HomeMy WebLinkAbout18226-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22110 Date JANUARY 14, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 1355 COX LANE CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 96 Block 3 Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 12, 1989 pursuant to which
Building Permit No. 18226-Z dated JUNE 16 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 ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ED & SARAH HANSEN ,
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-099344 - OCTOBER 25, 1989
PLUMBERS CERTIFICATION DATED JANUARY 14, 1993-MIKE JACOBI PLUMB.
Buildin'~or
Rev. 1/81
ti
roses xo. s
TowN oP 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 ° ~ 8 G ~ ~ Z Date ......~,1~~ 19.
Permission is hereby ro ted to:
f'.D~.....~.~.~'~..s~2~
ro4W,el~!>%i'1.....biln.~+.~(.~1i.1...G$.~'i....~~......C~j......i~~i,'.f~P'.1...tiYr. B~t~
of premises located at ...1.~:.~~..;.~~5..~J~...~.....~...~... 'F~:~
..............................................~cr../•••4r
yC.
County Tax Map No. 1000 Section ......9(0......... Block ........~......cC. gqLot Na..........1;1............
pursuant to application doted ........r/...~ 2 19.4..J..., and approved by the
Building Inspector.
Fee $..~Q.~~
B ing I tar
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OP, 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 17 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 Euilding - $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 - Residentia/l/$15.//00, Commercial $15.00
Date ..IGI.~ S.Z
New Construction........ Old Or Pre-existing Building.,~~~~
11 s.
Location of Property....1.~S,S,,,,,,,cC~x, Li9..........CU'rL/~p.(rU c~~
House No. Street. Hamlet
Onwer or Owners of Property,~~ S,i~'.YC.' 1~1;~ , , , I ~1~?-~ C
County Tax Map No 1000, Section....~~......Block..®°~G.~~,,,,,,,Lotp~?~.~{6.(J,...,,,,,,
Subdivision//.~~.j...~~//../
......................./j...../.Filed Map......... .~.7'Lot....................
Permit No, 1. ~+?;,~,,,,,,Date Of Permit..b.~l~Z4~~,,,,,,,Applicant..7.o~?L~ISd?~..~3L~r~?--C.,,,
Health Dept. Approval ..........Underwriters Approval... Y.G.:r.'................
Planning Board Approval
Request for: Tempor~arty Certificate........... Final Certicate...~„
Fee Submitted: $ „ ~
l~ C
o ~ aa, ~ o APPLICANT
oc~VFFO(/i'c0 TEL. 7G5-1802
o`' ~.1~ TORN OF S01iJT~O~.~J
~,.•'t" OFFICE OF BUILDII•IG INSPECTOR
cn E~1` :3
h~~, ~ P.O. BOX 1179
p e?s r TOtiVN HgLL
~o~QZ- ~ SOUTHULD, N.Y. ] 1971
C E R T I F I C A T I O N
Date ~ ~ ~ If~
Building Permit No. a_
~G z
owner ~J~h/S(W L'~j ~ S~}dZ/~f~
(please print)
Plumber I"til /K~ J AC. v ~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
~ ~
(plumb r' signature)
Swoxn. to befor~~m~e this
-~-J~-__-~- ay of cl (R G(.i,CG(/ 1
1~ ~ ~ b~-,~~~~
t7otar~ > NOC~j` P lic
f I ubl i c , County Notary public gtiele of
N
yy York
• ~ Qualifiawdoin
SuHo
k Caumy
Commission Expires [iecamber 8,18~~
i~
THE NEW YORK BOARD OF FIRE UNDERWRITERS A'~1,,~•: I
I P d `i}"I BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date C~i`~l'Oc+!{li ~p 6'~,SVftKi APPliration No. on file d'~'3a?~i Ssi9liSy Tz? (3?I'-J,1=~~/t
THIS CERTIFIES THAT
only the e(ectrlcol equipment oa deacrihed 6e/ow and introduced 6y the applicant Homed on Lhe above application numher in the premises of
I:T?Yl~i:ttlf Ift~~S:~S:Tk, ~"ciY, i~z113Pl, i"Y,1`s'c;{~'~r;+vt~;, ~ar4,
in thefollominq location, 0 Basement ~ (at Fl. ? 2nd F'l. Section Block Lot
nqs exornined on arzdfound to be in compliance uith the reyuireutent.s q(thia Board.
iIXTURF ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMi K.W. AMT. K. W AMT K.W AMT K.W. AMi H P.
