess fill be removed from premises: -7 Yes No
4. Name of Owner of premises l ..............Address ...................Phone No../. 3,~,
Name of Architect • .............Address ...................Phone No................ .
Name of Contractor ......Address . .Phone No..... .
iS.I's this property loc,~te;d within 300 feet of a tidal wetland? *YES....NO....
*I!f yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
j
Locate cleazly and distinctly all btaildings, whether existing or proposed, and. indicate all set-back dimensions from
ropc~ty lines. Give street and block number or description according to deed, and show street names and indicate whether
aterior or comer lot. I~
~+~Pa®~ tubing itl used
! '711 eMlfaet~'tll Yo. o `
ayetems aiairg~:}n8a be
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TY OF ~ ~ Door: dCCTrads dr/tN aFmodggty MASS~. 5cr2sEdS. ~aJO'
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• • • • • • ~C n n• • • being duly sworn, deposes and says {hate is the applicant
• • • •'i (Name of individual si nm ''contract) ,
~bovc'~namcd.
~W YL-Q
fcistltc ~
(Contractor, agent, corporate officer, etc.) •
~f said owner or owners, and is duly ;iutltorized to perform or have performed the said work and to make and Gle this
Pplic~tion; that all statements contain~d in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the manner sut forth in fire application Glcd therewith.
hyom~to before me this
i
.....L ~S~.day of . 19
u ~ n C -
Votary'. Public, ,~,r~~~-~-:':'.~ „~,T .County
CLAIRE L. d ~ ~~,:,~f. ,
Zj6~r.L[;-
i Notary Publb, State of Nwy YeAt .
No. 4879606
~ Quellfled In Sufidk CpuptY (Signature of appbcartt)
Cpmmhebn Expk'ee December 8,19
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