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HomeMy WebLinkAbout17335-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20281 Date OCTOBER 16, 1991 THIS CERTIFIES that the building ADDITION Location of Property 31055 NORTH ROAD PECONIC N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 74 Block I Lot 36 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 11, 1988 pursuant to which Building Permit No. 17335-Z dated AUGUST 22, 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FLORENCE A. WICKS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-065709 - APRIL 7 1989 PLUMBERS CERTIFICATION DATED OCT. 7, 1991 - HARDY PLUMBING & HEATING ~y Building Inspector Rev. 1/81 FOBM NO. A 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) rj o 017 3 3 5 Date ......1~. 19...4.. Z Permission is hereby granted to/~~ to ..~~2.... ..~~i~....G~~r:i!~~Yti.. ..G.~...~~~/USAF.uI~........~.~r!fy~.'~..'.'r~ -~''AA// ct premises located at ...--3.1 ~~1/.~.J........~....d2.. Cvunty Tox Map No. 1000 Section ......r~..~........ Block mLot No........c.1~...r~...... pursuant to application doted ..........~f.~,/.1 19.~L~, and approved by the Building Inspector. C s.-_ Fee $~~~„~'T i ild... Inspectof~ h~ Rev. 6/30/80 FORM NO. 6 (~~~JC117 TOWN OF SOUTHOLD (f u l'~I Building Department ~ ! ~ ~ 1 1 Town Hall ~ ~ Q 0~~{ ; ~a Southold, N.Y. 11971 ~ ~~,~V 765 - 1802 r'rt , _ n i ,r APPLICATION FOR CERTIFICATE OF OCCUPA 1`~L~~m.~ ~;~'f;`~..~~'~-'°~j' ,„~cY'a ~ Instructions .vx A. This application must be filled in typewriter OR ink, and submitted ~ e~..~ to the Building Inspec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. t 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- • tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 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. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions _$25.0 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling ~5.~0, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ ]00.00 3. Copy of certificate of occupancy $ 5.00 , over 5 years $ ] 0.00 4. Vacant Land C.O. $ 20.00 5.Undated C.O. $ 50.00 Date NewConstruction,,,,,,O1dorPre-existing Building Vacant'iand Location of Property . ~ ~•,2 nAi~ j~EClJn7e G House No. .Street Ham/et Owner or Owners of Property .~.~-.Ca:. ;,~(71;F,~. G{~~ County Tax Map No. 1000 Section Block Lot . Subdivision .................................Filed Map No. ..........Lot No. . Permii No.Q'7~~.~... Date of Permit ..........Applicant 1'n.~3.•.:d4~!-! ; W !4-tC,~~....... . Health Dept. Approval ........................Labor Dept. Approval . Underwriters Approval ........................Planning Board Approval Request for Temporary Certificate . .......Final Certificate . c9 r~ Fee Submitted $ .J. ~ . . Construction on above described building and permit meets all applicable codes and regulations. Applicant ..~~.6'.C.Q,,~-C,C.~_.. ~~,..~Q.pG~'.~ . aa~. to~to~~e e~,~aoa~1 ~ 33 THE NEW YORK BOARD OF FIRE UNDERWRITERS I~~ri~~t. 3 fSt)tti~91 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 Date P~ftk l Y: !)'P r "~'i^rf APPlication No. on file ~~~rr E3~ ?.'I ~If ~a~ .)'3 TH15 CERTIFIES THAT only the electrical equkpment as deacrkbed below and introduced 6y the applicant homed on th¢ above application number in the premiaea of 8~tJ2i. ~'#,UNEtiPis;p; yrjr',3C, T~iC}4f`I'6I nYt:f=lt, is~fa,;g3J.f;, 23..Y'. in thefofloukng location; ? Basement ~ /at Fl. ? Pnd Ff, .Section Bkoek Lot u~as examined on 19A.7{t'3} i' ° ' i rr t, and found to 6r in conEplionee with the reguirenrents of this /Joard. