HomeMy WebLinkAbout19081-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219372 Date SEPT. 19, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 1280 PECONIC BAY BLW. LAUREL
House No. Street Hamlet
County Tax Map No. 1000 Section 145 Hlock 02 Lot 12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 25, 1990 pursuant to which
Building Permit No. 190812 dated JUNE 6, 1990
was issued, and conforms to all of the Yequirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued ie DECK ADDITION Ta ERIBTING STRUCTURE.
The certificate is issued to ANN 6 LAURIH RROM
(owners)
of the aforesaid building.
SUFI~VLK COUNTY DHPARTMENT OF HEALTH APPROVAL M/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Bu ding Inspector
Rev. ]/81
roan[ xo. a
TOWN OF SOUTHOLD
6UILDING DEPARTMENT
TOWN F1ALL
SOUTFIOLD, N. Y.
BUILDING PERAAIT
(TH15 PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 0 ~ ~ Z Date ...........~..~.(~X~.R.......~A 19..~s'~
Permission is hereby granted to:
Q.~..... ~
~ ~ u.:.y.......~~.9.~
to ....~-°.`.~'4r~~:~:4.s~.......44...C~:4~:~......101,R~:l:~h-~`l:).....~?...~?^::?..JR~Y~P~`:i~...A.K!?:4~Sr.!.!;~.,
.~t~~Qy~ . .
p
at premises located at ~.A.~.~.~.....~p:.~rr^d;4....~°..~....1.'.?~:".!`.~ ..............:.u^xx.'-..................
.....Q 1
1
County Tax Map No. 1000 Section\.,.~..,~~..~`5......... Block ~ Lot No....A.
pursuont to application dated ........T..`!..\.,Gr!!~~.1.?~~ 19.~.!?.., and approved by the
Building Inspector. 1 v
Fee S.•~
Building Inspector
Rev. 6/30/80
~ - Form No, b
`TOWN OF SOUTHOLD ` ~~~~in ~~~~Er~ ~~p~,~
BUILDING DEPARTMENT '1~+
TOWN HALL ~ ~ S~~ ~ ~ ~ t"
f 765-1802 j~~`
9LDG i3~LNaml...;?'~E
' APPLICATION FOR CERTIFICATE OF OCCUPA TOWN OF;S0d1pF1t?t_D x
w..,....,~.,.~.
.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 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 2110 of 17, lead. ~
S. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
b. Submit Planning Hoard 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 huilding 525.00. 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, Uydated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential ``$15.0(0, Commercial $15.00
` v Date ....~4~~`.}~:~
::cw Construction. Old Or Pre-existing Building.. .
Location of Property. ,12~ ..~„~.~~uJLr,..~!~...~;~D.....,.L!:~4R"~'L.
-House Nonn. n,,~1 / ~/DS,treet Hamlet
Onwer or Owners of Property..[~TNJ~...~ ~°'~:Y!`'!'~'..~.r~„~
County Tax Map No 1000, Section.. NK .......Block....2;..........Lot....1,~+..,,._........
Subdivisionl! ..............................~~..~~~~..dd..Piled bfap............Lot...`..........':........ -
?crmit No.i9y!8~„~~,,,,, ate Of Permit.~i!'~l'V4 ....Applicanc~r:,U.~`r/~.~m~e~y{ip
D VVVV
fcalth Dept. Approval...... ...Underwriters Approval "
'lanning Board Approval ~
equest for: Temporary Certificate........... Final Certicate...~...
ee Submitted; oo....... ~
ic., 7f93~.2 j
n ; ~~:'ti~, ~'o~jrnr o~~ savluo~.o
/°;),g~g;;~t~y,%(i --c~ OfI'iCIiOI~ I3IIILUING IiJSPECTOR
. Ex~~s~:~ f I'.O. 4S0X 723
q, Mi,t, d~ ~ 1'0P,'IJ (IALL
`~A ~~~~~~~;;;''"`•.:',usrr~' ct- S0L3I'I1OL2), N.Y. 1 1971
September 13, 1990
PECONIC DEVELOPMENT CORP.
BOR 594
MATTITUCK, NEW YORK 11952
RE: ANN fi LAURIE KROM
To 44hom This May Concern,
V+e are unable to complete your Certificate
' of Occupancy becau:,o ,of the folloo-ting zcason~.
