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HomeMy WebLinkAbout17929-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18082 Date JUNE 6, 1989 THIS CERTIFIES that the building ALTERATION & ADDITION Location of Property 975 PINE AVE. SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 77 Block 2 Lot 8 Subdivision GOOSE BAY EST. Filed Map No. 1176 Lot No. 145T0148 conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 15, 1989 pursuant to which Building Permit No. 17929-Z dated MARCH 17, 1989 was issued, and conforms to all of the requirements of the appla.cable provisions of the law. The occupancy for which this certificate as issued isREPLACE WINDOWS & DECK ADDITION TO EXISTING ONE FAMILY Di~?xG. The certificate is issued to MARIALINA SIMONE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A ~ _ Building Inspector Rev. 1/81 rows xo. s 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 s 017 9 2 9 Z Date ~..A.A: C.~1...~ 19..Gl..~ Permission as hereby granted^^to~~ ,,,,nn ........1............~.°~?~ . ......~..5~,~ . Vin: t'~~..~..R~!~u... ~:.~.....~-ry5-......N~.:.y.:...J.! ~n~~... ro .a.t,R......~-t~~. ~ ..~....^:~~r` :~!,5~~...CQ~.CIK....~-~.~,:!~IA...zR....~?M . ct premises located at ..~.7a~..........~4r:~.%.....4~'!."f.: .~C~'lii?~A~.~ Counh~ Tox Map No 1000 Section O ~.1. Block ......0.~-...... Lot No ....~.g.. . pursuant tc application dated I.~ 19~.~.., and approved by the Building~~\\Inspector Fee $..~U:..~- _iC,fir dP-- . Building Inspector Rev 6/30/80 y ~ ~~c~~~~ r ~ TOWN OF SOUTIIOLD ~ ~ F~`"""°'°- t BUILDING DEPARTTIENT 19p~ ~J ~ r i TOWN HALL SOUTIIOLD, NEW YORK II97I TO~~OFg017HOLd 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE... _.v~s~~ NEW CONSTRUCTION ._.....OLD OR PR~E-E%ZSTING BUILDING_..:~.VACANT LAND....._.. LocaCion of Property.....~~75 .l"/n/E. l/vt ..............`~~.OL~rH~~-~........... HOUSE NO. STR/E ET HAMLET Owner or Owners of Property....././:~~~"~N~C~... Y.. ~~~~~~':vL...... County Taz Map No/.~~t 1000 Se~/ction .G'77G~ Block ~Z.~U. Lot ..~~~~.~~d~ Subdivision._....~!/.~OS~_ />i4-Lj LST. Filed Map .._..._.Lot ~~s~~~'1~7 /7t~ qq f M/'/~ NNA- - J-S/MO^/c Permit No. ~ ~~Z !...Date of Permit ..~-Z~~.~j/~~..Applicant . Health Dept. Approval Undcruritcrs Approval.__...._..___. Planning Board Approval Request for Temporary Certificate Final Certificate S'ee Submitted: $ r APPLICANT.....:::":uA i''a 0 .'n'6?~'.2-:^. _ . rev. ]0/14/88 ~ ~/~j?~ 8,~-c.~3~Y~11 ~J ca ~ ~e~~~ J 7 1 / 76S_18U2 BUILDING DEPT. INSPECTION C ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: C~j DATE S~ ~ INSPECTOR .l`.uL 11~.~. ...V.ali ?1 `IVAlu I li l.•ll"IL IV I.I ! ~ } 7. ~ H H FOUNDATION ^ (ist) s c~ FOUNDATION (2nd) _ _ m~ 2. ~ o ROUGH FRAME !x F PLUMBING t ~C 3. zf ~r ~ co I2ISULATIOPI PER N. Y. STATE ENERGY CODE m ~g~ ~ ~ ~ r C~yC 4, y ' I FIiIAL , - o z ADDITIOIIAL COMMEflTS: ~ x _ i - r x ^o H 9 H H O Z • x [*7 a ~ r H S ~ d M H ! t • I _ Y~ ~ u ~10r~' ro i I b a ~ ~ rr~ n ~ 4 ~ i nl~ ' 1 I , J 3~,. 