HomeMy WebLinkAbout18676-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218956 Date APRIL 5, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 700 TEEPEE TRAIL SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 087 Block 02 Lot 25
Subdivision NUNNAKOMA WATERS Filed Map No. 5126 Lot No. 8
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 14, 1989 pursuant to which
Building Permit No. 186762 dated NOV. 29, 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to ROBERT PUFAHL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING SLIP 4/2/90
PLUMBERS CERTIFICATION DATED N/A
c~~~
Building Inspector
Rev. 1/81
roaxc 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)
N ° ~ ~ ~ 7 ~ Z Date ....~.8'?F.:?'!.Y.L~:...... ~.9..........., 19.8.4
Permission is hereby granted tqo: p ,j~
...~.a9......~4?..Q:r..~°~.Y.~...:........
to ..~.>Nks~Afi:4:S~.....4)1....~9~:~Q:....4.+~.d~!1.....~.a....~....r,..R~s1
~:?:~.....a?. ~4:R
P,.ti:,,.~.,.... ~....G:..~~,~P........ ..............I.............
of premises located at ~..,9.R.{4.>;,R,. .........5„lf~~s:Sl.1X.!:.°.`.K
....~,1~.....~i~:,~:..
County Tax Map No. 1000 Section\\ ......Sa.:B:~....... Blo,/ck ......4>.~-:....... Lot No....ral,~~............
pursuant to application doted ..N..t-*A.c~!^?~5,........~.T 199..., and approved by the
Building Inspector.
Fee $..`ra~.r..
......,.~.~'a.-~.......
B ing Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD n (L~~~
BUILDING DEPARTMENT U
TOWN HALL
765-1802
BLDG
af~~'~T~
APPLICATION FOR CERTIFICATE OF OCCUPA Y TQWNOF>OOTPdOL~,,,
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 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``5.00 Commercial $15.00
. ~y11 ~~~C.i
Date .
New Construction.. Old OTr Pre-existing Building..
Location of Property.. .~.~.......4c°;e,(~z~ ~Y;G;:~....:/....~~~'v.~1~~
House No. 1. Street Hamlet
Onwer or Owners of Property
County Tax Map No 1000, Section... ~~......Block..... / ........Lot....../--.~ .
ll 1,"~
Subdivision.'.11v: ::~::':':2....X~.e
:..........Filed Map..~.~. ~.~ar...Lot..
Permit No.. .Date Of Permit. . ..Applicant.~J. ::~1~ .~a .
1 ..VI
Health Dept. Approval.....Y.1\`qJ^°::~~r .............Underwriters Approval. /
Planning Board Approval...~Y1a :G
Request for: Temporary Certificate........... Final Certicate...~~ .
Fee Submitted: $.....°.~.'5.,.
~ ~ gay 7 r/~G'~ ~ ~
C v zi~y S.6
S 6 . ...APPLICANT
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T_IJSULATION PER N. Y.
STATE EfJERGY ~
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NEW YORK STATE DEPARTkiENT OF ENVIRONMENTAL CONSERVATION
Building 40, SUNY--Room 219
Stony Brook, NY 11794
(516) 75L-7900
AMENDMENT TO PERMIT
- ~ EXT~SION OF EXPIRATION DATE
RE: Permit No. , ~ 17r L ~ 3 ~ 1 ~ rY~
~Krs.^,~ 5., C?ls~.~r
~o ~o C~-it~ ~1
Sou ~ ~„!~t j N ~ ~
Dear I
~JP~ ~.tl~=,u c~ 1 ~ : ~ ~ ~ i
- " Your recent request to extend the above permit has been
reviewed pursuant to 6NYCRR, Part 621. It has been determined
that there has not been a material change in environmental
conditions, relevant technology or applicable law ar regul-
ations since the issuance of the existing permit, therefore,
the expiration date is exY.ended to ~ ~G, 3i~ / 9' i
This letter is an amc~_dment to the original permit and
as such, shall be attached thereto, and a copy posted at :;the
,job site.
All other terms and ccr_ditiona remain as written in the
' original permit.
,3 Very trulQy yourQs,
~lt...-car v~-t~..c.- r
Daniel J. Larkin
Regional Permit Administrator
DJL:cz
L _ ~.fri'1.
