HomeMy WebLinkAbout18579-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219303 Date AUGUST 17, 1990
THIS CERTIFIES that the building ADDITIONS AND ALTERATIONS
Location of Property T1635 MAIN ROAD EAST MARION
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 04 Lot 33
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPT. 27, 1989 pursuant to which
Building Permit No. 185792 dated OCTOBER 19, 1959
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 ADDITIONS: DECK ADDITION, PART SECOND STORY ADDITION ALTERA-
TIONS AND PARTIAL FOUNDATION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to FRANK RUSSELL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N143425 JULY 31, 1990
PLUMBERS CERTIFICATION DATED PECONIC PLUMBING & HEATING
__yc=~JL_ """L°ls
B ilding Inspector
Rev. 1/81
rows xo. s
TOWN OP 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)
~.8~79 ~r
N ~ Z Date 19.
Permission is here~g'r/
a`gteJd trg/, ~ ,
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County Tox Map No. 1000 Section Block Lot No...........:~~
pursuant to application dated .........T,l...~..?~ 19. and approved by the
Building Inspector. ~
d.~
Fee S.a?.lo~...
ui1~1y5g Inspector
Rev. 6/30/80 ~
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,//pp FORM N0. 6 ~ ~ c " v
TOWN OF SOUTHOLD ~ ~ lj~,~-/siuu..~
Building Department p
Town Hall ~ ' ~,e~-~/~Q.~.~-~
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY .
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ s~.~s 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.,5ubmit 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: ~ --t '
1. Accurate survey of property 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 $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4. Vacant Land C.O. $ 20.00 U p
5.Uodated C.O. $ 50.00 /Date
New Construction,,,,,,OldorPre-existing Building Vacant Land
_ _J ~r
Location of Property ..I 3 S r~~`1-ll"-' ! ~,`~,g:r!....... L:..`~",'',~. l v''/f"tr) vdc.?
House No. t-' Street Hamlet
Owner or Owners of Property ...:"-..~'`.r;':~~~..... ~'`"~S'e~-~,,,,,,,,,,,,,,,,,,,,,,,,,,,
County Tax Map No. 1000 Section ....3~........ Block Lot.....~.~......
Subdivision ...Filed Map Nop..........4ot No. I
Permit No.t.v.5. d~Date of Permit .~~~`L/,q,yApplicant , t'`:\/~. F~, . ;~-%''~~?Y~~?l~CecL~
6
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 per meets all applic trl o a - egufations.
,
~~yy~~ Applicant....
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?OUJJDATIO`J (lsti ~ a~
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAeE 1
1195112
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10088
JULY 31,1990 6~761b99t1/90 N 14342H
Dale Application No. on file
THIS CERTIFIES THAT
only eke e/ectrleol equipment a described 6elour and introduced by~~~ks a~lplicant rwmed onths abaMe eppdtrtton number in the premises of
FRANK RUSSEL.L., 10635 RT_ 25 E. MAR10N, E. MARIO~, N. Y.
in the follotainR loco nt ~ I st Fl. ~ Ynd F1, ~ 011 T .Sertiun Block Lot
f1?(`v g9~ITe
une examined on and found to 6e in rnmpliance uitk the reyuirements of this Buord.
RXTW! RXTWK RANOlS tDOXINO DECKS OVENS DISH WASHERS EXHAUST FANS
OUTUTS ACIEf SWITCHES INCANDESCENT HUOIIESCENi OTHER .MAT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P.
4rt. 0 4i !1 3 5 F
DRYERS IURNAC! MOTORS FUTURt ANf1ANCR FlEDERf fFlCIAI RRC'Fi TIAAt CIOCKf RBl UNIT NEAiRRS A
~T1-0uTflll DIk1MlRS
NAT. N. W. Oll N. P. GAS N. P. NAT. NO. A. W. G. AMT. AAV. NAT. AMPS. TRANS. AMT. N. P. ND a AST AMT. WATTS
1 ~t1Q
SERVICE DISCOFR~IRCT NO.OF S E R V I C G~ E
AMr. AW. TTPE I d ew ; / SVI x i aw 3 / Aw NO. aER;ewO. cc' No. a NI.uG oi'nl'ILO NO. or NEUn•u Of . w E
.1 200 CB 1 X ] 2/U 1 1/0
OTHER ANAR11T115:
ELEC. ROOM HEATERS:5-1.25 K.W.,I-1.5 K. W.,1~-.?ti K.W.
MOTOR5:1-1/2 H.P.
6.F.C.T:-8
SMOKE. DETECTOR:-1
SAf,E ik L-ADEMANN INC.
P.0.60X 176A - -
5011THOLD, NY, 11.971 OMRAL MANAO~
11
Per
This asrtificote must not be alNred in any manner; rNurn fo 1M office of iM Boord if incorrM. Intpsctors_ ma~r_ be_ idsnKfied_ by. tMir •dentials.
DOPY F~ WILDING DEP/UITIiIB7T. TNR COrT OF CERTIFICATE JV~AT IIDI 1~ ALT9l~ lil~ffY ~H. _ tf
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TEL. 7G5.1802
c,~FF~U, C TORN OF SO~JT~Od,D. .
p O
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~ OFFICE OF IIUILDIt•1G INSPECTOR
T P.O. BOX 728 '
TOWN HALL
T
Of~ol ~ .
