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HomeMy WebLinkAbout18443-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAR'T'MENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219213 Date JULY 13, 1990 THIS CERTIFIES that the building ADDITION Location of Property 1100 MILL CREEK DRIVE SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 135 Block 03 Lot 51 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUG. 22, 1989 pursuant to which Building Permit No. 184432 dated AUG. 30, 1984 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. The certificate is issued to THEODORE & GEORGIA DUMAS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING SLIP 7/12/90 PLUMBERS CERTIFICATION DATED JOHN E. WALTERS PLUMBING 6/14/90 Building Inspector Rev. 1/81 ' IPO81H NO. 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) N4 ~ O ~ 4 ~ Z Date ...~..~.a^a'..~ 19`..'..[.. Permission is herebP granted to: //9 7/ to ...~Z.Gl~...... ...~~'l...... f!.ka~.....c~~:tl.... ..~~,~.........1.~..........~~9 ...:-........r ~ ct premises located of ...,1~~~..........~~~. . .........~'2:S;C%.6.!k:......~ County Tax Map No. 1000 Section Block Lot No.......::~~........ pursuant to application dated .........D.,1...J,~~ 19.~~ and approved by the Building Inspector. J Fee r.~........ wilding for Rev. 6/30/80 (~k v FORM NO. 6 ~ ~ ~ ; , 1 ~ TOWN OF SOUTHOLD D ~ ~ ~ ~i1 r Building Department _ 6j~ fir''- Town Hall (ter # Southold, N.Y. 11971 765 - 1802 6LDG. DEPT'.Ym 1~}' APPLICATION FOR CERTIFICATE OF OCCUPAN TOWN OFSOU't-HQLp Y Instructions A. This application must be filled in typewriter OR ink, and submitted ~®ure~ to the Building Inspec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00 , over 5 years $ ] 0 . 0 0 4. Vacant Land C.0. $ 20.00 ~r 5.Undated C.O. $ 50.00 Date.f~t ` NewConstruction v Vacant Land ......Old orPre-existing Building Location of Property l/, , ~'l / I 1 ~..l.t::{ 4!'~ ..............L J.e1c2~L.n House No. ) f) Street Ham/et Owner or Owners of Property ' (:~.r {.r.Nu ! ~ r' r~ r`~1,';,~{~ . . . . . . . . . . . County Tax Map No. 1000 Section . 1;3:x......... Block , . , Lot . Subdivision .......................Filed Map No. ..........Lot No. . Permit No/~y~..3.~ Date of Permit`~r??~~/.~..Applicant . ~4':4.c.ef.:.~~~~•~....... . Health Dept. Approval - ..................Labor Dept. Approval , , Underwriters Approval ........................Planning Board Approval , Request for Temporary Certificate .............Final Certificate , , , Fee Submitted S .~.5....`.- . Construction on above described building and ermit meets all applicable codes and regulations. Applicant .~TS~. J Aar. ro-io-~a t~eti 31` ~`j~ ~oz/~'al3 p/i~~~o OS~FF~~~C TEL. 7G5-1802 O,, TOIY~N OF SOYJT~ObD O L." ~ l:r~' ~ OFFICE OF BUILDI2.1G INSPECTOR o '"t~ P.O. BOX 728 Si' rn i - -e TOWN HgLL ~ ~ V ~ SOUTHOLD, N.Y. 11971 o F. ~ 1 ~ C E R T I F I C A T I O N ~y~~,~~ t j ti " Date 9(~ Building Permit No. /~~~3,Z , owner "[I{Eb(~~ `~,(yy(~ (plears~~e print)nr1• ~~.1 Plu^.ber ~6417~ WI~~`~,5 PLUtu~IIM-f ~~IIN~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1g lead. (plumber's signature) Sworn to befor^_ me this day of 19 I ~ ~ w~~l~-~ Notary Public Motary Public, County yJ(IAfCE M. YY11KI1rB ND. a86~1246, SutkKt ~ 'NrmEi~k~tJuM1Z`t 1 c'1~!.? "..,.E:,:iu:: ~~Un;c ~O:~tMENTv ~v ~ ~ FOUt3DATI0fi ( sY' t) c ti FOU6IDATIO!! ( nd) m 2. 