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HomeMy WebLinkAbout17796-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217856 Date MARCH 15, 1989 THIS CERTIFIES that the building ADDITION Location of Property 57225 MAIN ROAD SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 63 Block 03 Lot 21.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JAN. 17 1989 Aursuant to which Building Permit No. 177962 dated FEB. 1 1489 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 REPLACE EXISTING KITCHEN DESTROYED BY FIRE TO EXISTING BUILDING. 1 The certificate is issued to CHRISTINE & ROBERT HASCOAT (LA GAZELLE) (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING SLIP 3/15/89 PLUMBERS CERTIFICATION DATED MIKE JACOBI 3/15/89 Building Inspector Rev. 1/81 aosai 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) Na 617796 Z Date 19.9 Permission is hereby rant to; dfr~ f ~,~d.'Q.......... ~ • ••r...`~i~~..~.. ...1/.`.x.7/..... r/ ~ ~J~ ct premises located ot ..~f.~.....~5r••'•.................................................. ....~..1.. ~ .r~...!.................................................... Caunty Tax Map No. 1000 Section .......Y.~........ Block ........Q...~.... Lot No.......~e~..~i... ' pursuant to application dated f 19~, and approved by the Building Inspector. Fee $.~©.lt..~l~l 9 . B din actor Rev. 6/30/80 i 1ELD I;:S:'ECTIuN ~~ll6iE ~ COMMENT° \ -o v _ m ' H FOUtJDATION ( 1st ) FOUNDATIOtJ (2nd) _ ~ 2. a~ z o v ROUGH FRAME & PLUMBING H 3. " ra m H IIJSULATIOII PER N. Y. STATE ENERGY CODE x a 0 4 , ti... -eye` y FI;JAL 3 lr ~ ~ z ADDITIOAJAL COMMENTS: x~ c~ , ra ' ~ x ro 4 H b 9 `n H ~U H O Z 1 [+7 9 • r H T b P7 .9 H w. p ~ ~ ~r~~ pp 11 TOWN OF SOUTUOLD ~~fl ~ 51~}i3f~ ~ I~f BUILDING DEPARTMENT i/ TOWN HALL BLOG. CJC3E~j''"'°"~ ~ SOUTIIOLD, NEW YORK 1 197 I TOWN OF SOU7HOLD 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE... NEW CONSTRUCTION .......~~~)OjjL//DDJ~OR PR((E~~-E ISTING BlU'I,~LD'~,NQG......VAC T LAND....._.. Location of Property...:Y:~L~....V.v ~~.,,C~~;~;`~~~,- . HOUSE NO. STREET ----.-HAMLET G Imo. Owner or Owners of Property.......: J! ~...~~,1...C~11/.~ ~ 4(Xt:J,~.~(1,~, , , , , _ , County Taa Map No. 1000 Section . ~ ~ . Block . ,l(,~„ Lot Subdivision Filed Map ........Lot. Permit No. .~~.~.".Y:..Date of Permit ~~~~~~,~1,Applicant ~ , Health Dept. Approval Underwriters Approval.............. Planning Board Approval Request for Temporary Certificate Final Certificate Fee Submitted: $ „ APPLICANT... ,Y~:k`;~,YY~,,,,,,,,,,,,, ~ his' C0 z /765, rev, 10/14/88 2Ui cu-e- ° • TEL. 765-1802 ~Oc~VFF~C/(~pG TOWN OF SOUTHOLD y~ OFFICE OF BUILDING INSPECTOR z P.O. BOX 728 c°1~ ~ TOWN HALL "Og~o~ SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date_~~ L~ Buildings` Permit No. 7 / L owner ~o`Uer~ i~AS[_ocz'C " ~,-.~.t~~c1~ ~~s au~r~~i\ (please--print) Plumber ~4~~ l } i (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. ~`Q ~*~G~~ (plumber's signature) Sworn to before me this day of• ~ ~ ~U,Q, ~po~ _ 19~• Notary Public Notary Public, County NELEN K. DE VOE vfe-- ~N~70787A SU~tolhfCouMy~ Term Expires March 30,15_.. ~~7y~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMAR S: DATE ~ / S ~ INSPECTOR ~`y / 7)~(~ , ~ Q '7 rsS-isoz BUILDING DEPT. INSPECTION [ ]FOUNDATION iST f ~ R„OUC~H JPLBG. / , ~,,,,d,., ~ .A.