HomeMy WebLinkAbout18435-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hali
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22700 Date NOVEMBER 4, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 870 CHESTNUT ROAD SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 3 Lot 4.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 16 1989 pursuant to which
Building Permit No. 18435-Z dated AUGUST 29, 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 ALTER 2ND STORY OF EXISTING ONE FAMILY DWELLFNG AS APPLIED FOR
The certificate is issued to CARL J. & LISA ANN PARK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-196048 - JULY 15, 1991
PLUMBERS CERTIFICATION DATED N/A
uil ing Inspector
Rev. 1/81
F08M NO. 1
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 ° ~ ~ 4i ~ J Z Date ..............~.t,R..Y........ i 9.fJ...1
Permission is hereby granted to:
.Cr~irlk.:~ .....~Q:-~...........
...~.~-2.~:-...~:.~:.....i.i.w.-~.~...........
.:~.~......s~.....
at premises located at 0..... ......[5~..<.........s~.t!~s,~~
...........................................................................q.....................................................................................
County Tax Map No. 1000 Section .....l~.+ti....d....... Block .......Q..i~......p.. Lot No.....':~::.
pursuant to application doted ......M.ra~........~.~P..........., 19.A~.., and approved by the
Building Inspector.
Fee S'~.t.
.st. S.~'.!Y.SA..
Building inspector
Rev. 6/30/80
p(-y' nt,~r ~-z A ~ ' ~ Form No. 6 - ~70 ~.bs~t.,~.~-~
TOWN OI' SOUTIIOLD ~ U
4 BUILDING DEPARTMENT 1
is ~ ` J 1...1~, ~ TOWN HALL' ~I f 7~
765-1802
2
" APPLICATION POR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
icispector 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 '
f 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 - Resident/iarl $15.800, Commercial $15.00
Date , /,~J`„ _
New Construction... Old Or Pre~~-l1e.xisting Building....... •
Location of Property.... ~?~...,,..~;Ll~~~~„ ~a'~~~..........~e?~~t`.~®~~
House No, Street " "
Hamlet
Onwcr or Owners of Property~~k,~-,, ~ .~-~/l/..~~~/~.....
County Tax Map No 1000, Section.,,~........B1ock....~~............Lpt.
Subdivision./.Q ........................../...g.Filce~d Map..........~.Lot.......
Permit No..C~-1~~~,,,,Date Of Permit.~,~,(.~,1~~(....Applicant.C~r~.~,~,L/~sq.~~~~..
health Dci,t. Approval ..........................Underwriters Approval................:........
Planning Board Approval
2equest for: Temporary yyC~-ertificate........... Final Certicate.. V
'ec Submitted: S „ O~J W®
~ M.
_ . _
THE NEW YORK BOARD OF FIRE UNDERWRITERS Nal.),; '
70003$ BUREAU OF ELECTRICITY '
r BS JONN STREET. NEW YORK, NEW YORK 10038
IIUi~'1 15,1997 APPlicationNo.onfile 6k$09490(90 N 1961198
THIS CERTIFIES THAT
Doty the electrical puipmeat w dwcrihed 6ebw and introduced by the applicant Homed on the shove application numhsr in the premises of
,F CART. FARK, 870 CHF,3TN[fT R0, 501Y'I'HOLD, N,Y.
in the following loeotion; ? Basement ? 1st Fl. ~ Ynd Fl. .Section Block Lot ¦
JI1NF, 06,7.99]. ~
was e.Kamined on and found to 6r in compliance with the reyuirementa of this Boord.
q%iURE R%T RANGES COOKING tIKKS OVENS qSN WASHERS EXHAUST FANS
f>IJiIEiS ApEi fWITORS INCANDESCENT ~ f1U011ESCENT OTHEF AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. M. r.
7?. 3 73 6 { F'
DRYERS FURNACE MOTORS IIITUK ARUANCE /RMEK SNICIAL REC?T 71ME DOCKS ~Hl UNIT NEA7lK MUlll-0UlllT dMMERS
AMT. K. W. ql H. r. GAS N. f. ANT. NO. A. W. G. AMT. AMI. MAT. AMfS. TRANS. AMT. H, f. 11G. OF INT AMT. WATTS D":
SlRVIQ DIECOFMIRCT NO..gF S E R V I C E
AMT. AMI. TrfE ~ I/1W 1/]W 3/]W 3F tW ~'GPENtSCOND. ACC
COMD. ~.Of NbIEG a~„I~~ NO.Of NEUnALS a~~~l
t
OTMw AMARATYS: f
SNOKR 0£.TF,CTOR:-7.
