HomeMy WebLinkAbout18554-z
~
FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19577 Date DECEMBER 12, 1990
THIS CERTIFIES that the building ALTERATION
Location of Property 125 LZPCO RD. & 11955 SOUND AVE. MATTITUCK,N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 141 Block 3 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in tha.s office dated SEPTEMBER 29, 1989 pursuant to which
Building Permit No. 18554-Z dated OCTOBER 3, 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 SECOND FLOOR OF EXISTING TWO FAMILY DWELLING
The certificate is issued to ANDREW FOHRKOLB
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - DECEMBER 10, 1990
PLUMBERS CERTIFICATION DATED JUNE 20, 1990 - ANDREW FOHRKOLB
YCLri .G2~-
Building Inspector
Rev. 1/81
f'OSM N0. f
TOWN OF SOUTHOLD
6UILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
18554
N° Z Date ..1...0~ 19.~~
Permission is hereby granted to:
~/.::...~497~~'I.AIfFr ...~r~'
...s~.T.. ~rtr~f..~~..i..T~...~.. ~
of premises located at ..~s~...4~...~~l.G.~
....................................../~~~..,35.. o~..................................................................
County Tax Mop No. 1000 Section Block .......4~........ Lot No..~.7...
re~~
pursuant to application doted .......:.,(..l.~ 19.1.., and approved by the
Building inspector
Fee S.. ~3 k
? Build p Inspect r
Rev. 6/30/80
~~O~UI~ Form No. 6 (1 ad ~15
TOWN OF SOUTHOLD rW A n y~
BUILDING DEPARTMENT Wn G Vial/
TOWN HALL
765-1802 .DEP1:
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewra,ter OR ink and submitted to the building
in specCOr 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 wafer 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 I2 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $1D.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $I5.00, Commercigal $15.00
Date
New Construction....... Ol Or Pre-existing Buildin l
Location of Progerty....'~:~ . V PC.a . -t-VU .
House No.r'p• et Hamlet
Onwer or Owners of Property....::y~D~'~ ? • ~a~{~.~C
O~ .
.
County Tax Map No 1000, Section....~~ ~.....Block.....~........Lot......t.~...........
Subdivision. ......Filed Map........ Lot.... .
C. ,~~~5
Permit No.!~~". ...Date Of Permit..) ~ ~..Applicant.~*:......t~........
Aealth Dept. Approval ..........................Underwriters Approval........................:
. 1.
Planning Board Approval
Request for: Temporar~ertificate........... Final Certic
Fee Submitted: O ~
u p ~
~'P'C` J 7 _ APPLICANT ~ .
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TEL. 765-] 802
aS~~FOC~ co,, Town or souT~oa.~
`kx. ~c OFFICE OF IIUILDII•IG INSPEGTUR
o m P.O. BOX 728 Jk
v'F`" -c TOWI~IHALL
"O//~0~ ~~~Z- SOUTHULD, N.Y. 1 I97I ~ 2 a~
C E R T I F I C A T I O N
Date ~ ~a
Build" ,g Permit No.
Owner
(please print)
Plumber
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead. ,
\rw~nti-.~~ .
(plumber's signature)
Swo n o before a this
19 °LV. Notary Pubic
ttatary Public, << County ~S~~tsofNrWMMt
Np.4B79606
Q~1lisd In 8uNofk
O~aionExpins fNanif+ri.lf...:
TEL. 7G5-1 H02
~~FFQCkI'
o OG~ TOWN OF SOUTIIOLI)
4~.ati ~c OFFICE OF BUILDING INSPECTOR
j P.O. BOX 728
y ~ TOWN HALL
oyy~l ~ ~ap`r souTllol,p, N.Y. 11971
.Tune 8, 1990
ANDREW FOBRROLB
670 HOLDEN AVENUE
CUTCHOGUE, H.Y. II952
2ND 5 FINAL NOTICE
To Pihom This May Concern,
We are unable to complete your Certificate
oL~- Occupancy because of the following reasons.
/~J \An application for Certifica~tLLe of Occupancy '
/is not on file. (ENCLOSED) Uy~
% o Underwriters Certificate on file.' D~
T}ie check is (oiM~t]C.M~cklnot on file. ) $25.00 PQz,
No health Dept. Approval on file.
No final in~pecLion has been made.
Please contact our office on this matter.
Thank you far your cooperation.
Duild~.ng Permit 1t 1 $ 5 5 4 Z
Butldin~ Dept.
No Plumber Solder Certificate on file. ,
( all pcrmiLs involving plumbin_g(~ being
issued aflcr April 1,1988 )
OC_CUP_A_NCY OR USE IS UNLAWFUL WITHOUT A CERTIFICATE
OF OCC_IIPANCY. YOU ARE IN VIOLATION OF TAE CODE_Q)~
THE TOWN OF SOUTAOLD. THIS MATTER AAS TO BE CLEARED
UP IMMEDIATELY.
