HomeMy WebLinkAbout18646-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCh
No 219325 Date AUGUST 30, 1990
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property 2300 VILLAGE LANE ORIENT
House No. Street Hamlet
County Tax Map No. 1000 Section 26 Block Ol Lot 14.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 9, 1989 pursuant to which
Building Permit No. 186462 dated NOV. 16, 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 ALTERATIONS, DECK ADDITZON, STAIR WELL ADDITION, ROOF CUPOLA
(WIDOWS WALK) ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to GUILLAUME DE DACHAS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N145535 AUGUST 23, 1990
PLUMBERS CERTIFICATION DATED KING PLUMBING & HEATING 7/10/90
***PERMIT DOES NOT INCLUDE FO~UN~D-A--Th-O'N"'UNDER EXISTING HOUSE
C_.~"/ ,
..lding Inspector
Rev. 1/81
rosat 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)
Na 18 6 4 6 Z Date ...ll~~ 19~~
Permission is her by granted
~y~ J~ ~
/~T....... e. d
County Tax Map No. 1000 Section j.......'~...~~.......... Block ` Lot No......1.7.'M..~.....
19~~., and a roved by the
pursuant to application dated ..~1 PP UR1llI~T1
Building Inspector, ~j~ r
lJ~f9~~t2 ~~IS~'"!~ j'~or,SE-CALL ~7l)!~~
Fee 5 ,A.~
~Jnl~GS s ~r~~til~~'~•
`tf'..`.1..~~:9......
. . . .
~ B Iding for
Rev. 6/30/80
" d lb ~ Form No. 6
L ~ { `p~~l, TOWN OF SOUTHOLD
F ~ BUILDING DEPARTMENT D
C['j~~r/_ TOWN HALL
o. 1J 765-1802 2 6
~~~jf,. ,APPLICATION FOR CERTIFICATE OF OCCUPANC ~-°1
TOWNtUF SOUTIipLU
A. This application must be filled in by typewriter OR ink and submitted to t e u 'ng
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 1% 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.
C. Fees
1. Certificate of Occupancy - New 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 $1 .00, Commercial $15.00
Date 'f "6. . ~a
New Construction.. Old Or Pre-existing Building.. ,~y y,
Location of Property...-r~ ~Y~ Hamlet•.••••.••,•,.
House No. U ~ ~ ~ ~u ME Street ` ~ ~ AL l~?fl5
~lidQSl,e De O812~1
Onwer or Owners of Property...,..~~:~.
County Tax Map No 1000, Section ..............Block................Lot......................
Subdivision .Filed Map............Lot......................
/ rr~~ r 'f~J
Permit No.f.~..~.r.~....Date Of Permit.~l~~~•..ApplicantN~.~.~'y~~.~.~~. f .~~C..•
Health Dept. Approval ..........................Underwriters Approval '
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: ~ O
~/Ya 3~~
GI3UJy'0 2ig3 J S~ APPLICANT ~$~f2L~G-Ss~ C~~~~~,Ta~
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THE NEW YORK BOARD OF FIRE UNDERWRITERS x
a ~ <r!~~L:L;a
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date EITYGIIS'f' 1~4,'l ~)9f) AAPliration No. on file fa.~C`j "/t>hi,}j~0 ~t "{r1ht; „I Ca
THIS CERTIFIES THAT
only [he electrical ue
iq
pment as described below and introduced 6y the applicant Homed on the above application number in the premises of
~~NNG-d
t,tfif,LF.?dP~h; 11F~ t'~1-ililtrTS, 2Ja4 U'it,l~tlCa. 3,t~Pl>;;, AtY'(` ~ 3, t}&Tk~fS'f, ~i.Y.
in the ollowin locot' n• ?~~I"1`~~"~l~{T a~
J q f,4 ~IBasq~rent ~ lst F'l. ~ 2nd F'!. .Section Block Lot
[,IIJ~>1T$, t:
@ was exmrtined on and found to be in contplianre with the rryuirernerzts q/this Board.
