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HomeMy WebLinkAbout19044-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19084 Date MAY 25, 1990 THIS CERTIFIES that the building ADDITION Location of Property 385 GLENWOOD ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 137 Block O5 Lot p/o 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1990 pursuant to which Building Permit No. 19044-Z dated MAY 24, 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 EXISTING DECK ADDITION TO EXISTING OAIE FAMILY DWELLING The certificate is issued to PAULINE KETCHAM (owner} i of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A vV~"`"~ Building In ector Rev. 181 Fnaa: rro. a TOWN OF SOUTHOLD iUILD1NG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ i ~ ~ Z Date ......................~.~.~..T.........., i9.~.i~ Permission is hereby granted to: ~r{ ~ /j ~ ~ s ....~.....I:`.~ at premises located at....c~~........~.X$:::!~t!:a':Q'!?4 .............:.......C,~.:Gev~',....................... i P County Tax Map No. 1000 Section ..,'.~~.A~.~].,........., IBlock Q.~.~r Lot No.....~..~.Z. pursuant to application dated .............1•.l:<.L.•f••7................, 19.9..x., and approved by the Building Inspector. Fee 3...`~:.. riding inspector Rev. 6/30/80 I TOWN OF SOUTHOLD E, ai ~f s " . Building Department ~~Y ~ ~ jgc,~ " ' Town Hall ~ , ~;d_..._, ' Southold, N.Y. 11971 765 - 1802 ~ ~rf~+~ ~ ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted w to the Building Inspec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installs- , bons, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to Apri! 1957, Nonconforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25:00 BUSINESS $50.00 2. Certificate of occupancy onpre-existing dwelling $ 50 .00 3. Copy of certificate of occu anc $ p Y 5,00, over 5 years $IO 00 4. Vacant Land C.O. $'20.00 S.Undated C.0,~~.,,// 50.00 Date ....~J~~'~~,,".1 :0........ NewConstructionv,~,'.~Old rPre-existingBuildinnng Vacant Land ..A.).......... Location of Property . 11L~\WC1.Q~..:~.~~.~~.r . ~~'\.G~Q.~!!+~.1..l y . Nouse No. ,}S~ee~[ ~Namler Owner or Owners of Property ~.~~~\Y:?':. \~~:4 !\p':w~........ . County lax Map No. 1000 Section , Block Lot T.,./~.r~... }1.. . Subdivision ~C~.UPS.1.`1~.~ :...............Fited Map No.~.1 ~l .....Lot No. .l: Q..I~.°.f. Permit No. Date of Permit ..........Applicant . Health Dept. Approval ........................Labor Dept. Approval . Underwriters Approval ..Planning Board Approval . . , . Request for Temporary Certificate .....................Final Certificate L16~.!-~;~........ . Fee Submitted $ ..~,~a.. ~7~ . Construction on above described building and permit meets all a icable codes and regulations. Applicant . G,Y¢~~ . Rev. 10de~78 C~.~-,3 qS GI coy ~ q©sv ~ r FOAMNO.6 4~ ~`~.`-...?~V ~,'I,I.ti~Y•%~j_~_v`' ''~a TOWN OFSOUTHOLD j~ ti " . Building Department ~ ' Town Hall . €Ll,,j' ' Southold, N.Y. 11971 ; ~ ~ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted r~ ~rrow~r to the Building lnspea for with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S•9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. A. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa• bons, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Nonconforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa• tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $.25:00 BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $ 10.00 9.Vacant Land C.O. $ 20.00 p~ S.Uodated C.O. $`50.00 Date ....