~~~fFOt!~~c;~ ~ TO~i'N Ur SUUTIIULD
,~(-Yi]Gu:~~ 4; ~ Ol~f'ICIiC?rPSUILD[h'GI~ISPC•.CI'OR
. u~ ~ ~.M~<l'~
~ a ~y,c ~ T01VN HALL
' • O,yf/ SOUTIIOLD, N.Y. 1 1971
.0~.~ r March 1 , 1990
' ANDREW FOHRROLB
670 HOLDEN AVE.
CIITCHOGUE, N.Y. 1]952 .
To 4thom TYtis May Concern,
47e arc unable co complete your Certificate
of/O/ccupancy because ,of the follo~+ing reasons.
An application for Certificate of Occupancy
is 71ot on file. (ENCLOSED)
*to Undcrc+ritcrs Certificate on file.
/-?J 't'he chec}; i:: (rS~YSu4~Eu~Ylnut on file.) $25.00
Dto Ik.t]L-h Dept. Approval on file.
rto °inal ~nst-~ec:tion ham been made.
Please contact: our office on this matter. - •
Thank you for your coo~aration.
I:uilQir.g PcrmiY (I ] 8 5 5 4 Z
Duilc7ing Dept-.
?I tlo Pltimbcr ~olcler Certificate on file. ~ '
( all ImrmiL•~ involving plumbing being
i~sucd aftr_r <tpri.l 1,1984 )
_ ~
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?OUtlDATIOa (1st)
~OUtJDATI0:1 (pndl ~
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~OUGH FRAt~2E ~
PLUMBIiJG ~
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_IISULATIOPI PER N, Y. I y
STATE EPIERGY
CODE I _ _
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ADDITIOPIAL COM.MEI3TS:
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST f ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
L~~-
DATE b ~ INSPECTOR "v4
\ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( Z ROUGH PLBG.
[ ~ FOUNDATION 2ND INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
/ ~q/ V / r
C
DATE INSPECTOR
r
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAC, 1.
1oD11bs
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date AFCEM9$R 20,1940 APPlicotion No. on file b8446590190 N 165045
THIS CERTIFIES THAT
only the sleet equipment as described below and introduced by the appllcent named on the ebooe opplicstion number in the promises of
F~KOLgg
ANDR$li t FONROLB, 125 L1PC0 RD, MATTITUCK, N.Y.
in thefollowinq taco io nn B t ? lxt Ft. ~ Ynd Fl. .Section Blcek Lot
~EZ'$MBSR ~';`~~90
wos exomined on and found to 6e in compliance with [he reyuirementx of this Board.
RxTUR! RXTURES RANGES COOKING DECKS OVENS qSN WABNNS EXNAUST FANS
OUTLETS ECIYTACIES SWITCHES INCANOESCFNi~FlU0RE5CENi OTNEn AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P.
it 27 12 1.1. 1 12.] 1 F
dK
DRYERS RJRNACE MOTORS WTURE ANN/ANCE RRDEK SrEC1AL REC'?T TKNE CIOCKt RELL IRt1T IYATERS M ~roT DlhtktERS
AMT. N. W. Oll M. P. GA$ N. P. AMT. NO. A. W. G. AMT. AMP. NAT. AMPS TRANS. AMT. N. P. ~ ~ tEET AMT. WA1/5
,e, 1. F
5lRVKE DISCONNECT NO.OF 5 E R V 1 C E
NAT. AA11. ME ~
~ t / tW 1 $ JW 3 H JW 7 / AW O~RCeCONe. OF CC
CO~ NO. OF NI.UG a~ HI
~~y NO. OF NEUIRAIS Op NEUT~tAE
' OT/IFR AiPARATUS:
2ND FLOOR WIRING l)NLY-1
PAN$hBOARDS:1-9 {7IR. 100
G.F.C.I:-2
SMOK$ D$T$f,TOR:°1
G~
ROi(ARD DIa,LZNGNAM LIt'.~756-1C
P.O.BOX 574
LAURFyL, NY, 11948 OMRAI MANAONI
71
Per ~I~~
lhia certificaro must not bs olrorod in any manner; rNurn to the office of the Board if incorrsd. Inspectors may be identified by lhair crodantials.
COPY FOR BUILDING DEPARTMlNT. TINS COPY OF CERTIFNJLTE ABJST NOT' BE ALTERED IN ANY NA111ER.
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BOARD OF HEALTH ?
3 SETS OF/PLANS
FORM NO. 1 SURVEY . Y
TOW V OF SOUTHOLD CHECK •'.~`-~f3I _ .
BUILDING DEPARTMENT SEPTIC FOR:I .
TOWN HALL
EOUTEOLDGS 8021971 NOCALL . -°2. ~~::S.~y~7..
MAIL T0: -
Examined 19 ~ r - _L~
Approved .~~~-3 19~Petmtt No..~~ti!`~~~ ~
Disapproved.a/c ~ ~ ~ ~ Q U ~ n
SEP 2 9 l9AB ~Uf
~B mg Inspector) BLDG. DEPT.
