HomeMy WebLinkAbout18161-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218959 Date APRIL 9, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 320 WELLS ROAD LAUREL
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 09 Lot OS
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 26, 1989 pursuant to which
Building Permit No. I8161Z dated JONE 1, 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 ADDITION TO EXISTING DWELLING AMENDED TO INCLUDE DECK.
The certificate is issued to LORETTA MARCELLINO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A '
UNDERWRITERS CERTIFICATE NO. H014930 MARCH 26 1990
PLUMBERS CERTIFICATION DATED JOE ZUHOSKI APRIL 3, 1990
ilding Inspector
Rev. 1/81
roans xa 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°- :1816 Z Date 19.....~~
Permission is h/ereby'~gJranted to• / ~ ~
~/~YLash `/~f'i7Jr~r~::?./._______"_"~'F...~....~~i.~G(.f'~is2D
to ..~rd.l/r~~CCj.........~c'.1._.~'~~..'~•••• ••~•~-..~~^~wl, ........~?3r4...........
of premises located at ....~.cP~..'.~.........~,~/`~~~:~y~......~~
County Tax Map No. 1000 Section ..../.~.."t Block ..........c1.......... Leo~t No........~~.......
pursuant to opplication doted 19...1, and approved by the
Building Inspector.
dd
Fee 1•.
~Sddo
~.L.. .r~il............
Bui g 1 for
Rev. 6/30/80
,5 `q4Y Form No. 6 w
TOWN OF SOUTHOLD Lla~u-!,.~~? g1~``~~{~~
. BUILDING DEPARTMENT gt iii ~
31" TOWN HALL ~
76s-Iaoz APR - 6199U
1„~
l i. d 1;
APPLICATION FOR CERTIFICATE OF OCC,UPANCY.'
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) uon-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{ 15.00, Commercial $15.00
Date ...:`I~~//~~~.//~
New Construction........... Old Or Pre-existing Building..~.1JN.',t,1~1~...
r ~
Location of Property.... .Z'.~
.............W.~~:-S.:QQ~~ ............CXl.13.T.7./.TVI~~.........
House No. Street Hamlet
Onwer or Owners of Property...~~cc.TT/~''..(/~~~G~rQ~/./,~Q,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
County Tax Map No 1000, Section....Z'Y .....Block...1............Lot...
Subdivision .Filed Map............Lot......................
Permit No..{Y.~~'.~....Date O//f~~Permit..~O.'f~P.1......Applicant.LN.~•.~Cll~~mQ~......
Health Dept. Approval...... ~~6T ...............Underwriters Approval.........................
Planning Board Approval....
Request for: Temporary Certificate........... Final Certicate..~......
Fee Submitted: $..Z~l~
~-C.. 3 rlc~P.2 q . IN
C Q z y S/ ..APPLICANT
y/9/9~
r -
THE NEW YORK BOARD OF FIRE UNDERWRITERS )'A(;x:
$t)'1.5G97
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
Dote MARCH 26,199E ApplirationNo.onJile 6~a7G[$9l$`) H E:i49:i0
- THIS CERTIFIES THAT I'F,RMT'I' Ro. 1$"1.6
only the electrlco! eQpMepment v descrihed INdotD and introduced by the opTdticont nomad on the chose epplicotion nuwsher in thepreYnises of
1,Gk@;TTA MARCEI:,LIRO, 32E WF.`I,f,S ROAD, KA'PTITUCK„r{~,Y.
in thefollotrinq locotion; ? Basement ® IAt Ff. ? Yrtd'~. GUr Ser[iunl26 B/ork~3 Lot F'
u~os examined on MARCH 19,199E and ound to lPe in com
f plianre with the reyuirernents of this Boord.
flxTURE ftTACLES SWITCHES flXTURES RANOES ING OECXS OVENS WASHERS EXHAUST FANS
~UTIETt INCANDESCENTFlU0RE5CENT OTNEN AMT. K.W. MIT: K.W. AMT. K.W. AMT. K.W. AMi. M.I.
l4 13 I7 14 F.
1
DRYERS FURNACE MOTORS NTURE A ANCE REDERS SFEQAL REC'?T TIME CLOCKS fly UtRT HEATERS MULi}O{ITIEi WERMER$
AMT. K. W. Oll N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. :AMT. N. P. ttD. ~ FEET AMT. wATTs
SERVICE DISCONNECT ~ S E R V 1 ~C E
AMi. AMP. TYPE I1w}~ 1 N tW 1 F 7W 3 O JW J $ ~W OE CG COND. A. W. G. NO. OF N4D:G Oi H NO. Oi NFUTRA4S Oj NEUTGW1l
PER 8 OP CC. COND.
