HomeMy WebLinkAbout18381-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
~ CERTIFICATE OF OCCUPANCY
No 219310 Date AUGUST 21, 1990
THIS CERTIFIES that the building ALTERATION
Location of Property 48650 RT. 25 MAIN ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 07 Lot 12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 11, 1989 pursuant to which
Building Permit No. 183812 dated AUGUST 14, 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 ALTERATION WORK TO THE BATHROOM
The certificate is issued to EDMUND E. & JACQUELINE ZENESKI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N124042 APRIL 13, 1990
PLUMBERS CERTIFICATION DATED JUNE 6, 1990
cam' ? _
it ing Inspector
Rev. 1/81
roast xa s
TOWN OF SOUTHOLD
BIiILDiNG DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N ° $ 3 ~ z Date ......t:G~ •..y........ , 9.~7..~
Permission is hereby granted to:
P.,. r~...... i. ~
ro ...........f~?'.........~....Z...................................
of premises located at ...........:1yj7~/.~ ..~/...a~.~............~r/..~~a.~/Kij....,crc.~ ...:l.~~rr.P.~-yt..~i~~
County Tax Map No. 1000 Section7.,.r~~....7U....... Block .......~.....r'Lot No......~.,~..
pursuant to application dated .G^ 1917....yand opproved by the
Building Inspector.
Fee S.. r/C/
Building Inspector
Rev. 6/30/80
, ~ /J Form No. 6 ct; ~ ~ """i,
~9 TOWN OF SOUTHOLD n
BUILDING DEPARTMENT
CY" V
~ TOWN HALL
Q ~ ~ ~Q~ 765-1802 TOWN DCi.6~PY'."""""°'~~~
i~~ l CyF
S0U7F~p~s
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 b+~ilding.
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.
e
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 $1/5~77.00, Commercial $15.00
Date rl.. .y.~ .
New Construction......... Old r:p~e-existing B lding.y~t .....i-~~'`.. p~ ~ fJ
Location of Property.....~.~.-.~........J':-"~.t:^:C:~~:e~"e~.....•.~E"~°Ci~V
House No.yNy j)1~n~ StreeJt ,~/$/'amlet
Onwer or Owners of Property... 4 l' Y::~yC 11, , ; , ,'~~~„0. ~,~~a. , , V(_r,~~`~[~J~sL..6Y/,~/....`~~~a~~V
County Tax Map No 1000, Section... ,v~~...B1ock........~......Lot.... ~
Subdivision...... .Filed Map............Lot..
Permit No..l. ~1....Date Of Permit..p.~~~`~ ~::.<.Applicant....~. r~-y{-lr;~~,~f~,.'
Health Dept. Approval ..........................Underwriters Approval......................... -
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate........... ;
Fee Submitted: ,
~c.~ 3~~ Via.
~S~ai /yo ~ ~ ~-~~:~r~.~-:~~l~r..
LICANT
as ~iy3id
THE NEW YORK BOARD OF FIRE UNDERWRITERS , ;,1,I
1 UIIl07I BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
paw APRIL 13,19id0 APPlicotionNo.onfile t'`'067Y.8N~84 Pd y7p(Ih7
e
THIS CERTIFIES THAT
only the electrkol equipment err described 6ebso and Introduced 6y the applicant named an the shoos application number in the premises of -
F:pMUND 1ENE9KI, KI'r; J'i, aOUIIl01. i), N. Y'. _
in tkefdbutnR kfrntion; ? Boeement ? Ist Fl. ? Ynd Fl. .Sertion Block Lot
avers eromined on MAKCiI 19 , 19'~ I I and found l0 6e in comp/ianre with the reyuirementK of this Berard. -
RXTUtl ANS SYRiCNlS RXTURES RANGES COOKING DECKS OVENS DISH WASNlRS EXHAUST PANS
OUTUITS INCANDE]CEM-flUOI1ESClM OTHER AMT. K.W. AMT. K.W. AMi. K.W. AMT. N.W. AMi. M. P.
? I 4
DRYBIS RMNAC! MOTORS PUTUR! APPUANC! RIDERS SPlCAAL REC'PT TIME CU7CK4 EELL UNIT HEATERS MUlil-0UTIRi DIMMERS
AMT. K. W. Oll H. P. GAS N. P. AMT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. AMT. N. P. SYSTEMS AMi. WATiS
NO.OP RET
SlRVIC! DISCONNECT NO.Oi S E R V I C E
AMT. AAV. TYPE ~ I / 1W 1 / 3W ] A 3\V 3 / IW NO. O~CK rCOND. Of C COND. Of HI~IEG M NO. OF NEUTRALS Oi 'NEB pAl
!e
OTHER APPARATUS: _
IfAftiKDOPo WTKING ONLY ~7 ~
(d.t. t.I;-i t
li & S I;ONIKAI;1+)K LIC.N!T!R i`,
/
BOX 27b
SOI1iNOL0, NY, 11'?.t ONOIRAL MANIIORR
ii
Ptr
This csrtiBcoN must not bs oltxsd in any manner; roturn to the office of the Board if incorrect. Inspectors may be identHied by their cndentiols.