~ ~ O~ SOUTHULD, N,Y. 11971
C E R T I F I C A T T O N
Building Permit No. *g 5 -]q ~ ,
Owner
(please print) ,
Plur,.ber ~l~G9i,~iG, ~~/!/l7,~rrVCil~~l~~~~
(please print)
I certify that the solder used in the water supply system
contains less than 2110 of to lead. „
~.-dZtly _ ///~~-~f ~/~/Pl~.l~d
_ ~i~~lKl4dc~t/ ~J
tuber's ignature)
Sworn to before m this
~ day of
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19 ~'j. Z Nota y P blic
notary Yublic,~//!G~(/CyC County ~s~~s~~~1~°`N~~1
Notary PuNhQ~413447~~Nava York
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JAMES A. RICHTER, R.A. 515 Seventh Street Greenport, NY 11944 516-477-0998
~.rchitecture
3~1~~90
GIILDFifZ DesIGN
~ sQ
AUDITION ALTEP..ATIONS ToTNE d~~. ~ ''i
~p ~ ~ O
RfSS5FiL1.r I\ESID£NGL`
Ma1N Romeo ~ .AST MA~ton?, N.Y.
NF~W C~IROERS SN~LL ~ MIGR.o = LA Lv Mt36R. AS MPG.
~Y T~u55 ~oIST COQPgRATIaN. ILL (IRDE,~.S Sf~ALt_
a~AR ori! A /`71NIMuM of THR€~ C3) STUbS ors
So LID T3EARINC~ To FOI~MDfaTION $E.~ObJ. f3Ll. faIRDF~S
SNAIL 8~ SP?KE.D (.;Lu~A AS PER MF~+? . SPEG.
GI I R IaEJZ. ~ NIA~C • s~'A t~l = 1 ~ G"
~F,x~STIAIC~ ~GITGNbN) TOTAL LOAD = 890 #~•fi'
„
~ (!S~ 3- ~ ~4u X~(o MIGR.O~LAM C3ERM
~Lly?NGt f300Nt' TOTAL I.OAb = 73O#/1...~
~f USE 3 ' ~ K Nt?GP-o=LA~1 81%AM
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ass-isoz
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~NAL
REMARKS:
~~~~Lu~~
~ //d ~
DATE ~ INSPECTOR
I~~~C~ 765-1862
G I BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
FO ATION 2ND (]INSULATION
FRAMING [ ]FINAL
REMARKS: ~~~-t`._- ..wag.
~ .
' -
~
DATE ~ O INSPECTOR
I~~~q
765-1802
BUILDING DEPT.
INSPECTION
[/J F UNDATION 1ST ( ] ROUGH PLBG.
[ ~ FOUNDATION 2ND [ ]INSULATION
[ 1 FRAMING [ ]FINAL
REMARKS:
DATE INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU TION
[ ]FRAMING ~ [ FINAL
REMARKS:
DATE INSPECTOR ~
~ 765.1862
~~,~~,0 BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ROUGH PLBG.
]FOUNDATION 2ND [ ~ INSULATION
C 1 FRAMING ( ]FINAL
REMARKS:
DATE ~ ~J INSPECTOR
0~ / res-is®z
BUILDING DEPT.
f NSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
C~ MING [ ]FINAL
REMARKS:
J~ _ ~
DATE r ~ INSPECTOR ~.~..~lJ
I
~ ~ ~ 765-1802
BUlLD1NG DEPT.
~~-~t~ INSPECTION
FOUNDATION 1ST ( } 1R000H PLBG.
[~FOUNDAT{ON 2ND [ ]INSULATION
[ ]FRAMING FINAL
REM RKS: -
~ -~.~c. CJ z' ~
DATE o~ l ~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ SULATION
[ ] FRAM{NG [ ]FINAL
REMARKS: ~
ems,,.
DATE l~ INSPECTOR
BOARD OF HEALTH
3 SETS OF PLANS
FORM N0.1 SURVEY
TOWN OF SOUTHOLD CHECK ..._i: r .
• BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY ~ 7 7 _
TEL.: 765.1802 CALL
~ ~ /9 MAIL T0:
Examined 19 . .
Approved l~/!.1~......, 19l./. Permit No... f~`•5~~~
Disapproved a/c
(ByrYldin~ Spector)
APPLICATION FOR BUILDING PERMIT
Date ~ 15 ~
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 i
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. ~ y-•
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Suc'!~i
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, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessa{ry~ inspections. _ p
~bl,a I-~OW1e _.1..6N ~znr4vnew~S g~D ~vo ~ciane .L~`t
(Siggature ot" applicant, oar name, if a corporation)
• - (Mailing address of applicant)
State whether applicant is owner, lessee, ageent, azchitect, engineer, general contractor, electrician, plumber or builder.
p ...ii
Name of owner of premises ~Y:!•i,iu,~~ J~ .tFS 5~.1~ .