OTHER AMARATUS:
W[.k:1:NG 1~OR ADDITION 'PO HOUSN:-!
YANPsLBUARD5:1-6 CTR. 1GE
G.F.C..C:-1
tiMERF: DSTk:CTOR:-I
I
I
tA~
WILLIAM McDE:RM07"P G!/~~
WfiLL' S ROAD
Bob 52?,
LAUREL , NY, 119Q8 - ~~bY1QAl~~
' Per
This certificoro must not be alrorad in any manner; roturn to the office of the Board if incorrect. Inspectors moy be identiBsd by 1Mir crodantiak.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIG E MUST NOT BE ALTEREp Hi AItY'MANNER.
;
Oc~~FFO(~(,`O/ TEL. 7GS-1802
1, TO'4Y~N OF SO'UTIIOd.D
1="~ ~ . < OFFICE OF BUILDIIQG INSPECTOR
; P.O. BOX 728
~ TOWN HALL
//~.'Ol SOUTHOLD, N.Y. 11971
~vJV . ~ 1 `C E R T I F I C %s T I O lV
`ro ; i .
i i ~i
,f`
APR - 61990 '
S~ Date 1
,F.~DiNP.i .:'1!1"s
Fiiit~~'J
Building Permit No. ~j
owner ~t?~~A ~t'!!3/~~~LL~~tJ~
(please print)
Plumber ZU,4y5.e/
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1g lead.
S' ~
(plumber's 'ynature)
Sworn to before me t~/his
_,~day of li Y
°f P~ c~btary Public
t7otary f'ublic,~~COUnt
y 37~/9aD
~{j 3/3
~E' D ~...'_J:i j~Dn':c ~I i;UaYMt.NT°
_a
H
OU2IDATION ( 1 g't ) - - y \
c
~OUtJDATI0t1 ( pnd )
9 ,T m ,
-i.GCo o Ga
OUGH FRAME & O
PLUMBING
® G ~ N
H
a~~ [+1
IISULATIOP7 PER N. Y. ~
"7
STATE ENERGY
CODE
• x
a
. ~ r
m
y
d
o O
FINAL ~
V f ~
- ~
ADDITIONAL COMMEPITS: m
~ x A
O
x
' Q,9
H
• a \
N `n
O c
/ A
' r
H
2
i ~ d
m
~o
y
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING INAL
REMARKS: ~
~,,~.,G~___/__~~
.SZc1/ih~l~ ~-a-(~d~~a.~ ~
~r~~ ,
DATE ~ INSPECTOR
765-1802
BUILDING DEPT.
1 NS~PECTION
[ ]FOUNDATION i5T ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND 1~=Y~n~ULATION
[ ]FRAMING [ ]FINAL
REMARKS: a,
Or
DATE~O INSPECTO
~ 765-1802
G BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST (lam] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
FRAMING [ ]FINAL
REMARKS: ~~-C._
DATE --s INSPECTOR
765-1802
BUILDING DEPT.
I NSPECI'ION
[ ] FO DATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
DATE ~ l~ INSPECTOR
/o~ ~ 3Z,,
--r-------- - r...._._
D~GK
-
I ~
/56
I.
Rl~ Van'
2118 R'lOb6 ,
3%/O ~ '
e-/v zk~
/R15o4 51kr?6
RSPNALT ~ SN~NbGE
/scB Pn~q
- - - ~ /~s" Pc/woo0
i
SoFr* u ! 2XG t ~y to KAF7~e3 /6 oc
/~'-l9 ~ zx~ I+~wrEs
AsB65Yo•j 5N/ubtE'
Gc13?4G Z~ , / L d Pa Ae,4
~/z"P~l~no.~
.2u4 SAaS'-F k/Ac~S /b~~ac.
R•/rl /NAIL. I ~ K /z f1.apR ~BEAm /Z"ac.
, 'TE,em~r~ SN/ecd 5/cc~ SE-ai..
