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HomeMy WebLinkAbout18858-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CI~TIFICATE OF OCCUPANCY No Z-20876 Date JULY 21, 1992 THIS CERTIFIES that the building ADDITIONS Location of Property EAST END, PRIVATE ROAD FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 4 Block 4 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 5, 1990 pursuant to which Building Permit No. 18858-Z dated MARCH 12, 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 TWO NEW BATHROOM ADDITIONS TO FIIISTING ONE FAMILY DWELLING The certificate is issued to FRED G. POLLARD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-200546 - AIIGUST 16, 1991 PLUMBERS CERTIFICATION DATED JUNE 23, 1992 - MARIO ZANGHETTI, JR. Building Inspec or Rev. 1/81 soaas 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) 18858 N o Z Date 9?I ........art..........~ t4..~l..G ,sic ~-~C ~~%~~C Permission is hereby granted to: ~ ....~.d'`.~. ....G..G!l.'~~C . . .....~.~.....~2.11 ' Y ~d ...J..D...~.......~~~....~.j.. at premises located at .............:G......~:~l~fr'1.....5...... .....L...~:':it/.-~Y..+N........ County Tox Map No. 1000 Section Block Lot No...,~ ~yy~ q~/ pun:uant to application dated ~.((./.~/f. j........~........., 14.~1C~, and approved by the Bui lding~^Inspec~tyor. Fe~,1..~17/.~ Building Inspector Rev. 6/30/80 4 , roan: xo. e .Jl1N 2 TOWN OF~SOUTHOLD a c' ~ ,Building Department ,;.I:~ Tewn Clerks Offiee i j L4~ 4,., - ~ ~ ~ ' Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY • Instructions 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-(5-9 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 completed 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 alt property lines, streets, buildings and unusual naturoi 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 X5.00 2. Certificate of occupancy on pre-existirg dwelling or land use X5.00 3. Copy of certificate of occupancy X1.00 Date ..~~a~.~.9.~ New Building Addition Old or1Pre-existing Building ...Y.......... Vacant Land ,1, Location Of Property, .~13~:.T.....~.!1?5~.....F..~.,~fz.~.(.~5....Z'5.4,!4.!:~~.....'.'t•'.~ Owner Or Owners Of Property ...f....fl..~.d.......G.:. ~.°..L.i-..~..F#C~ 5ubdivision ................................................y.............Lot No...~R....... Block No...~:...... House No.........,... Permit No. ~.R.l.t+7.~.... Date Of Permit~.l.~.~~~°....Appiicant ~,,.4~.~...rr..olUT(j(~,(,'T! n),~,,,,s;!1?,~; ' Health Dept. Approval ....................:.......................Labor Dept. Approval Underwriters Approval ..............................................Planning Board Approval Request For Temporary Certificate Fina) Certificate Fee Submitted § ..:.~.al...:.4 ~ Construction on above described building and permit e is all app cable~c~es o repgulations. APPlicant ..................~Id1a..a`.... / ....'...t•:f.:h'...1..~.~"r.s.!..S'~.~nSJ_ Sworn t~before mq.-thin day of ,.:~uN.~ (stomp or asap C un AtRI<s F. COHEATV JR. Notary Publtc ~ ~kl Newry Publtc slate of New Yor;. . No. 480e5Se e~~we, 443 95 r ©Telrm Expletesi tl2r5t~u9~ Co ~.aog~ ' r r ~ ~ r TEL. 765-1802 oc~yEf011tco TOWN OF SOUTHOLD ~'.'c OFFICE OF BUILDING INSPECTOR P.O. BOX 72$ ~ } 2 rt ~ TOWN HALL ~ ~ o~~~ ~ SOUTHOLD, N.Y. 1 1972 ~ ~ ~ i'. ; C E R T I F I C A T I O N Date 12,31 Ufa Building Permit No.J S S 5 8 OwnerF'REd G• PoLL~9gd (please print) PlumberM/i~ ro Zi4 Nq h.T(',° cTR. (please print) I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. (plu r' signature) Sworn to befo~ne this LG~~~~~ ~n _day of ~4N~-. 