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FlU0RE5CEN7 OTHER AMT K W. AMT K W. AMi. KW. AMT K.W AMT. H P. z { I DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS I AMi W. Oll N. P. GAS H. P. AMi. NO. A. W. G. AMi. AMP. AMi. AMPS TRANS. AMi H. P SYSTEMS AMT. WATTS NO.OF FEET SERVICE DISCONNECT NO.OF 5 E R V 1 C E AMi. AMP, TYPE METER r LW 1 R 3W 8,e' ~W 3 %4W NO. OF CC COND A. W G NO. OF HbIEG A. W. G. NO. OF NEU1RAl5 A. W. G. EQUIP. PER B OF CC. COND. OF HIAEG OF NEUTRAL OTHER APPARATUS: (d,h,i',I: -~l '1'ft~l{'X i~7Gii'P"t.i~fG: §'r'C6;R ~t1i:E1~Y Y s,' 6:S,i~:C'E9t I r t,ahf i, i(:. s,'14.'' 7 ?$UR'('II 13r1`? U,I":af I'i:iY,:~ :.i~)k1r1'klQle)), iV'Y; 9I~1 `1'} 6ENFRAIfJNANA,?OER, Per r 1 ~;fi „~;-~r 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 CERYIRCATE MUST NOT, SE ALTERED IN ANY MANNER. F 0[~~C TEL. 765-1802 o O~? TOWN OIL' SOriJTJ30b~3 ~l F ' , ~ ~ OFFICE OF BUILDING INSPECTOR c ~~.ti~1• P.O. BOX 728 `n Ex'' ~ -c TOWN HALL ~~j, j SOUTHOLD, N.Y. 11971 ~Ipl ~ ~b C E R T I F I C A T I O N Date ~b ~ 9~ Buildi/n/g~/Permit No.3 ~ Owner .C_~t0~ll~ ~ ,~,1~.~CA (please print) Plumber ~ 9 (please print) ~ JJ~~"CC~~ I certify that the solder used in the water supply system contains less than 2/10 of to lead. Awl \~-K / ~ /~A \ J i (plumber's signature) Sworn to before me this , _~___da y o f 1~,~ j~-Q~ 19~. Notary ~blic ~ Notary public, County CATHERIYEA.MAG°^!N Notary E'tfi,~Il_C. ~~~yyyccvt's ci ~ d~w~ York 1'lVr aj•'[y~~.a^J fhu>k aad in 5ulto;k Oat,i:ty (,7 1 Cs~~rtissba E~irea May 14,19 VICTOR LESSARD ~ 1 Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR _ ~ = aj P.O. Box 1179 " ' ' Southold, New York 1 1971 (516) 765-1802 ~ ~~i = ~ ~f N PAX (516) 765-1823 ~ iy ' :y OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD January 31, 1990 Mrs. Florence Wicks P.O. BO% 314 Southold, N.Y. 11971 Dear Mrs. Wicks: I am returning your outdated check 113306 dated Oct. I1, 1988. On May 9, 1989 we notified you that a plumbers certificate was needed. We never received the plumbers so we could not do the Certificate of Occupancy. I am sending you the plumbers certificate to have filled out by the plumber. Please return it along with a new check for $25.00. The Code of the Town of Southold requires a Certificate of Oc- cupancy when the work under a Building Permit is finished. Thank you for your attention to this matter. Y..ou/r~s truly, / Secretary - ,l FLORENCE A. WICKS i POST OFFICE BOX 314 _ 6p-791214 ~b SOUTHOLO, NY 11971 ~~jf- l/1 19~ x~ PAY TO THE ~V~n/N Q~ S!/V/ ~dG'7 ) ~ ~ ~/,y,.., ORDER OF r'V - ~ L~Q~~- 1. 1 ' ~ DOLLARS ~'i NOFi'Tf'1 FOFII~ C3/~NK 3ou1~olE, NY 11971 ~ r M[MO i:02L4079i2~: ~i'03i11~478~4 8il' 3306 _ _ c'1::LD iGSP~C:~UN ~~U;,:E ~ ~OaMMENT~ ~ v ~W t. ~ _ - FOUNDATION (1st) c~ ~d FOUNDATION (2nd) ~~1 2 ~ z Gt 00 ROUGH FRAME & PLUMBING ti H~ 3 . x~ m IIdSULATI0A1 PER N. 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V / G G /AMSON c ~ ` ,t ~'r~er, 4 "y{i ~p1N i fo YT~NF 7}~' '^~f x.3..3 G".~~ r MON. e; /,71 t ~ 5 - . 1 aMOM i ,exf _ ~ _ ~ ~A~ n g '+w r ~ t~` ~ t l I 5 t X ~^L hRf F ~f ~ ~ Y ~ - _ ~ ~~t> 5 ~ ~r y• PF. ~7 FR• 1~ ~ ~ uuev'1' I s'HEO ~y 1 ~ IY 6 p 'SZY 4 u / Y QG h o JI ~ a ~a 4a~~ _ ~ e"oa~ ~~ya' ~ r s ~ ~ f h stiff r 1 ~ i~, .fine Y., . 1 ' ° ~r,e~~l ~ ~ ~ VT ga o dv - 42 ~ ~ ~ ~ n s~~ ~ ~ ~ \ ~ A4• °s` W _ ~ f,40 { ~ ~ r, 5 ^b~,...,...,~.