~j . ~'.~~;".1 ~ Construction~~ New r.... , .Old rPre-existing Buildijn~g Vacant Land . Location of Property . , J~~ . Sl~~ W ~,b , l~,/~,G~D,C. t . ~y\ fJ.~V~,~ .1../ v, . . House No. \L Seel ~ Hamlet Owner or Owners of Property , ....~.~`ti\\U~? 7?~. y`:\~w~, , . County Tax Mafp}No. 1000 Section Block Lot Xn./1~ ..1.. I. Subdivision ~j~.('/\til~~.ZS.~!~~ ...............Filed Map No. 5.3 gl .....Lot No. .Y. ~ . ,I.~.1 _ Permit No... Date of Permit , ...A licant pp elt a rv H a h D pt. App o al ........................Labor Dept. Approval Undorwriters Approval ........................Planning Board Approval , Request for Temporary Cgrtificate .....................Final Certificate N t.-r.'r7~........ . ~ , Fee Submittad $ ..~`J.. Construction on above described building and permit meets all a icable codes and regulations. APPlicantl~C~¢ir Rav. 10.10.78 R~z,3 4s 9~ C o ~ 19oSy r ~ ~ ~ ~t?s-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING (/FINAL l: REMARKS: ~ t t l~~e C < DATE ~a S ~ INSPECTOR ~lELD I.'-SP~CTiU.9 ~~UATE ~ COMMENT° m 11 7. ` ~ 0 H ,S _ y ,.G FOUNDATION ( 1st ) - a FOUNDATION (2nd) 2. z o ~/I 00 ROUGH FRAME & PLUMBING Q~ ti H 3. ~ ~ rn cn IIJSULATIOfI PER N. Y. y W STATE ENERGY CODE x a H 4, ~ FIiJAL~ o z z ADDITIONAL COMMENTS: x rn ' x .a H ~ m ..G y H O 2 f ~ ~ CT7 > ~y r v H - ~ d t*] b H BOARD OF HEALTH 3 SETS OF PLANS FORM N0. 1 SURVEY - . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY ~OUTHOLD, N.Y. 11971 CALL TEL.: 765.1802 1,,,, MAIL T 0 Examined , 19`x.°. Approved ~ 19 9D. Permit No. ~ ~I O'~7 "tt,., • x:='. ~_~...r.~:a y-.. 4 r Disapproved arc ,~oa~.._. ~ ij ~ ` ~ E ~ MAY 111990 ~.u ...w v~c., a ~.r ,~r~ (Building Inspector) TC7`v'L'f+i O~ f:~si1: F.Y7t. ~ , APPLICATION FOR BUILDING PERMIT Date . ~ . INSTRUCTIONS a. This 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 azeas, 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 pazt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment 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 o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t< admit authorized inspectors on premises and in building for necessa echo s. (Signature of applicant, or n5a~me~, if(~ 1co~rporation) (Mailing address of applicant) State whether applicant is,owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. ..........................~.~!y'Yak!'~............................................................. \ x Name of owner of premises 5L ~1..~~.., . o.°.,;;,: s,,.;,,,~.. . (as on the ta~.roll.orwlate"st deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . Plumber's License No . . Electrician's License No . . Other Trade's License No . . I. Location ~/o~f land on which proposed w+o~rkwill(~be done . . Llouse Number Street Hamlet County Tax M• No. 1000 Section , Block ~ Lot ~ \ . . ~ Subdivision ~~.~,\'1i1f1R-r Filed Map No. Lot~~~1'~ . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......~~.~.P~~,Q.. . rr~raa>e ~s~taeou r,Nwro~+a ~alt,~I1M1y1MM b. Intended use and occupancy ~q AR . 9~t ,gt.reQ aYMf MNIMtr~1 3. Nature of work (check which applicable): New Building Addition . ~J~~t.~. Alteration . Repair Removal Demolition Other Work . (Description) 4. Estimated Cost ~ ..~J~~ . Fee . ` (to be paid on filing this application) S. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage,nuntberofcars 6. If business, commercial or mixed occupancy, specify nature and extent of each •type of use . 