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HomeMy WebLinkAbout18648-z ~ A FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20036 Date JUNE 261991 THIS CERTIFIES that the building ADDITION Location of Property 475 MIDFARM ROAD SOIITHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 63 Block 7 Lot 24 Subdivision Filed Map No.~Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 14, 1989 pursuant to which Building Permit No. 18648-Z dated NOVEMBER 16 19$9 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is i issued is DECK ADDITION PARTIALLY ROOFED OVER AS APPLIED FOR. The certificate is issued to JENNIE CARLSEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-114466 - FEBRUARY 15, 1990 PLUMBERS CERTIFICATION DATED N/A / Bu lding Inspector Rev. 1/81 eos~s xo. s TOWN OF SOUTHOLD BALDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N a ~ 6 4 8 Z Date .....l% 19.~s.: Permission is hereby granted~to~:~ ',d ~ , p .,gin..... of premises located at . County Tox Map No. 1tl00 Sections.........~ct...Kr,'~....... Block lot No............~~..j...... pursuant to application doted ....~/~~~~Y.....y.' 19........, and approved by the /f~~ 0/~ r` ~~l Building Inspector. l , , ~ 0 G~~it~a o e~ Fee / , . uildi ....tor...~t Rev. 6/30/80 ' _ Form No. 6 'C.~"~ - 3c~.3- ~~~q' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL T65-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted Co 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. ~i 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. i 2. A properly completed application and a consent to inspect signed 6y the applicant. If a Certificate o£ 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, dditions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory huilding $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 Up,Iated Certificate of Uccupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Q.dd~~-~e„` Date ...~D.~~.~.~~.~ :lew Construction........... Old Or Pre-existing Building......... y K t Location of Property.....LJ.? ..................~"LLd~~1~~Y1.~.10~...,,.:~de¢,~'~q~d House No``'.~~'' StreeC Hamlet Onwer or Owners of Property...1L.1?.!?b Car ~St'itn County Tax Map No 100~0r, Section.~4:?..........Block.....jA.........Lot.~i7 • Subdivision..C CiIVCS ~V ..................Filed Map............Lot Permit No... ~8.~.~,~....Date Of Permit..~~/1 /0,~a~....Applicant...:~:`~{/!'4~~'s~..!:~s~`i'4~.9C........ ({ealth Dept. Approval.....N .................Underwriters Approval........................: Planning Board Approval,.M. ~ ' / . RequesC for: Temporary Certificate........... Final Certicate.. Y Fee Submitted: $ ~ .APPLICANT . C o ~ a 0 03 ~ • . ~ . _ - . - t _ _ r..__-- _ _ _ _ - ~ F~ )~..._-~_.v _ - ~ - - - - _C~~ C-f _ ~ _ . _ . 5 ~ ~ ~ - ~ _ _ y,_~, fns / 6 Y ~ ~ of -r Ft K- x v i~v S E.G YH x - ~ _ 2 H LA K CR _ V ND 4!1 N _ P ~ ?r - - x _ - - AosT ,~~TE iN - s . f y . - - - - _ _ 0: q - _.r_____-__ . - - _ _ _ Ec w ~ _ . O TE 8:. aY.. j¢ . - - ----N E: g - - - - UIL iN p ~pq _ - - --Z ~ t. 02 -8- M- _ AT _ _ F lL WI P -F R HE G [ SP Cr 4N z - - - - -9-.