HomeMy WebLinkAbout18892-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20875 Date JULY 21, 1992
THIS CERTIFIES that the building ADDITIONS
Location of Property CRESCENT AVENUE FISHERS ISLAND, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 6 Block 2 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH. 12, 1990 pursuant to which
Building Permit No. 18892-Z dated MARCH 19, 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 BEDROOM & DECK ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to CT. BANK & TRUST CO.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-174663 - FEBRUARY 15, 1991
PLUMBERS CERTIFICATION DATED JUNE 23, 1992 - MARIO ZANGHETTI
~ ~
' Buil-
d~n pector
Rev. 1/81
roses xo. s
' TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~.889~
Na z Date ......~?1..,.x..........1....9 199
Permission is hereby grouted to: ~ ;f-'
...~.0..,.....~.~...a.:~.....a:.~.~...0 y'
~.............6~~ ~
of premises located at ..........L..z....~~
County Tax Map No. 1000 Section .....rb......./....... Block ......~.........~+/Lot No.....r!..~...........
pursuant to application doted 19.y"l.[/., and approved by the
Building Inspector.
Fee ~~~/.lf...~.~...
Building Inspector
Rev. 6/30/80
a ~
Y~lit.M NQS B
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Imtructionrs
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
inspector 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.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of c"ampleted site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
,.1. Accurate survey of property showing ali property IiHes, 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 in-
formation required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
-1 Date
New Building Addition Old or Pre-existing Building Vacant Land
Location Of Property.C.:.tE'.~~.G'.E.NT...nU..~"a.:...FIS•~C1~S...~;.SLA.uc~.<..~;t~;:~
Owner Or Owners Of Property C .t.':...Q?C~.!~?.k d, T1~u~T...C~:...,1;(~LCoT .5,.;..~.rULCy
Subdivision ................................................1.~(?............Lot No. Block No...°~...... House No.............
Permit No. ~.$.~..`laa.....• Date Of Permit~.l.~ 9.I.4.°. APPlicant zd::s....~~...: "-~TI?I~J, C ~,ru,c),,S,;;t?c„•,
Health Dept. Approval ....................:.......................Labor Dept. Approval
Underwriters Approval ..~.7Y~°~..1'
............................Planning Board Approval
Request For Temporary Certificate Final Certificate
Fee Submitted $ ..al.~(.:...°..~......•.....••••••
Construction on above described building and a it mee/t/s~/.qII app. bl~odes and regulations.
w APPlicant ....vk(~'~`.Y,E~.,?,..•/~ LS 1• c;~ Cn3T
5worn~before n>~fils - ~ _ ,
J _ ,
day o('~~.uA(~ ~ . - st9mp or seo~
Notary Public Cou ~ " rioUry~PUbgtia~SieB~teol~NewpYgr6
.
_ _ ~ _ No. 4E05559
• - Quatlftea In Sutfalk County
y y ~ ?t form Expires 1?J3v9Q~-
co ~.2 6 S3;t5y
• TEL. 765-1802
~oS~FPO(k~o~ TowN of soU~ant,n
OFFICF. OF BUILDING INSPECTOR `
P.O. BOX 728
~ TOWN HALL
w0~~1 ~ ~~®~`t- SOUTHOLD, N.Y. 11971
C S; R T I F T C A T I'O N
Date_(,L~3! 4a
Building Permit No. ~ $ 8 qa
Cr• p~rul< d 7AUsr
Owner YA L c u Tf STA N L~ y
(please print)
Plumber Mrs i o 2~ nJg y, a rr i ~ o__
(please print)
I certify that the solder used, in the water supply system
contains leas than 2/10 of 1~ lead.
(pl be s signature)
Sworn~to before this
d ~ `'d'ay of J u a1£.
q ~
19 l~ 1 ~'~/'~\,I Notary Public
Notary Public,V``F~~~"~~- CUUrity ~H®M,pSF.DOMERTYJR.
N~taryrr~ublia State cf Naw York
" No.'4a06559
OugiiB~o in Suttolk County
Tartu Expiroa 12r3VK~
THE NEW YORK BOARD OF FIRE UNDERWRITERS r af.,<
f (l U(lr•'tl(' BUREAU OF ELECTRICITY
8S JOHN STREET, NEW YORK, NEW YORK 10038
Date fi~N~i'$4i,tst~V I45. Application No. on file i'=f"?`"'`;~-1~9{'f a~"rf`~i
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the o6ove application number in the premises of
Dldt.'t'Slf,t'!YI"'F S'1"cLtltl.~;Y, ~?~;R'9' Cdd!) t:)h'a~ Fy' l~LfNfdA'?'~?Pa?RT, F1S}iPti3t;9 S`i:{,~3iY9a, Pk,]'.
in thefoUowinq location[ ? Basement 0 Ist Ff. ? 2nd Fl. ~s17"(' .Section Block Lut
was ezarnined on F h;TfftSi41I?y I 9`}1 and found [0 6e in cmrtplianrc• with the rw/uirerrtenta of this Roard.
FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K. W. AMi K. W PMi K W. Ami K. W. AMT. H. P.
.:{I s3
DRYERS iURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEtl UNIT HEATERS MULTI.OUTLET pIMMERS
AMT. N. W, Oll H. P GAS H. P MAT. NO. A. W. G. AMT. AMP. AMT. AMP$ TRANS. AMT N P, SYSTEMS AMi. WAiia
NO.OF FEET
SERVICE DISCONNECT NO, OF S E R V I C E
AMi. AMP rypE METER 1 2W 1 g 3W J 9 3W 9,a' dW NO. OF CG COND. A W. G. NO. OF HbIEG A. G. NO. OF NEUTRALS A W. G
EOUIP. PER 9 OF CG COND OF HbLEG OF NEUTRAL
OTHER APPARATUS:
i'~ h i`tTN'Cl?5. :l.IEi.. )'Lit°. #`3~~.f; ~ ~~~~.E%E.ct~-~ .c~~
P`l~%ltryt{~; frii,FiN17, f5 , Ilf;.i`.7rE GENERAL MANAGER
t ;f
Per
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.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST. NOT BE ALTERED IN ANY MANNER.
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BOARD OF HEALTH
3 SETS OF PLANS
FORM N0. 1 SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL
TEL.: 765.1802
,~~j / / MAIL T0:
Examined/~:/~!Y~~-. J.(~.., 19~d / q
Approved f:!<.i~!Vlt% .l . y.., 19~~Permit No../.
Disapproved a/c
/
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19j~,~
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 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 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 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
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 to
admit authorized inspectors on premises and in building for necessary inspections /f
(Signature of applicant, o name, if a corporation)
%~d ../fax.. aad ~~~1. ;,c
~ , • . rJG~,r3r`?~,
(Mailing address of applicant)
State whether applicant is owner,/lessee, agent, a/rchitect, engineer, general contractor, electrician, plumber or builder.
4~...rt chi?? P7yrl,.. .
Name of owner of premises ........N:,!1!~...fY:.. ~~~r1!S't , , , -
(as the tax roll or latest deed) c, / ~ _
o . ~-t~a
If applicant is a corporation, signature of duly authorized officer.
(Nam nd title of corporat o~ fficer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. ...,13.3.51 .
Plumber's License No. ..J`.<S.y:./~ .
Electrician's License No.
Other Trade's License No. a.~i ~.-1~"GS .
1. Location of land on which proposed work will be done. C,.!'~.$:C.'ee~a`... /.o!u`~r .
/fY~~
5 ~/k~..~. ~~w.
House Number Strefet- Hamlet
County Tax Map No. 1000 Section W Block Lot , , l ~ ,
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended ~us~e and occupancy of proposed construction:
a. Existing use and occupancy .....'~c~ .
(f
- ~ r
b. Intended use and occupancy ...1~L,1~.
- - - _ _ y
Pp ...y , ~ ~a ;
3. Nature of work (check which a 1
Re atr cable): New B : tion
' Remov 1 , • • uildmg Vv • htion Addition ~ • ' ' • Other Worka (Description)
P ~ ~
4. Estimated Cost /.rd U1IC9. Fee ..~dt ~ ~ . .
y I (to be paid on filing this application)
S. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars
6. If business, commercial or mixed gccupancy, specify nature and extent of each type of use • .
7. Dimensions of existing structures, if any: Front Rear , Depth .
Height ...............NumberofStories.............:................'.........'.........:.......'
Dimensions'of same structure w~tli alterations or additions: Front Rear .
,Height . . Number of Stories .
8. Dimenstons of entire new construction: Front . Rear ...............Depth .
Height ...............Number of Stories , , .
9. Size of lot: Front : Rear , Depth .
10. Date of Purchase : ................Name of Former Owner .
1 1. Zone or use district in which prerr4ises are situated .
I2. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Will lot be regraded i .................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 ...................Phone No. .
15. Is this property located w,thin 300 feet of a tidal wetlandl *Yes No
*If yes, Southold Town Trustees Permit ma be required.
PLO DIAGRAM
Locate clearly and distinctly all 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.
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STATE OF NEW YORK, S~ S
COliNTY OF
• • , , , • • , ~ being duly sworn, deposes and says that ITe is the applicant
(Name of dividual si mrjg contract)
above named.
He is the ....G?~1,2~f,,.,LO~OVa;L
(Contractor, agent, corporate officer, etc.)
1 of said owner or owners, and is dulyl, authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be perfortned in the manner set forth in the application filed therewith.
Sworn to•before me this
~3 v~
................~a
:.....day of , 19 ..~~•C~
Notary Public, :Su
ff4 ~k County
MARY 8. PNI`IVULWI(,~L,
NUTARY PUUUC, STATE OF NEWYOHk _ - (Signature of applicant)
NU. 52.5267950 - SUFF9tK ~NTiY.. •
• - PAMMISSI9N EMPIRES M(3o~FU ~ !
1~ m.~.<6tv.__ _ ~ - -