1 z o ROUGH FRAME & o PLUMBING `3 O m H z 3. ~ c~ IflSULATIOfI PER N. Y. ~ ~ ~ • • y STATE EfiERGY O CODE ~ ~ /o CYb W _ FI:]AL `I ~ ~ ~ ~ ADDITIOfIAL COMMENTS: x W ~pD 1t.sc.Qc iy.s.~.J J°.t~.ti,..~1' - - - ~ ' x ro N 9 9 H \J O \ . ~ H ~ . x b m -o H 765-1802 BUILDING DEPT. ! NSPECTIO~N [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ SULATION [ ]FRAMING [ ]FINAL REMARKS: 4 DATE ~ INSPECTOR ~ I' l rsS-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION ] FRAMING [ ]FINAL REMARKS: E f DATE INSPECTOR ~,~"y"I i )~~~C~~ 765-18®2 BUILDING DEPT. 1 NSPE~TIQN [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [L-}'ANAL REMARKS: ~J~ ~~~~-S~ DATE ~ ~ INSPECTOR r~ 765-1802 BUILDING DEPT. I NSPECTI®N [ ]FOUNDATION 1ST (r/]~ROUGH PLBG. [ ] FOUNDATION 2ND [INSULATION [ FRAMING [)FINAL REM RKS: ~i~-~-~~' r DATE ~ INSPECTOR /~~~3 rss-iso2 BUILDING DEPT. INSPECTION [ FOUNDATION iST ( ~ ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ , DATE 3 INSPECTOR ' i : ~ i i i i I I ~ ~ I ~I ~ ~ ( t t t i r 1 i i~ t j ~ ~ I i i ( W 19' j ~ ~ t i I_..~ { ~ - - } - , ~y ~..J } r ~ s - f ' u y~'* ~ -f ~ i° ~ ~ i ~ ~ 1~ i ! I i Ii ~ ~ ~ i I ~ t i~` ~ ~ 'i" ~ i~ I i ~ ~ . i C 1 1 ~ ~ - I I ,~p , y~~,„y _ A y. _ F ~ _ 7 1 i T j i I ~ 1 I ~ i i ~ I ~ -t6l y,[ f~ fi- i ~ ' ~ ~ ~ ~ ~ ~ ~ ~ I to .l _ ~_t~ i ~ ~ ~ ~ r i ~ I ~ i i i ~ ) PSi~ l._ ~ 1~ ' i 1 i ; 11 ~f. ~ i ~ ~ ~i ~ i ~,I t.. f a j I ; I ! _f...r t I ~ i' i i ~ 0 i I j ~ ~ i 'i ` ( j' i ~I ~ i I ^_""...""""r"""1.""~" : ~ fJ 4 s ~ i I~ : i ~ { i ~ i i~ i 1; j i ~ i _I~ '3--~ i i j ~I i I' I ~I i ~ i 1 i I ~ 1 ~ 'i I ~ , I~ ~ ~ i( t~ ~ I ~ ~ i s f i ~ I ~ ~ a i i I i # I ~ r i ~ ~ i i ~ - r ~x ~ o ~s ~ } - ~ ~ a1 ! f~ i. ( i I ~ i I i ~ ~ ~ I i i i i tt ~r 'I f ~ I ! - i _il. I +~'~i i { i i .i i_ ~ i- ~ i ~ ..-'I ! I ~ ' ~ ,j i i ~ t : i ' i i I i i ~ ~ i I I ~ I i ~ i s I A ~ 1~ 4 I~ r ~ IG 1~~_~ I I ~ 'r I i ; ( a ` ' i t _ Z_ a ~ I ~ j ~ I i I , ~ ~ I J ! t ~.r~ Zc i y I j ! i ~ ! ~ f f ~ I 'r ~ { r ~ { ~ ( C t~ ~ _ ~ . ~ . ~I. i__ ~ . i ! I ~ I i ~ ~ _ i i { ~ ~ i ~ ~ ~-I i I i i ~ ~ ~ ~ i I, I ~ a1 ~ f i i ~ ~ i : ~ 4Y F• ~ 1 ` T i i ~ _is I I f - I ~ ~ s i s ~ ~ ' ~ j i ~ - - I ~ - ~ ! iz _ .i. , j ~ fir- i- . i"--~---i ° ~a~--~~-~°{-~--= ~ .m-- _ l..r.~.,..--F__ d. i , c ~ • _ I I f ~ ~ ~ ~ k. . . . . . . i - I ~ -~i y ~ - 1 1 ~ I 1 • _ _ '-'i -i-_. t ~ . r- ~ _ _ - J ui~ I I 't , , , I ~ 2~. _ 1-- - F z ~ _ I , 1 • j ~ / ~ v . - - ~ - v . t 4 a f~->~ ; - ~ - ; 1 r, a, i , r 7 ~ t ' ~ I ~ . ° <-d . _ - L...j.~.. _ din.., ! ~ I , r ~ H ~ ~ , , `+v , ~ t--' t - `cn . ~ P ~ c.A, w _-tea.. I,I ~ i _ - ti. 1 I I ' ~ i I I L y~ , _ F I . ~ , - - I , . _ - a I a i - - _ a ..r---f --.I _ --L --1 , _ , - -1 - ~ Y ) - - - - - tl - , 1 IC j I f'7 I 1----- - - - ~ I ~ ~ - ,1 - ~ ~ ~.i I i •-1_ ~ ~ - -y- r-~-- - - - -f • - i I ~ t' . , , _ I I ~ , ~ t_.._,.~.. , ~ ~ ~ R f- l _ I 1_~._ t-_i _ _ ~ i 1 I i T I Y I I I~~-_....__?. Y . , -t--.