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HomeMy WebLinkAbout18386-z t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19368 Date SEPTEMBER 18, 1990 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property :3345 PRIVATE ROAD #1 EAST MARION N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 22 Block 3 Lot S.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 27, 1989 pursuant to which Building Permit No. 18386-Z dated AUGUST 15, 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 & FIREPLACE ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to STEPHANINE SEREMETIS & MARTHA ANN CAMPBELL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-148488-SEPTEMBER 11, 1990 PLUMBERS CERTIFICATION DATED AUGUST 22, 1990-K & K PLUMBING & HEATING ~y B ilding Inspector Rev. 1/S1 rows 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) ~ ~ ~ 3 ~~7 Z Dote .~.../../J 19..x.9 Permission is ereby rant to: , to ..~a.~...... ~ 1 r P .~.~2y~~......... i w at premises located at ..~:3~.a~........~.....fl ~{.~...,~.~.....6r~~.....~5(~t1....~:...~..~a.......... .......................................~::.~~,.a:~............................................................................... County Tax Map No. 1000 Section Block Lot No.......p.....~~...^...... pursuant to application dated .......1./..~.~ 19.~J, and approved by the Building Inspector. ~ Fee $../~1./..ate„ <=y~v.".r.••~• tip ..~a-:................ ~B i ing Inspector Rev. 6/30/80 Form No. 6 D ~ 2 TOWN r SO?'THOLD L5 + BUILD' _:G ~°ARTMENT 'vC1' -a5-18C BLDG pEPt TOWN OF SpU7HOLD 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 19 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. ,~T3. 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, I 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 $105.00, Commercial $15.00 Date :!;~p~e.un~ ~,U',~q.R.~ New Construction.... Old Or Pre-existing Building.. Location of Property.....3.j~S... I?+4Vak ~f~.~I.~4~, ~ZpJT~?~j~... .;„.~:~`~{RVI01~...... House No. cStreet Hamlet Onwer or Owners of Pro ert ~~'~'P:' tl7 J C ETl ~kR'~'F4 Nl~ C~kM?~&lili p y.... ~g County Tax Map No 1000, Section...... 2':...Block....3 ..........Lot...d•'.Z Subdivision ....................................Filed Map............Lot...................... Permit No...~ 8.3g~.4C..Date Of Permit...~~4tS}~f~~RgApplicant..{C~~~~~[~~~ESER.C'dAET2i.. Health Dept. Approval ..........................Underwriters Approval Planning Board Approval Request for: Temporary Certificate........... Final Certicate....~,/...... Fee Submitted: 2 5.0 U ~ ~ ..APPLICANT CO ~ 19368' . ~I~~~~~ To ~ G MY ~c.wm~eYS sovt~~~2 c.e,~. ~0.~~~~ ~ . . TEL. 765-1802 S~~FO~-~ TO'4R~N OF SOYJ'I'~OE,?J ~ ~ < OFFICE OF BUILDING INSPECTOR ~ „ P.O. BOX 728 TOWN HALL ~O`~,~! ~b~~ SOUTHULD, N.Y. 11971 C E R T I F I C A T I O N , Date yl Building Permit No. Owner ~ . ~C zm~~'~ S (please print) Plumber ~ ~ ~ ~lvm~~ ~e~ k~ (please print) L~cFJ~'~~ .~,iJE~ l I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~~f `(~~w W oC V„ c:~h~v~ (plumber's signature) Swor Ito before me this ~ day of ~CUSr , ~'~/t/' 19 / Notary Public Notary Public, ,jU/=/-~L~`S County ~+a+r...~~,a~ ~eex THE NEW YORK BOARD OF FIRE UNDERWRITERS f f l~)cr71.... BUREAU OF ELECTRIGITV 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date SP;P'P[:!•1.