¦
.Po'C -
STEVE'S R(.F:C/S.AY.BRk'fS6N I,TC,~9494E; _
A.O. BOX 126k G
SOIJTHOL71, NY, 1.7.977. ONW MANAOR
I1
Ptr 7T
This prHficaM must not b• akerad in any manner; return to the office of tlls Boord if incorrect. Inspectors may beidentifisd by their crodanNals. e
OOPT lINLDING DEPARTMdlT. TNIt COPY OF CERTIPIGTE''htfST NOT BE ALT~ED IN ANY MAINER.
INSPECTORS
Principal Building Inspector O~pSUFFO(kCOG
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector y x Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspector ~ • ~
p! Southold, New York 11971
Building nspector ~ ~'a Fax (516) 765-1823
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
August 18, 1993
Carl & Lisa Ann Park
P.O. Box 1701
Southold, N.Y. 11971
To Whom This May Coneern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 18435-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1ELD I::S.'c~..:U:J ~~U„: Cvt~1MENT.^.
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c0UI1DATI0:1 ~ (1st) ~I a fu
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?OUNDATION (2nd) _ m~ e"
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30UGH FRAI~fE & v
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PLUMBING
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I1ISULATIOPI PER N. Y. Lp
STATE EP7ERGY
CODE
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H
FI11AL `.l
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ADDITIOPfAL COMMENTS: s
P
X
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765.1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[)FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS:
DATE ~ G~`~~ INSPECTOR ,.A%
~~.,~_a~ __a_~
BOARD OF HEALTH
3 SETS OF PLANS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORPf
TOWN HALL y / ~r
~l ~ ~~qq SOUTEOLDG5- 8027971 VOCAL G_~ ~:~~U,,.~ , , ,
Esamincd.lt~~.a.q., 19Q.L MAIL T0:
.\pProvl•~t~~l`.. e~~., 19 Permit No.~. D
Disapproved a/c ~ pU~ ~ D
.
BLOG.DEPT.
TOWN OPSOUTHOLO
(Building Inspector)
APPLICATION FOR BUILDING PERMIT / /
Date ~~~t~-.'./........., 19~~
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 givin; a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. T}te work coveted 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
Regulations, for the construction of buildings, additions or 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 necessa~ryr ~in~spe~cti~ons,.
(Signature oC[ a/p~p~l-ic~an]t/,for name, if a corporauon)
' (Mailing address of applic~t) •
State whether applicant is*~ownper, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...............~~.t`l~~l+A~~...................~/................................................
Name of owner of premises . ~-:?"«:.C-: ~:~~.1~ . .
(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.~~...~.."~y.
Plumber's License No. .
Electrician's License No. ~':~t?•iIFO.@?v.......... .
Otter Trade's License No . .
1. Location of land on which proposed work will be done. '
(louseNumber ~-C~Street. Hamlet
County Tax~~\tapNo.I000$eChO? Block Lot`['r~
Subdivision Filed ~1ap No. Lot .
(Name)
State existing use and occupancy of p~re(m~is~es and inten~.d/end /u^se~and oocupancy oC proposed construction:
a. Existing use and occupancy •~•~'l • • •+-`4'\/~~
• b. Intended use and occupancy . •'=~yy`• • • • • • • • • • • • • • • . . .
3. Naturcofwork checkwhichl
• . • . • R` applicable): New Building , Addition Alteration ,
Repair ~jnaval . Demolition Other 1Vork . ' .
4. Estimated Cast • , , (Description)
Fea
5 If dara!Iennumbeber of dwelliri (to be paid on filing this application)
g units . Number of dwelling units on each t7oor .
g ~ of cars
- 6. If business, commercial or miffed occupancy, spec" r~ and extent of e ct~type of use • , , , , , , , , ,
7 Hei~htsions of existin stru Nures, if any: Front , , , , , • , , Rear , , • , , • , , Depth .3~
g mbcr of Stories . " "
1.~~...........
Dimensions of_same structuret~ ith alterations or additions: Front ~ ~ • ~ • • ' ' ' ' • ' '
De ~ , i.... Height . Number of Stories .
8: Dimensions of entire new cons ~ ~ ' ' ' ' ' • Rear .
Hei Itt ,traction: Front Rear ...............Depth ~ .
. Number of Stories .