197 2 : ~ Notary Public Notary Public, L{~-~~u-- County ~ ~ ;H®RtAB F. ~pHERTY JR. NOliry Pu Na a80655GNew YorM QU?llOfa in Sff ilu, ?U^~ Tem Exp _ ~ , 1. - I~ _ II - - - OUtJDATIO;I (lstl - ~ v ?OUtSDATIO;J (2nd 7 ~ ~ I o '.OUGH FRAi~iE & II •PLUMHIiJC N H~ 3. ~ m m I,ISUL6TIDJI PER SJ. Y. I ~ ' ~ ~ STAT° EPJERGY i CODE II r w n a FI;1AL o cs. w, ADDITIDT7AL CDMMETTTS: e • X. M 9.. • HI O n m f / y v • m v _ _ _ II . i~ _ ~ ~ ~ ~ ~ i~ W o 4 ~ o ~ 'I ~ © m4c~w~o ~ ~ ~ o~ "w 'il _ _ U ~ ,T i B~ ~ ~3~ ~ ~ ~ i ~ ~ ~ i APPROVED AS NDTED oA~` ~,Ll~,L9U s.e ~ -~'Z'-' FEE:'~~P• Ord BY: _GiJ~ NOTIFY RUIL9ING 9EPARTMENT A T65-1802 9 AM TD 4 PM FOR TliE FOLL.OINWG INSPECTIONS; 1. FOUNDATION - TN;O REOWRED FOR POURE9 CONCRETE 2. ROUGki -FRAMING t4 PLUMBING 3. INSULATION 4 FiPiAL - COfdSTRUCTSON P,~UST dE CEkMFI_ETE F{3fi ~ C ALL CONSTRUCTEON SHALL MEET THE REQUIREMENTS OF THE N Y STATE CONSTRUCTION ~ £AdERGY f'ODES. NOT RESF'OrdSlRLE ~~in trFS1(;N OR CONSTRUCT!C1rv:-RED":.~~ occ~~~NCYOR u ~ U NL~1NF K~" C ~ ^'.~~JP~tCY THE NEW YORK BOARD OF FIRE UNDERWRITERS, N;;c,>~ ~ f 1 9 i 100065E euREwu of E~ECTRICrrY - l _ ~ 85 JOHN STRElT, NEW YORK. NEW YORK T009B Date AUGII^a'P 76,7991 APPlicattonNo.onjile 6$034I.911/90 Ni.0054E THIS CERTIFIES THAT only the electrical puipKnent ae dsecribsd 6ebPe and iwtroduosd by tMuppUcant named on the oboes appBcotien number in the promisee 4/ FRF;Ii C,.P6LLARD, FAST FNO, F'RCYAT>', SECTION, F'L5NF;R5 1'S7,AN~, N.X. in the fallou~inp location; ment ~ I et Fl. ? Pnd FI. Sertion Block Lot JIiLX 25,7. ,eoe examined on and found [u be in compliance with the'rpuiromente of fhir Board. FIRTIIY CgOgNO [Hats OINf WASNlRS RXIIAUST FANf WTI!}f AaFf fW17C11K INCANalSClM PlUOeNClM OTHin NAT. K. W. AMT. K. W. AMT, KW. AMT. K. W. AMI. M. P. ORYRRS RIRNAq hgTORS Fui11M iwuMta F1R~Ri sFRaM SEC•?i iIAAR CLOCKS Rut It?Rr7R?AIRtl 4NI1i1.0YT1Ei DIMMlRS AMT. K. W. Ql N. P. 0A5 N. P. NAT. NO. A. W. a. AMT. AAV. AMT. AMPS. TRAPK:' AMT. H. t. ~ tk lAT AMi. WATTS 3lRVKS DIRCOlINKT MO.O! S ! R Y 1 C E AMT. AAV. lrPt ~IIF 1 / TM 1 / ]'A' ] / S\V ] / AW HO. CM CC. COND. ~ A.. W. MO. OP NHFG A'~~ NO. Ca NENKAlS OF mVTMI ~Y,' S 3 OTINR AFFARA7us: C.. F'. C. T:-1. ~ -e'aC e= 'L & S CONTRS. INC. I,CC.~9268 ` Y.O. BOX 202 - z FISNF.RS T.SI,ANA, NY, 06390 ONIMAI MAFIAORR _ ]l i Ptr ~~n Thit nrtificaM octal not ba olNrad in aay moattar;. rNWn the efthe R~ircprteef..... s.'^aY:.. iTlaMiffad by 1Mir cradenKals. ~ ' ~ BUARll UP' H,ISAL 1 t~ ~~erTS or P~nNS FORM NO.1 SURVEY TOWN OFSOUTHOLD CH$CK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY ' ~OUTHOLD, N. Y. 11971 CALL If ~ TEL.: 765.1802 MAIL T0: Examined .................19... , 19 ..Permit No::: d Q.~ ~ f ~ J 4i APProved .!!C ~Z..1.~., ~ ~lT. ir/ ~ LS \"J 1 r. ~~tiJ1 . . 