-_..... , G.. r. y 1 . --i,- r - • I- ~ -I~ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE ] 1004121 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEWYORK 10038 Date JULY 27,1990 gppticotionNo.onJile 65530889/89 N 142737 THIS CERi1FIE8 THAT only the ahxtrieal equtpment as dsecrihed 6ebso and introduced 6y the appNcan[ norraed on the ehoav epplieation numher in the prensiese of THEODORE DUMAS, MILL CREEK DRIVE, SOUTHOLD, N,Y. in thefoibwinR hreation• © ement ® lAt F1. ? Ynd Fl. OUT .Section Block Lot uw a:omined on JULY 19 ,1994 and found to 6e in compliance with the reyuirementK of thin Huard. gXTURR RXTURK RANOES COOXNHi DICKS OVRNf DISH YIIASNERS EXHAUST PANS OUlIRTS AQRf SWITCNRL 1NCANafSCEM PIUOKESClM OTNEa AMT. K W AMT. K. W. AMT. K.W. AMT. K. W AMT. X. P. 28 37 34 28 i 1.2 6 F DRYERS WRNACE MOTORS tVTURE AMIIANC! t#DlRS fr[gAI RRCIT IYAEf]OCItS RNL IXNT HEA7iRf tAUUI-011T11T DIMMlRS AMi. K. W. Oll M. P. GAS M. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMR. TRANS. AMT. K P. ~a t$T AMT. WATTS ] 30 6 600 SMVIQ DISCONNECT NO. of 5 E R V 1 C E AMT. AMP. TYPE ~ i N e5Y 1 / TV ] / SW ) / AV PER rCONO. ,?1F CC. COND. NO. OF H4lEG Of ~XWI~IGEC. NO.OP NFOf11Ala Of NWEUIOIIAL 1 100 CB i X i 3 1 5 O7N6R AP?ARATUS: BEDROON3-1 G.F.C.I:-5 _ TRACK LIGHTING:-30 PAUL R. BURNS LIC.S282-E 275 TONN HARBOR LANE SOUTHOLD, NY, ].197]. oMSRAI RIAIMOM 11 Psr Thin oarKlkals nnat not bs alb.ed in alry manner; return to iM oNiu of the Eoard if incorrect. Inspactora may bs identifhd by tFlei DEP .THIS I T aF ALTERED IN ANY MktNER. BOARD OF HEALTH ' f~ 3 SETS OF PLANS P•K U ~ FORM NO. 1 SURVEY K, ~ " ~ ' TOWN OF SOUTHOLD CHECK ~ 3$`(......... . R ) BUILDING DEPARTMENT SEPTIC r•oarl , , , , , , , , . i~~ . TOWN HALL ' SOUTHOLD, N.Y. 11971 NOTIFY TOtNIVI:rFSC,,rt~nll_Tt TEL:7G5-1802 CALL G u Examined .GG~ ~ , 19 ~ / MAIL TO Approved .v.~~,~........, 19~PermitNo..,~~~`~ Disapproved a/c _ (Building Inspector) APPLICATION FOR 6UILDING PERMIT q Date 2.~ 15 / INSTRUCTIONS a. Tlus 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. Pee 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 apphcation, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available far 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 ttte Town of Southold, Suffolk County, New Yark, 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 aerees to comply with all applicable laws, ordinances, uilding code, housing code, and regulations, and to , admit authorized inspectots on premises and in building for necessary sections. (Signature of a plicant, ~ r name, if rporauon) (Mailing address of applicant) Stat/e~wlte/t~her app ' ant is ownbr, lessee, agent, architect, engineer, general contractor, electrician, lumber or builder. tag. i . ~ .Q . P.............. . Name of owner of premises ~ p, ~.e q- •1. et, ~'r1 (as on th tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate ogfficer) Builder's License No. ~ ,3, ~ ~1 i Plurnber's License No.~ ~ ~~e~-.~ Electrician's License No. ~i . ~ !~-S........ . Other Trade's License No . . 1, Location of land on which proposed work will be done. e•, o , , 1 C'~ e~.~. ~Y'1 house Number Street, Hamlet County Tax Afap No• 1000 Section ~ Block ~ Lot Subdivision Filed slap No. Lot . (Name) State existing use and occupancy of premisestand intended use and occupancy of proposed construction: a. Existing use and occupancy .~'S ` ~?