~4~'' [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ )FINAL REMARKS: U~''~^, ~~.e~ / r DATE ~ INSPECTOR ~7~ p~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL / REM RKS: a~~~' d'~- ~~C-~(_` DATE ~ INSPECTOR I 1~7p~ T65-1802 BUILDING DEPT. [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INS TION [ ]FRAMING [ FINAL REMARKS: _ ` a~ ^ DATE 3.13 INSPECTOR y~ l ~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU N [ 7 FRAMING [ INAL REMARKS: ~ ~ DATE ~ INSPECTOR g THE NEW YORK BOARD OF FIRE UNDERWRITERS I rttrt f S (I(1I:f"9.r BUREAU OF ELECTRICITY 63 JOHN STREET, NEW YORK, NEW YORK 10038 fiF'ft!(. Ir;ryCSH" i+f)i`f~l i; iT~tfI€1 ~7 I'! tj?: `+.i; Date Application No. on file THIS CERTIFIES THAT oralytJte electrical egpip Cent os deacrihed below and introduced 6y the applicant Homed on the above application numher in the premises of S COt~} I K i LA (ifi:.p~{f•. V?E.GEfiijl'{t;~lnt filo-ltFl {is3 k":ijy Aii tl Ft,ill l7y fV, i. in the following Inca Fp Bq.9e~nt ? Ixt Ff. ? 2nd Fl. Section Block Lot h~I1~fI::I I , e A ! was examined orF and found to 6e in contpliarwe with [he reKluiremenLx q(this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DI'iH WASHERS EXHAUST FANS I OUTLETS ECEPTACLES SWITCHES INCANDESCENT FWORESCENi OTHER PMi K W. AMi. K.W AMT KW AMT K.W AM7. H P. I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEll UNIT HEATERS MULTI.OUTLET DIMMERS AMl K. W. Oll H. P. GAS H P AMt NO, A. W G AMi PMP. AMi AMPS TRANS. qMi H. P SYSTEMS AMT. WATiS NO.OF FEET ( S u i1 l 7 t:; tf SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP TYPE METER ~ A, 4W ~ a. BW 3.9 3W 3,e' 4W NO. OF CC COND A W G. NO. OF HbIFG A. W. G NO Of NEUTRALS A W' O. EQUIP. PER B Of CC COND OF HI-LEG OF NEUTRAL OTHER APPARATUS: ¢t1 t"SI`IN 1;1111f1a UIiH(~1411LFt°I lii Ht+I~' 2<'(~ 1:UP~11'ia4>IG{4~-1 F1..~C. 4241i.k4~l N'r?N'(S';i'~.ik:S-;! ;;,6y,3;-Y, k. W. P.[f'ii`i. 1"~ if ~ )il;~f'.1'tf'Id ~{11 N(i4jj (~3 [i lit i:R1df;.hytlAh'Ut;;l• Gil{. i0s; TEttAi`k, L7GIIf'Til€t.~-°! UNRs tlf]itUg}1! LTi;.~#~~i'bt F 4;a1 F1f3Nf;cLl I,. hl. 1„Uli`HG!f fl['„ W'[, }19 Sti OENERALMANAGER B Y f 'ij~ Per ~~`f't. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by ~ihel~ credentials. COPY FOR BUILDING DEPARTMENT. THiS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BOAKD OF HEALTH 3 SETS OF PI.A~S D ~ ~ ~ ~~~~(~~P }~j FORM NO. 1 SURVEY UU , TOWN OF SOUTHOLD CHECK • T ~ ; P~ BUILDING DEPARTMENT SEPTIC FORM • • • • • : TOWN HALL NOTIFY ~ 40UTHOLD, N.Y. 11971 7/0~. •/S~~• • • • • - ,)~t''~, ~ TEL.: 7851802 CALL _ T~?l~'.4~t~,r_~,a~~,~'li~ MAIL T0: Examined ~ 19 ~ p~~~ / C~~ 19~Permit No. Approved Disapproved a/c (Bull ing Ins tor) APPLICATION FOR BUILDING PERMIT J. ~y Date ~ 0>r? ~.~..1 19°. ! ~~C,~~ f ~~'J INSTRUCTIONS a. This 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 Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 4 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 necessary inspections. ..:-1 a.h n .~.I,~ri.~.. !~~.1~: r.1 ~-~c-, Sn cJ . (Signature of applicant, or name, if a corporation) ' ..I. of}:K.l~?4~.v•(J('.~.fac,~;`FPtc? fc~!....... ' (Mailing address of applicant) Jll ~ ~ ~ti"]~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. NameoFownerofpremises ~~:-.~.~2-~.j.~~ •~~~~'CA~~: • • •~1CQ~C(~~•~'• ~~1J~`1f14~• ~~~CUCL~,~ • • • (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ('"~`~Name and title~~~~ ~ /J• ( rp officer) ALL CONTRACTOR'S MU~T~~~ SU OLK COUNTY LICENSEU Builder's License No. . . • • • • • • • . ' Plumber's License No. ......1.