HomeMy WebLinkAbout17783-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20134 Date AUGUST 8, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 1835 MASON DRIVE & 55 HICKERY DRIVE CUTCHOGUE NY
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 6 Lot I5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 23, 1989 pursuant to which
I
Building Permit No. 17783-Z dated JANUARY 26 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to CURTIS W. HORTON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-146486 - SEPTEMBER 4 1990
PLUMBERS CERTIFICATION DATED N/A
A~~
uildinq Inspector
Rev. 1/81
aosat< xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N ~ 0177 8 3 Z Date/~.~ 19~.~
Permission is hereby granted to:
~3.~..
• .
to ..tt.c1... '.~F.6..f,...y..~.~.....
yy
ct premises located at .../..Gl
................~,1... ......~~../.ZLl.!~............
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County Tax Map No. 1000 Section ......./i..4....~... Block ............~t......~~L}}ot No............1%,~~..
pursuant to applicotion doted ....~..,1.~~..,.~ 19.Q.,1.., and opproved by the
Building Inspector, /
Fee
i~ Buil g nspector
Rev. 6/30/80
Porm No.
' TOtJN OP SOUTIIOLD
BUILDING DEPARThIENT ~
• TO[JN HALL
765-1802
APPLICATION FOR CERTIFICATE OP `OCCUPANCY
1. This application must be filled in by typewriter OF, ink and submitted to the building,
inspector with the following: for new building or neca use:
1. Final survey of property caith accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
Z• Final Approval from Health Dept, of water supply and sewerage-disposal (S-9 Form).
3. Approval of electrical installation from Board of Pire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less Chan 2/10 of 1~ lead,
5. Commercial building, industrial build ins, multiple residences and similar buildings
and installations, a certificate of Code C~;mpliance from archi~_ect or ensineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
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.
Zf a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
• Fees '
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $2$,00, Accessory buildins $25.00,
Additions to accessory building, $25.00. IIusi~:esses $50.00,
2. Certificate of Occupancy on Pre-existins Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4, Updated Certificate of Occupancy _ $50.00
S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .
ew Construction..,.... Old Or Pre-ex ~ ( " '
' is tins Buildin
x ation of Property,,,,~•~ „3 ~ /v//~ " " '
//v~ Street Hamlet
iwcr or Owners of Propcrty..l.~~(~L~~/~~~~... AI.
unty Tax Pfap No 1000 ~ ~/..DD" q/ j?~
Section....LQ.L/.,.Block.....6,,,.,,,.Lot....P.~-~7`'~~.
bdivision...,, '
.P/filed i`Tap......•• Lot. _
rmit No,.`~~~~~,.Datc ~ ~~p/
or Pcrmi e., ~a~. ,Appli~ant~i^.'',2~~;~=lr/.. f. , ,
p Approval...... .......:......Underwriters Approval~,~ Y~,1•~~.
ginning Board Approval.......,, '
;uest for: Temporary/~Ce~rtificate........... Final Curticate.,, v
' Submitted: oLJ , G!~
~ o ~ ~ ~ Y APPLICANT ~f%~%' ~ • . .
12LD it:SPc^CTiOfJ ~~UATn ~ COMMGNT° \
ro
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FOUi]DATION (1st)
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FOUNDATIOIJ (2nd) - ~
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ROUGH FRAME & o U GI
PLUMBING
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IidSULATION PER N. Y. ^
STATE ENERGY \\U,
CODE ~ ~
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FINAL
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ADDITIOPJAL COMMENTS: x
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THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'7,f;1=, ~
T L~I~a; i
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Stti>''1'w;t~i~6tR O~,1+i4C1 ~ 7t1~l~4~D~tfl~Cr N 1~f~i~G
Date Application No. urs file
THIS CERTIFIES THAT
only [he electrical equipment os described below and introduced by the applicant named on the above application number in the premises of
<'t,lt~'P7F~ f40it'I'Ci~, 1•?l~Sf11V 1)ttY':16;, ~°kY'C4;"k{t}(a7~;, N.Y~
t,?Lyf
in the following loco i , ~IEosgr~t~rr}t ? l,ct F(. ? 2nd F'l. 3ertion Block Lot
~{Y(i,l,ri,' S S
uws examined on and found to be in cornplianee with the requiremea is of this Ruard.
iIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER bNi K W. AMi K.W.. µ1i KW AMi K W AMT. H P
8; 3
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. Oll H P GAS M. P AMi NO. A W. G. AML AMP AMi AMPS TRANS. AMi H p SYSTEMS pMi. WA1T5
NO.OF FEET
~
SERVICE DISCONNECT NO.OF S E R V I C E
AMT AMP TypE METER I A, ]W ~ ,a 3W 3 %3W 3 B dW NO. OF CC COND A. W G NO OF HbIEG A. W. G NO. OP NEUTRALS A W r''
EQUIP. PER % OF CC. COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
k~Rf1F;Lf3finRllE;•1_.f ~:CR. It)tr
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PA'ff'y1fHaIC;, IAY, '11~.3CT GENERAL MANAGER
t..?
Per °e"`-<'""."
g 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.
CGPY FGR BUILDING DEPARTMENT. THIS CGPY AF CERTIFICATE MUST N®T'BE ALTERED IN ANY MANNER.
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JNAUTHORIlED ALTERATION OR ADDITION
- ~ j ~ ~ ~ ~ TO TNIS SURVEY IS A VIOLATION Oi '
~ ^ ~1, 9 ~J/' ~ ? ; I SECTION 7209 Oi THE NEW YORK STATE
O' r1 EDUCATION LAW.