1 I Disapproved a/c ' R. ` MAR - 91990 i (Building Inspector) , APPLICATION. FOR BUILDING PERMIT Date 1 CMG 9' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. i b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of Layout of property must be drawn on the diagram which is part of this app 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 perry ' shall be kept on the premises available for inspection throughout the work. j e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Oecupan~ ~ 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 t; ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New, York, and other applicable Laws, Ordinances ~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary inspections. , ~ (Signature of applicant, or t{'ame, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises • . (as on the tax roll o,r latest deed) If applicant i a cornoration, signature of duly authorized officer. (Name Citle of corporate office!t)~~~~ ALL CONTRA OR'S MUST BE SUFFOLK COUNTY LICENSED ~ ' Builder's License No. ...f~,~yv?.. /.u~l....... . Plumber's License No. ~Sy-.~• • . Electrician's License No. ...1~.'.~~:' Other Trade's License No. ..v~~."~i . Location of land on which proposed w rk will be done . . . klouse Number 'Jtreet ~ Ham et I County Tax Map No. 1000 Section Block Lot . Subdivision Filed i`Iap No. Lot . (Name) 2. State existing-use and occupancy of premises and intended ise and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy ,-<6Z'+r~Fl'..... i - . d , 3. Nature of wor} (check which applicable): New q, r w E3uilding , Addition Y Alteration , . Repair , • Removal (7emblition Other Work......... . ~j (DescripSian) ated Cost , ..~d ~ ~ . Fee ~ ` 4. Estim Clfr' , . y . ..,'l. ,JT."d O D . (to be paid on filing this application) ' 5. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage, number of cars 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 . D pensions ~,tra ~e structure with He~gt [ions or additions: Front Rear . De th ..............Number of Stories . 8. Dimensions of entire new construction: Front + Rear .............Depth , , Hei ht Number of Stories . . . g 9. Size of lot:Front Rear..........,....:....... Depth 10. Date of Purchase .....Name of Former Owner . 1 I . Zone or use district in which premises are situated . . 12. Does proposed construction violate any zpning law, ordinance or regulation : . 13. Will lot be regraded WiII 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 within 300 feetyof a tiidal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO"I' DIAGKAMed. Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions From property lines. Give sheet and block number or description according to deed,,and show street names and indicate whether interior or corner lot. r- .-n,~ , - - I i i COliNTY OF . . STATE OF NEW YORK, S.S bein dul sworn deposes and sa s that he is the a ~i~ ....'.r~a2~ti°y`f'• t; Y Y PPlicant i (Name of i [dual signing contract) i above named. - I ~ ~ He is the ...........................~1• • ...4..vyJ.~`~1~..-~................................ . (Contractor,'agent, corporate officer, etc.) i of said owner or owners, and is duly authorized to perform or have peifonned 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 wilt be performed in the manner set forth in the application filed therewith. ~ Sworn to before me this .....................day of....~.......,19.~~ 1lotary Public, . , . !1, ~:t: Y~~• • • County t .rr HELEN K DE YOE ~ , ;/G ~~'.~71f~. . f aPpi; j N6TARY PU9trC- SU(e o1 New York r r, t - . ICat?t ~ No A?s}T8 ih. "uNutk Gunnttyy~~~~ 1 f ~ . r,~ Tenr Ea6ire5 M2rch 3G,19~~• , ~ ~ ~ r+' ; ~ ~