(as on the tas roll or latest deed)
If appli qt is a corp~_ i n re of duly authorized officer.
ame and title of corporate officer)
Bu' der's License No. ~.xi"'b. ~.~c!?l~ • , • • ,1.3301 C-~"~
Plumber's License No. ~'FS'N.'f.. ~L~':~b"°p
i
Electrician's License No. Jr~2-. ~ .~:`t~~ ~~~':"-'.-1'"~~~
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
House Number Street • ~ • ~ • • • • •
Hamlet
County Tax Map No. 1000 Section ~ Block ......y . • • • , , • • • , Lot .....~3......... .
Subdivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises an1d intended use and occupancy of proposed construction:
a. Existing use and occupancy ......R~.S 1V•Ptu~!1t~r• • • • • • .
b, Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition • Alteration .
_ 'Repair Removal . Demolition Other WorkG f•°~?4~~1N.?9}~~/.r•
(Description)
4. Estimated Cost ..~-•S..S~,.~Q,CJ ~9~ Fee .
(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 r .
_ 7. Dimensions of existing structure, if any: Front Rear Depth , .
Height Number of Stories .
Dunensions of same structure with alterations or additions: Front Rear .
Depth .Height ......................Number of Stories .
8. Dimensions of entire new construction: Front Rear Depth .
Height . Number of Stories . • . . • • • • • • • .
9. Size of lot: Front ....1~.'•I Rear Depth ~ .
G 10. Date of Purchase , j Name of Fo er Owner .
11. Zone or use district in which premises are situated 2>?w B1~12t:' . .
] 2. Does proposed construction violate any zoning law, ordinance or regulation: I~JQ .
' 13. WIlI lot be regraded .......Will excess fill be removed from premises: es No
14. Name of Owner of premises F}-~jy~Z .2NSS~J I .....Address Me l W . 2.°.^~..krY~t"~rw~Phone No. ~d ?Z-.?.-Q..g~
Name of Architect ...........Address .Phone No..... ,
Name of Contractor ~i' ~R.. ~'v.i l f)f'.r~ .Address R.4 :gw~ 67 b.. C7~: • .Phone No. H7,7,- 12-5,$', , , ,
15.Is this property located within 300 feet of a tidal wetland? *YES....IO':
*If yes, Southold Town~,Trustees Permit may be required.
i I 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 pumber or description according to deed, and show street names and indicate whether
interior or corner lot.
Se ~ f?~~~FFC
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E ~ i34+JN"tl` A+1CT;Y.,t.lt.3f=.ti d~d~l+rat~V~..
~f0 1~EP~YiG)t/1: I;.~CIS'~ Flla~
r~~tO~R ~~t~~!~' l~l~~lol!#HI~~ ~Y
~r CaliAtS14Nf3 away ...w.._
pP1VF.VdA~' CptjSTFitlCTiOSd ._..W...--~-e '
CE55P001_ COt~£'YlitlCTiC,~% .
CELIAR GONffi'7' C"f -°n^^--
~
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STATE OF NEW YORK,
COUNTY O/~~ ~S
. • . • • • • • ~ •2~ ~ ~ ~~t ~ ~ ~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. I
He is the II
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly 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 performed in the manned set forth in the application filed therewith.
Sworn to before me this i,
Notary Public, County
e~w
- y / LIN A O PER II .
Notary Public, State of New York' (Signature of applicant)
No. 4822683, Suffolk County C~~
Term Expires December 37,19.
E N ER~Y CODE CAL._CULQTIONS ~F~a NpitJ-ELEGT2FC -NE~ar>
Fa.a: mass/e - Pia. /~~vnJG~: ~E3i~ Caireaa 6000 QEanEE L).as _
ii ~li4~a~~ ~ATEC .ev 7r'~b ~ D-rt. ~ /O ~ I. A- : 70~F
~ ~UBS7'S'TE/~\ ARE4~ Q Desi ,4ttowa,~ pEt. ,u At.to~vEO ,QE/~'.,AQks
i~ ' U'~ U ~ BTU BTUH
EXTE.Q /a?i.1 \VALLS (L~FS~53) ~ I I 0.17 1
EXTEl~./.a Q \VAGLS (pP~IQUE) y'.~ ~ 0.05 Z B 7J
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1) EFATING EpUIPf+r^S.7' '1Y7 MEET 7813.23 - 755 EFF. TO TBE BE:`? OF MY INCW7..EDGE, -i~~
21 EiEATING CONTROLF ?t) MELT 7813.13 BELIEF. F,4L PROFE.9SIONAL ~ .y ~ ; t'
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RANGE 45 SCJ 75 DEGiiFCC F.9HR.RiE~IT. JUDGEMENT TIiESE PLANS ARE r,
WATEP. HEATIM 2ER 7813.31 TE3RU .38. IN O'aMPLIANCE WITH THE CODE. I~,_ ~ i"„
G~~i
S) PZPE INSULATION 7813.19 ~'~~n ~~F'
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WINWWS -DOUBLE GLASS. ~~pn ~
E) CJN~TRUCTION 1b MEET N.Y.S. ENERGY CODE- A~FESSIONA
a /d G ~ S'