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HomeMy WebLinkAbout18710-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20358 Date NOVEMBER 19, 1991 THIS CERTIFIES that the building ADDITION Location of Property 1150 SMITH ROAD PECONIC N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 98 Block 3 Lot 27 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 19, 1989 pursuant to which I Building Permit No. 18710-Z dated DECEMBER 27 1989 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 BAY WINDOW ADDITION IN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DONALD DOHRMAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/p, PLUMBERS CERTIFICATION DATED N/A . -~L/ _ ui ing Inspector Rev. 1/81 F rosai xo. s TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o 8 710 Z Date ~ 1~~.... Permission is hereby granted to: ....fi. /~..~......,....~:.,.~~..d ct premises located at .........,/.f~~...s~.~.~~t.../.~.: ~7~':E:: County Tax Map No. 1000 Section Block Lot No...........a`~.:.~... pursuant to application dated .................1.1~~.l,r/'~....................., 19.t~.~`A., and approved by the Building Inspector. ,ry d Fee Bu ng Inspec or Rev. 6/30/80 _ I FORM NO. 6 ~ - ~ ~~g ~ TOWN OFSOUTHOLD ~~`s~'~-~" Building Department s , ~ {t~i;~ Southold, N Ya111971 765 - 1802 ~ ~ "~APPLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted alms 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 installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. 6. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pxbperty 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling, $25.00, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $100.00 i 3. Copy ofcertiticateofoccupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 j ~}Ca J~ -y 5.Updated C.O. $ 50.00 Date NewConstruction,,,,,,OldorPre-existing Building Vacant Land Location of Property .1150...`xnL ~ ~1, , ~ ~ ;a, , ~ ~ \.4.,., . House No. Sheet Hamlet Owner or Owners of Property . ~y/-l~.l~~ lc'.~...~~.~ ~:M Q.~ .........r.~.......... . County Tax Map No. 1000 Section `I. ~ Block Lot . ~ . 1 . Subdivision .................................Filed Map No. ..........Lot iN~o. . Permit No~ 8f1,10 Z. , Date of Permit I;~,~a.`1,~~ .Applicant .1~C?ly~ ~7.~NR;[~Q+. S . Health Dept. Approval ........................Labor Dept. Approval . Underwriters Approval ........................Planning Board Approval . Request for Temporary Certificate .....................Final Certificate , Fee Submitted $ Construction on above described building and p mit m s all ap"~icabl odes and regulations. Applicant Rev. 10~10~78 a~~ ya9~9 c o ~a oast TEL. 7G5-1 fi07. .~rzt;7 ~O~~Ei't)L/(~~;' 7!'~~trN t)I' SOIJTIIO'd.~ 'l; . r r~ ~;c.~ Ori~ ICii OI' I1IJILDING Ii3SPF.CTOR ,rrl ~ ~ :Q-- I'.O. BOX 7~8 u~ '~'~~p~ r-r-' 1'OPiN 11IvLL S1yOy rr,., `4,~ '~'~'9•~~J SOlli'IfOI,i),N.`:.1197i ~~~1. `t{E `-y' May 4 , 1990 Donald Dohrman 1150 Smith Road Peconic, N.Y. 11958 To 63hom This May Conccrnr t•7e arc unable to complete your Certificate of U~ccuhanry becau.;e of the follouting reasons. /r/( nn application for Ce;-tific:ite of Occupancy ^ is not nn file. (t'sNC1.OSED) / J ::o Under`:~ritezs Ccrt-ifir_atc on file. I~ J^?( 'i'he check is (x~tt~Lxlt~7C~ot on file.) $25.00 t:n ?tc~alth Cept. Approval on file. I:o final in:;pect:ion hay been made. Ple.~:;e contact our office on this matter. Thank yoc.c foz your c:ooperaY_ion. ' i3ui1d5.nr; Permit it ? S ~ ~ ~ Z Buildin~i Ucpt. ~ * * j-J rro Plr_:mher Solder Certificate on file. ( all permits involvincl plumbing being i~:we<1 aftor April 2,1909 ) ' ' IIUATE ~ COMMENTS 1SLD Ii.S1c~.1Citd ~0 'FY rn 3 ~ 1 . ~ .~.3 FOUNDATION (1st) c ca FOUNDATIOSJ (2nd) _ z 2. ° d P,OUGH FRAME & PLUMBING s~ ~ _O m 3. y IiJSULATI0I1 PER N. Y. ti STATE ENERGY a CODE m ) y r H Sr 4, FIidAL 0 ` ~ I z ca ADDITIONAL COMMENTS: (*x ~ V ~ ~N v cn x ro H 9 y o z m A H~ _ x~ d lT7 ' '0 H ~ n> rr t7G Ei .rte ~ - ~ e v ~ ~ ~ ^ c 1~ ~ ~ ~ n °a ~ ,9 ~ s _ - ~ f ' i .~i ~wN TOO~~m 4°, 4 i f11 r T "a.' (~lY p 9 ~ ~ Cj ~ QJ ~v,1 ~O 7J 'Q 2 cn ~ ~ ~ r ~ Z ~ D Gam'! 