K~'~? / NEW YORK S'Ci~l'I; UEi'AR'1't^?N1' OF 1st173R01>t1:EN1'AL CONSEP.VATIOLI ~ ~
k~
iy},~.' '1;,. Regulatory AfCr,Lt:+
' "hk.";d•'; .Building 40, 3IINY '
. '°r,~.';~'"," .~k„ Stony Brook, idY 11;94
v.'1"+?~r (Slu) 751-7900
Robert F, Flaeka
~~~-~,~}~u fs~~~ ~ Commissioner
i t~N~. .
,
-'~~~'S ~},fig;~~<;'7 rtrv;',;,-;,•.,,', A COFY OI' TttIS AU1'IfORI7.A'ClOIJ hIU;iT RE AVAILABLE ON PROJECT SITE
1!'9~p~F~'~pV~z''''~~' _ _ _
. 1Ai1~~7", H~" . .
~~iM1!, .
~7 ..,~~7,~t•_. ~ ' January 22, 19$1
N
° :Gary Flanner Olsen, l~tty. ~
For: Marjorie Berson
F'`~'.~e.~`'..,. ~ P. 0. Box 3$ ~
'~r~~~'~t^. .;;.,.Main Rd. '
F J ~il~,y~''i+ay , ~,,:'SOUthtS.l$./r-nT,~r
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y~d~~~~y~iv'~t~olti~'';.'S' .v j.' TldtV^.. if rnr+r tr t t
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•i~~ TIDAL ilETL.ANJS NOTIFICATION LETTER APPROVAL i [
r ',.s 'a~~qP "ii 4
~ Deaz Sir: ~
~,t `w*s'` Sri Thie ie to inform you that we have reviewed the notification letter (or ' 4
" v ~ ,<r~~^^,`+~.a a Permit application) filed on Dec. 2 19$0 and have determined that
~A11'~v gm~,,~~i,,,~it will not be necessary to file a permit application (or secure atidal -
r, fvs n, , ~ptetlands permit) to construct a home and associated septic system
~~ti~~~4"~;~~„~'f~ccording to plans submitted to NYSDEC*. Project site on Hogg Neck.'
'~~''~~~,<;:~?!;~~;;',:BaY, westerly side of Tepee Trail. Lot with Tax #1000-$7-2-25-Lot
' `~F43 ~ !#;.of "Mag o£ Nunnakoma Waters"ar. ScTnChold, Town of Southold, Suffolk
h x w~ N. X.
r . ~ w~ r'FM ~ tCOU.ritY, ~ '
v~~'~~~t~,4asuming you have ohtained all other necessar ermits you may proceed
Y P ~
' ~ ri~.'Lr"~,j9~'~'i' t our ro ect adherin to the s ecial conditions (if any) found on Chi!
'Vial h'Y P .1 S P
exhhu t
~t',1yt J t)II d'
.~~x yt~',~~~4'P],asls show all work to be done within 100 of Tepee Trail. NO fiih~s
~~~`~~$~''~y~~~ading or excavating is to be done Further than 100' from road.
Y ? A )riW +y ~I ds v11;Fn ~ '7#"'f
~~it,,•, ~';~~~~'J"'"~~a~.~~A.... D~Ni~7, tj, cry "f.
a~~ '~„at" Regional Permit Administr r 0'
'~JS. +tCt~tached: Receipt No. U 21799
+',k,, v,1t''•~.p....:{... tjantla_rv f
r?'P",, L, ,,,^'a,r'. Date Issued
~~t;~':i;,~~ti1;;"~f''~'<~'`," ~ March "il. 19f~2
,
-~'~~~;y~,y'„d'°' Expiration Date 4"
ck't'U.S. Army Corps of Engineers
ai _4y„'~+,~ w? , ~ b1YSDEC Law linforcement -Region I
.hi aj~o~h~',y::,
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THE NEW YORK BOARD Of FtRt= ~ ~ ~ Ttet'tS rhrl a
tonal*~ euREwu of E~ECTRICm
85 JOHN STREET, NEW YORK, NEW YORK 10088.
Date AF'K11. '16,5~39(i Application No. onJile 67944;S4SY~yL1 N 1?G01Y
THIS cERi1F1E$ THAT -
only the electtkvl puipwtent as dascni6ed 6elorD and introduced 6Y the applicant named at:the ~4xv:~appBatian nun?4ar irA tMpntwiao of
R06(iKt NI11~AN1, 7nt) 1lLi'@E IKA(L, '3Unl'HOLD, N. Y. ~
in theJoUotcinR locution; ? Basement ? /st Fl. ? Ynd Fl. CvAK ~ :4txNon Blaek Lot
u~ss exomixed on RAR!:N 7'?, t"?9n andfoundto be in rnntpliance rciththe. regairement~oJ'tfibe Bwrd.