- fi TT 'iv~ :W RE UI ED - - - R E - - . _ _ 2. RO GH - F A IN ~ ~ E O PLE E R_ r0, -C .E - - - - - - - TH R Crf N SH ll M Q [R~ rS-E)f - - - - ---.moo - °o- r rE co sr uc to _ _ ~ , xE-Fr & E ER- -Y E?i-, ICv OR C y- Sf C~ F R - - - - - - - -9 ST UC 4 - _ 4. I ~ ' U I a . i i ff +w LS I ~ ~ ~ i l~_ L-_ ~ , ~ _ ~ , ' + ~ e I ~ ~ ~ I I j i i - - - - ~ ~ i~~~n/S!I ~ I ~ I I i I _.._...,..._____._._~..w I ~ ~ ~ ~ ' ~ iF. - I-_..I.. - I - j I ~ ~ I ~ I , ~ I i i-- i i_- ~ ~ I ~ i --i ~.i__ - - . , - r ~ ~ i- _ - I I I I ~ I ! ~ 1 - _ ~ ~ ~ .T I . = - - - I ..I I I I I ~ ~ i ~ i ~ ~ ~ ~ I I i ~ ~ L_ i ~ L cry - ~ - _ _ - ~ ~ I ~ ~ I~ . ~ ~ ~ I~ _ i T' - - - ~ ~I . _ ~ ~ ~ vaM _ ~4,. . i , - t ~4 ~ I i ~ I I ~ I _ ~ - - - - - ~ I ~ C I ~ f I j--- ~ ~ I - - ~ -911 _ L. I ~ ~ , ~ i ~ I I I, I I ~J a;_ ~ i ~ f - - b w ~ ~ - - i ~I r- - 4_ ! - - ~ ~ ~ - ~ ~ I~ ~ I ~ ~ r- ~ _ I I ' _L.. ~ ~ I_ I. j l i i ~ I ~ ~ ~ E _ _ _ _ _ _ _ __I I ~ ~ ~ ~ ; ~ ~ ~ I it i ~ ~ : - ~ . ~ ~ . ~ ~ I - - ~ .im" T- ~rn - . _ ~ - I i - - ~ i _ ! ._I _ I I I J i ~ ~ ~ ,._L.- 1I i I I~ I i i i i ~ ~ ~ t , THE NEW YORK BOARD OF FIRE UNDERWRITERS TRACE 10001.21 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 1003® Date FEBRUARY 15,1990 APPlicotionNo.onfile 67U6989()/9p N 1144fifi THIS CERTIFIES THAT _ only the shrctrtcal puipment w dsecrihed 6eloto and introduced 6y the applicant named on the efwos eppliaNon numher In thepremisee of - JF~NNY CARLSEN, 1 MIDFARM ROAD, SOUTHO[,IJ, N.Y. in the folba:ing location; ? Baeement ? l xt Fl. ? 2nd Fl. OUT ~ Sectwn Btock Lot uae examined on aANtIAN.Y 22,1.990 and found to 6e in cam lionce with ther p eyuiremente of this Board. BXIUM RXTWES RANGES CODKRiO tNCKS OVBiS DISH WASHERS UST FANS. tXITIETS TACIES SWITCHES INCANDESCENT PIUOIIESLENT OTHEN NAT. K.. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P. 1 1 ~ - DRYERS FURNACE MOTORS FUTURi AFNIAtKA tiEDERS fMC1A1 RECFT MMEtAOCKf ~ VMf t1EATERS MULT40YT1ET DIAAMlRS = AMT. K. W. ql N. Y. GAS N. 1. AMT. NO. A. W. G. AMT. AMY. AMT. AMN. MANS, NAT. n Y. ~ ~T AMT. WAT75 SERVIC! DISCONNECT NO.OF S E R V 1 C E AMT. AMY. TYPE EOUI?. 1 / 7W 1 A 7W S / 7W 7 / AW OPER HCO~. OF ~C ~ ~D. NO. OF N4lEG ~'w;~ NO.OF NEUIKALS ~ ~I l~~l - OTIIlR At7ARATUS: - - RcX)P'ED OVSR EXTERIOR PORCH HT.RING--1. G..A'.C.T:-1 ~ / - PAUT, R. Bi1RNS 1,1C,~""?.82 E o'~ 'l75 TOtiN HARROR LANE SOUTHOTIU, NY, ].1971. GENRAI MANAGER 11 Per This artificata must not be altered in any manner; roturn to tM office of the Board if incorrect. Imp~cfors may be idamiRsd by RFeir cradenfiak. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATB MKT NOT BE ALTERdD IN ANY MANAGR. :TEED Ii:sr•EC~iuc) ~~uATE ~I corr~c,vrs ~ ~ ~ i. ~ ~ t _ y FOUi7DATI0N ( 1st ) C FOUNDATIOtJ (2nd) ~ 2. z a ROUGH FRAME & .PLUMBING H 3. ~ "3 \ IIJSULATIOAI PER N. Y. STATE ENERGY CODE a r k. ~H FIiJAL © o z ADDITIONAL COMMENTS: ~ 1^^ ~ ro I x \ H ~ 9 O Z \ 1 . ~ [T] 9 x d • m b .a .~..._.._.__._...-....n--..--....~r.~wenwra...+.n.•..«...w..~a.n..^r~~...-...n+w...~~x....--w'Y~..