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HomeMy WebLinkAbout17334-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218110 Date JUNE 13, 1989 THIS CERTIFIES that the building FARM BUILDING Location of Property 46530 MAIN ROAD PECONIC House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 03 Lot 003 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUG. 9, 1988 pursuant to which Building Permit No. 173342 dated AUG. 19, 1988 was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is FARM BUILDING AS APPLIED FOR. The certificate is issued to WILLIAM J. SMITH (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N074502 & N074500 JUNE 1, 1989 PLUMBERS CERTIFICATION DATED N/A ui ding Inspector Rev. 1/81 nosas 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) Nfl 017334 Z Date 19..~.$ Permission is hereby granted to; „ ....Y.~...a...... ~ at premises located at .....7~~t..~.-7..~~....... ...................................................~1.~~~............................................................................ Caunty Tax Map No. 1000 Section ......c...~/q~.... Block ......CJ..~.....II Lot No...Q.Q...~........ pursuant to application doted ............Q..,,1.j 19Q.~, and approved by the Building Inspector. Fee $5~.:... ild Inspector Rev. 6/30/80 TOWN OF SOUTUOLD ~ ! 'i l4,..J {~=a 3 c~.n...F.:a...~.. BUILDING DEPART2ICNT .o.x..,,...?~ k TOWN HALL ~ ~N SOUTIIOLD, NEW YORK 1 197 1 BLDG. Dk'PY. 765 - 1802 SA~NOFSOUTFtOl17 APPLICATION FOR CERTIFICATE OF OCCIIPANCY ~i DATE.~~~4 ~ . _ NEW CONSTRUCTION ....OLD OR PRE-E%ISTING BUILDZNG......VACANT LAND...._... Location of Property...YNS.~a...........'~/.AJiJ~2U~o~ .c~Gi/%r(/OL~lI_...... UOUSE N0. STREET HAMLL'T Owner or Owners of Property...~i44~~~yyt'~*7~.~.~~~Ir~ County Taa Map No. 1000 Section . /.5... lilock Lot" Subdivision Filed Map ........Lot.......... Permit No. ~t3~~~.Z...Date of Permit .s~~~~I.~~....Applicant ,~i,,t:~AM,7. SM~~~I. Health Dept. Approval e/Sb1~ Underwriters Approval:a.g~~,~~~f .p~_ ne~~jyS~~ Planning Board Approval Request for Temporary Certificate Final Certificate Fee Submitted: $..~S.V;~,,,,,,,,,,,,, APPLICANT...U.~M~WG~6°v;. ~ ~7y~frY 6 ~,.~/~y rev. 10/ 14/88 j~j/~1~~ ~i% O 4 i ~F. FORM NO. 6 Y TOWN OF SOUTHOLD BIIILDING DEPARTMENT '~I ? TOWN NALL 765 - 1802 APPLICATION FOR lirERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspectoz with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, s[reeCs, and unusual'~natural or topographic features. 2. Final approval of Ne~lth Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electric 1 installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less than 2J10 of 1Z lead; 5. Commercial buildings; industrial buildings, multiple residences and similar. . buildings and installations, a certificate of code compliance from the Architect or Engineer responsitjle for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings QPrlnr to April 9, 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. A properly completed !application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 3. Date of any housing c',ode or safety inspection of. buildings or premises, or other pertinent information required to prepare a certificate. C, For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of, the entire lot prior to April 9, 1957 shall also accompany the application. If 'a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $f00.00. 