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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 1 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 NO. N-065709 - APRIL 7 1989 PLUMBERS CERTIFICATION DATED OCT. 7, 1991 - HARDY PLUMBING & HEATING �y Building Inspector Rev. 1/81 FORM NO. $ 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) No 017335 Z Date ......1 ... ................................. 19...4..Permission is hereby granted to- ......................... to ..C��� .....��.. Yti .......... ....%0F. .... ...�/ ...:K .. .... One.......... .. ... .. � ...... .... .... at premises located at ... 3.l �1/�J........ .... . . .............................................. ................................................ ..,+ s,� - S ............................................................................... ................................................................................................................................................................ County Tax Map No. 1000 Section ......r ........ Block ..............z... .Lot No .......c.1�.-A...... pursuant to application dated .........�f�/1................... ............. I 19.tfg and approved by the Building Inspector. Fee $.,-;o ...r�'T i . .. . ............ *--?ild. ln<.spectoor� Rev. 6130180 FORM NO. 6 1{ ( �JC117 � • TOWN OF SOUTHOLD Building Department ! 1 1 Town Hall h O 1991 ; a Southold, N.Y. 11971 ,_- 765 - 1802 r'f1 _C ,�,,. APPLICATION FOR CERTIFICATE OF OCCUPA 1` L ?? ' Instructions vx A. This application must be filled in typewriter OR ink, and submitted =vm� to the Building Inspec- tor with 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 $100.00 3. Copy of certificate of occupancy $ 5 . 00 , over 5 years $ 1 0 . 00 4 .Vacant Land C.O. $ 20 . 00 5 .Updated C.O. $ 50 . 00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . NeWConstructiOn. . . . . . Old OrPre-existing Building . . . . . . . . . . . . VacanttLand . . . . . . . . . . . . . Location of Property . 310�5 5. . . . . . . . . . . . . . . °.2 bA-) . . . . . . . . . . . . . . . . . . . l��CfJK71 G House No. . Street Ham/et Owner or Owners of Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section . . . . . . . . . . . . . . . Block . . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . Permit No.17.31'6.'. . . 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 .) voC . .W-4. . . . . . . . . . . . . . . . . . . . . . Rev.10-10Je e�,� aoa�1 THE NEW YORK BOARD OF FIRE UNDERWRITERSrl�t. i(at )W)I BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date P ftk l Y: !)'P r" APPlication No.on file ;3,q THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of MIS. W)'01 01Cf; fa`TI')N' VIC}W111I N.Y. in thefollowing location; ❑ Basement El ist Fl. ❑ Pnd Fl. Section Block Lot was examined on 19A.7{t1} )'° ' and found to be in compliance with the requirements of this Board. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT j OTHER AMT I K W. AMT K W. AMi. KW. AMi K.W AMT. H P. z { I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMi %.W. 011 H.P. GAS H.P. AMi. NO. A.W.G. AMT. AMP. AMT. AMPS TRANS. AMi H.P SYSTEMS AMT. WATTS NO.OF FEET SERVICE DISCONNECT NO.OF S E R V I C E AMi. AMP, TYPE METER I�,LW 1 R 3W 8,e'SW 3%AW NO.OF CC COND A.W G NO.OF TI LEG A.W.G. NO.OF NEU1RAl5 A.W.G. EQUIP. PER B OF CC.COND. OF HIdEG OF NEUTRAL OTHER APPARATUS: '1RACR !�IGii'P"t W-- 4 §'r'C6;R �t1i:E)YYis,' 6:SIi:C't9tlrt,ahf i,i(:.s,'14.''7 h ;.OTJTIIGid), MY; 1 P'Yll'i GENERAL.00ANAG)IR, Per— 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. TEL. 765-1802 o O�� TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date � 9� Building Permit No. 3J Owner '/ C_ t0ll� (please print)Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Awl\�-K ✓� / � l� /�A \ J i (plumber ' s signature) Sworn to before me this _Q___day of W,661iL 19—qj. Notary blic � Notary public, County CATHERINE A.MAG!V4 Notary Pubk State(,,'Nev dewy York O ul tad in Gutto;k UwIty(7 1 Cs.x*sbn B#99 May 14,19 VICTOR LESSARD 1 Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR = a P.O. Box 1179 " (516)765-1802 ' jj Southold, New York 11971 ���i �� =��f CAX(516)765-1823 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD January 31, 1990 Mrs. Florence Wicks P.O. BOX 314 Southold, N.Y. 11971 Dear Mrs. Wicks: I am returning your outdated check t13306 dated Oct. 11, 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 $25.00. The Code of the Town of Southold requires a Certificate of Oc— cupancy when the work under a Building Permit is finished. Thank you for your attention to this matter. Yours truly, / ' 4- U Secretary rov �W FOUNDATION ( 13t ) c� �d FOUNDATION ( 2nd ) m�1 2 . z Gt 00 ROUGH FRAME & (� PLUMBING cn H� 3 . x� m INSULATION PER N . Y. y STATE ENERGY CODE 4i a . 