-~-~ - 1 r7>r / . r~ ~ n ' ~ ~ s o cJ L YO i C7 gvai /oN ~ ~ _...r. ~ 0 1 ,l - - ~ o II Gpp r~ I y7nYeY ' ~ ' Fem. uou~~ a o .l n •r t p ~ 1 i 4 kn~ Q,YEA ~DS~ { \ \ ~v.il ~ U m \ v qQ/ ` N \ ~ ~ Una+;thnmM, nlte a on or addkion t ~ dO Yhis SlNPyiS VI Intian Ot . ~ Ca f~ . I ;'wClOn 7?x.3 of e o aw York utatb a` < <7 Y'duaationtew. •.>/..3.," q • .5 ~ ' -y. ' {'Q " W. - ~i 6. ~ r- . ___._~,plss oP thls a melr not irearin® the hlitd 6UM1ey0 & ked sea{ a ~ embossetl sent a ail not [re iwnaidemd F'" r.G~ ~~r.. t°r/ry r- y to fxr availd true ca I"c" t"1 ^"'"t' f3uePante6e lndt a hereon shall run cnty Yo tfia perso P r wham tho surcoy Ia nrepueod, and n to bet';slf io the { tltla nnrnrany, g v r..anini agency and lendsn;f initittrtl li eo~i hereon and • Yo the aasipmoos of a Iondinp In~ni- tutlon. TilAafRr1Y s re nm tranaFerahlo e ^ ' / ?/f^~ f'a ~ ~ PR ~7~ -~t~^ -r ~ ow e~s.Dnal ina itu ons or subs9auent I ! ~J i.~ r: ~ ~ ~ ~ C. I: o~I~, :>c~/~~ : Ica ~ E~ f~.l l~..l l"~~~"rl- . ~ I~~ c,'. - •yuc~s7tati`s~~t^E:ll -~a ~~•u~=. W~rz•jia ~`oe~~ F,ouk F ct~, y cK vq o _ ~ gA.i{Sl r - r .i ~ ~ r,,~..,.~(,~ ~c 1~._ U n...... ~ ~ ~r'~;a~.`f n _ 1 ~ ~ °s <s26~ Qa ~i<~f/r,^~^c,?•~(7rlt'Y ti~clr's/e.'[fr_~tr.~ .j~ _ ~ ' F~,%,~iv_a c,yG'~'C'~7 ~7~:,r' /~/dens Gy- ~F" , /o ~ . ~i.._ • - ~ _ ~ ~ ~ e ~ ~ `~°t_~ ~ - ~ ~ i ~ 1 ~ i ~~~i_~ - ~ E i1- ~ ~--i -i--I _i ~ v ~ ~ ~ ~ - fL. .~s ~ _ ~ ' - ti ~ ~ ~ I I ~ ~ ~I I i ~ ~ I i I ~ a ~ ;-t I ~ A- j - f _ ~ ~ ~ f. I _ . _ ~ _ _ ~ tom. - ~ - _ x- . ~ ~ _ ' I - ~ - - , ~ - j ~ ~ r_A . ~ I f i ~ i Sri ' ~ _i _ e , ~ ~ 'r «k f r- ~ - - ~ -fir, ~ ; ~ ' ' ._G~~.~ ~ - ~~~~~~-__r. ~ ~ . ~ ~ ~ I ~ i j ~ i 4-- . ---r ; i w_ _ , i 6 f { ~ I" I I i i I _ ~ ^F I ~ ~ ~ _ ....p ~ ~ If F ~ ~ ~ ~s ~ ~ ~ , . { a~,~ I - - _ I---. ~.._i-._. f i ~ ~ r ~~11 # I I , ~ II ~ _ I- 1 ~ ~ _i ~ ~ _ - - ~ - - - ~a~... ~ ~ ~ ~ I ~ ~ ~ I f . ~~f__._ ..f~. ( _ _ f Ifr ~ t - - _ I - I. ti - - - ~ ~ - ~ - k~ / ~ I . f i i si. - r - ~ ~tf - - - ~ - r - - - I{II I a _ _ ~ - ~ t ~ ~ - I r-. ~~t-_ ~ ~ - - - I ~ , / n V- k ~ V ( \ 1~ ~ ~ ~ I f - i nti~ ~ - - ~ ~ _ ~ . - - _ ~ ~ ~ ~ ~ ~ ~ I 'J IIf l ~ y~~1~ C~ ` Il BOARD OF HEALTH ~':;j ~4~)y I' ~FORMNO.1 3 SETS 01! PLANS L~~'~I SURVEY U TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ' aLDG. nErN7. TOWN HALL , mev~ oF_ S.OUYHOLD °,OUTHOLD, N.Y. 11971 NOTIFY ' TEL.:765.1802 C Examined e`~ p~ ` 190.(. c~ ~.~Danre/ 1. ~sche/ Approved ..~`/.~/v. 9~. Permit No... ~ -2d Sou„d /9oac~ / 1 ~ff. . G~cerporf> l?.Y. //9Hy Disapproved a/c . (Build' g Inspector) APPLICATION FOR BUILDING PERMIT Date .......lYOY~. 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 ptot 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 Depaztment 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 c e, housing ode, and regulations, and to admit authorized inspectors on premises and in building for necessary inspection . . ~_G.c (Signature~of appli ant, or name, if a corporation) ~unIGIL ~~$GhG? ^tv S'e+tindCfood lyr^ten or'f` IVY/, ~lof~~ (Mailing address of applicant) ~ ' . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..ls~N.F rWt Lon }r0.C'1'e Name of owner of premises .~7.:~n e . ~A.r.(St-~? . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized ot'ficer. (Name and title of corporate officer) ALL CONTILAC'lOR'S UST IIE s~Irr•o~K C,DUNTY LICENSED Builder's License No. ~et.taiil. t:.