3. Copy of Certificate of Occupancy - $5.00 -over 5 years - $10.00 4. Vacant Land Certi€icate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial ~ APPLICATION ON BACK t rev. 10/14/3$ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~acar`, # ~(}{}{};f BUREAU OF ELECTRICITY 65 JOHN STREET, NEW YORK, NEW YORK 10038 Date Jtlpl~ ~Xr r`f~~ APPlication No. on file J~~q~'i~~a ~~j`s~"~S ~ Si7f3!i fl iR THIS CERTIFIES THAT only the electricol equipment as described below and introduced 6y the app/icont named on the above opplicotion number in the premises of Wl:bl,Iil7~i r>t+itT.rl. `rl3 ,ta~a)~ kh~, YUr~#;~ ?~IN9-1, sc)i7T}l~Jt,i;, i~.Ya ' in [he following location; ®Baaement ? lxt FI. ? 2nd FT. AYi,(`i- .Sertinrz 8lack Lot uns exmnined orz I~Ir~.X ~ ` andfourzd to be in cornplfance with the requirements of Utis Board. FIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAU57 FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. K.W. AMi K.W AMT K.W. AMT. H P DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K. W. Oll H. P. GAS H P AMT NO A. W G. AMT. PMP. AMT. AMPS. TRANS. AMT H P NO. OF FEET AM1. WA115 SERVICE DISCONNECT NO.OF S E R V I C E AMi AMP TYPE METER ~ ~ tW ; H 3W ~ A~ 3W 3A' dW NO. Of fC COND A W. G. NO OF NI-LEG A. W.O NO OF NEUTRALS A. W O EOUIP, PER .P OF Cf.COND CE HbIEG OF NEUTRAL OTHER APPARATUSI . ~'~f~d%~-~ L~~ SZ'~~~i~i' ~ h:~api. f STC~. /I Ix~Y!'i~.rlr. u~t3. r~ ~~9~.IE+ ~.o. nor aahR SOf}TtiE}Id), rFY , i ~ ~ % GENERAL MANAGER 71 Per i` 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST,ND7 BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS I'~~''• ' 1~CE73 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Data `T~.(~~ ~,I'~~Y~~ AppBcation No. on file Bi iS'~i (3'}J ii$~~Y ~ [1.7 t1 ~{YCi THIS CERTIFIES THAT only the e(ectricol equipment as described belou+arad introduced by the app(icont named on the above application number in the premises of wa~Pr,x;~~ s~s'rx, nt~.r:nr ~l>„ Yltrl,F~ 3?~~~-~, #;c1i["(ttts7,T), ' in thefol(aminq lncationt ? Raaement ? lat Fl. ? 2nd Ff. ~E~~ .Section Biork Lot MAY t'1 ,19da9 , u~as examined me oadfound to 6e in cmfep(ianre with the rvyuirernents q(thia Board. FI%TURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT fLUORESCENI OTHEH AMT K W. AMi K.W A.Ni KW AMi K W AMi. H P 3 8 2'i ~ i 4 4 3~ ~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELL UNIT HEATERS MULTI.OUTLET DIMMERS AMi. K. W. Oll N. P. GA$ M. P. AMT NO A. W. G AMi AMP AMi. AMPS TRANS. AMi H P SYSTEMS qMi. WAIIS i NO. OF FEET SERVICE DISCONNECT NO.OF S E R V I C E AMi. AMP. LYPE METER 1 ~ YW 1 A SW 3,9' 3W 3 B 4W NO. OF CC COND. A W G. NO. Of H4lEG A' W' G NO. OF NEUTRALS A. W. G. EQUIP. PER A" OF CC COND. OF HbIEG Of NEUTRAL G 1G{7 t:ki Z { 1 7 OTHER APPARATUS: F,hf4t7. i'iYJt?3~1 H~A'Cb,Yi r a'E ~ i4r'4'^k~~ct~il..CrO Tf.Pe (/~C~ ;;9'~Vi:' S 7~;lL1+, /~:Titi. AIIiYt~k~'t , i,'I't~, ~3tC~~~k: P.a>, Iat~~ 77.G~ G~~~~ ,~i)1YTHYYI=D, $(Y, 1'3.571. GENERA/ MANAGER 9.7. Per ~ I " 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. r'Ic:LD i;:s~C.iu;l I ;;obKMCrrrs ~ ~n ~ ~ . H ~ _ _ yy~ FOUIJDATION (1st) ° FOUNDATIO;d (2nd} _ - - 2 . ~ ~i [.ci ~ zo 6~ P,OUGH FRAME & Q PLUMBING ti~ H b 3. I1ISULATIOfI PER N. Y. y~ STATE ENERGY , CODE x a c~ .J^ r 4 . ~ FIidAL z~ ~i ADDITIONAL COMMENTS: x , ~I x~ a~ oQ z _1~ m 0 c~ ro y l`7 33~~ 765-1802 BUILDING DEPT. f NSPEC?ION [ ]FOUNDATION i5T ( ] ROUGH PLBG. ]FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: ~ D DATE ~2 Z ~ INSPECTOR G 1~t4,r~j 7 r. ~ ~ M BOARD OF HEALTH D , ~ =~tl~~~~ 3 SETS OF PLANS G: j`~ FORMN0.1 SURVEY ...~..~~p........ 1 ~ ~9$8 ~ TOWN OF SOUTHOLD CHECK ..6 BUILDING DEPARTMENT SEPTIC FORM . ~_M._.....,., ' ~ - - TOWN HALL PtA ~ J SOUTHOLD, N.Y. 11971 NOTIFY TOWN Gw `'.