C
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIUORESCENi OTHER AMT. K W AMi K.W AMi KW. qMi K.W. AMi H.p
,}17 t~f .fr
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
SYSTEMS
AMi. K. W OIL M P GAS H P AMi. NO. A W. G. AMi AMP pMi AMPS. TRANS. AMT H P NO. OF FEET AMi. WAiiS
( .~(7 ~ va (eO~
SERVICE DISCONNECT NO.OF S E R V I C E
°°AMi. AMP TYPE METER ~ ~W, I 3W 3 % RW 3,e' 4W NO OF CC. COND A. W G NO OF MFLEG A W G. NO OF NEUTRALS A W. G
EQUIP. y PER % OF /CC. COND OF HbLEG OF NEULRAI
1 I (}ii i`IS 7 rt ~ ~6 U ~l~
OTHER APPARATUS:
:IPaGF, t,Af?14~t4~1NN !'N ills^.~3~i?i?5~-G
- ~/C/~~
>(3i1'I'fll7f(U, lVV, '!fn`r;f
GENERAL MANAGER
Per i.
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.
E COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
i~
t f F
TEL. 7G5-1802
~oS~FF~L~1-~0~ TO'4VPl OIL' S~t1T~OlLD
f '~~y~'
.ryg+ OFFICE OF BUILDI2~IG INSPECTOR
o _ P.O. BOX 728 - -.~+n.R,.~~:.
~1,y,,, ~ V
cn ~ mti' .c TOtiVN HALL
.r0~~0~ ~ SOUTHOLD, N.Y. ] 1971 / ~a y~~y~
aRJI. [ V r~l
BL6G. t}6s-;.~
N OF SOUTrpGo
C E R T I F I C A T I O N
Date 10 Fp'C7
Building Permit No. /~l~~/~ /
Owner cj ~ ~-c, /~-u, n7~ d~- m ~S
j ~~//(plea//s~~e print!
Plucbar /~t~G N~~..+u oty~L
(p ease print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
~C~ `
- (plumber's iynature)
Sworn to befar^_ me this
__~___day of
14 9i, i ~6VL (/i-e
_.L_ Notary Public
Notary Publgqi~~c, County
NEIEN K OE Yad
~~470/876 Su~flolk CouhtY
lam FxP~ IAa~ch 39,19....
~~FFOIk~~ TEL. 7G5-1802
~p OG~,{ TOWN OF SOUTIIOLD
L~:~a~i .c OFFICE Or I3UILD[NG INSPECTOR
~~n~ P.O. BO\ 728
~ ~ T01VN FIALL
.YDyfcs~ SOUTIiOLD, N.Y. 11971
Ol,~,~
7~i y ~yo
To Sthom This 'May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
/xy nn application for Certificate of Occupancy
i s not o n Life . ~~c-P~-a-~'-c~
!X1 No Underwriters Certificate on file.
The check is(~t<s/not on file.} ~as~oo
No ttcalth Dept. npproval on file.
Nu final i.ns,pecCion has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Ilui]di.n~t Permit IE / ~ ~ ~ ~ Z
Uuilding Dcpt.
No Plumber Solder Certificate on file.
{ all permits involving plumbing being
.issued after April 1,19II~1 )
P_ b. Q~ 3~0
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^C.lUN ,~UAin ~ ~Of4MENT°
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FOUNDATION (1st)
FOUNDATION (2nd) - -
2. ~ D ~ d' z ~1
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P,OUGH FRAME &
PLUMBING
tiOQ~
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IIJSULATIOf7 PER N. Y. ~
STATE ENERGY
CODE ~
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ADDITIONAL COMMENTS: ` m
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r65-1802
BUILDING DEPT.
INSPECTION
[ }FOUNDATION 1ST ( } ROUGH PLBC.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ]FINAL
G-~ c~ ~ G~
~ 4
REMARKS:
~c~~t rw~ ` '
DATE ~ INSPECTOR/~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ,z~`~~~ or
DATE ~ ~ D INSPECTO .c-~,
765-1802
BUILDING DEPT.
f NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGI~t PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ]FRAMING [ 7 FINAL
REMARKS: ~~~c.~%r C~"G~ ~ ~~P-~
DATE INSPECTOR
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BOAKD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY 1l.
TOWN OF SOUTHOLD CHECK • - .
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL
TEL.: 765.1802
r MAIL T0:
Examined /1. 19 ~~~7 y
Approved ...~l/~,~ 190i~ Permit No..~.[1 ~'J. ~
Disapproved a/c „
TOWNLOF 50U'I~MOLD
~2.~ ^.~?2 .
