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HomeMy WebLinkAbout17317-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19185 Date Ji11.Y 5, 1990 THIS CERTIFIES that the building ALTERATION Location of Property 355 PRIVATE ROAD #25 SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 59 Block 9 Lot 31.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 3, 1988 Aursuant to which Building Permit No. 17317-Z dated AUGUST 12, 1988 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 CONVERT EXISTING GARAGE INTO ROOM AS APPLIED FOR. The certificate is issued to ARLENE McCARVILL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-046721 - NOVEMBER 18, 1988 PLUMBERS CERTIFICATION DATED N/A B ilding Inspector Rev. 1/81 n~osaz 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 o 017 317 Z Date ...~C7..~..~~ 19R.1J.. Permission is hereby granted to: 4 ~ ~3.~.,~. ~ a ...G~..........~ O _s~...~~....~....a~~..,.................................... at premises located at ...............................................~62G~"~~ u/•••............................................................................ ............................................................................p....... .....................~~..yy...................................... Cvunty Tax Map No. 1000 Section Block LLot No....... ~,1... pursuant to application dated ............~.r/.,~ 19~~/..., and approved by the Building Inspector. Fee . uildi nspector Rev. 6/30/80 Form No. 6 ' v TOWCI OF SOUTHOLD J BUILDING DEPARTMENT TOWN HALL 765-1802 • APPLICATION FOR CERTIFICATE OF OCCUPANCY 1. This application must be filled in by typewriter OR ink and submitted to the building inspector 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 12 lead. S. 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. 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 featuxes. ' 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. 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 S years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . ~c~G~.. y'1~.'~! •v Construction........... Old Or Pre-existing Building...?.,, ution of Property.. ~ 3.P ~VrIAAl.C~?~1 L!~1:°~: House•No....... ~ Street.... N..•~~'j q q~ Hamlet ..;ucr or Owners of Property../,7~.~.~~1,1;,,,~"< ~ /2y>tL2- =aunty Tax Map No 1000, Section...=d~ .......Block..... g..... ....Lot • ubdivision ......Filed Map......... ...Lot...s3.~1° 1...:........ :'crmit No.,~7,a~~,7~.Date OE Permit..~~~~/~~ /~p /,,1dsp~P~~`~ np ......Applicant.. . ,C..... ~:ealth Dept. Approval •••.....Underwriters Approval .Tanning Board Approval 2equest for: Temporary Certificate........... Final Certicate........... Fee Submitted: c (,d ~ 191 APPLICANT ' , THE NEW YOR A +'A'~r• ~ K BO RD OF FIRE UNDERWRITERS lillfO7. L1 BUREAU OF ELEGTRICfTY 83 JOHN STREET. NEW YORK, NEWYORK 10038 Date IuC)A~t:M11F:N 78, i4}tM APPlication No. on file h7A'i43}i }?%ii$ 14 Pl4n'T2i THIS CERTIFIES THAT - only the alectrkal equipment w described 6ebEO and Introduced by the applicant nomsd on the above applicotion number in the premiwa of . ARi~F, t;Id MCCAkV I',~II,, Yf4Q SQfIN11V'!P;V Fl.VN:_, /Y01,}~ ~~i UN'P' hf.), St)0'I"Hb)Idl, R,Y. in the fdlowing kECation; ? Bw,gment 0 /at Fl. ~ 2nd FI. .Sertion Block Lot teas examined on NfaV h.PF H N,N 1 h ' 19H>; andJound to 6e in complianre with the requirernentA of this Buord. AXTUR! RXTURES RANGES Ct)DIIIN6 DECKS OVENS DISH WASHERS EXHAUST FANS OUTIETS AClES SWITCHES INCANDESCENr.fIUWEStENT y AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. M. 1. }1 l ~i i~ ~ F• DRYERS RJRNACE MOTORS SUTURE AMUAtKt REDEK SEW AL REC?T 71ME CLOCKS ENL DIRT IIEAilRS MIXII.OYTIET OFMMERS AMT. K. W. Oll N. Y. GAS H. P. AMT. NO. A. W. G. AMT. AMY. AMT. AMTS. TRANS. AMT. M. P. SYSTEMS AMi. WAi15 NO. W 1Wi 1 lillli SRRVIC! DISCONNECT NO.OS S E R V 1 C E AMT. AMP. Typt METlR 1 R tW I X tW 3 X 7w ~ X AW NO. OF CC COND. A. W.p~ NO. Of NI-UFG A. w. G. NO. M mUTRAUi A. W. c. EOIRi. PER % OF CC. COND. d NI-IEG Of NEUTMt OTHlR AMMA7U5: i~ANF;iIHOA.4inS.2-]t <~rk, t-u4 !:.t~.c.tr-r "'l "AIiL i<. IifIQNS '.'l+ 'fUMtk NAkNi7u I„iv x: OI!'i'fliH~D. NY, 1?')71 ONW ~NAOp lY ~ i,ICr:NtiFi (du.. k i•: Per -This cerHficaN must not ba oltsrad in any manwr; return to the office of 1M Board if incorrect. Inspector may bs idenafiad by tMir credentials. COPY FOR lUILDING DEPARTMlNT. THIS COPY OF CERTIFIGTE MKT NOT 4E ALTERED iN ANY MANNER. I::LD I:: s:EC:_u:~ ~~uA.E ~~dKMr:urs ~ . ~l ~ H _ - - H FOUi7DATI0N (1st) ti FOUNDATIOtd (2nd) m y 2. z 0 P,OUGH FRAME & PLUMBING U1 ti ~ '-1 ~ 3 . x' m m IIJSULATIOP] PER N. Y. y STATE ENERGY CODE x ~p a 4 . / y FIN AI. o ~ E z ADDITIOPIAL COMMENTS: x x ro H ~ ~ 9 y H o z m A • r `p\ y ~`F~ d' [*7 .b H 1731 765-1802 BUILDING DEPT. INSPECTOON [ ]FOUNDATION iST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ NAL REMARKS: Cc~ f - ~ t I DATE ~ ~ INSPECTOR i . t . t_ , l ~C/yrn)~~WV v~• ~/f~1 Y~ 765-1802 BUILDING DEPT. sNSPECT'®N [ ]FOUNDATION 1ST [ }ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [)FINAL REMARKS: ~~P a _ ~ DATE ~ INSPECTOR - ~ t~J~T Cam©vT~ ,2ao,~ C E. / L l /V~(~ SAN C,tY't~b Car+'!~zo~ GA~~~'-r: I P`X a ~ ~ ~e.cr-ss c.+~~7~ ~3y Car,Pdrt;;z_ 1~~~ Ia k a (___uU_~~ In~ _ { _ ~ N ~ G.-. Fy J~°'~ ~"06.f zi'c~.~ t~.- .`-°d~-~'C~.'~°'` ~`~,~'.L ~.d~P" ' _ 1{~ f ~jf i; t' Y ~ j v ~ ~ I c' _ : ~ ~ x I ~ ~ 1 ~3~0 °r ~-~usy CP~k~N Ire - L.;; r a v r~.. ~~..r~-t.c.-~ t+l f Ca.vct~~~~~" ~ UI ~ [`b:Vay l~tC lltM! tdWd1 f?0~ 7Id U~~/iv~r ~ ~ ~ ~/~rr~~,,~ Pay .~.~Jr~T'ta~af~•. _ 1 ~ ~ r- ~ ~r a ~ ~ /4 ~ J f" D -C h ; F±~ f~1 t ! ~f`. D M ~ -r-t \~j ~ 1 S~l~ Wiz'-S ~ F: u~ { l ((.'f~ f G _C d `z..t,~. i E j ~ U C`T v,} ~ h- lL. l Cn_ o r ~ I A35r'~-a ~ ~ a ~ ~ ~ ~ v ~ i K r- n. n v r' ~x r s-r D n n iZ An a rte,.-,~,,, - , . RA c--e,aa~ ; I b~.cK lox as ~C" Q' ~ S L~E~'G"?l..S' 6 nl C-P C fl~C °~~"G`~"~ ~i ~ ,x ~ ~.~c..~ INS Cr ~ C ~o S ~T ~ r~ I, r ~t~ o N1 ~ ~ I~ ~ ~l j~. 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I. • B i ~ x-r ~ r 7 y 1 ~ e i r x j z `y't>* w r i r = ~a eN {t,m t . ~ I gyp' ',y~`-p$^~,' e A 1 4 ~ J ni. .Ji i F~ 11 ~ 7 r t y~I dp dHYa.WWQt~`~` Y iJ~? t A N ? s L-{I" v c: ~ N. t ~ A w 3,t~bttOW VQ m. K~. x~ , ,t - •rav . ~ 4 a { t t 't` 4: 'N. i s z4 t ~ }'~i8~'~" ~ N' d`,~°{4/~ S~ ? i~z f z Ri ~ }i ~,b 1 ~ p z7 E'Y ~ q / ,fy i A a l,~su f j 1 ~i,~ I' ~'v~ '7;t4 ii. j t t'E~_~5~R da-u uz~~ Ft b~~~1A~1 s~~z ~~tiMti Ilf~f"e~Qlw' BOARD OF HEALTH r 3 SETS OF/PLANS I/••--.- ~FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM SOUTHOLID,N.YL11971 NOTIFY ~-~~~~I`~DLl TEL.: 765-1802 CALL MAIL T0: Examined 5~~~~/~C~., 19 . Approved ....Q~~Z'......, 19~~Permit No. ~~~~7~ ~ ~ \v/ Disapproved a/c e7!-,dN `s~I r ~p ? ~ , ~ I+70U L//~ TOWN Of SOUTFIOLD l Iding Inspector) APPLICATION FOR BUILDING PERMIT Q Date f. l U GU 19~~` 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 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. , (Signature of applicant, or name, if a corporation) ~ ~ (Mailing address of applicant) ~ / State whgther: I?p c~nl,is~owner, 1e&sge,,Fagent, architect, engineer, general contractor, electrician, plumber or builder. .,_fi~ ; U~ LD.