•. Ylai<-Ft¢n! . Plumber's License No . . Electrician's License No . . . Other Trade's License No . . 1. Location of lan//yy--d~~~•on which proposed work wAifll beppdone. .c~ ..................((f............................. . .....~.~!Y .......1!J GS7Qrw,, Ro4°( JO(.t.~'hald House Number Street Hamlet County Tax Map No. 1000 Section ....Ce.~J........... Block Lot ~ . Subdivision Filed Map No. Lot............... (Name) Z. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy n,g Ig, ,(!'aYr,.,f y...res,rde ~ rR, , ,w,r~~; ~7 ; . , . , , . b. Intended use and occupancy .~.!^~),e.~a!Y~.'1.~K..~`?cs'.!"~tr.~ ~di°~.3C.~,f~%~~~ •La:+'L~2..... i 3. Nature of work (check which applicable): New Bui]ding ~ Addition Alteration , , , , , e 1Vo Repair Removal Demolition dernol,sl+ e.Yisf~,.,~ d~~k a~~ replsice u„!-1, 9ar9cr d•e..clti r ~ ~ (D`GSCriplion) is<, ~ ~ 4. Estimated Cost ..1r.0.Q0.... ~ : Fee • ` (to be paid on filing this application) 5, If dwelling, number of dwellingi,units Number of dwelling units on each floor . . If garage,numbcrofcazs ..:z 6. If business, commercial or mixed occupancy, specify nature and extent of each IYpe of use . . 7. Dimensions of existing structures, if any: Front ~ Rear Depth : . Height ...............Number of Stories . Dunensions of same structure with alterations or additions: Front . s.°."'~• Rear S° . Depth . h'.4 ~ .Height ..Same ,'Number of Stories .:r:r:~'"`?............. . 8. Dimensions of entire new construction: Front . Rear Depth . Height Nwtjber of Stories . . 9. Size of lot: Front, . .J~a sczr.Ye , , , Rear Depth . 10. Date of Purchase, ..~9. 8.,7... Name of Former Owner . h:!~.4!'>. !`?S . 1 1. Zone or use district in which premises are situated . 12, Does proposed construction violate any zoning law, ordinance or regulation: . ?Y.~ g 14. NameoofOwner o d remises , ,T, ~ ~ ' ' ' ' ' ' ' • • • • Will excess fill be removed from premises: Yes cty,t? p ~!YN.<t ..S?h'klf!Y ..Address 3 ;N;d~°4~m./?`.I.S~h:. Phone No..7~,5'.5~1.~8 . Name of Architect , ~ ......Address ..Phone No......... , . Name of Contractor .~a'.r! z? ~ ~?Fh!'!........ Address ,ZgJew.n~R:l. BP!:~.... Phone No, 4!y7: ,0,6 ?p, , , , , 15. Is this property located Faithin 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trustees Permit mayy~ be regwired. PLO'i' 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. ,1'G'.~s% Su,~vCy~ I , STATE OF NE\V~R3 ~li S~IS . , , , , rri~~ . • f ~ ~ h being duly sworn, deposes and says that he is the applicant (Nmne of individual signing contract) above mm~ed. ie is the G.an.fr.4RfO.!... , . . (Contractor, agent, corporate officer, etc.) >f said owner or owners, and is duly''iauthorized 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 ~~~Ork will be performed in the manner set forth in the application Gled therewith. ' sworn to a ore me t us Cl day of l9~ . ~~~.1. • Y rotary Public, . .Count CLAIRE 4`®LEW . Notary PubNo. SIAM of NswYak (Signature of applicant) No. 4S'fi96t18 QuaiNied in Suffolk County ~l/ Commission Expires q ecember E,19.._"