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HomeMy WebLinkAbout18702-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219787 Date MARCH 12, 1991 THIS CERTIFIES that the building ADDITION Location of Property 585 BIRCH AVE. SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 77 Block 02 Lot 16 Subdivision GOOSE BAY ESTS. Filed Map No. 1176 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DEC. 20, 1989 pursuant to which Building Permit No. 187022 dated DEC. 20, 1989 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is CONSTRUCT AN ADDITION WITH GARAGE (IN CELLAR} TO issued is AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to DEAN L. EICHORN-JANET RAYMOND (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N167862 JAN. 4, 1991 PLUMBERS CERTIFICATION DATED TIMOTHY HORTON MARCH 8, 1991 Inspector Rev. 1/81 goaai 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) No 18702 Z Date ....1~/.. Permission is hereby granted *~• f- .. .. ct premises located at ...~~c,~~ ~ .. .... .................................................................. ............................................. 3~'' •~.. ................................................................................. County Tox Map No. 1000 Section .......'7.,7......... Block .........~......... Lot No.......~.~........... pursuant to application doted ........................................................ 19........, and approved by the Building Inspector. Fee $.&.~i.,.:~.~. ... .cs%~~ ... ~ ............. Buil ' g Inspector Rev. b/30/80 ~~ Form No. 6 ~,O ~ ` '' TOWN OF SOUTHOLD !J ~mtln~yk 2K SS ~ ~ BUILDING DEPARTMENT ~ ~ 2 Iyy! TOWN HALL 765-1802 ~LGC1: ~7EY7. TC1Vdw OP~-v?'JtJ`i4S%Yi_~:3 APPLICATION FOR CERTIFICATE OF OCCUPANCY v~~ 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. G. Fees 1. Certificate of Occupancy - Nero 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 $15.00, Commercial $15.00 Date ......................................... ':ew ConstrucCion........ Old Or Pre-existing Building ................. Location of Property..:~~~.~ ..................~. I ~L~~ . ~•V ~ . • • • • CsCx?S~• ~~;y •L~T~C Y~•S • • • • . House No. Street Hamlet • ~nwer or Owners of Property.11J.CAN.L"~letlU2h;_,~,5~`lf_E;[„(L~1;~,U'~o~'~,,,,,,,,,,,,,,,,,;,,,,,,,,, County Tax Map No 1000, Section..../........Block....Z..........Lot...~~° ................ Subdivision ....................................Filed Map............Lot...................... i'ermit No ................Date Of Permit................Applicant............................. :iealth Dept. Approval ..........................Underwriters Approval.... •••••••.••-•••.••••. Planning Board Approval ........................ Request for: Temporaqqr//y--Certif icate.......... Fee Submitted: $..plJ.... • :J•°?~• ~ yi 33s~ . 3~li~~l~ Final Certicate.......... APPLICANT .- THE NEW YORK BOARD OF' FIRE UNDERWRITERS I~~ct~. 1 {N)?)Y, ~i 1i BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10038 Date 'f YytQtl ~,K lr ll~r iT"1$ APPI-eca[ion No. on file n~9 Fw „': rd'; "a~jf ~}+~! $1 ti;7`y'Ps~ THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of bE?I't9 Ff{~IiLlkleir `a }5°.`~ F11'rl;'lP 1791.. ;tu[fTtftaf,?;, l~1.~'- in the foUmuing location{ ^ Baxement ® lat FL ^ 2nd F'l. ("T'~ ji)fl 9 Sertinn Block Lot wax examined art I)I''(J p'{7t~il~lY i:'i , 19'?i) ared found W 6e in contplianre uith the reyuirenzents of this board. FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS FIXTURE ECEPTACLE$ SWITCHES OUTLETS INCANDESCENT FIUORESCENi OTHER PMi K W. AMT. K.W AMi KW. AMl %.W AMi H P ! r, ~ n 9'l I I1 '~. i DRYERS FURNACE MOTORS F UTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CEOCNS gEll UNIT HEATERS MULTI-OUTLET SYSTEMS DIM MERS AMT. %. W. OIL H. P GAS H. P AMT. NO. A. W. G AMi AMP. pMT. AMPS TRANS. pMT H P, NO. OF FEET pMT WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E PMT AMP rypE METER EQUIP. 