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HomeMy WebLinkAbout17994-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20644 Date APRIL 15, 1992 THIS CERTIFIES that the building ALTERATION Location of Property PRIVATE ROAD FISHERS ISLAND, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 9 Block 1 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 14, 1989 pursuant to which Building Permit No. 17994-Z dated APRIL 5, 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 TO REBUILD DORMER ON EXISTING ONE FAMILY DwFra.iNG AS APPLIED FOR. The certificate is issued to SCOTT NELSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. H-027695 - MARCH 20, 1992 PLUMBERS CERTIFICATION DATED N/A R~~nsp~ r~~ Rev. 1/81 sows xo. ~ 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) NQ 017994 Z Date G~~.M`.~.......~ 19..~.~ Permission is hereby granted ta: ~ ~-t~ ~3 ~~--~..r..-~.... . .~~._~-o...~ ....~:r~ ....i~..639'D to ...............~....C .L . . ct pre/myi/ses located at ......~.~.~.r........,~.a.:~:... .....~YGUCe*!~ County Tox Map No. 1000 Section ........q Block .........f.......... Lot No....~.~.............. pursuant to application dated 19.~~/, and approved by the Building Inspector. Fee 5.~d..d~.. Building Inspector Rev. 6/30/80 ' Form No. 6 ~ ~ 7 ! <<. TOFlN OP SOUT110LD ! BUILDING DEPARTMENT e ~ TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OP OCCUPANCY A. This application must be filled in by typewriter OF, 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 Pire 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 responsibJ.e for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and e "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. ~es 1 Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory build ins $25.00, Additions to accessory building $25.00. Businesses $50.00. . 2. Certificate of Occupancy on Pre-ex istins 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 $15.00, Commercial $15.00 Date .........,,_April.8; 1992_......•,.,..,.. New Construction........... Old Or Pre-existing Building.,. Location of Property.... ~xivate ZZoad. n££ Eouestrja}~ 7lvepue, ;(gj.S}i€X5. ~S~ari41) . House No.' Street Hamlet , Onwer or Owners of Property..... Scott H~ Nelson Couney Tax Map No 1000, Section....~~9.:.....B1ock.,,001. ,,,Lot „ 006 Subdivision ....................................Filed Mnp............Lot...................... 17994 04/05/89 Scott H. Nelson Permit No ................Date Of Permit................Applicant............................. Eiealth Dept. Approval ..........................U~iderwriters Approval......................... Planning Board Approval Request for: Tempo~(ra~ry Certificate........... Final Certicate.... x Fee Submitted: $~~~c,G' ~ ~ Q~.y 3~~0 Cb ~ r~ ~ln ~ ~ APPLICANT TEL. 765-1802 S~FfQCl~C O~ OFFIOWN OFL~S~OUTHOLDoR . o ~ P.O. BOX 728 U'' TOWN HALL _ O~y~o~ SOUTHQLD, N.Y. 1;971 ~ S 7C~ C E R T I F I C A T I O N x Date March L~, 1992 Building Permit No. Owner Scott Nelson (pl@ase print) Plumber James Marshall (ple se print) I certify that the solder used in the water supply system ' contains Less than 2/10 of 18 lead. James Marshall was the licensed contractor who supervised all ,plumbing work during the constuction of the Nelson residence. James Marshall passed away in November 1989 and is therefore unable to sign this certificate. ///%//J~ /p/ _ ////u/! mil/ ( umber's s`~e) Sworn to before me this ,p ~ day of /~d.rc.-~ ~.j P ~ ' I 19 9 ~ . t-~- u'"l2' N ary Public (J Notary Public, ~ County aaARY 8. PANkIEW{OZ . ~u~ratr vuaLlC. StatE OF M~EMMii ram q0. 