1 ~t A ~ ~ k~ T' R I ? (i ~ v'O • i iii J ' i j C ~ ~~7\1 • sr I ~ ~ ~ ~ y ~y ~oo~{rF n 5 1 .i ~ ,y '1 (1 Q W 1(~. u G9`~Y R~+~y~p i' r ~ ~ • ) `1 'A1' of i ~ I~ ~ 1,~\ v r ~ S y r a o 4 O ~ ~l O l ~ , ~ r` " (^U fly 11.1 rJ 1J 9 ~ ~ a ; m = ~ a ~ ~ ~ u a l ~ ;:li, _t II rhh A~~l pg~~a~°~~ ~~y2 Farld ~ ? i} 11 \ '~v j~ ~ Ye'yTg~ap, r~, ~ g e_E Y' 88 _ p O b ~ p ~ r C~ Is D ~ ~ BOARD OF 'HEALTH 3 SETS OF PLANS . ~ FORM NO. t SURVEY ,5 ~g~Q ! TOWN OF SOUTHOLD cxscK aSP . ' ~ f BUILDING DEPARTMENT SEPTIC CORM ~"'s`~ TOWN HALL TONy°~~ C ~~~~~'r'~~_tl SOUTHOLD, N Y. 11971 NOTIFY ~ TEL.. 7651802 CALL n MAIL T0. ~ Examined .~~-.C.w. ~ ~ 19 Q _ ~ n p (3~,t. x'77 Approved ~pL~-l-'~ . ~ ..1.., 19 ~R. Permit No~.7.oI a.t..Z't-.. ~~kP.~„ ~11a,« ~i' 0 Disapproved a/c 1 t 7(e~ (Buildmg Inspector) APPLICATION FOR BUILDING PERMiT Date 3 15 ~ INSTRUCTIONS a Tlus application must be completely filled in by typewnter or to ink and submitted to the Building Inspector, with bets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing location of lot and of buildings on premtses, relationship to ad~otntng premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the dtagtam which is part of this appl capon. c. The work covered by ttus 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 petzrt shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used to whole or to par[ for any purpose whatever unttI a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Bwlding Permtt pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lasvs, Ordinances c Re;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbe~ The appltcant agrees to comply with all applicable laws, ordinances, building code, houstn~ code, and regulations, and t admit authonzed mspecton on premtses and in building for necessary mspecuo . f~! ../.7. (Signature o[ appltcant, or name, tf a corporarton) r~ ..c • (Matlln~ address of appltcant) State whether appltcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or butlde, .........G~":r.etc...~.4N~'??A.4T.~R Name of owner ot"p rerittses ~ /2!,1/ft1 . S (MO !f/~ . . • (as on the tar roll or latest deed) If applicant is a corporation, stgn3ture of duly authonzed officer. (Name and ttlIe of corporate officer) Smider's Ltcense No. •.(6 0 d' N. z..... • , , Plumber's L,cense No . . . Electrician's Ltcense No . Other Trade's Ltcense No . . 1. Location of land on winch proposed work will be done. ....~~'.`'.°.•S ~ 97S.. ..Pi,v~ ...9, : So ~ rh7,o G D . Iiouse Number Street ~ ~ ~ ~ • Hamlet 4 County Tai hfap No 1000 Section 07 T:•.~.P....... Block ~ Z ; D ~ c"'U ~ Ca ©O• , . , Lot........... Subdivision ..C' OOS E , :8 Ay C ~ Filed Plap No . Lot i ~.?;,,/~C ,/S! 7~ !5 (Name) State eetsung use and occupancy of premtses and intended use end occupancy of proposed construction a. Existing use and occupancy P~•~•V•~ ~ b. Intended use and occupancy • • • • • • • •P~ ~ ~H.T, • • • ,,,T b,~F ~...Lq~e.