EO<•Y PIS BUILDBIC DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER.
'
p 1~ ~ ~
~ TEL. 765-1802
e Cp TOWN OF SOUTHOLD
Tow
~ .,c OFFICE OF BUILDING INSPECTOR
o T P.O. BOX 728
v' yc TOWN HALL
"py~o~ ~ SOUTHOLD, N.Y. 11971
''~l C E R T I F I C A T I O N
Date G~
Building Permitp No. ~ ~3~
Owner~~~ ?y~i~ /1, 7 ~.pS~'j 1
(please print)
Plumber 1~~{b~ ( i
(please print)
I certify that the solder°used in the water supply system
contains less than 2/10 of l~ lead.
!
(pl er's signature)
Sworn to before me this
day of av,-~-2- ~ l/ dJ,e- ~/-e---
19 (~U Q Notary Public
Notary Public, County
NOtARY PURL
C, S~ of Yal[
1ec am~~ExpLres~Mare 19~..,~,,,`~~
If:S:'c"v-•"•Iut+C ~~llAiF. OOMMGNT° M~
rn ~
a~
3
H
FOUiJDATION ( 1st )
ti~
FOUNDATIOtJ ( 2nd ) _ _ ~ S.
2 . ~•Zl.~ ~
z
0
P,OUGH FRAME &
PLUMBING ~
4
H
3. ~
m~
I1ISULATIOPI PER N. Y, • •
STATE ENERGY
CODE
m
'G
r
4, y
r'/
~ ~ ~
FINAL
N
~ o
z
ADDITIONAL COMMENTS: ~
f
x
ra
a
• r
H
- x
Cy
P7
H
~~3~/
ass-1so2
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
DATE t
,INSPECTOR -
~~~EF~(1Lk' TEL. ?GS-180?.
~ 7~o~trrr or~ sovl~uo~.v
a~ /rrA~~.iTt~~js Off'ICf:01'ilU1LU1NG IIJSPEC:T012
5~.,~~ ~ 1 'l'OtiViJ ifALL
S0(, I'I It7LU, N.:. 1 1971
tel. `»r'.,
April 27, 1990
EDMUND 6 JACQIIELINE ZENESRI
P.O. BOA 1647
SOUTHOLD, N.Y. 11971
To wham This 14ay Concern,
(•7e are unable r_a complete your Certificate
of Occupanr_y becauac of the following reason.
nn a?plication for Certificate of Occupancy
is not nn file. (ENCLOSED)
/~`!o Undcrurriters Certificate on file.
/y//'1'he check in (~~i$e~.$$~~i/not nn file.) $25.00
P:a Health Dept. Approval on file.
I:c'r final inspact.ion ha:, been made.
P]e,jsr contact: our office on this matter.
Thank yo:.r foz your cooperation.
Building Permit i1 1 8 3 8 l Z
Building Uept-.
''**/~No Plumber Solder Certificate on filn.
all permit:; involving plumbing being
iseue<1 after April I,I984 ) _
1!f~~~~^^^---
~i ~ ~ ~ BOARD OF HE<1LTH .
~ I y~; FORM N0.1 3 SETS OF PLANS .
SURVEY
s
' TOWN OF SOUTHOLD CHECK
~~a.""" BUILDING DEPARTMENT SEPTIC FORM
BLDG. OEP7. .
TOWIVOFSUUTWOLO TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.:705~1802 CALL
Examined 19~% r • . • MAIL T0:
y ~U/..
Approved ~ • 19Q.l. Permit No..F .Q.30?,Z
Disapproved a/c~/
(Building Inspector ~~,L~%~"'" /
APPLICATION FOR BUILDING PERMIT
Date . ~ 15
INSTRUCTIONS
a. Tltis 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 far 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
Buildin; 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.
Tlie 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 inspe tions.. ~ ~ ~ ~i
r~v: -'«'r s.e`i1•?:;#F~d`E 1•argt......
,LCt c.~ It;>i~9 1d t.9h~4~' (S~nature applicant, or name, if (a corpora~ti,/on)
=i r",~f .,r,.ga9~e: +:ft• !o#F. 6". s, Y(/ Q L~ t-E'~ ~GC.(:.('l~~C..'~t'l
c'±'; , , I ~ r,n+~9f'r 9fl'tirk . .
~ r^ s`} (Mailing address of applicant) ~j
State whether applicant is owrier, jg~eg„agent, arc(titect, engineer, general contractor, electrician, plumber or builder.
~w.h.'Cltl.......... 5.+:,' I,, a.a'xa141; 4[ g~#Y3#'9f~#t+l{~
Name of owner of premises . " ;...,y~4, , • , • , • • • • • • • • • , • •
r-.~t;..,.t, ,
t,~,. }!`(d~ ~ 3£1 ~y };'~~s t~l~he tax roll or latest deed
If applicant is a corporati~ sl~iili6u?re~~~liij'u:}~~U~~ "~~li,~f.~-ir:"•
e.
(Name and title of corpora~t~ o fee
Builder's Liccnsc No. ~ . .