TOWN OF SOtp'HOLD
APPLICATION FOR BUILDING PERMIT
Date 19 .
INSTRUCTIONS
a. This apphcatron must be completely filled m by typewriter or m ink and submitted to the Building Inspector, with "
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. PIoI plan showing location of lot and of buildings on premises, relatronshtp to adlommg premises or public street
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apple
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 Permrt to the applicant. Such perms
shall be kept on the premises available for inspection throughout the work
~ e. No building shall be occupied or used to whole or in part for any purpose whatever until a Certificate of Occupant
shall have been granted by the ButIdtng Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th•
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Regulations, for the con~frlrtofbJ~j113in'~, additrons or alterations, or For removal or demohtron, as herein described
The applicant agrees to comply with all apphca le l,~ws, ordinances, b ildmg code, ho g code, a d regulat ons, and t~
admit authorized rrrrspeet~ors~or~p~e~rmer-anCl;rri building for necessa ns ecri s. ~
(Signature of applicant, or%name, rf/a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or butIder.
~t-::ti~~
~ .
22
Name of owner ofpremise~ ,~t1(:0~~~1.:~.. o L'.> .
~ (as on the tax roll or latest deed)
If applicant is a cotporatibfi~ si;nature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SU~O COUNTY LICENSED
Bwlder's License No. ~+.C,(,,~~~`~,/c , , , , .
Plumber's License No . .
Electrician's License No . . .
Otftcr Trade's License No .
I. Location of land on which proposed wor/k~will be done . .
House Number 1~y~ .5o~'~I~.x7~rr-'/c'//Street Hamlet
County Tax heap No 1000 Section G. T. , Block Lot , . ~ 7• , _ , , , , , , , , ,
Subdivision .Filed hlap No Lot .
(Name)
State existing use and occupancy of prem~is7es-and intended use and occupancy of proposed construction:
a.Exrstm;useandoccupancy ........d..4~4!n.....~~:?`.~7/L...-,.,.;-?.~.~6.~:7/;-~~..........
b. Intended use and occupancy
3. Nawre of work (check whtch applicable): New B~ tdmg Addition Alteration
Repair 6~..... Removal Demolition Other «'ork , , , ,
(Dcscnp23on)
4. Estimated Cost Z.~,~G~L? Fee
' (to be patd on filing flits apphcaGon)
5. If dweihng, number of dwelling units 1...... Number of dwelling unrts on each Cloor , ,
If garace, 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 , , , .
He~gtit Number of Stones , .
Duncgstons of same structure wath altcrahons or addrttons. Front Rear .
Depth Height ......................Number of Stones .
8. Dtmc~stons of enure new constructton• Front Rear Depth .
Hetglt>! Number of Stones .
9. Size of lot. Fr x......... Rear . Depth
0 Date of Purcltase .,,,,,,,,x . ~ 1 Name of Former Owner , ,
I. Zone or usp. district m vvht~p„premtses are situated . .
2. Does proposed construction r~olate any zonuig law, ordinance or regulation' . .
3, will lat be regraded . . will excess fill be removed from premises: Yes No
4. Name of Owner of premises ............Address P}ione No...... .
Name of Architect ...........................Address ...Phone No............... .
Name of Contractor ..........................Address ...................Phone No , .
S. Is this property located within 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit may be re wired.
PLOT DIAGRAM
Locate clearly and distinctly all buddmgs, whether existing or proposed, and indicate all set-back dunens~ons from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
tenor or comer lot.
A D AS NOTED
GATE: '3 ~ e.R aY .t~~+
NOTIFY 8~ IAING D t?A
765-{802 $ AM ~ 4 PM FOR THE
FOLLOWING INSPECTIONS
{ fOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2 ROUGH -FRAMING 8 PLUMt34NG
3 INSULATION
4 FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C O
All CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N Y
STATE CONSTRUC170N 8 ENERGY
CODES. NOi RESPONS18f~ FOR
DESIGN OR CONSTRUCTION ERRORS
i"ATL• OF 1E4t' Rl:_,f~,'1/ S.S
OLN'TY F... LR.~) ~ OC1r
, . ~ ,P; ~ VS! . J..-..r.. ~ .....~~.t( ~C,J...... being duly sworn, deposes and says that he ~s the applicant
(tiame of tndicidual s3~mng contract)
otie named.
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly auihonzed to pezfonn or have perfonned t}te said work and to ma}.e and file this
nhcation: that all statements contained in this application are true to the best of his knowledge and belief, and that the
irk will be pcrfonned m the manner set forth m the application filed therewith.
.orn to before me flits ,
....day of ......19-.1.
nary Public, !(Q, , , , , , .County
~ /
. CIAHiE L. (itEVN ~ ~ ~L Lt ~ f(rC
~m~a'IaS7$606N~11rYaelt ~ (Signature of applicant)
Qwiftled fn $t1MWk County
Commisewn Expires oecsmee.8, {g