„'c 6 TEL.: 765-1802 CALL , MAIL T 0 : ~/rm ~wwp-k- . , Examined ..0./... 19 nun. ~3~ ~ Approved ~~~g......., ]9~Permit No.~.7'33,T.~ :We.eG,rp~io-eZ. 7T Disapproved a/c v/ ~(B ing nspector) APPLICATION FOR BUILDING PERMIT Date . A.. ~ . . . . 15 A. 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 inspect/ion. (Sign EEEure of appl' nt, or name, if a corporatron) . /'a . ~px Q.. G~z~~~v~omT n/.Y. PYY . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........QIN.N,~2 . /LL/q Fi ~ / / N Name of owner of premises W f!`? (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. ...~:3.c~~~.-l~r Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done . . House Number Street Hamlet County Tax Map No. ]000 Section a.7~~.°........ Block ~ cS 0 ~ od ©oo Lot Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of lplremises and intended use and occupancy of proposed construction: a. Existing use and occupancy Fl.°f1 C . b. Intended use and occupancy ...GA!i:9G~..~: • •~7or-~mf,E • • .(~.~QnrM, lyL,(y# , , , , , , , , , . , , , ,,`~r7,. 3. Nature of work check whiRem 'plicabie): New Building Addition Alteration . ( P. a ; Repair dual . Demolition Otheril'~'jct(1~ i', • • (~ripi:itin) 4. Estimated Cost OaI,Oe°° Fee , . ~ (to be paid on Cling this application} 5. If dwelling, number of dwelling units Number of dwelling units on each Coor . If garage, number of cars ..s.,.. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7: Dimensions of existing structure's, if any: Front 'Rear Depth , , . , . Height ...............NucgberofStories........................................................ Dimensions of same structure with alterations or additions: Front Rear . Dc th ! 8. Dimensions of entire new const ~ • Height Number of Stories , . . ...ruction: Front ..,aA.°.......... Rear .~a~ ..........Depth . Pa............ Height ry Number of~tories , ..QNf . . Z~~ .o.4~.rSC!^!A`.~.1. Rear Depth . 9. Size of lqt: Front . 1C1. DZone or use d strict in~hich ra ' • ' ' ' ' ' • • • Name of Former Owner ../.!~~~!'e° • • • • • • • p ',misesaresituated 12. Does proposed construction violate any zoning law, ordinance or regulation: No . . 13.' Will lot be regraded .........I• • • ................Will excess Cll be removed from premises: Yes No l4. Name of Owner of premises . G?.!'~ :A!? ~:.d:/t'<~?`!.... Address S!f.S3A.ha~:":°.°°O ngcyy~c; Phone No.. ~637.~~7 . Name of Architect , Address ...Phone No. . o • a~? g~no„~cs • , • Address ../(iuF,y/4~,p, ,N,`r!, ...Phone No..%~~ :d y$:~- . . 15.Is thisoprocperty located within 300 feet of a tidal wetland? *YES....NO. v. *If yes, Southold TowrS Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all I buIldings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block jtumber or description according to deed, and show street names and indicate whether' interior or corner lot. • I 1 SCE' ~TT~~W~~ STATE OF NEW YORK, $.S COUNTY OF • . being duly sworn, deposes and says that he is the applicant (Name of individual signi~tg contract) above named. He is the 1~', (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 Cle this application; that all statements contained in this application are true to the best of ]tis knowledge and belief; and that the work will be performed in t}te mannerlset forth in the application Cled therewith. Sworn to before me this ...............1.(J.... y 19~~ Notary Public, ....~..a?I.•. ~~(/1Je- County ~~~~GV~tt~,btk (Signature of applicant) ?(tt~fl1~~IMros1A~arch ~i t~tl~