~...,,,, a,.,,,~.;«.,.: ~ BOARD O F HEALTH . (c'y~x,,, ~ - 3 SETS OF PLANS ~ ~'v~ ~ ~ . ~r°.'~~'ib_ ,_-..:~.I~~3 FORM N0. 1 SURVEY II i ~ TOWN OF SOUTHOLD CHECK ~r II9R8 ! ~ BUILDING DEPARTMENT SEPTIC FORM ~ja TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY SOU~YFiOLD TEL.: 765.1802 CALL Examined . ~ 19 .~U MAIL T0: rQ Approved 19U7~ Permit No. I .~.-~a.~ S~ Disapproved a/c i (Burg In ctor) APPLICATION FOR BUILDING PERMIT Date ~U 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 orsareas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ca#ion. • 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. (Siggature of applicant, or name, if a corporatton) - (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......©t~~/. F!~ Name of owner of premises m~:' . aPNN. A. cKS (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Buiider's License No . . Plumber's License No. ~~r`.9 3. ` . Electrician's License No . . Other Trade's License No . . I. Location of land on which proposed work will be done . . •31 d5S ......................!t!oeJ°N.RoA~.................,t~,ECOn!r.c...................... House Number Srt7re'e/t / Hamlet / County Tax Map No. 1000 Section `T....... Block .......l Lot . ~fP . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy F/119~1L;`1,,,, I_d~vSP ......................,r....,,.,.............. __.r,s ~ Anil ~ ate; , b. Intended use and occupancy • • • • • • • • • • • • • , , , , , 3. Nature of work (check which applicable): New Building Addition Alteration . p Remo Re air CJC~~ ,~al . . . . . Demolition Other Work . . ,¢5pJ 4. Estimated Cost . Y~YI . Fee , 4 - g ~ (to be paid on P1ing,this~a,~plYgi ) - 5. If dwelling, number of dwellin units Number of dwetling 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 . . 7. Dimensions of existing structure , if any: Front , Rear . . Depth............... . Height ...............Num~erofStories........................,............................... Dimensions of same structure with alterations or additions: Front . . . Rear , . , . - Depth . I. ,Height . Number of Stories . , , , , , ' 8. Dimensions of entire new constriction: Front ...l.~:.e"..... , . Rear . !a.'. Depth .rQ' - Height l~.......... 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 . NO . 12. Does proposed construction violate any zoning ]aw, ordinance or regulation : . . 13. Will lot be regraded ....Nh ~ Will excess fill be removed from premises: Yes ~o Name of Architect . , ~QpN W `~,Y,S ' • Address ~~l'?JS. R!: /~-.®A.~ ,Phone No..7,3'~:: $,O,S$', , , 14. Name of Owner of premises MRS Address . . . .Phone No............... . Name of Contractor . IS*Is this ro ert loca•~~~~••~~~""'••Address ...................PhoneNo,...... p p y ped within 300 feet of a tidal wetland? *YES....~... If yes, Southold TownTrustees Permit may be required. PLOT DIAGRAM - Locate clearly and distinctly all '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. ~ I STATE OF NEW YORK, $.S COUNTY OF (Name of individual s: nil ~ ~ • ' ' ' ' ' ' • • • • being duly sworn, deposes and says that he is the applicant 'g ng contract) above named. He is the . : .....................I,..... (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 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 i .....d~a/y of I''..../. /~ti~u-cry" 19d''~ Notary Public, ...~~F~'..7a ~:~.tl.?'G-.. , County ~ ,y-~~ I (N1TIIgY7t18t~ Sta~teol~NerrYak •'•t•'" ~ •`^*~-c'9`:..4~:.. L~.. . Na ~T07878, Su4tatk (Signature of applicant) farm Expirex M1Nroh 38,~