~1~;i? 12,1115)!7 ApphcationNo.onfile ~'FrC+{~43JRP)/13~? hl :1~~AFt2S THIS CERTIFIES THAT only the electrical equipment os described below and introduced 6y the applicant Homed on the above opplicotion number in the premises of 4'Cr,PiiA.7T.P, ,511R1;?tA;13"fKf, li"1"1+'f: h~`C. N1: t~;.. Pf~Nt.I.N, in the following location! ~ Bosernent ~ Ist F'l. ? 2nd F'l. .Sertion Black Lot AIH:[J5h' 1`)911 was examined on and found to be in cornplianee with the requrrernents q(thia Board. FIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT RUORESCENT OTHER bNi K W AMi K W qMi K.W AMi K W. AML H.P. ~ ~ 3 41 ~i e~ { 1.7 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMi N. W. Oll H P. GAS H P AMi. NO. A, W G AMi. AMP AMT. AMPS TRANS. qMT H p SYSTEMS pMT WATiS NO. OF FEET 1 .7 f) SERVICE DISCONNECT NO.Of S E R V I C E AMT. AMP TYPE METER I 9W ~ % SW 3 H 3W 3,a dW NO OF CC COND A. W. G NO OF NbIEG A W G NO Of NEUTRALS A W G EOUIP. PER .a OF CC.COND OF HiiEG OF rvEUTRAE OTHER APPARATUS: IN~rul~lclre ~x;~a~l.tffrar. c~Nr.L~~i tt , r<`.17. T : ~•Nl3~ '1°hts i s jr;y); i"i lil , IxaY ,I ~^OU1X>I f~fi r~L~!'1-7 i.: 7.ra1:,r;, 3 _ ~ F;AGC & I~~llr;t4e'lN(1 INC. l.,T<T.~;f6:d5}; P.O.H4}X 1-?fi8 af11f`f flO1L f), NY, 11 "d'1:R. GENERAL MANAGER L'1 Per ~ " 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. COPY FOR EUILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~~FF~Lk~~ TEL. 7G5-1802 O~ COG` TO1VN OF SOUTIIOLD ~^a~.~~ ~ UPFICL• OP BUILDING INSPECTOR ~ " ~r~~~>. P.O. BO\ 728 rn r~ y: c~ ~ T01VN fIALL .yf/ol ~ ~~p~' SOUTIiOLD, N.Y. 11971 9/Y l ~a To Flhom This 'May Concern, We arc unable to complete your Certificate of Occupancy because of the following reasons. nn application for Certificate of Occupancy i . not on file. No Underwriters Certificate on file. Tlic c:hcck is (outdated/not on file.) No Ilcalt-h Dept. Approval on file. No final ins.pccCion has been made. Pleaae contact our office on this matter. Thank you for your cooperation. I3uildi.ng Permit it 1 ~ 3 ~ ( Z ~ca~rtC~~c~ Building Dcpt. No Plumber Solder Certificate on file. ( all permits involving plumbing being .issued after April 1,1981 ) 7~k~ a~_ ~1cLD ~.;5:"C:IU;! ~IUniE COcYMLNT° r ~ - q„ . H, H FOUiJDATION ( 1st ) i FOUNDATIOtJ (2nd) _ _ 2 . ~ _ o ROUGH FRAME & Y - - ~ PLUMBING T e 3. ii ~ ~ ~ IJJSULATIOP! PER N. Y. • • STATE ENERGY ~ CODE ~ c x FI;JAL ADDITIONAL COMMENTS: x { t~ ' x ~ ro a~ z ooP yg ro a x`~ . d `N m -a H G ~ 3 v ~ tss-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [``7 ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ 7 FRAMING [ ]FINAL REMARKS: ~'-'~~yt..,~,/~-~'- ~ks?~ ~ `r DATE ~i' ~ INSPECTOR ~ ass-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST (?~ROUGH PLBG. [ ] FOUNDATION 2ND [INSULATION [ ]FRAMING ~ [ )FINAL REMARKS: DATE ~l INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE/ ~ Z INSPECT~iR - ~ / ~ T65-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ )INSULATION FRAMING [ )FINAL REMARKS: ~ - ~O`.~c~ DATE © INSPECTOR BOARD OF HEALTH 3 SETS OF ~Y'LANS . FORM N0. 1 SURVEY . TOWN OF SOUTHOLD CHECK -7cZ6. BUILDING DEPARTMENT SEPTIC FORM SOUTHOL/D, NAY.L11971 NOTIFY TEL.: 765.1802 CALL •~16.3~3~:35.7..3."-c~„~,,, MAIL T0: Examined ..~//.:S........ 19`.'./. Approved ..~~s/......., 19~,.PermitNo.!. ~ D ~ ~ ~ a a Disapproved a/c 0 JUL 2 7 ~ TOWN OFSOEl1T~I10LD ( uilding Inspector) APPLICATION FOR BUILDING PERP~IT Date 19 . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 setslof 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 • ~r 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 sh~ll 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 s;>>all 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 d molition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, h using code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspect' s. ufl~' (Signature of applicant, or nom , if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. .....~R~lt.1T~' :..............................qq................................................. Name of owner of premises . FJR: ~W.%}14CIiS.~.. ~K...lrt:.~wt`i''~IvA,S_< . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . Plumber's License No. ~~A . Electrician's License No. . Other T'rade's License No . . 1. Location of land on which proposed work will be done . . 3'3k5 'Piuv+~•rc~ 1z-A. N~-f . tr,.-,--.~ M~1 .~~:r~..Pa~ ~As-i:..... n House Number Street Hamlet County Tax Map No. 1000 Section ......Q?7!........ Block ~ Lot . 8?! . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~1Ryf~.& ...~J§uack~ ~}`4G44~F7.Gt ......';r:+,~ c..• ` . rz3itr:, . , b. Intended use and occupancy SttJGtiWv...~{~tu.iy~-~.. ,~\y(p;~~' ....fir,.":" . , , . • : . 3. Nature of work (check whiRemovlicable): New Building AdditionG~~~2y~~/~`.'~YAlteration X....... . Repair al . Demolition Other Work . t' (Description) 4. Estimated Cost ~ ,~i,~J~ bbO ' Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling units ~ Number of dwelling units on each floor t . If garage, number of cars Nb.'ICPF~~ . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7 He'gl tsio~~~ e•,,ist:ng•st;u Numb if any: Front ...~U Rear ...5~.~........ Depth .'.z~r.......... . ~ ~ ~erof Stories 1 ~ . r_. Dimensio:hs ~of same structure wit~r alterations or additions: Front . SJMV~ Rear . SR tl~ . De th p 8. Dimensions af.en i new con 'Height ..."~A:Hht; Number of Stories . ~.i~..::.. ~ p .n............ g ction::Front Rear De th 9. Size of to Fro ZNu~ bier of Stories . 1 ~t `F'`~ ~ Rear `.~.4~.~ Depth' 311 . 10. Date of P 'ftllYizse i`.IQ~i`l.......' Name of Former Owner w.:.`~.EL~Gt ti1• , , , , , , , , , , , , 11. Zone or use district in which premises are situated R~.~.~ . 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~o . 13. Will lot be regraded .'ATc~......~ ............Will excess fill be removed from premises: Yes No 14. Name of Owner of premises SSRe~~~S.'CAWP&61.4 Address 74. ,Fi~1.0urz,N.'~yh~Y, ..Phone No. Z~1.2 :7`tl- 517b . Name of Architect . ~r!>S~~g~~ .,"1'.e~>~J-? .......Address I'•d•??l~ Z$g,~?"EN?•,NY.. Phone No. a'~t4~: 3$zr'zr$73... . Nune of Contractor Q~YN.~-.',................Address l+tanr,~ ........Phone No . 15. Is this property located within 300 feetyy_of a tiidal wetland? *Yes No • *If yes, Southold Town Trustees PermitPLOT DIAGRAM ed. 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 according to deed, and show street names and indicate whether interior or corner lot. `a 22 ~ SViWt3"`•~ STATE OF NEW ~RK,~ I K S,.S COliNT~Y1OF . . ,1!NL~}~'t. ~:~?'M~~~ • • • • • . • • • • • • • . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the • • • ~ • • • • ' ' ' ' ' ' ' ~ ~ (Contractor, agen 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 mannerlset forth in the application filed therewith. Sworn to before me this O q ............~.~~...dayof.'~..... 19 0.l Notary Public, ....~~-C..C~~..... County ~ ~Q~ NO~YP~a.4>4~rt'pof~t~ewYerk (Signature of applicant) QuelNled In $uHo~lk Count, Commtsabn Explreq D$csmbar 8,1