52.828196(1- SBFiDLK COUIFII! fXMWIS819N s YI~14y . r'1cLD" I;:S'a~C:lU:i ~~U6:E ~ OOMMENT~ ' -v ~ m H H FOUNDATION (1st} ~ FOUNDATION (2nd) ~ 2. z 0 P,OUGH FRAME & PLUMBING m 3. ~ m m; IIdSULATI0C1 PER N. Y. • • - STATE ENERGY CODE 4. _ m ~ H FZ;dAL w O ADDITIOPIAL COMMEPlTS: x ~C ~H{\ H~~ O Z e m a r H - Z d- m ^v H ~ George K. Baum & Company , INVESTMENT BANKERS Munitipal Division PI«Se ~;h~ ~r~~os~&. my ~~,~.~c. ~t~ohg w+'~h -tl~e, vlecc~.ss~c y ~G Pei w o~R,`C -zo (`ecc tv~ my ~cc-t(~LCq~e o~.~.'P~`~y- s~ yam. have CtYhr CjyeS'-1toY1S1 ~~~5~ cc~~~ vY1e ~i-f X03- ~5~9- cog 7 0 ot2 ~1z-G'3~ 42z® l~nar,k s yo~c het p, ~i j~"---..R. APR - 6 ,;;u? . SUITE 4fi27 ONE WORLD TRADE CENTER MEMBER OF NEW YORK, NEW YORK 10048 NEW YORK STOCK EXCHANGE, INC. 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M4tlIf~H!l9~flif ~e . ~ TO'r~id Or SCUT:iOLD, CI. Y. fiOUSI::C CODT IiiO?~CTIOiI itC CRT Location PRIVATE ROAD FISHERS ISLAND, N.Y. ~nu,;.o^r 6c s~ree~) l::un~cipallcyJ Subdivision bias No. Lot(c) Name OI' Olfner(C) SCOTT NELSON RESIDENTIAL OWIv~R Occupancy l tyP°) l o~:,ner- Tenant ) Admitted by: sE~ Accomp2siied by: Key available YES Suffolk Co. Ta+c DIo. 9-1-6 Source of reQLtest ARTHUR TEBBENS, ATTY Date APRIL 8, 1992 D'. ^LLI`IG Type of construction STUCCO/WOOD FRAM ;;`stories 1-1/2 Foundation STONE/coNCRETE Cellar Crat~rl space Ll'HITED Total rooms, lst. F1 5 2nd. Fl 3 3rd. F1 Bathroom(s) 2 Toilet room(s) Porch, type OPEN Deck, type Patio, type_ Breeze:vay Gara;e Utility room YEs Type Heat oIt FIRED alarm Air Hot:•later Fireplace(s) 1 No. E:cits 2 A.ircor_ditionirg Domestic hot~:fater TANRL85S Type heater OIL FIRED Other ACCESSORY STDUCTUR~'S: NONE Garage, type const. Storage, type const. S~~irzino pool Guest, type const. Other V?OLATTODIS: .CtIAPTER 45--N.Y. STATE UNIPOItki l:IIDr PRL•'VENTION fi UUILDLNG CODE Lr,Cation DPscrirtion ~Art.~ Sec. NO VIOLATIONS WERE FOIIND. II _ I . - ~ L 1 . I 1 I Remar'cs: BP #17994-Z -CO z-20644 ISSIIED FOE ALTERATION TO REBIIILD DORMER ROBERT WALL DBIC Of Insp. APRIL 24, 1992 Insacctad by: •Time start end BOAKD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 ~'EL.:765-1802 CALL MAIL T0: Examined ...............19... Approvedi~ 19~~Permit No. 1. ? • .1~. Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT ~G Dat~./~T.. 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, accurateyplot plan to:¢c~ia~, ~'~e ,cording to schedule. b. Plot plan showipg,loc~tiot} of1Q'ands.o.t{,buildings on premises, relationship to adjoining premises or public street or areas, and giving a det~l~d.desc~ppott.of~tayout of property must be drawn on the diagram which is part of this appli cation. :Z'.':~..',,,~, S'!: 1.!-E N ^ c. The work covered by this;~ppjcation`rta~}t not be commenced before issuance of Building Permit. d. Upon approval ofF~Y;is application, the Building Inspector wIll issued a Building Permit to the applicant. Such permi~ shall be kept on the premis~s.AVailalile for~inspection throughout the work. e. No building shall;kii occupied or used in whole or in part For any purpose whatever until a Certificate of Occupancy shall have been granted byxthesi~iliiil~gilrr~spectot: APPLICATION-)"$.IjF., $Y MAFFSSrAft~ wilding Department for the issuance ofa Building Permit pursuant to the Building Zone Ordinance o the Z'pwn of Southold, Suffolk County, New York,. and other applicable Laws, Ordinances o. Regulations, for the copstrla,~cti~ ~of~la~IQjngszadditions or alterations, or forsemov~l,or demolition, as herein described The applicant agrees to eo,~;pJyiW}th,al; aBplcable laws, ordinances, buIlding code, housing code, and regulations, and t<_ admit authorized inspectors'ts~premisES xTtB"in building for necessary ins ections. 