1 ~, PW I R 3W ].6' 3W 3,B dW NO OF CC COND. PER .e A. W G Of CG COND NO Of HIdEG A' W' G' Of HbLEG NO OF NEU1RAl$ A W G' OF NEUTRAL OTHER APPARATUS: a`T•tc)Kla' fsl{`PASt"PfrR;.-f ~'li'c~r / y,~j~~ l ~~ ~:.F;.c.u.M;r,~;L~'rrt.ft; e'ct9te/, i:~9t..if•a.r;ta',-~; ~ 3W{>k;t) t't'ITIiA'9'92Y R11,rb$ }'g;Cflh{,;t", #~V, 114F$ GENERAL MANAGER I,1 Per This certificate must not be altered in any manner; return to the offices of the Board if incorrect. Inspectors may be identified by their credentials. COPY POR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. a ,~'c~~FF~L,~-~, 0~0 ~,, ,., O~ TO'(Y~N OF SOYJTIIOd,D f a ~ ~ OFFICE OF BUILDING INSPECTOR o ~T+;~"~ ~' P.O. BOX 728 ~F~~ ~~` ~~~ ~ TOWN HALL 0'~ ~~~ SOUTHULD, N.Y. ] 171 Ol rya '~ C E R T I F I C A T I O N TEL. 7G5-1802 ~ ~~ Date ~~~~~ Building Permit No. i~ ~0 Z -~- Owner ~PAiv ~ic,fi'7~ .~,~ (please printy Plumber '~irr~ n~l~i cs /~7 aPZ% i_-' (please rant) I certify that the solder used in the water supply system contains less than 2/10 of to lead. ~. ,. (~Y~ tuber's signature) Sworn to before me this u~ day of J'}(EUL C~~- 19 G~ (f Rotary Public, ~/s5 1~ . ~~ t,v ~t..~._ ~~( (~ Y,! fr~,e rr .~'..~ l1 Notary Publ~~ - rs Ws: ~ ^t~C 5 ,.,:,.,,.~ ... tf ~ ~ I~ ,,.~---"- JtID~TTO:! ~ (latl [JiJDATIO:I .(2nd 1 )UGH FRAME ~ .PLUMBING :1ISULATIOPI PER N. Y. STATE E1IERGY CODE F ~ ~~ / . ~-~ I011AL COMMEtlTS: . f.I~J . ~~ ~~ ~•~ . ~. x ^o . 1--i 9 y O ~_ m a ~_ r rv -___-~----~--- -o a .. ~ ~~~ ~ v 765-1802 BUILDING DEPT. 1 NSPECTIOIV [ ]FOUNDATION 1ST [ ]ROUGH PLBG. DATE / INSPECTOR ~~ F. [ ]FOUNDATION 2ND [ ] IN CATION [ ] FRAMINC,~ [ FINAL ~P zo ~ 65-1802 DEr , s fNSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL L DATE a' ~ INSPECTOR R ~ 76.5-18®2 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST ((,.}~2000H PLBG. DATE ~ 6 IN5PECTOR [ ] FQk1hIDATION 2ND [ ~ INSULATION [~/]" FRAMING [ ]FINAL J p ~ ~ ~ rss-isoz BUILDING DEPT. f NSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [) FOUNDATION 2ND [ _ INSULATION [ ]FRAMING ( ]FINAL C~..- DATE ~ J C~ INSPECTOR ~•-- --t o2~j FORM NO. t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 Tt=~ • vrn_rnna Examined ~~~........, 19~ Approved . ~~?9......., 19~ Permit No.,l~.7~.2.~ Disapproved a/c ..................................... BOARD OF HEgLTH ............ 3 SETS OF PLANS ?!~.......... SURVEY / . .......... CHECK s~~.l~J.:' :.... . ...... . SEPTIC FORM ................ NOTIFY's ^~/ CALL .../. ~S:.:.~.~:3~:... . MAIL TO' ....y ? ~.-.~.~~ ~ .... . wl ;Inspector) APPLIC TION FOR BUILDING PERMIT Date ......... . ........> 19 .. . 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 to scale. Fee according to schedule. b. Plot plan shotving 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 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, housin; code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections ~ 4 (Signature of applicant, or name, if a corporation) .P (~, 6g~ 15~.1~. . shy ~ !-lc?~4. N :~ :. t 1 °I,z J ..... . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder. ............. ~ U?.N.~.t2-........................................................................ Name of owner of premises ..~~~4`?..1: ,. L . ~L,F\b~~l, ...~N:1? ...~~.. ~.4=; ~. , , ~, , ~~l,~a ~M C?N,1~, , . , , , , , , , , (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ............................................. (Name and title of corporate officer) Builder's License No . ......................... . Plumber's License No. .......' ................ . Electrician's License No . ..................... . Outer Trade's License No . .................... . Location of land on which proposed work will be done; ~ s Q ~2c(:1..!~~.~._...... ....cs-cx>s~,gt}~'..C.ST~L`TES House Number Stree//t.~~ Hamlet County Tax \tap No. 1000 Section . ~.~~: ?:. ~. lfl....: Block .................. Lot ................,: , , Subdivision ............... .............. Filed ntap No. .............. Lot ............ . (Name] ~ .. -. State existing use and occupancy of pfr_emises and intended use and occupancy of proposed construction: a. Existinguscandoccupancy .....! ~61v1.~.`:..~e~.l.~~:+~L~ .............. ..... ............ ~•, •. d use and occupancy .... ~~.'M (:.... a ~ (1~. E`ls ~ ..... . .........::................... . 3. Nature of work (check which applicable): New puilding .......... Addition .. ~... Alteration .......... . Repair .... ....... R~movaX .............. Demolition ..............Swimming pool........... . Tennis Court ....... Accessory Building..........Fe11ce .......Other Work:. 4. Estimated Cost .~~.SU U... ~ ...................... Fee ................................ .... (to be paid on filing this applications S. IC dwelling, number of dwelling units . , ~~~......... Number of dwelling units on each floor .............. ... . If garage, number of cars . , ...Q,N.~ ............................................................ . • 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 ..,.'J.1.~........ Depth .. ?.Q~......... . . Height ............... Number of Stories ... ©.~.~.......... ................ ..... . . Dimensions of same structure with alterations or additions: Front .. 3~ ............ Rear ~~~..y }; , , , .. . Depth . • • ~{ 5 .............. . j Height ..... ...........Number of Starks ..QN .. .. .. • ..... . 8. Dimensions of entire new constnrction: Front ....~ . ...... Rear ...? :~......... Depth .?;`,f. ,~, , , ..... . Hcigltt ........... Numb r of Stories ...Q.N E ... ............ . 9. Size of lot: Front ... ! ~f?'. g ........ Rear ....1.4d ~ ............. De th t 20 `. ...... . 10. Date of Purchase ....~{ .~.1~.~ ~',.~Q ...............Name of Former Owner ..: ~ Irk-t~.. ,fa?1~ti--.~ :'f......... . . 11. gone er use district in wlrici~ prcnjises are srtuated ...................... ......................... . . 12. Does proposed construction violate any zoning law; ordinance or regulation:..`No .... . .......... .......... . . 13. Hill lot be regraded N ~ ... L .. , . , ... • ....Will excess fill be removed from premises: Yes ...: Np . . 0 14. Name of Owner of premises 41-..tJil'? E~C.Btn?N,~~^f12&~V~yQ~$tcss ~'~l?O.K: Rb lZ , `.fi':~!o:-D. Phone No. ~ dos ; St73tq , , , , , , Name of Architect .......... ...............Address ...................Phone No.................. Name of Contractor ...... , ...!.... ..: .. ...Address .. ...... . .. ... ..Phone No.. ~ . ...... . 15.Is this property located within~100 feet of a tidal wetland? *YL~S...r~NO.... *If yes, Southold Town ',Trustees Permit may be required. PLOT DIAGRAM Locate cleazly 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. L L.l ~*~ 3 g. ~~ i `~ ^ 1 ~.~_ ~ ~ ~ o c~ls-ct l~c~ 2g` ; 35' !1 uo' ~~~ ~ _ --._e~ _ _ _.___ . ___ .~ ~~, ~- C~ ~`~ ~ I~ S.S .........~.! ~~. , .~r..~: ~ ~~~~ ............. . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ,. about named. (Contracto ,agent, corporate officer, etcJ of said owner or awncrs, and is duly authorized to perform or have performed the said work and to make and Gle this application; that atl statements contained in this application arc true to the best of his knowledge and belief; and that the work will be perforned in the manner set forth in the application filed therewith. ' ~ Sworn to before me this F ,daY of .. ., 19 Notary Public, ~~~. 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