~•.,SCl~CO~J~ Electrician's License No. ...F7 ~S°J.~. ~0./t~~l Other Trade's License No . . 1. Location of land on which proposed work will be done . . House Number Street Hamlet County Tax Map No. 1000 Section ....~O.J Block Lot ~ ~ : . Subdivision Filed Map No. • • • • • • . Lot . (Name) 2. State existing use and occupancy of premises and i`n~tenlded use~and occupancy of 1p~roposed construction: a. Existing use and occupancy r'~.~(1 1 1`~~.~~. ~-t~V-.l~-~.. ~(1 . , T R , ~ •%~.1i0. ~G~.'.~.. , , , , , b. Intended use and occupancy ...•.`~.Q.(Yl:?.~ . i. ' r I ' p (p ~licable):.New Building Addition Alteration . 3 Ret air of work heck whiRemoval . . . . Demolition Other Work . / i (Description) 4. Estimated Cost WQ? 000 Fee , , , ~r........ . ` (to be paid on filing this application) 5. If dwelling, number of dwelling nits Number of dwelling units on each floor . If garage, number of cars . 6. If business, commercial or mixed'~occupancy, specify nature and extent of each type of use . f.QS.~fx1.~fC~n,3,-'.... . Dimensions of existin structures g g.... > if any: Front ~q r!~ Rear ~.9 Depth ..`,>'.(4 sad....... . Hei ht Number of Stories ~ . r . D Pensions of sa e s ructure wi}h alterations or additions: Front ~.y~,~, , , , , , , , , Rear 3g . r . Number of Stories . De th 7b'~........ , .Height . ' 8. Dimensions of entire new constriction: Front . Rear Depth . 9. Size of lot: Front ler of Stories . . . . g 1 r~a~ Rear ..:.~ygta~~' Depth ....a>F~: 10. Date of Purchase Num r Name of Former Owner . . 11. Zone or use district in which pre~rtises are situated ~ . . . 12. Does proposed construction ~ 1 'te any zoning law, ordinance or regulation: n.4 . 13. Will lot be regraded 4 . rL 0 Will exc s fill be removed from premises: Yes 14. Name of Owner of premises . A~`~'. /~a~Coc~l`..... Address .~rCF.K~'JOL't..~.1.6 x... Phone No . . . Name of Architect ' Address , ..Phone No. NatneofContractor.v0~'1.~.~ r.1f,t!{Li3./Ofl;LnC,Address /3F7[:~Cf.k-4~~'.~a.PhoneNo.7.~S'.C~~?.i/...... 15. Is this property located within 300 feet of a tidal wetland? *Yes No . X.. *If yes, Southold Town Tru~tees Permit map_be reqquired. PLOT DIAGKAM Locate clearly and distinctly all IbuIldings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block dumber or description according to deed, and show street names and indicate whether interior or corner lot. ~;t.R., ~Sll1UV'~--~J ' I I~ r II Ii I STATE OF NEW YORK, COUNTY OF St..l.~~:o//I~JJIS-...... $'S Name of indivtdua~m,l ~ • ~ ~ ' ' ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant g pg contract) above named. He is the j ~.~7~ ~RC4:~e.r. `.~l~c<r........................................... . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Sworn to before me this ..............f.~.......day of~....~..........,19 ~.X Note Public l~!:~+.?, ~2, ,dl? ; , , , , , , , , County HELEN K. DE VOE NOTARYPUHLIC,Stetcaf ouw,lYmA "'7-~6liCG~~•. No.A7678'/a,SuflolkC ntygc/' (Signature of applicant) Term Expires flfinrch 30,19. ~ / NIO/F jOSEPH & 40' 30" E / ~A RIL YN KRuKOWSKI 149.28' 8190" t90 74' 00' 00" W MAIN ROAD N 66 LP ( $.R. 25 ) AREA = 1.0001acres SURVEY OF PROPERTY A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000 - 63 - 03 - 21.5 Scale I" = 20' Nov. 30, 1988 V YS. LIC NO 49668 PEOONIC SURVEYORS, (516) 765 - 5020 P. O. BOX 909 MAIN ROAD SOUTHOLD, N Y 11971