•ox,o. ,7..a4~?f' , 3. Nature of work (check tvhrch applicable): New Building Addruon ++,~Utera[ton . Repmr , Removal Demohtron Other CVork . RrP<i)CG w,.r,Jn~v~ !S~'x Iy' ,,v:.,u AFCk ,.~ESt- sedfi (Descnptton 4. Esttmatcd Cos[ `tt oP.4 Fee . (to be paid on rlrng thrs applrcatton) 5. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage, number of cars . 6. If business. commercial or mtCed occupancy, specrt'y nature and extent of each type of use . Dimensions of existrng structures, rf any Front Rear Deptlt , . Heteftt ..............NumberofStones...................................................... Dimensions of same structure with alterations or addtttons• Front Rear . Depth lIcight ....Number of Stones . Dimensions of entire new construction. Front Rear Depth . Hcigltt ...............Number of Stones . 9. Size of lot Front ....~9~:~`.~ ~ Depth /'C o ° Rear 10. Date of Purchase .....................Name of Former Owner . 11. Zone or use dts[nct m which premises are situated . 1 Does proposed construction violate any zoning law, ordinance or regulation• . 13. will lot be regraded will excess fill be removed from premtses: Yes i 14. Name of Owner of premtsesNF.R,lA.K^:'~ S/!fo?!~. Address'if~!'~ucBERRY /t,v~; , ,phone No. B.?y:.« . . Name of Architect ...........................Address . !?14KOEN clTy phone No............. . p.............. Name of Contractor 4r6K?.~}u6~ . a:~:....... Address PP:~4~! .177,Ih1[eK pr~,phone No Y.7.u f , IS.Is this property located with in 300 feet of a tidal wetland? *YES....NO..._ *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildutgs, whether exrshng or proposed, and,mdtcate all set-back dunenstons fro property lines. Give street and block number or descnptton according to deed, and show street names and indicate wheth interior or corner lot. ~6 t~ ~ ~ 3 ~ 5~`X i0" GrRDr~R t i ~ ~ ~ x ~ 3cArtS r pP4'R4VE k° R'^°'E~3 ~ ° S T S C.c,A DATE; 3 l~ C,' ~ )_7 _~.3~,, ~ j= Oo r / N6~ S ~ ~ Q,C-'E. FEE _J~. - ~ L. . NOTIFY BLALDtNC ~ ~ (rt AT ~ ~ p~ ~C' / ~y h /cG /Y<ti 765.1802 9 A^^ ,r< r4E FOLLOWING III,- j i. FOUNDATION +1 ~ ~ 4 FOR POUREC C N. ~ `tQ 2. ROUGH - FRAA, NC, ° ^ ,e 3. INSULATION ~ ~ G~Ve ~ ~Q~, ~C~'~~ 4 BE COMt'LETEOFORpCrCrj' 4T ; ~~~4`~'`~~'~QQ,~C~ THE REQU REMENTS OFQ THE ~K1 v r`~~~ OtuG STATE CONSTRUCTION & ENERGY CODES. NpT RESPONSIBLE FOF DESIGN OR CONSTRUCTION ERRORS STATE OF \E1V YORK, S S COUNTY OF . • - • . , being duly sworn, deposes and says that he is the applica (Name of mdrvrdual signing contract) about named,. Elctst}te...\.~. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the Bard work and to make and file t1 apphcauon, that all statements contained m tlus apphcauon arc true to the best of his knowledge'and belief; and that t: work wdl be performed rn the manner set forth m the apphcauon filed thcrcwtth. Sworn to before me [}us HELENKOEYOE p ` NOTARY PUBUG, State of New Yak L.S.. ..day of ~'1.'14~:Lc:-~........, 199. No d7O7878,SuflolkCouM7a. .~/r- ~ y,~/ /I Term Exgres March 30.1 ~otar}• Pubtrc, 1'~`:...'.I:. L•'>'•~~• • • County (Signature of applicar N~-~