'r-,T a~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~Co~39C~ State wh/et~her applicant is owner, lessee, a~g..en~t, architect, engineer, general contractor, electrician, plumber or builder. Name of //owner of premises 3Gv7`f- % v~~~n.~! . (as on the tax roll or latest deed) If ap scant is a corp ratio sign ture of duly authorized officer. (N e an title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . Plumber's License No. ~ 1.~~~.. . Electrician's License No. .~°1..~ Other Trade's License No. ~.~..a. . ~c~ . I. Location of land on wliicli proposed work will be done . . . House Number Street Hamlet County Tax Map No. ] 000 Section 9........ Block Lot Ca Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intende use and occupancy of proposed construction: a. Existing use and occupancy ..4-5!!v,~. • . . !t!n!~• •~•zD~?~~~!~?4~ . b. Intended use and occupancy 3 oY./.1~ . . 3. Nature of work (check which applicable): New Building Addition Alteration f~ . Repair Removal Demolition ..............Other 11'ork . ~E~ u i ~ d- ° ~ D t`- yy (Description) 4. Estimated Cost ,~4.°.° Fee .~.(..,,/..Q./.v..!/• . ' (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, if any: Front ...............Rear Depth . Height Number of Stories . Dimensions of same structure with alterations or additions: Front Rear : Depth ......................Height Number of Stories . Dimensions of entire new construction: Front Rear Depth . Height ...............NumberofStories...................................................... 9. Size of lot: Front Rear Depth 10. Date of Purchase .............................Name of Former Owner . 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded ............................Will excess fill be removed fr m premises: Yes N 14. Name of Owner of premises .,5c°~ if(~('S?.cv „Address~61~.~aCfis?:~~e: Phone No. Name of Architect ...........................Address ...................Phone No............. . Name of Contractor .V4.~~n1 . ~f2i`D~r~e 5.... Address~S~jFr~, , , ,Phone Nos~7gu 15. Is this property located within 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trustees Permit may be required. PLO"C DIAGKAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate wheth; interior or corner lot. APPRbVEb 11S NQ4'ED DATE: ~ 8.R B..G,.LL..f~1 Zr NOT'IF1aBUILDMIG DEDE ~EN~T A1~ ~CCJPANCY OR 785.1802 8 AM SID 4 PM FOR THE ~1 4' ~FOIINDATIONPE~TW0RE4111RED E.~E IS UNLAI~~Ut FOR POURED CONCRETE ~~iTHOUT CERT~F~CATE 2. ROUGH -FRAMING PLUMBING 8. INSUTATNDN 4. FINAL - CONSTRUCTION MUST OCCUPANCY BE COMPLETE FAR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION i ENERGY Cn[1ES. NOT RE$PONS~L~ fOR DcSIGN OR C0NSTR1ICTI0N ERRORS STATE OF NEW YORK, S.S COU Y OF . ~i~f-~.,-~~......... being duly sworn, deposes and says that he is the applica ( of Ind' idual signing contract) above named. He is the..l~~!~1~~~!0~..........i~ve5/~;eN1/.....30cC.YotJ...J~?~[C'~S /NC._....... (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 Gle tl application; that all statements contained in this application are true to the best of his knowledge and belief; and that t: work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........day of.... 19 /I . Notary Public, ~ ..Cl'. 1V.L!!~., County HELEN R DE VDE .r ~Na~70187&~ kCoumY (Signature of applicar Term Expires M:rch 30. I8~