~1'I V ~ t ~ COPIES OF THIS SURViV AlAP NOT BEARINQ
r~~L~/ _ ~ I ~ THE LAND SURVFYOw'S :N':20 S[AL OR
I ~ ' I ~ EMBOSSED S[AL SMALL P'Gf 6E CONSIDERED
~ IIi i0 BE A VALID ILUE COPY.
GUARANTEES tP'DiCAY~p :'t.^.:OV SMALL RUN
,i ~ ONLY TO TH: JL L.. n _~a rtiE SURVEY
I_ ~ ~ IS PRF?ARFD, At `D ~ t•. ~ L. CALF 10 THE
TITLF COYAPAii Y, v':'V~P•~:a.h ~nt AGIJGY AND
LENDING 6"S;iRUil.': , .._Jn, AND
i i0 THE ABS;G:::LS i.,C ~:AD6VG WBib
-XY~r ~ i ~ I TUt1ON. GUARANffii A c n.Ji YaANSRRABLE
L tf i t-? 13 ADDINONAL IISYIiUfIONS OR SUBSEQUEM
L 1 t1 ~ CWNERS.
r'CX~?~' 1
<;a,..,,..>r;L~or^i' New 7~~rk: ,
BOARD OF HEALTH
pp 3 SETS O F P L 1 .6 , l~! , , ,
~~_~tlw.._,~. ~ ~ FORM NO. 1 SURVEY .G~. K............ .
TOWN OF SOUTHOLD CHECK ?t`.~I~~.. , , , , ,
BUILDINGDEPARTMENT SEPTIC FORrf
TOWN HALL
_.1
Nb-~SCS~U1`NOIO ~ SOUTHOLD, N.Y. 1197} NOTIFY
U0,'Af'P'f. TEL.: 765-1802 CALL
Examincd~ .!f-b 19... MAIL T0:
Approved ./~y`~.~9..., 19 Permit No. ~ 77.0.~.~
Disapproved//a/c
.~^"/(Boil g Inspector)
APPLICATION FOR BUILDING PERMIT
Date p.~, .3...., 15~j•
f
' INSTRUCTIONS
a. This application must be completely filled in by tgpewriter or in ink and submitted to the Building Inspector, with
I sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl
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 perm:
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 Occupanc
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 th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
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 t;
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...~,,~L~t~ .t~~~.
, . ~~Z?-Z!~~ .
(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. .
Plumber's License No. , , , , , , .
Electrician's License No . .
Other Trade's License No . .
I, .Location of land on Lich proposed rk will be done . .
/ 8 3~ . ~~H.,.~e ~ , E .
House Number : Strcet~ ~ ~ ~ ~ ~ ~ ~ ~ " "
•.•amlet /
County Tax Atap No. 1000 SeCCIOn .....~.d . y BIUCk Lot /
.
Subdivision Filed slap No. , Lot .
(Name) 1•
2. State existing use and occupancy of Premises and intended use and ccupancy
oG/~osed co traction:
a. Existing use and occupancy .....!~.?'1:~, .
b. Intended use and occupancy ..~,~~lrt•(. . ` ,
-
f (
_
Repair Rempplicable): New Building • Addition Y Alteration .
3. Nature of work check which a'oval Demolition Other 1Votk , .
,q ~ (Description)
4. Estimated Cost :.~l li~~. t~~ Fee %r,~ .
? (to be paid on filing this application)
5. If dwelling, number of dwelling!iunits Number of dwelling units on each floor .
If garage, number of cars } .
business. commercial or mixa
7. Dimensions of existin^ structure occupancy, specify nature and extent of each type of use .
s, if any: Front': , Rear Depth
Height Nunl6er of Stories , ~ ~ ~ ~ ~ ~ ~ ~ ~ ' •
• Dimensions of same structure with alterations or additions: Front Rear .
Depth ...................i..Height...................... NumberofStories....
8. Dimensions of entire new constr<ction: Front Rear Depth
Height Number of Stories • • . .
9. Size of lot: Front Rear......:...'........... Depth
10. Date of Purchase ! ....Name of Former Owner
11. Zone or use district in which premises are situated ~ ~ ~ ~ ~ ~ ~ •
12. Does proposed construction vie}ate any zoning law, ordinance or regulation : .
13. 1Vi11 lot be re~,raded ! Nill excess f711 be removed from premises: Yes No
^ P • ~ ....Address ...................Phone No.
14. Name of Owner of remises . .
Name of Architect ................Address
..........Phone No.. .
P P y
Name of Contractor .......:.........Address ...................Phone No............:.
IS.Is this ro ert loca,
* y ' ~ted within 300 'feet of a tidal wetland? *Y);5....NO....~ 1.
If es Southold Tow' Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly alli buildings, whether 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. , O
I
ICI
I
STATE OF \EtiV YORK, S S
COUNTI' OF .
' ' ' ' ' ' ' ~ • • • • • • • • • • • • • • • • . • • being duly sworn, deposes and says that he is the applicant
(1\ame of individual signing contract)
above named. !
tie is the .3...
(Contractor, agenf;:corporatc officer, etc.)
of said owner or owners, and is dul •
y' authorized to perform or~have performed the said work and to make and Gle this
application: that all statements contajncd in this application are true to the best of his knowledge and belief; and that the
work will be performed in the mannen sM forth in the application 1Tled therewith.
Swom to before nee this
...day of L ...U 19 ~.I.
UUUU
Notary Public . A: ~b~ County
HELEN K DE VOE (Signature of applicant)
NOTARYPU8L10,Statoo • • . ~..~~t~j~""~•1• • .
Np. 4707878, Sufloik~Co~untyo~
Term Expires Mxrch 30,19.._.