'e~ ^ GNro y~--^°y, ~p 7o~~nZ~q~b~`G~7 D O m 0 p n m~ W 4p y cnirn~~ 00~ Zz ~,p,~m4 ;o ~s °z ~ ~~y~+,~ z r ~ ~ N Sf~i7:t~ N ~ C ~p ~ N~~4. i 68~ _ \ rte....., nfio 2 r , O Q Q m 1-{ H o ~r t o r, E s t a t e s 0 0~', ~Q sfifi i ~ ~ ° ~ ~ n, a , L oo'w. too. Ia 2~ K ~ p~'Q~ ~ ~ U S 0 ~'t~ a* s , s ~ ~ ~ t ' 1~ i C. 5 ~a~~~r ~ o!" a 7 v ~x ~e°t nF}r r ~ ; o ,a, V.,~ a ~ tt. a ~ ~t~~ ~ f . O ~ ~~i' N " Off. 1 m ; ~ ~ ' ! N ~ D ' N ~ }k= r ~ - r 3 to _ . N . r ~ ~ ~ ~ . ~ (~1}1 ~ ~ " ~ ~ ~ D ~ M D W 2E• ^ Q 39 N - ~ c = Y ~ ~ - a ~ o ~ OD -t QM S ~ 2 ~ 2 O°~ n -~c ~ Igo ,p ~ T ~ w D Z 5.10°Z3~E. 100.0 1 ~IIOO'to It.dio.~ .1 _ - H~~k aoU~-~- OL~~ w P2tVATE 2.OAO nn ~t~~ j 1N ~~p~ n + + ,r,,. -I ~ ~ e : 9 f98g ~ 0 4 Np t s,-,...rc7vvfv~tlr~urFrt~[t~ ~ `s A r_, Fp ° ~n~ ' D 1 ~ ~ .t N AD ~ Y BOr1RD OF HEALTH 3 SETS O~PLANS~....... FORM NO. 1 SURVEY . TOWN OF SOUTNOLD CHECK cf I.......... . 6UILDING DEPARTMENT SEPTIC FORPf . TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY ; J.. ~~y/ • . . TEL.:7G5-1802 CALL I %(P 19~ MAIL T0: Examined ~g.~.~ . 19~Pcrmit No. ~~7`a,! . Approved . ~.Z ~ . Disapproved a/c . s?z 6~. ~ (B 'ding Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF80U HOLO _ _ Date. ' 1'S , INSTRUCTIONS a. Tlus 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 adjpining 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 stall 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 Couniy, New York, and other applicable Lativs, Ordinances or Reputations, 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, h ~ code and regulations, and to admit authorized inspectors on premises and in building for necessary ip!~ectio s. Signature of applicant, or ame, a corpor tton) a • (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~Ql~.~..~Q~.... .~.?,IMF..6! . (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. a.lnl.~~~• . • • • . Plurnber's License No . . Electrician's License No . , OtlterTrade's License No . 1. Location of land on which proposed work will bed re' House Number q ~S/treet Hamlet ~J County Tax Map No. 1000 Section { . • • ~ . • . • Block .....1~.......... Lot ..CX..~ , , Subdivision Filed ~1ap No. Lot . ..(Namej • • State existing use and occupancy of pre ices and intended use and occupancy of proposed construction: a. Existinguscand occupancy b. Intended use and occupancy 3. Nature of work check which a II ~C wl~~ ( Pp Icable}: New E3uilding , Addition Al oration . Repair , R~mov~l . . Demolition , .........Siaimming pool . Tennis Court Accessory Building..........Ferlce .......Other Work:. 4. Estimated Cost .~.7u/.4/.... I Fee (to be paid on tiling this application) 5, if dwelling, number of dwelling units Number of dwelling units on each floor , If garage,numbcrafcars ~ 7, Dimension o mxistinals~ructures,~ccupancy, specify t)r re and extent of e c type of use , • g cif any: Front . , Rear Depth ~ , • Height ~ Number of Stories , . . Dimensions„o same stnt~ture with alterations or additions: Front Rear • ~~t ~e j~a'~: Height Number of Stories . 8. Dimensions o~'e~itlre neiv dgpktnrction: Front Rear Depth , Height .:Namb'er of Stories . 9. Size of Ir~~.. ; . ~ Rear Depth 10. Date of Purchase y,, , , . , . .....Name of irormer Owner , , 1 I. Zone oi' uss~d'istair,~'ih.yv,)}iclr ure~ises are situated . ! 2. Does pfop3~~'a~~•ee"r>siiuct4~ `v' late any zoning law, ordinance or regulation: 13. \Vill lot be regraded , , , , , , , \Vill excess fill be remo d,n,~frPQm premises: est ' Nc~ t~. Name of Owner of premises ..,~..D. p tie :~4~ . ,Address . ~~d~ .Sr,.t;~ !Sa • Phone No..~~YY. •1i1 Q Q„i' . Name of Architect ,Address ...................Phone No. * Name of Contractor ~e+. ~ ~ , ~ .7 p •~~ea.•.fNtt... ..Address . .Phone No. l.. IS.Is this property located within 100 feet of a tidal wetland? *YES,..:NO.... *If qes, 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 t}umber or description according to deed, and show street names and indicate whether interior or corner ]ot. ~ +y l J ~ ~ ~ ~ f~ No 4 / 77 ~j•7 Z STATE OF NE1V YORK, S.S CO TY.~.yF, . , • • ~'Q 1 ~K.. • • Nr.~•Q~ being duly sworn, deposes and says that he is the applicant • (1\amc of individual si Wing contract) „ about named, (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duhy authorized to perform or have performed the said work and to make and Gle 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 perforned in the manner set forth in the application filed therewith. Swom to, beiorc me this i ~ q i ~?........day off 1901., y Notary Public, ......~~r~&n~,~„7G~, .:t!~~ , , , , , County HELEN K DE VOE NOTARYPUOLIgSgteaftdewYOrA Na.4707876,SuttolkCuontt~~,,~~ (Signature of applicant) Term Expires Maroh 30, t9._.zJ .