r
R%T1MR At1K SM/ITCBK R _ - Q T RANS
OUT{flS INGNDlSClM FNIOtfSttNT OTNER AMT. t. W. AMt. t, W; AMT.. K.W. ANi..... t. W. AMr. M: ;
3 3 S
- DRT'BS RNiNAGE MOTORS MURR AMtlAttp IRflMf SMOµ. 'A TIAARtLOC%f Rµ YlRt MATRRS OIIAItIRRS
AMT. t. W. dl N. t. GAS N. r. AMT. NO. A. W. G. AMT. AMr. AMT. AMtt. tMAtt{• iwt. n. s. ~ ql AMr. wutE
SRRVIp RIiCCMINRCT NO.OF S E R V 1 t !
AMT. AMt. tn"t ~ t / tw 1 / SW 1 d Tv 7 / nv NO' rtR+CDND. Oi ~
CGS ~D. NO.Ors M41E0 A. W ND. Or NFUTAAIfT ~ ~R~.
OTMa ANtIRATUS:
WYK tNfa t'qK C.AKAPf. At)I)~CtMON ONi.°4-t irr
PAUI fi. UUI2N`i 4CC.R2Fi2~-Y: ~
7b TOWN NAKftOK L,ANfr
OII f H 01. C~ , N Y , 1. t 91 t el1~At MMMOM
1 ] /
Po _
ThiE,.urtificota muN not ba ahead in an moaner; return ro the oNice of tlr RDardif inwnaet. - ..their credaMiak.
COPY FOR LDING DEP NT. 3 ill~tMRR
W _ _ _ ,..~s,w...~,.,,.< . N,_~.
765-1802
BUILDING DEPT.
INSPECTION
ATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
DATE 2 / INSPEC7'O
r
)~Y RE`!tPL.N~E i Yrci.~ C 0464. l.~c:A~
y ~!I LHOS iGNUMIu . f ~ -
F ~r i~ ~ wC.!:.I.
~ ~
~ ~ THE WATER Sl.
p+ Vs-ly'~ra / l t.~ Mt~tC)I~t~. IT SYSTEMS FO
U <'j ~ f lG,~~",~ ~I~F~ CONFORM 7`tY`
r ~ op r. M
3 ~r S 0. ' ~ / ~,rl . i=", SUFFOLK CO.
i
tT t
~ _U rry , ~ ~ AT?PLIG
or ` ~ f
~ jt3~ ~p iV ~r~ 1:)^ ~ ! SUFFOLK CO~-
~ ry r71.~~• I i c>•~..~ ~ SERVICES -
Z ~ ° -1 ;,a^~:'} ;;A~. ~ C.) ~.2 I CONSTRUCTION
° 1 O ~ ~ FN~ - it f i DATE: _
~ { : £ {r ~ ~ x ~ A.r, ~ ~~,w6 y , ~ j H. 5. REF. NO.:
~ ~ ; A ~ h - "-y5'~~ t... 1 ,i i APPROVED:
f
rn ~ 4 ~d ~ ~ O \ .c: SUFFOLK CO.
-"V.(~ J
=7 ~ ~ i~ ma dQ ~ y i0~, rJ m ~ i_; DIST. SEA
( _ -o s~ {ti OWNERS ADDRE
IL~r' 1yld~`~ -NO °TI: L+ECIC ' .~-~~5,af - f(,j. - IL~LC~ ~z:
9 _2g f ~t;``~ • n~. , j..y ..X~iSThit
~
~i; i PROP U:
isa?L:. I DEED: L. IJ jA
I R _ I
i • TEST HOLE
s~ t
U t ~ HO. ' r / _ '
1 - 1.iF';.~1~.
Fi1L;;?' FLO' -FC. kV. aF ii1.8 k'L.i-E'~~;_1
i, ' -f , ( 1 • ~ 7'~ 1i~J. HtGi1 krAYl ~..(t2'r TC1 h~1~AtJ =:^alU
i ~ • - -
[`I~~~l~,~ ` ~,1r,~`,r~ y ~ r ~ V.LATE:fc l~
~ ;
,
- ' ° _ - . Ah t'~r:,t. 1'` :P'::0,19.59
y._-
BOARD OF HEALTH
3 SETS OF PL S
FORM N0. t SURVEY .