~-- ~ • Name of aw,peF of ptglniS,eS:_t •/s; t;°y~.'_.,«:~. ~ . y, 3•t ,Iq,,p ;a~,,,h.r;;c.,,;,;.,..p , ~ (as on the tax roll or latest deed) If applicant~iJ~'°cbrp`o $'~i8n,''signatufe~of'duly aut razed officer. (Name^and .title of corpora officer) ALBuildeNS LAense No. ~+~~.~P(p. ,/.%./OLK COUNTY LICENS ~ ~ ~ Plumber's License No . Electrician's License No . r Other Trade's License No . . . 1. Location of ]and on which proposed work will be done. ..~15.~.... ~-~.!'~.~.v..~g~.y~- . . House Number ~ ~Stree~ Block q Hamlet Lot ~:J County Tax Map No. 1000 Section ( , , ~ . Subdivision Filed Map No. Lot............... (Name) 2. State existing i~se and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy • ..........,a ~ ~t . .,.,.a,. l( b. Intended use and occupancy ` 3. Nature of work check which a ~ w~~BN ~ ~j~~'7 ( l7plicable): New Building Addition Alteration . Repair . Removal Demolition ..............Other Work . (Description) D 8 d' 4. Estimated Cost ; ~a Fee . ` (to be paid on filing this application) 5. If dwelling, number of dwelling',units ©N~'..... Number of dwelling units on each floor . If garage, number of cars ....i 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7 He ~htsions fisting stru Nums, if any: Front ....$.4!....... Rear SO. Depth v~:2 . bar of Stories....dNt` Depth . , i' ith alterations or additions: Front Rear ......vCJ.! . Dimensions'of same structure w Heig}rt ~ Number of Stories 0!:~~........... . Y -+3'. D)mensions of,~e?rntire ew construction: Front Rear ...............Depth . Height Number of Stories . /a Rear .~i~ Depth ......i'lJa'! . 10. D"ate of Par haset `.9.'S ..Name of Former Owner ..NJ(/`/.~/Q . . . 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: f~Q . 13. Will lot be regradedp ......D/,?.~........ Will excess fill be removed from premises: Yes No 14. Name of Owner of remises .................Address ...................Phone No..76 33.7, Name of Architect '..Address ....Phone No.. . Name of Contractor P p y I!~ ~';SA.~b~ IN.C•....... Address 'P.A, ~X. ~v7,d~.Ci~'Y... Phone No.. ~7.?.'/;7.~• . 15. Is this ro art located '',within 300 feet of a tigidal wetland? *Yes No .l!r.T~ - *If yes, Southold Town Trustees PermitPLO~ DIAGRAM ed. Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockipumber or description according to deed, and show street names and indicate whether interior or corner ]ot. i~ APPROVEq AS NOTED DATE:~S.RN~~ O NOTIFY ILDING DEP T SAT 7B5-9802 8 AM TO G P FOR THE FOLLOWING INSPECTIONS: t. FOUNDATION - TWOREOUIRED FOR POURED CONCRETE ~ 2. ROUGW - FRAMING ~ PLUMBING 3. INSULATION b. FINAL - CONSTRUCTION MUST 8E CAMPLETE FOR C.O. ALL CONSTRUCTION 8WALL MEET THE RE4UIREMENTS OF THE N,Y. STATE CONSTRUCTION 8 ENERGY CODES. NpT RESPON$IflLE FOq DESIGN OR CONSTRUCTION ERRORS STATE OF NE1y~f`OR~-` ~,S.S COUNTY OF ~ ~ ~ . • V U~1.~-. ~~-T • • ~ • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. I He is the ....p (Contracto ,agent, corporate officer, etc.) of said owner or owners, and is duly author o erform or have performed 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 manner set forth in the application filed therewith. Sworn to before me this f .~Jj(.~-day o . (.(;-rS.~., 19 ~t Notary Public, • r?• County \ _ P Notary Puhlio, Stetq C N p487 60 York ~ . tlueliNed in Suffolk County (Signet re of applicant) Commission Expires Detemkier f3, 19_,,..-