9. Size of lot: Front •J`-• ~y ~ ' • • I'........ •
•
Rear ~~~ti R~-........... De th ~
10. Date of Purchase . • , • • . • , Name of Former Owner ~~~AD. W.ry
11. Zone or use district in wh ch pre rises are situated ~1',~~5[A~CCL~'Arat~leS..?LTi1(~h4, • • .
1... Does proposed construction violate any zoning law, ordinance or regulation:
13. 1Vi~llotberegraded
p • • . , 1Vi11 excess fill be (emoved from premises: Yes Nc
14. Name of Owner of remises . , , Address~X.47P 1 , Phone No~,Fj~:~, •
Name of Architect , , , , , • , , , , , • , , , • Address . '
Name of Contractor. '''•••••••••••••••PhoneNo
Y ..................Address .......Phone No..........
i /
]S.Is this property loc,'ated within 900 feet of a tidal wetland? *YES....NO:~f.. •
*If es Southold Tooyn Trustees Permit may be required.
. PLOT DIAGRAM
Locate clearly and distinctly ajl buildings, whether existing or proposed, and indicate all set-back dimensions frorr
property lines. Give street and bloc~C number or description according to deed, and show street names and indicate whether
interior or comer lot.
i
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~~I
STATE OF NE1V YORK,
COUNTY OF iS.S
• • • ~ ~ • ~ • • ~ ' ' ' ' I • • • • • • being duly sworn, deposes and says that ho is the applicant
(N'amc of individual signing contract)
about named.
fie is the
(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 file this
application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
work will be perfarnted in the manne~• set forth in the application Glcd therewith.
Sworn to bctorc me this
• f .day ofl',......... ~
• Q 19~~..
Notary Public, . I'~~, kJ //II
•~•t/•~:. County ~ ~C~~
HELEN N. DE VOE ~.X.x! •
NO7~RY PU9LIC, State at New Tax ^ .
• No.470167S,SuttolkCoxxly V (Si,nature Of applicant)
Tara Expires March 30,19~~
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AREA =30,522 SQ. FT. N 3.40' -[oc+m
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(48.1) (48.3)
S. 4T °49'40 lal. i2' MAP
162.45'A CT
N~O/F HEtEN M. CONWAY
~ vacant)
SURVEY FOR
LISA PARK
~dT SOUTHOLD
TOYKN Of 501JTHOL D
SURFOLK COUNTY, N.Y.
Ifl00 - O ii - D$ - 4.2
SCALE i"¦ 40'
JAN. 31, 1988
~y~ONANt)SG9 MAR. 16, 1987
~~y~ c~co`~O
a ~
N~ ''f ~ Prepared in aaordonce wi?h the minimom
standards for Title aurveya as e,tabl'uhed by
F a9 9 the L. 1. A. L S. and approved and adopted
F N.Y.S. LIC. N0. 49661 For such use by The New York State Land
Title Association.
P S 8 EN8INEERS, P.C.
6) T6'S ~:~6020
P. O. BOX ~09
MAIN ROA
SOUTHOLO, N. Y. , 11871
86 - 124 A
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' CR IU_lFI tZ-Ji- f-asi.. (T>n..N_ ro Wurn'gYeP r~ '1- i prlL
DATE: ~~B.P. M g~gg I
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WS~~~a t._ />'i~ ~~ni.~~ n~~, r:,nrEn "'G. N+i NiOTIFY BUILDMIG DEPARTMENT AT
- ~ u Hcn-~-.n A&en = 765-1802 9 AM TO 4 PM FOR THE _
' ~r FOLLOWING INSPECTIONS. ~~~grE '
- ~ I '~y~q,9 ~ ~ M~x~~~ 1- FOfl POURED CONCIIETE EOUIRED -
" ~ _ 2. ROUGH • FRAMING 1 PLUMBING x~. ~ ' ~ ~ j
J~~t ~ 3. INSULATION
. ILtI~ER ~E`RTfFlCAfliQlt( 4.. FINAL - CONSTRUCTION MUST
Q/~~ ALBECONSTRUCTION SHALL MEET ('L ~ S T I'1~ ~ It`' - " _ - _
QIVIEAD CONTENT BEf .L.. TIRE REQUIREMENTS OF THE N.Y.
CER114FAGtE Of OCCUPA sTATE CONSTRUCTION 6 ENERGY
SDLDERUSED/NWATEl~ cQDes. NOT RESPONSIBLE FOP sulE 14 i a nrPgaeoer m~WHet~rT~lr~llh
o.~e_ .c uer,
SUPPLY SYSTEM CANNON DESIGN OR CONfiTflUCT10N EBRORS ~y ~ I {
EXCEED 8/~f0 of f 9G LEAD 1
' ~ ONM'ING vpM.[II I
-'.-l. 'ter" ~
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