~ ~I~Co/J~. [?AaL$
i
i
I ~
~..i ~ ~ ~ ~ ~ .
i
("o~x. Foaj~l6r 34" I ~ i
i ~c~a./ ~
i ~ ,
i
i i I ~ i i i i ~ i ~
i
I ~ ~ ~ i ~ ~ I ~ j I
I ~ ~ ~ ~ ~ ~ ~ '
i i i
1
I __~.l_..__ ~ ~ I! ~ ~
I i _ I ~ ~ ~ ~ ~i i I I I
~ I i -
i j ~ I~ i i i~
i i i ~ ~ I
i i I..._. ._..I...._.m,_..._.~ I
i
i j ~ ~ 7 I r~ ~ ~ _
~ i ---~----t~...«
i, ~ j r
~ ~ ~ ~ ~
i i I . I i j
t ~ i i ~ j
i i i I III
i
i ~
I!~~ j ~ i ~ i I
i i
j
i i I ~ ~ ~
i
r
i i j ~ i i j
I
i
i
~ i
I
~ ~ ~ ~
r ~ i
~ ~ i ~ i i i~ ~ i
i ~ ~ i ~ I ~
~-,~-T-~
~ ~ i i -1-i ~ 1- ice-'- j
i
~ i ~ ~ I
ti i I ~
: I ''~I I
ill I III
~ i I
I I•
,I I
- - ~ i
i
~I I
I i I I
-
li~ ! i
-r-
i~~l
-i i I ~ ~ i
I ~
-r-i_
( i
-
-
~-r-I-J- - i
_ i ~ I
I i I
-r-~i-
i i ~
I ~
i
_ - i I I
~ I ~ I
~
~
-r-~I. I
I '
I i
i -
I I
-i-+-~ I
i I i i i_ I I
i, .i
f ; ~ ~
~ ! ~ ' r in ha i
:
~ i! 'i f t s r onl
i
-j-' ~-;--j--~ j
,i
d I
-------Tr- ;SEE. ~ i
~ ~N TI g ' ~ i
-i ' 7BLri-
1$0 9 AM
~~1 ~ ; LL W N IN,Sp C 10 S: _
_ _ I'' ~ I E UI E
~ ~ E I
_ ' ~ ~
4, INAL. CO{yST ~ i
~ i I i P, E1;E F,OR C.
j ~ ~ ~ ~
_ i i I TFIT
~ i . . ~ . N RE i
j~ i t R ON U p i
-Y- :
T_
I
-'~_r
i
' ~F ~ ~ f
i
' i H W
~ .
! ~ R ~ -
- U ~ i
' ~ ,i
_ u
- -
~ ~
ii N, 'II
~ i I I L P P
i , ~ i _,i P - -
' o
i i u ~ Q
~ i i i ~
i I I i I ~ A
I E' m( 4 iG
i ~ T 1~ U 0
' ° a+r
i I I
' 6' :
~ I I i
~ TITLE NO. S-210102
ALSO DRIVE
~ ,
~
~ APR - 61990 i
' ~ 1 4.3}~xy~.x: s- ~.,..,,~,„a,-ate i.`:~
13LU1a. 4:iE:f'7'.
• TLl`v~/!V ~F Fi<J~1$h1f3(_~ ~e
W O m~_-.
C m
C Y
1D
m A
r
t^ K. TUTHILL
y/ II
111
V
O
O
a
' N.OD+ID'SO"E 164.86' N ~I
to ~
2 ~ D ~
O
O V,
A N I
oL~/Y w.iu {V
~ ut' ~ ~ VI
~r ~ m
C N t ~ I
y ~
~ 0 M
k
D o ~ ~ ~ ~~nJ'7 ~ ~
Q Zrirw~ _
~ .DO 60 W. - 162.6G -
y
T. & W. RICHES 3
1~
Tn
SURVEY FOR
OSCAR a LORETTA MARCELLINO
. LAUREL ~ ~ 1 ,
TOYIN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
GUARANTEED 70~
SCALEt 1°=40~ a eloa
en°GE?+GOY TITLE GUAR
NOTE ~ • +MONUMENT ~ NOV. 13, 1967 OSCAR q I.ORETTA MARCF.LLIYO
NORTH FORK BANKQ TRU5T CO.
LAND SURVEYOR
N.XS, IIC. NO.7.97?.6
RIVERHEAD, N. Y.
i
BOARD OF HE.\LTH
3 SETS OF PL.\NS
~ FORM NO.t SURVEY
' TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC r•oart
TOWN HALL
EOUTHOLD, N.Y. 11rJ71 NOTIFY gg
' f'`lrEd~`~~Fi5~1802 CALL ~!S
JJ
Examined . K+~ ~ 19~'/ MAIL TO
Approved 1JKfjf. Permit No.~V./~~~ ~~Z~
Disapproved a/c
D .w~-'Q
MAY 2 6 ~J8,9 is
G;~~^~+Q`~Ii~ BLDG. 4EPT.