3 OF FINAL ADDITIOPtAL MMENTS : e ra ro H\ -N H O zC ra A • r� d� m ro H 9s USE IS UNLAWUL WITHOUT CEffIFIFICATE 07 C � VIEW eul AS NOTED spa L113- DATE: S FEE: NOTI AT 765-1802 S AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: t. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE SQ 2. ROUGH - FRAMWG �a� kpJ 8 INSULATION PLA4MBING 15 a �AP�2 ���� ��\ 4. FINAL I AL - CONSTRUCTIONMUST p COPLETEFOR Co. 5k^ � �S ALL 4TRICTM MALL MEET THE �a DESIGN OR CON$Tlp mom f tX 15 SX16 rrt{ - Sa%r'E>..3 - VEA i 9arsit �zoQF — g`� .>nEn� - Co[F7tiG - . iv, 2oAj 424�'1 ,�` - - HAG Vil- L 6 � ATF CFia� - PLY 6Fo�L Fac y�qT�o ✓ i I ij STv'D5 I svg if o2}�GS/4l 2 N8 FiR ( 3oX Auk FLev2 -61 5 j G %Zface_ (cc A) /4-1 - fi /N— -S( L.0 SEA�-v _ ._ __-__ _-__-____ __-. ____-._. g�/� GEm EN7 /3 L.CC fL ?E -- -- S N i r 4� ------ --- - -- -- - - G 1hQS 3owA) WI�)CS ALL wog (c To eon F_ 3/ dJ�� //, 120�� Ar YF L4 5" FELT ,NE 2S oV(r2 NA g VENT CD Y END VtF-W li F F wP?F✓Z ?)2 CC PT -BE L-0 (Z- wicr-5 CeMe,luT 31C) 5.5 N. F,D C;-,-I " C-S I qrpjoTc f4 eo V / G G /AMSON +t "y{i �p1N YTPNF -a130e. a4 � MON. e; AV 1 aMOM 01 cry If i f t 5 y' r-7 l FR• 1�f � uev'1'I t IY 6 / Y YG h o JI o kV � e"oa�l 1 r ��t e � � f All 9 stiff r 1� \1 o dv n \� Z 5 BOARD OF HEALTH . . . . . . . . . . . . ( . . . . . . . . . . . . . . . . . . . . .3 SETS OF PLANS 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 SOUYFiOLD TEL.: 765.1802 CALL . . . . . . . . . . . . . . . . . . . . . Examined . . . . . . . . .. 19 .�U MAIL T0 : Approved . . . . /,--? 7�. . . . ., 19U Permit No. 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 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. (Siggature of applicant, or name, if a corporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . .©t,J!vk1.�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises T� .aPNN. A , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . !!oeJ`N.RoA�. . . . . . . . . . . . . . . . . �Econ!r.c. . . . . . . . . . . . . . . . . . . . .. House Number Street / Hamlet / County Tax Map No. 1000 Section . . . . . . . ./. T. . . . . . . Block . . . . . . .1 . . . . . . . . . . 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 . . . . . / A l L `1 , . . 14 D v S P_ . . . . . . . . . . . . . . . . . . . . ... . . ... . . . . . . . . . . . . . . . . . AAiI �. ate;•:. , b. Intended use and occupancy • • . . . . . I . . . . . . , :': 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . .C. . . . . . Alteration . . . . ... . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work 4. Estimated Cost CJ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- (to be paid on P1ing,this,a, PIN ) rr rtX4 4 W- i 5. If dwelling,number of dwellingunits . . . . . . . . . . . . . . . Number of dwelling units on each or::°,'. . . . . . . . . . . ... Ifgarage, 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 . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . I, . Height . . . . . . Number of Stories . . . . . . . 8. Dimensions of entire new construction: Front . . .1 4.... . . . . , . Rear :.. . . . . . . . Depth .rQ' .. Height . . . . . . . . . Number of Stories . . . /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . I . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . , '. . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . .Nh . . . . . . . . . . . . ... . . . . . . . Will excess fill be removed from premises: Yes Name of Architect �QpN W`�YS ' • Address s�?JS. R!: /�®A.� . . . Phone No. .7•�V:: 14. Name of Owner of premises n1RS Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . IS * this ro ert loco . . . . . . * * * * " " ' • •Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . N p p y ped within 300 feet of a tidal wetland? *YES . . . .tNO . . If yes , Southold TowniTrustees 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 �i STATE OF NEW YORK, $ S COUNTY OF . . . . . . . . . . . . . . . . . (Name of individual signing . . . ' ' • ' ' ' • • • • being duly sworn, deposes and says that he is the applicant 'g ng contract) above named. He is the . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 . . . . . . . . . . . . . . . . . . .ddaay ofI'',. . . . . . . . . ., 194'f Notary Public, . . . . 7a. . . .tl.?G V. . . . . . . County . . /}, (BltllRv t�Sta all Now York t. • . c 9` . .4�:. . y. . Na 4M7878,Suffolk (Signature of applicant) Term Expires Much 38,"141