-,S.t:t.~ ,l.:~C ~ . f b. Intended use and occupancy i°. ~ ~ ?'l.`~; }.~..~.....Ctrc~u~_ - ' i 3. Nature of work (check which) applicable): New Duildin . , ' ` t . g • • • • • • • Addition Alt~iation' Re atr • P R ~moval Demolition > . OtherlVork. 4. Estimated Cost ....~.v.~ , , ~~ription) ~ • Fee U v, t?.~? . 5 If daratlennumber of carsvelh, (to be paid on filing this application) ltg units , , , , , , , , Number of dwelling units on each floor 1. , , , , , g 6. If business, commercial ar mi$ed occupancy, specify nature and extent of each px of use . ~ • • • • • 7. Dimensions of existing sttucttires, if any: Front , : , ~ ' ' .Rear Depth . Height .Number of Stories . , ~ ~ • ~ ~ • ~ " " " z' •P • Dimensions of same sttucture~with alterations or additions: Front ~ ' ' Depth . •~.$a.. .Height . ~ • Rear 8. Dimensions of entire new construction: Front • ~ • ' ' ' ' ' ' ' 'Number 9f Stories • Height ..~.Ti Rear ~ Dcpthe.~.~ , , . N tuber of Stories . • • • • • . < 9. Size of lot: Front ...~/.a:~`. ~ Rear J ? . 10. Date of Purchase Depth ./S!o'' ~VameofForme Ow~ter --r 11. Zone or use district in which ;}remises are situated . , ;~1j;a, ~,e'.cf,.,~y y~~z?:~°;~:ot : ~~;n, ti~5• 12. Does proposed construction violate any zoning law, drdinance or regulation: ~a , , , , , , , , , , , • , • • tiVill e c f b e ve m remises: Yes p .7'6~, f'~::?d''C>Leo'ra i 5~4inr ~~e~$ d"~~~yrt~g.,~ ~ p 14. Name of Owner of remises . Will lot be regraded I Address ...................Phone No763:'•-,.~8;3lr~ Name of Co tractor ' • • • • • • • Address ' ' ' ' Cse y.. • • . • • .Address P~ ~3vii sYJ $~asib o7.1 • • Phone NO..... . 15.Is this property loNated within `~9;7/'• PhoneNo.7.GS~:.•Sl~~,?,Z- 900 feet of `tidal wetland? *YES....NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all buildings, whekEter existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. i /29. z 5 G, ~ l'', . t,~ v '~1`~SNC~D t ~U J L~ v C. ~ /Z s ~ Iy 1JE w ~ rinarT ~,\o ~ ~ RI`~~ ~ ~ .Z y , A 2 3G' v 1 ! E ,9C 13L' Y. ~y~ ~ J ~ .V a,r ' Y y a s STATE P \E\V YORK, ~I lC 2. COU OF...~,,,,,. S.S ,ni. ' ' ' ' ' ' • • • • • • • • • • being duly sworn, deposes and says that he is the applicant 'amc oftndividual ~ Iiing contract) above named. Ilcisihe ~ i (Contractor, agent, corporate officer, etc.) ~ • ~ • ' ' ' ' ' ' ' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file t$is application; [hat all statements contajned in this application arc true to the best of his knowledge and belief; and that the work will be performed in the mannersct Forth in the application filed therewith. Sworn to before me this .....day of 19~./. -Notary Public, P~;~?~!, ~f;-, ~;~~!a4 . • . • , County NOTARY PUBLIC, Terma.~70 es8 MiYo0t Idaw York / uffalk Cau_ Myq r • • D h 30,1 (Signarnre of applicant) ~~`p" ° a a~~v° m aq ~ q 's ~@ ~ o b O"~ ~ i a ~ tea= ~Z~ Z 0 ~ , , o_ ~ $ G'~ oo' ~ 0 R C' ~O ~ ~y \pO f ~~o_ ~ $8 9 ~m ~ r ~ i N J 1 / I l ~ ~ t~m ~O ~ ~~9 T any N~~~ Ey? 3~~/ oqa~~ ~ av= / E ~ p'~ ~ ~ ~ 0 ~ [ ~ o OA \ ,rte ~ 3~ ~O~ V< C- i P~ ~'p1F0~RGE 0~ Q ,yQp 1pP~ ~ q~ E i k t ~ ~ h\ Y b' yo~~ y ~ n oOZ Cn 41n~~ Q~ y ~a~ »ir ~ c~2O ~ ~ r~ ow~`'~C,~ O ~ O I ~k, 4~ 3 6 VI 2~ O bb m 4~ ~ q a~yb~Cfi~ v I'~ ~ O ~ ~jra ~C 0 ~ ~ y p n ,l7 O A ~O Of