Itl fi Jtr I 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEtl UN17 HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. Oll H. P. OAS M. P. AMT. NO. A. W. G. AMi AMP. AMT AMPS. TRANS. AMT. H. P SYSTEMS M1t. WAiia
NO. OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
AM1. AMP. rypE METER I 1W I a. 3W 3.a 3W s,6' dW NO.OF CC. CONO A. W. G. NO OF HbLEG A. W. G NO OF NEUTRAIa A. W. G
EQUIP. PER 9 Of CC. COND OF M4LEG OF NEUTRAL
OTHER APPARATUS:
-1i D17 i'Pi(~1`3 1J 4iIPdt; fTt_~jl -i
ti. 7' ~l
`I'fditN;#`. "t{'~ A;!(1"~C;'!'7$i~. 1,[f'.~3`l~'}~^; ~ .cr~
~~"b~PCPi A`a N'CliYO:' GENErRA~.MANAGlR
41V7~.XCi#;rr;. fllX, ! 7't U;= y I ~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 BUILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUST N®T BE ALTERED IN ANY MANNER. ~
1cLD 1::5: cC: iiJ:i jjUr,ir. ~
:;0:`tMCNT°
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O
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'OUNDATiON (1st) i
2 _
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'OUNDATIO)J (2nd) m
? . 7 / ~~J
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ZOUGH FRAME & 7 /
PLUMBING 1
3. ~ d' .~'3
I;~SULATIOPI PER N. Y. . , y
STATE ENERGY
COpE
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FI;JAL
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pro ~ .
ADDITIONAL COMMENTS: m
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
]FOUNDATION 2ND [ ]INS LJSTION
[ ]FRAMING [ INAL
REMARKS: ~"~'W
/e~~.
n, O
DATE ~ ( ~ ~ I ~ INSPECTOR
/
BOARD OF HEALTH
FORM NO.1 3 SETS OF PL.\~ry S I....a
SURVEY ....4:K,.... 1~
TOWN OF SOUTHOLD CFIECK . ~ • ~ ~ ~ r
BUILDING DEPARTMENT SEPTIC FORM , , ,~4
,L,~~
TOWN HALL
SOUTHOLD, N. Y. 11~J71 NOTIFY
/ pC TEL.: 7651802 CALL yDa
EsamincdQ7~~~........., 19}~}iQ /G MAIL TO: ,
Approved ..12,6......., 19`' ~ Permit Nola.?26~
Disapproved a/c
(Building In ector) J'~
APPLICATION FOR BUILDING PERMIT yp
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 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 Petmit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appticable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Tite 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 necessarv_ins'lpeyc~tirons. ,r~
(Signature of applicant, or name, if a corporation)
.
(Mailing address of applicant) •
State whepether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
_ I'
ti'ame of owner of premises ~ Ems.... i"U.~L=~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of c/orporate officer)
Builder's License No. , , , , , , .
Plumber's License No .
Electrician's License No . .
OtlterTradc's License No .
Location of land on which proposedywork will be done. '
House Number ~j / Street. Hamlet ~ • ~ ~ ~ ~ "
County Tax i\lap No. 1000 Section ` Block ,L/,~ [ 0C7 • • . , • , , Lot ~U,~1 U ~ C~ .
Subdivision Filed t`tap No. .
(Name) Lot
• State existing use and occupancy o(prcmises and intended use~!a99n__d occupancy of proposed construction:
a. Existing use and occupancy ..~~'S (d7L7?~, ~ ~ ~ • • • • . ~Un L
b. Intended use and occupancy ~ ~mG. • ,c~y-tJf`~ ~ ~ , . • • • - ~ . •
~~ce-,~.~
1 •
3. Aaturc of work (check which'i
Repair , , , , • • • ,applicable): New Building Addition ..1/ , . ,Utcration •
Y~
Removal . . Demolition • • ~ ' ' '
Othcr~5'ork.....
4. Estimated Cost ~~.~QQ (Description) .
. Fee
5. IC du•ellin~, number of dwcllin (to be paid on filing this application)
'g units Number aC dwelling units on each floor.. ~
Jf garage, num bcr of cars V.J. , • ~ ~ ~ ~ ' ' '
6. If busyness, commercial or mixed occu anc . " " " " " • • • • • • • • • • • • • • • ~ • • ~ ~ ~ •
7, Dimcnsion~~creisting structuj~cs, if any; FCYonpccif ~irc and extent of c c p/r.~jf u~ . , • • •
Hcicht ••~pJ .NurrtbcrofStorics•,, '''''••Rcar ~~.vY~..~D~~h.'.7~Z7......
Dimensions~of same structure with alterations ~ ~ ~ ~ • ~ ~ ~ ' ' ' ' ' ' : ' ' ' ' '
Depth . or additions: Front ..~~j Rear , • . .
.Height . ,aD . Number of Stories . •
Dimensions of entire new construction: Front . ~ • • ~ ~ ~ • ~ • • .
Height Rear . .Depth ' .
~~uynbcrofStorics.
9. Size of lot: Front Cfl•7/~9J A. ..r:......... .
10. Date of Purchase / Rcar , • , C~,
, , • • , , , . Depth . ~.(g~. ~ • ~ ~ ~ ~ '
me of Former Owner
11. Zone or use district in whidt pr'emisgs are situated • IQ r,q m"D... , .
12. Does proposed constructton violate any zoning law, rdinancc~gu~tion:
l3. Will lot be regraded ./,ll1Q, ~ ~ ~ ~ • ~ ~ • • •
( 1V'll excess fill be removed from premises: Ycs
_ 14. Name of Owner of remises
p ~'~,~'cSl;)6t1~)~ (~~.~ddress GpX, LH',i.UZ~,
Name of Architect , ~G • •~~~~E~~r~ ya' .Phone No. ,
'Name of Contractor ~ • • Address f~a:{3ax, {q7~; • _ , , , .Phony. No..7 6~ :ydo~'• • ~
Y~FC~'`~.. •~4-P~• •~:r!C. Adilress .gqy?~y~:? . ,phone No. 7 6oQ..''