Plumber's License No. . • , , .
Electrician's License No .
Outer Trade's License No . .
1. Location of land on which proposed work will be done.
.
I[ousc Number Street. Hamlet /
County Tax Map No. 1000 Section ~ • • • • • • Block , . , , , . I• • • . • • • • , • • Lot ~~%b.
Subdivision F.ilcd ~fap No. Lot .
une)
(N.
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exis[mg use and occupancy ~.1
:l`.V.1ti4V1.1~~ ~.L~{-•~~~; t~.i..x~~-x-Q~
b. Intended use and occupancy l f `jam-:tip'
i '"'i.
3. Nature of work (checl. w•hich'',applicable): New I3uilding • dl
Addition . 1 ~
Repair Re}rtoval n
• • • cmolitiofi t~1~o~k~
4. Estimated Cost ~ , ~ ~to ~ , • • • • • . • • . • (Description)
' Fee
(to be paid on filing this application)
S. If dwellmg, number of dwellin .
o _ • • • g units , , ~ , , , , , , , Number of dwelling units on each floor .
If "aracc, number of cars
Hci_Itt , • cd occupancy, specify natr re and extent of each type of use .
e
` res, if any: Front Rear `-"'-,-,T.,., " " " "
7. Dm ens ons oottex~stmalsorum~u'I ~ .
Nu Depth...
Dimension tuber of Stories ' ' '
s o
same
s'uju
wrthalterationsoraddition:Front
p ~ tZ'J!~,, , , Rcar ...~~„Q,!~~.
Dc th Flci t .
' 8. Dimensions of entire new construction: Front • ~ .....Number of Stories , , • , , •
Height Number of Stories Rear ...............Depth .
9. Sizcoflot:Front~ Rcar,.. •
• f0. Date of Purchase ..~,j~-,'~±:-~,-~ G~ De th .
t •...N meofPormcrOwner. - ~ ~
1 1. Zone or use district in whrch ~ ~ • • ~ ~:~y~+vyrtd~°
~j
~ remises are situated • • • •
1... Does proposed construction violate any zoning law, ordin nee or regulation;
13. Hill lot be re"raded p •
14. Name of Owner of premises ~~INv;O~ ~ • it ex,~es~611 b4Femoved fr • • pre • . s~ .~~~Yec ~ Nc
Name of Architect~,~fJ~.?'~' r ss , !~h ro, ~d't.~
Name of Contractor , • • • • • • • • Hd ress ...................Phony No. .
Y a..........
IS.Is this propert loo ~ "•••••Ad ress.. .....,Phone No. .4•'J';:],,,,~~~~••
ted with in~00 fe t of a tidal wetland? *YGS..,,NO.Y.r!
*If yes, Southold Town Trustees Permit may be required.
PLOT DIA~RAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block',number or description ace rding to deed, and show street names and indicate whether
interior or comer lot. ~
IL. ~ r.~ ~4 a-•~ .
n
~ _Lo-, c~.~ -
______..e~
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'~..A~ ~.r
tr~~ <a - ~_...__.~i. I Wc~ni
' ~ Stl0 ~N0119n 1~N ~ rJISSQ U~j
f ~ I tl0i, NOdJ~~b N d000
°r`' ~ AE1N I~ 4 NOLIDfkll lb'1S
G`~'~ i1'N i0 SiN3W3 II1Di3H 9Hl
133 •1'Ir'MS N01A~nd SNOD l'Pd
I', lSn NOUOtIN1SNOD - '1VNId 'tV
NOltb''1nSNl 'E ~
d'~~~ss~+~~ 99 ~~rr~/ ON16Wfl1d p bNIWYd~ - HOn011 '
4~Cl~t~ 1 ~gNOaQadnnaaod
~ d8w aavu, N~moNnod •1
Li ~SN011,~3dSN1 DNIMO'1'101
3H1 Wd f Ql W1Y 8 Z081.98L
~~t~~ ~t~C~~E oalo•Ilne w~,N
~lrr~ Mil'll~~ira
aau~ sr a~aar ,
ST,1TE OF NE1V YORK,
COUtiTY OF , S
/a'~~q'~''.........
- b ing duly sworn, deposes and says that he is the applicant
• • • • • • . • • (i\< ~ of individual si nin
above named. $ contract)
ileisthc
i
(Contractor, agent, c rporatc oCficcr, etc.) ~ ~ •
'f said owner or owners, and is duly :juthorized to perform or I}avc performed the said work and to make and file this
pplication; that all statements contained in this application arc [~uc to the best of his knowledge and belief; and that the
''ori" wdl be perComud in tltc manner sGt forth in the application ~~Icd thcrewitlt.
^vom to before mu this
• day of..~'....... ,1
'otar}' Public, ,l~l,-~?~ . J/: } !~!,L ua'~~'_.... County
HELEN K E YOE q~-~~`•'~'•"~~• "•i~•
:~J ^
NO7AftY PUOtIC, State of New Yak U ' ' • • .
No.4707078,Suflalkfaunly (Signature of applicant)
Tam Ezgrec f4areh', 30,18~~ ~