/~An application for Certificate of Occupancy
is not On file. (ENCLOSED)
/ / ao !tnrler~.oriters Certificate on file.
`3'hc check i::(c~G7QX'.~-~Xtr°cl'c3~not nn file.) $25.00
t:o flcalth eept. Approval on fi1c.
I:o final in:~pection has beetr made.
P]e.~:~c contact our office on this matter.
Thank you foz your cooperation.
c7uildin~ Pr_rmit 19 0 8 1 Z
IIuilclir.cl Uept,
dkk/~/ tto Plumber Solder Certificate on file.
( all permits involvin7 plumbinh being '
.insuc<I after April 1,19II9 )
1:. L 17 l ~ l:.l l.~ rf l.':~L~( f: N r._.
-o .,,Re
1. ~ ~ ~t)<
4`
H
_ _ y Oda
FOUNDATION , (1st) ~ ~
c
ti
FOUNDATION) (2nd)
2.
z
o
P,OUGH FRAME & q
PLUMBING
m
H
3. z
m
m
IIISULATIOPI PER N. Y.
STATE EP7ERGY
CODE I ' Q,~
Q c-
4, ~
H
'
FI;lAL
- p
x
ADDITIOPIAL COMMENTS: x
cv
' x
'
' N ~
A ~
' H ~
F~ ~
O
~ '
- r'
H
~
Z
v i
ro
H
- ~ c i
` 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING f FINAL
REMARK5/J:
DATE ~ INSPECTOR
,
- BOARD O"F,~HEALTH
3 SETS cyt PL.1.V5
FORM NO.1 SURVEY v~,s~
TOWN OF SOUTHOLD CHECK ~?"~.3~.aZ........... .
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
• SOUTHOLD. N.Y. 11071 NOTIFY E G~,e2iC/~ 7Jouf3/z~4?~-
TEL.: 7G5-1B02 CALL , , , ,
0 MAIL T0: 72z ~ s7r°Z •
Examined ~Lr l9 9 '>r7. BoX S?~'f ,
APProvcd .~••{^fhi, . 199. Permit No. ~ 9 L~ $ ),'.C.. ~~7f"/7t-iG/G j_ N y //95z
Disapproved a/c ~ ~ ~ 11 ~~J 1s i
D ~ ~
~ 2.8 X98(1
.:~:~~~1.....
(Building Inspector) u'o, r gLpG, pEPT.
APPLICATION FOR BUILDING"PERNH7 7oWNOFSOUTHOLp
Date ...'T._./z.~___......, I5.`~~
• INSTRUCTIONS
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 part of this appli-
cation.
c. The work covered by this application may not he commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pezmit
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 I~EREBY MADE to the Buildin; Department for the issuance of a Building Pernrit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all appiicable laws, ordinances, building code, housing code, and rco ilations, and to
admit authorized inspectors on premises and in building for necessa inspectaans.
~~c~rc ~Eu~A~t,~ti i C'a,e%~.
(Signature of applicant, or name, if a corporatwn)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engin r, general contractor, a ctrician, plumber or builder.
.~!`>N ~ L/~uKl•i x.,28.
,...'Ye,....;,, m.rp~...... .
Name of owner of premises .
(as on thr,ax roll bt`1ltest deed) -
~I`• V +e~
If applicant is a corporation, signature of duly authorized officer. ;~~4 •
A . ...has;~
,t~~~i~~~ "
(Name and title of corp/orate officer)
Builder's License No. .1~,". 7~ .
Plumber's License No .
Electrician's License No . .
Otlrcr Trade's License No .
t. Location of land on which proposed work will be done; -
E{ouse Number ~ Street Hanilct
County Tax D1ap No. 1000 Section • • ~ • • • • ~ BI'uck , . , . 2, , , , , , , , Lot j` , ,
Subdivision Filed i•lap No. Lot .
..(Mantcj ~ .
State ecisting rase and occupancy of premises and intended usye and occupancy of proposed construction: - ~ -
a. Existing use grad occupancy ~l NG~,~ , Y!~?? fL , ~~i ~~(r' 6
b. Intended use and s~'/1~.,%''
occupancy
3. Nature of wor}. (checl. which apple
icable): New Building . • Addition ~Utcration
Repair RFmov~l Demolition ~•~.ing pool.`
Tennis Court Accessory Building.......... Fence .Other 1Jork. .