IS.Is this property located within
*If yes, Southold Towq Trustees Permitemay bearequiredetland? *YES....NO?~
_ PLOT DIAGRAM
Locate clear]y and distinctly all' buildings, whether existing ar 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 lat.
~I
ill
~i
I
'I
i ,
T,1TE OF \E1V Y'OR1;, S$
OUNTY OF .
• • • • . • ~ ~ ~ • ~ • • ~ ~ ~ ~ ~ ~ ' ' ' ' ' ' oil' ' ' ' • ' • • • • • • • • . • being duly sworn, deposes and says that he is the applicant
(~amc ofindividual si;nim•Icontract)
rove named.
4
:1Sthc.• .
.
(Contractor, agent, corporate officer, etc.) • ~ • " " "
said owner or owners, and is duly a~ythorizcd to perform or have performed the said work and to make and Cile this
~lication; that all statements containdd in this application arc true to the best of his knowledge and belief; and that the
rk will be performed in the manner sc~ forth in the application Glcd therewith.
om to bciore me this
day of. I' 19.9
an' Public, ~!-e:~e?c,! , ,k.-,UG`~........,
County /l ~
NQENK.~YBE~I ..,/.G.l .~~r/,-....
NOTARY PUBLIC, State of w York .
(Signature of a lycant)
Tam
~Fica~TMirchh 30k.1 ~ PP
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: Lam.,
l
DATE INSPECTORS/o /
I
765-1802
BUILDING DEPT.
INSPECTION
[ FOU ~D~N 1ST
] f ) !ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: r
DATE~~-/ ~1~ INSPECTOR~~~
~G~~=~'-'~%~~ 765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND L~~-rRSULATION
[ ]FRAMING [ )FINAL
REMARKS: ~ ~ ~
DATE / fl INSPECTOR
r
~~ry~
765-1802
' BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [l : ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ] FRAMIN~^ Q [ ]FINAL
REMAR)(S:
~
DATE ~c3 INSPECTO,i~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING [ ]FINAL
REMARKS: /~~u
DATE a~~ INSPECTOR
l U ~ Z ~ 765-182
BUILDING DEPT.
1 NSI~ECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ]INSULATION
[ ~MING ( ]FINAL
REMARKS: __J~ ~
DATE ` D INSPECTOR ~1~,
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~RI~F~AlEQFQCCURAIVCY f6rwa+•rdi•tributtn0
SQLQfR USED MI N/ATIER ~ ~ .ytsm: PiPino .n.n w
SU?11YSY5TEMGjvMOT ~ of Tvw• K ~
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UNpERWR1TERS ECERiIFIGRE -7-[lzl7/7Zti?r <.:;:T-~,t</.-,~.r.._;~».~ OCCUPANCY OR
RiQUIRFD ~xlSTrnr{, w141.iS
I~pp-- % - I . USE IS UNLAWFUL
~p DASIId1ED ~°ws~/t~~;r°(~ WITHOUT CERTIFICATE
NOTIFY /G &?N o1.2C
DATE: ~ ~ sv ~~Op~ pL.~i Fy r,r(., lar~_- OF OCCUPANCY
766-1802UILDING OEPARTM AT
9 AM TO4PMF RTHE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REOINRED
FOR PDURED CONCRERc
2. ROUGRI -FRAMING 6 pLUME1NG ~l U +Yn E ~ HRN,SG"YJ
3. INSULATION
4. FINAL - CONSTRUCTION MUST GG ~ 1 jqN
BE COMP.1~~ETTE FOR C.O. C u7 C jl 06up~
ALL CONSfilUCTION SHALL MEET scACE: li ear Aerfloveo av: oflwwN aY
THE REQUIREMENTS OF THE N.Y oATE~(~/7~~9 flevlseo
STATE CONSTRUCTION 4 ENE
CODES. NOF RESPONSI FOR
_ DESIGN OR CONSTi1UCDON ERRORS
OPAWING NUM9Efl
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APPRDVEDASNOTED - _ . .
DATE'. B.P. p
FEE: 8Y:
NOTIFY BUILDING DEPARTMENT A7
755-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING d PLUMBRiO
3. INSULATION R~~+me~' FIA+~S~r~
4. FINAL - CONSTFIUCTN)N MUST COX LfirwG'
BE COMPLETE FOR C.O. G u u{: ~../~r
/
ALL CDNSTRUCTRNI 1~ MEET SCALE ,Qrl~ APPROV EO BY: pgAWN BY
THE RE/QyUIRE~MEN~iB/~yOF 11Ri N.Y.
STATE CQNSTRUC110N ~ DATE' ~ ~'~~I REVISED
DES~iGN CON
OPAW ING NUMBER
OF
nxu enlnreo ax NO +ooNl cl.can.nwr.
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