7. Dimensions of existing structures, if any: Front ...............Rear 'Depth . Height Number of Stories , . Dimensions'of same structure with alterations or additions: Front Rear . Depth .Height Number of Stories . 8.' Dimensions of entire new construction: Front Rear ...............Depth . Height ...............Num;berofStories........................................................ 9. Size of lot: Front Rear...................... Depth 10. Date of Purchase ...........................'..Name of Former Owner . ' 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation : . . 13. Will lot be regraded ............................Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . .Address ...................Phone No............... . Name of Architect . . . . . . .Address , , ...........Phone No.... , . Name of Contractor ................Address , , Pltone No............... . - 15. Is this property located within 300 feet of a tgqidal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO~DIAGKAMed. Locate clearly and distinctly all I buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. \ \ QNVNi~ ~G A VJN~~~ R.~~ a\~o\ ~~~QQ ~ a ~0U ~2,~. ilPpR04l~ I3 A~ N07EL~ DATE: S ~ /~O f3.P. N ~ 4 ~_'1~,. FEE: - ~BY: •L NOTIFY ?;tfdl.l."~iNG gEPARTMENT Ar 765.1$02 r; AM TO 4 PM FOR rNE FOLLOWING PNSPECT1gN5. 7. FOUNDAr10N - TWO RECIUIREb , FOR POURED CONCRETE 2. ROUGH • FRAMING R PLUMfiINr 3. INSULAI'IC3N I 4. FINAL - ~'onerrRUr,TION MUST ~ 8E COMPLF'15 5'<r+: r tiCCd.1~ANCY OR ALL coNSTRUI~:'rPr~N x.:~ tipper ~~I.AV*a~Uh THE R Qu1R>rnnr-Nl"S t'Ir ~ ~ v. C~{~~IFIC~~~ sraTE coNSTRUCi°IDr~ `e1I~~~~"( CODES. N07 RESPO!v:ai5 5~ p~ OCCUPANCY' gESIGN OR CONfi'al'RUCTIQTd STATE OF NEW Y R \ S.S COUNTY OF Win, ~ . ~v,Y \v:.l~... . (Name of individual sign ~ ~ ' being duly sworn, deposes and says that he is the applicant ng contract) above named. He is the L:b.~!'~...................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contijined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannet set forth in the application filed therewith. Swom to before me this ........day of,... ~1:. ~.C'~........, 19 Notary Public . ...........'1`~~-0~~..... County 1WARx ~ rb~ (Signature of applicant) NMrY+ ~a~ ~ OwMiaMiMOr.~O, iNt j - 4 4 i I P~ZQPQSEC~ Llf~l* CHf~t~dGE 4 MAP ~j~ ~?~C~P~2T`~r' f I f9> viF~2f~ S'UI~Y~Y~f7 F't3R. D / ( ~ 1 , ~ x.56 3250 E, 150.03 _ a - j m c~it --ra-~,cauv,..,~~T_Y'_'fiU_f~EQ W~. --_.'is --...F Cl / or ~ $ F.LEET'S NFCk ' ~ ~ ' st67 S.F.-~\'~ m / CUTCI-1QGkJ~ , N.Y, I ~ ~ {I I N I I ~ F so.o so_o_ p6'€'tit)~'EUA~NO'aEe= i Ifl I Q f- m I c I. DATE 3 P I ~ O a Q i I TEE - u O~./NERS ADDI~~E~S~ ~ nlOnvv e~_wnn+c t~.P~+FTr,'dIENr n' w - IQ5 FL.EETYJDQD RYJAD I Tes IF,07 'a unn r., f For' T:-~c 'I 17 I F I' I - GUTGHpGCt'E -NY ?IgSS ~i K)LLOpJ~MS IL~~ Cl ~ ~ i 1 FOUr:QATIOiV - TWCI REOUIRF'F] I m ~ / ' j w{ / I FOR POURE6 GUNC kETE Z ^I p J 2 ROUGH - FP.AAAING ft PLUM`+"'- ~ U 3. INSULATION !S~"~_ o t ~I O.-. 16 - / ' 4 FINAL - CONSTRUCTION MI i~ I ~ ` ~--7,- ~ ~ ~ I" ! BE COMPLETE FOR C.C I ~ ~ i~ --T ~ 75Qp SrR'" i I ' ALL CONSTRUCTION SHALL MEET I ~ ~ L_.._~~; ~ ~ ~ THE REQUIREMENTS OF THE N V. .m - ~ ~_~I CLl i 1 I STATE CONSTRUCTION b ENERGY ~ aN~ a l ttl I i CODES. NOT RESPONSIBLE FOP ~ 7 N ~ j ` ' I DESIGN OR CONSTRUCTION ERRORS om w 1~ ~ j - ~ J I 7 Fh I ~ j Z Z ~ I I i r - SL1.4, 50.4 1 M;xa,O-g5' i G!_EhI'Ln/4G?P gl2'ST4U1`E~IBIJ~t~i f20AJ .37 i ~ i / i _ / _ ! i i f~ ~;~or.~ur~(~NT { ~~..I~`I w,EwE I t~ i ~ I I P,. j <E Of NFA. 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