Buildi Inspector
APPLICATION FOR BUILDING PERMIT
Date ..~~,..g1......, 19~).^'
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 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 necessary inspections.
{~~'`1~. ~(.~~~`I1.O.
NSA.. ~ I~~.`? , .
(Signature of applicant, or name, if a corporation)
..~:a:~~ ~a~.~~t>~uT t~y..~~g.s1...
(Mailingladdress of applicant)
-
State whether applicant is owner, lessee, agent.. tect, ens' e r, general contractor, electrician, plumber or builder.
Name of owner of premises .l~N~.~~T1W~!!~.~.~! ltr!°.SAS .
(as on the tax roll or latest deed)
If applica is corpora i s~ nature of duly authorized officer.
...........O.f(~!~ ~ .~~EFi.~..'...... .
(N me and title of corporate officer)
ALL CONT ACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. ~ .
Plumber's License No . .
Electrician's License No . .
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 p~.t~.......... Block { Lot ~ .
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of prej~mi~se-CS a~ndyri-n~,te~,n..de~d--use and occupancy of proposed construction:
a. Existing use and occupancy 1~LtJl~Y~!"` ~ .
b. Intended use and occupancy 61
3. Nature of work (check which applicable): New Building Addition ? Alteration ~ .
p . . Demolition Other Work .
(Description)
Re air Remov Fee
4. Estimated Cost ~(.~D•
(to be paid on Filing this application)
5 If darallennumber of cadwel~ g ujfits V..N. Number of dwelling units on each floor .
g g .............n-
6. If business, commerciaLor mixed ~~~occupancy, specify n t Ie a d extent of eac~h,~1',pe oNUSe ..-l .
' 7. Djmehsior}s~+R( ~Clsting structures? if any: Front ~....~e~r ...'kb::.~~..... Depth .
Hei ht G.. ~ er of Stories ~,x~rJ.~~''~:....^p,.-.,... ~r ..............~~.rr.r. ,~cr...... .
h alterations or add'tions: Front Rear . k:~ ~ . , . .
Dimensr f ~ m cture wrt~ r ~
' Depth . , { ~ , .Numb • Hei ht , ~ Number of Stories It . ~ , 1 . .
S, Dimensions f ep~t}r~ new gpp~tru~ctiongFront , r:'~~..... Rear Dept9ri ...~r(~.
' Height ~?i~,-? . Nultntfer of Stones a r a .
' d
' 9. Size of lot: Front . Rear . th ..~1.~•~~. r
10. Date of Purchase ...-~PI!v•..(. Name of Former Owner . ~ . • • .
1 1. Zone or use district in which premises are situated ~~is~~~'~/v.` ash L... • • • . • • • •
12. Does proposed construction violate any zoning law, ordinance or regulation: .
' 13. WIll lot be regraded Will excess fill be removed from premises: Yes_.y,,~p o
14. Name of Owner of p emises ~1~el~~F.~r
~~~'~Address~~}IA1„~jONS'~;,K~,G.,~~Phone No. ~~~~..2'.~./'~6~
' 'Name of Architect 71'C.~~ ...~L.4.~1,.5, //UG'••. • • • • . Address~~J$PK.~1Q'OR.
r~('r.NyPhone No.,s(~ .,'~j1~.
Name of Cp ntrpactoy ..........................Address P one No............... .
15. Is this ro ert located within 300 feet of a tiidal wetland? *Yes No
*If yes, Southold Town Trustees PermitPLO~DIAGKAMed.
Locate clearly and distinctly all puildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block riumber or description according to deed, and show street names and indicate whether
interior or corner lot. ~
I
i!
STATE OF NEW YORK,
COliNTY OF 'S
• , , , • : being duly sworn, deposes and says that he is the applicant
(Name of individual signijrg contract)
above named.
He is the
I (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 manner; set forth in the application 61ed therewith.
Swom to before me t~hjis
................9.. ..~.dayof.. ...........,19.9
Notary Public, r!?~.. ~ . ~t.. ~I{" County ~,~p~n t
HELEN K DE VOE 'I ` ? .''K ..\.v.~. .
NOTARYPUBL1D,State~ftdewYork i atureofapplicant)
No. 4701878, Suflol Douo ,
Term ExWres March 3 ,1
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