(Buil a Inspector) TOWN OF $OUTHOL4
APPLICATION FOR BUILDING PERMIT
Date 15~i
l
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
br 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 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
Re;ulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described.
The 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 in)sp~e~cti~n-s. /~n
(Signa[ttre of applicant, or name, if a corporatton)
' (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . rL~~~~..,/~~: ~~r~i~rl!t~4 .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) _
Builder's License No. .~7.~3. /r~.~.... ~~~'lES ~j(]~~N•
Plumber's License No . .
Electrician's License No . .
Outer Trade's License No .
1. Location of land on which proposed work will be done. .
House Number Str//eet. Hamlet ~
County Tax Map No. 1000 Section ~z.eo........ Block ....9 , , , , , , , , , , , , Lot . s
Subdivision Filed t<tap No.
Lot
(Nantc)
Stale existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~.Fr.S.~.~~./I~4-• • • • • • • •p.~.~... , ,
b. Intended use and occupancy ../.~.~(iQE~~}:~-....~C`~'~.:R',,t-
~,sm~.. _ _..a_._
`t. ~ gyn.
3. Nature of work (check which applicable): New Uuilding Addition .
Repair Removal • • • • • rUtcration .
• • • Demolition Other 1Vork .
4. Estimated Cost ..~sva~o, I , , , , , , , , , . • . • • • , • • • (Description)
If ara_c,numbcroFca Fee
(to be paid on filing this application)
5. If dwellinS number of dwcllin'
• • • g units ....,i Number of dwelling units on each Moor..
g rs
6. If business. commercial or mixed occupancy, specify n t arc nd extent of e • • ~ • • • • • • • ' ' '
7. Dimensions of c, fisting structu~res, if any: Frontp ~9'~ ~~ytype of use , . *g , , , , • •
Height Rear [ Depth . Ja~.t........
. Number of Stories ..`rq, ,
Dimensions of sa a structure with alterations or r • • ~ ' • • ' ' • ' ' ' ' : 'eS:6 '
Depth ditions: Front Rear /
• .v,~
r • . IIcight . , , . Numberr of Stories ~ . •
' 8. Dimensions'df==t~itire itc'`t~ cansFruction: Front ~ ~ ~ ~ ' '
Hcigltt .t'+~.... Rear .I.'?~..ra.~....... Depth .3+~.t.......
.~Nu{nber of Stories . • •
9. Size of lot: Front ,/.Q1V....,.......... Rear ~ PD. j .
a•
10. Date ofPurchasc Depth
I Does ro osed constructto ~p ~ ' ' • • Name of Former Owner lhR777rUC.C , ,b3(/f4~..~p~P„• , , ,
11. Zone or use district in which remises are situated . R(7,jL/~~,T,/f¢~,,, , • • , •
~ p p glare an zonin law, ordinance or rc ulation: .
13• ~Villlotberegraded ..~9, y g g
• . ~Vi11 excess fill be removed from premises: Yes No
14. Name of Owner of premises t=(y~~?7,'(R-,~•l,q~~,~~,j,~ddreas . ;,~jpy(, ,(D,°/'
Name of Architect , I„ ~ • • • • • .Phone No.2~J~j : C~~,r~~, ,
_ Name of Contractor .................Address ...................Phone No............... .
IS.Is this property loc ••••""••••Address Phone No....... '
~ted within,'~00 feet of a tidal wetland? *YES... NO
*If yes, Southold Towp Trustees Permit may be required. •
PLOT DIAGRAM ~
Locate clearly and distinctly alb buildings, whether existing or proposed, and. indicate all set-back dimensions from
property tines. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
!i
i
I
I
I
_
l.~;iLLS RoAr7
STATE OF NEtV YORE, I!
COUNTY OF S.S
r
• • . • • • • • • .(Name of individual si~nit~ • • • . • • ~ • ~ • ~ ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant
lg contract)
above named.
p
11CISthC
I (Contractor, agent, corporate officer, etc.) • ~ ~ • • • • ' ' ' ' '
~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
~Pplication; that all statements contai~ied in this application arc true to the best of his knowledge and belief; and that the
,vork wdl be performed in dte manner $et forth im,the application filed therewith.
~tvom to before me this I
a.~:. ....day of. ~ 19~~.
~otaryPublic. ,,,,;,,,~~,•,hJ.t,(/b~:...... County ~
HELEN K DEVDE -'QG"'"` t-• : ~V~ + •C?.f+~l....... .
' (Signature of applicant)
~1~47078L7~ Suffolk
~u'
Term Explree Merch 30,
I