TOWN OF SOUTHOLD CHECK .
6UILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD. N. Y. 11971 NOTIFY
TEL.:7G5.1802 CALL
MAIL T0:
Bxanuncd .'A1~ ?1^.~:~`Rk . a19., 19 ?l.9 .
Approved !t!.`~'?1-~..~°.I., 19gq. Permit No.I a'. ~o.`.~i
DisapProveda/c
(Building Inspector
APPLICATION FOR BUILDING PERPAIT
' Date ..~~..1 19~5.~~
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 Ocpupancy
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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporanon)
X52`1 ~~y~ ~~.use;.;ty~~d.~>6~.r.,~~,~,u~1-~;~~;Qlr llril~_
(Mailing address of applicant)
State whether apppplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owneroCpremises ....m
(as on the tax roll or latest deed)
IC applicant is a corporation, signature of duly authorized officer.
(Name and title of corpol/ra~~te of-fi7cer)
Builder's License No. t -7.
Plurnber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. aC''.... ~~~4.~; ~;CG;~~..~ . ~y~q~e~t
house Number Street. Hamlet
County Tax f,,,fa``p No. 1000 Suction .p....~~.~.. • • • • • BI'vuk Lot ...Zr.~..........'. _
~IVOhva.Ke+w~-«. (Ja;.7l'~rr~............ Filed DIa No. ~ <j c ~ ~
Subdivision P Lot . p .
...(jV;une)
2. State existing use and occupancy of premises and intended use and occupancy oC proposed construction:
a. Existing use and occupancy ~`"~ti'e~-, , ~`rw;~ .
6. Intended use and occupancy ........:,?u;..,,; .
3. Nature of work (check which applicable): New Eluilding , , , , Addition Y • Alteration .
- Repair Removal Demolition Other SVork .
(Description)
4. Estimated Cost ~.p,o Fee .
(to be paid on Cling this application)
5. If dwelling, number of dwclli~rg ~u-nTits Number of dwelling units on each floor .
If garage, number of cars . , , .IS~LY .
6. If business, commercial or mitred occupancy, specify n~htrc and extent of each type of use ,r .
7. Dimensions of existing structures, if any: Front ~ , Rear ..56 Depth .
Height N~mber of Stories . 4"14......... .
Dimensrons of same structure,
with alterations or additions: Front ..7$ Rear .
Depth ~ ~.r Ileight .........Number of Stories ."~w o , .
' 8. Dimensions of entire new con'stntction: Front . . z Rear .:ZZ Depth ..'z 2 ; , , , , , , ,
Height tNumber of Stories . ~.rG:-. .
. i.
9. Size of lot: Front ....1vO ' Rear ~ DePth .~~z-~...............
10. Date of Purchase ..~`-t,~:~.,I,,,,,,,,,,,,,,,,,,,,NameofFormerOwner
i I. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: )1145 .
t3. Nill lot be regraded , , ,
. • . • • . w . Nill excess fll be removed from premises: t Nc
14. Name of Owner of premises .`~o~~ , , , Address7°.°.
~e~e-c.~':rw~.... Phone No .
Name of Architect ~ ,Address ..Phone No....
Name of Contractor ~~:e~~'~.~{°r-: , ~~;-s , Address"4~4 4~u.4:~4Le°:'.~.:. Phon~..Nn,_`7.f?S.:`t:? .
15.Is this property located with in~00 feet of a tidal wetland? S ..NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly X11 bui]dings, whether existing or proposed, and. indicate all set-back dimensions fron
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. I
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STATE OF NE1V YORE, I S.S
COUNTY OF
• . • 5~ being duly sworn, deposes and says that he is the applicant
(Aamc of individual sip ling contract)
about named. I
fie istlte
(Contractor, agent, corporate officer, ctcJ
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 cont~mcd in this application arc tnm to the best of his knowledge and belief; and that the
work will be performed in the manneF set forth in the application filed therewith.
Sworn to before me this i
I ~ ~
Notary Public, %:'°S~~t4:. l?~,:.~L~/-C....... County
NELEN K. QE VOE ~~s .
NOTARY PUBLIO, State of New Yark
No.&7Q78'l8,Su4tulkCoufifbr (Signature of applicant)
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BUILDING DEPT.
INSPECTION
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[ FOUNDATION 2ND [ ]INSULATION
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