4. EstimatcdCast~4~i~00~;^l Fee.....................................
5: If dwelling number oC dwellin un (to be paid on filing this application)
g its Number a(dwelling units on each floor
Ifgaragc,numbcrofcars
6. I
C business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing sttuctures, if any: Front Rear Depth . .
Hci'_ht Number of Stories
Dimensions of same structure with alterations or additions: Front . . Rear . .
Depth Height Number of Stories . ~
S. Dimensions of entire new constntCtion: Front , , Rear .a~.0.~ Depth ..~5~-(0,~'
Height ~lumberofStorics. ,r'
9. Size of lot: Front 0 , , , , , , , , , , Rcar , , ~0~ 7 Z Acpth .lr'.V.d...
l0. Dateoflai•cizase ,,,NamcofFormcrOwner
1 1. Zone or use district in which preti)ises are situated .
l2. Does proposed constructSQn violate any zoning'law, ordinance or regulation :
!3. Hill lot be regraded tVill ccss fill be rcmwcd from premises: Yes N
l4. Name of Owner of remise . , rtli~ ~lf~; /Z;?c~n3 Addres r~l~..Pltone No..~9~' .
P s~..
Name of Arahitrct .idress .Phone No. . .
Name of Contractor~~~~?!~,~~~V~~!~~ddress,•.:~`!7./lyd~. Phone No.72z+":~....
IS.Is this property located within f00 feet of a tidal wetland? *Y]:S.__.NO..,.
*If yes, Southold Town',Trustees Permit may be required.
PLOT DIAGRAhS
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
oroperty lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. 4
l7~~,~- ~'f~C ~ ~c ~ - ,
Z-ZX 8 OC f~- " r i7.kL~
tCcrjrJVt) 4~~ ~ S yh¢~C l° o
C
Z 1~8 CG¢ .C~o" 04, ba,~rv~ s d~ma a~e: ~ ~J ~ ~ ~ 'l.
~~~k ~ s,~,~ C~~~ I~
o~``~~ ~y!~,{~ APPROVED AS NOTED
N"r'"v` ~ ~ t~ BATE: . B.P. it . ~ ~ B 1 ~
A.,ae~ r$,e~R.~''~u ,c,s,14, r a~ r)r~ t . FEE: k3Y L'. `L
NOTIFV (3tIII..OINC; t7EP1tRTMENT A?
765 1802 S AM t"C) ~ P;V FO!% THE.
FOLt.OWINf, IPl!,'r' F C TtOty ;
t. FC)UNGATIOr.+ - TWCD FtEOl1fRw.C)
~CC~~ANGY Q~ FOR POURED CONCRETE
~,a 2. ROUGH - FRAMSNG & PLUMBINC3
US~yEn ISy 1~~tAW[~~"~.~, wsutArfoN
W~1f~4iit ~~~~~r~LY l'~ 4. FINAt_ - COPaSTRUCTIpNMUST
V n BE COM?LETE FOR C„O
~F Q~LUPAPC+y THE REOUfHEMENTS OFATHEMNLY.
STATE CONSTRUCTION & ENERGV
CODES. NO7 RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OP\E1V~'OQ.fC. G~ $,S
COUNTY OF .
• • ai~ne of indi~
u`~s~n~iiJ~ ~ • ' ' ' • • • bring duly sworn, deposes and says that he is the applicant
~ ; ig contract) ,
above named. I
FFe is the t'2~ i`D~rU:r_ , o~ 'i~~sr~.iC :~i<, ~U~(,
t~~rn~ti?'r Co~2P'..........
. . . .
(Contractor, agent, corporate officer, etc.) -
af said owner or owners, and is duly' authorized to perform or have performed the said work and to make and Gee this
application; that afl statements contained in this applicatiai arc true to the best of his knowledge and belief; and that the
work will be pcrComted in the manner,sct forth in the application filed therewith.
Sworn to b/c/f/ore me this
......pif.~..........dayaf.//l~-~i..........., 19~~
Votary ~Pu~b~lic~, , , , , , , , ,(9,-:~,~ .Q........ , County ~ - ~
~1'~/>X.l.~ ~ • (~L/ -eL~ DREW A. WALKER A-S ~TCELS i tom. ~l
NOTARY PUBLIC, State of•New Yotk ($i;nature of applieartU
Na, 4898779. Suffolk County
Term Expires January 11, 19~,~