HomeMy WebLinkAbout17640-z FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.... Z 185 12..... _ . Date . NOVEliBER 3 , 1989
THIS CERTIFIES that the building ....ACG.$$$O~iY . .
Location of Property . , , 4 170 INDIAN NECR LANE PEGONIC
House No . .....................Street .......................Hamlet
County Tax Map No. 1000 Section 98........Block ...........Lot , 5: 3 . , .
Subdivision ...............................Filed Map No. ........Lot No. .
conforms substantially to the Application for Building Permit heretofore tiled in this office dated
Noq,., 23 , , ,1988, , , , . pursuant to which Building Permit No. ~ 7640Z, , , , , , , , , , , , ,
dated Nov 28 ~ . ,1988. , , , was issued, and conforms to all of the requirements
of the applicable provisions of the (aw. The occupancy for which this certificate is issued is .
Accessory pool house.
The certificate is issued to , PATRICIA S PHILIP NARCO , , , , , , , ,
/owner,$S~YrR,H
of the aforesaid building.
Suffolk County Department of Health Approval N/A , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
UNDERWRITERS CERTIFICATE NO.... N097596, OCTOBER. 17 , 1989 , , , , _ , , , ,
PLUMBERS CERTIFICATION DATED: DAVID ANTONICR 8/30/89
uildmg Inspector
Rev. 1181
rosa: xo s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
RHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No (,17640 Z Date ....!/...~..r~ 19.~;fs
Permission rs fie by granted to~
~o....~~, 6.~~.
ct premises located ot ....Y:~.~d....la;4rPy1~t..Q.-!~..
.......l,.C.k<r
County Tax Map No 1000 Section ./.0... Block .......~....ppLot No ..sal.. 3
pursuant to apphcatwn dated ....,1,~~2.^.r 19.Q.~ and approved by the
Building Inspector,
! o
Fee $.~f~ ..Xr~.
c~ .z-7 P••~
f~.... .
/ Buil n Inspec r
Rev 6/30!80
' TOS7N OF SOUTIIOLD (2 ~ ~ ~ ~J ~5
BUILDING DGPART:ICNT ~ l5
TOUN QALL~} ~Lg
`1 C' l
SOUTIIOLD, NEH YORK 11971
765 - 1802 BLDG. DE?7
TOwN OF SOUTNOLO
APPLICATION FOR CERTIFICATE OF OGCIIPANCY QQ Q
DATE. _ ..~~~.1~~ .
NEN COHSTRUCTZON ._...._OLD OR PRE-E%ISTING BUILDIHG.~_.VACANT LAND..._._..
Location of Property~~~_~..~17.~~r~.~Q~~..~h~..._...~~_..
O U O . ~11l`, ,n, T II(((lA~~~\M!(~L\ LT
Dvaer or Ovncrs of Property.....~.:aG~ ~~`}~~~5 _4 .I.1. ~1\.C~_
County Taz Map Ho_ 1000 Section IIlock Lot .
Subdivision Filed Map t........_.
~ c/ '7 1
Pec...~c No. r~~ l~Z"' _Date of Permit ~~~h~.~.U~~.Applicant ~.L::ll~:-53.....
Bealth Dept_ Approval Undcrvriters Approval.__..._....__.
Planning Board Approval
Request for Temporary Certificate Final Ccr[ificatc
Pee Submitted: $
APPLICA ~ _
3
C~~
rev. IO/14 /88
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'AC:r; ~
7110lJN$4 BUREAU OR ELECTRICITY
BS JOHN 3TRE ET, NEW YORK, NEW YORK 10038
paw OCTOBER 17,.983 APPlicotion No. on jile h41 k1889/89 N D3'15tik;
THIS CERTIFIES THAT
only the electrical puipment w described 6ebm and Introduced 6y the applicant named on the above oppitcatbn number in the promises of
PHILIP MARCO, S/S Fi]70 INUT.AN PiECK ROAD W/U, PECONIC, N.Y.
in tksfolbminq locution; ? 8wement ? lxt Fl. ? Ynd FL OUT .Sertion Block Lot
maa examined on SP,PTF.NBER :?3,1389 andfoundm6e in complianre with the reyuirernentx of LhG Brrord.
FlXTWE RXTURES RANGES COOKING ttECKS OVENS qSN WASNlRS EXKAUST MNS
OUTLETS ACLES SWITCHES INCANDESCENT ~ FLVOIIESClNT OTHER AMT. K. W. AMi. N. W. AML R.W. AMT. R. W. AMT. N. P.
G II .f .I EI I
DRYERS lURNACE MOTORS IUTUM AMLIANC! IEERERf SMCIAL MCIi NW CLOCKS Eltl UNIT HEATERS MULTI.OUTIET gMMERS
AMT. K. W. dl N. P. GAS N. P. AMT. NO. A, W. G. AMi. AMP. NAT. AAaS. TEAKS. AMT. N. E SYSTYIK AMT. WATTa
NO.OE E9T
1. ! AC1(1
SlRYIQ DISCONIMCT NO. p S E R V 1 E E
AMT. AMt. TYPE pT~ 11 tV/ 11 aW ~ / eW ~ X AW NO. Of CC. COND. A. W. G. NO. GF NI.IEG A. M'' G. NO.Of NEUMALS A. W. G.
F!R / OF CC. COND. q N41E6 OF NEUTRAL
OTt1ER AMMIATUS:
PANE).&)ARDS:7-1D i,TR. 1.0U
1sLEC. RATER NEATERS;:I-4.h K.W.
~o~
TOW1,E & SONS ELE:C, CONTR. LIC.~!i5U-E
33 LINCOLN AVF
liAS7'IC' REAi'}#, NY, tl9!>1 . OEN)RR[: I~~IALiRR
11 '
Psr
This grtificafa must not be altered in any manner; roturn to the office of fhs Board if iMOrrM. Incpactors may be ' by their crodentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICA E MUST NOT BE ALTERED IN ANY MANNER. ~
TEL. 765-1802
~~S~FFO~-~0~~~ TORN OF SOYJ'TB[OIL;JJ
:4" ~c OFFICE OF BUILDh1G INSPECTOR
~ " ~ P O. BOX 728
'r' ~ ~ TONN HALL
"O ~ ~ `r SOUTHOLD, N.Y. 11971
~MOl ~ ~b0
C E R T I F I C A T I O N
Date i~ L p ~ I
Building Permit No. ~ ~ ~Q ~DV~. ~ ~
Owner ~~G
(please prznt)fJ
P1ur,.ber Q~cJ 1 t7 ~"N Xrfki~C~~
(please print)
I certify that the solder used ~n the water supply system
contains Less than 2/10 of 1$ lead. ,
(plumber's signature)
Sworn to befor^_ me this
~iay o f ~ G C•c_ ,,~~i~
19~. ~ ~!'-~E~tf'
Notary Pub11.c
Notary Public, ~U~k County
~YNMYYak
Oommipiort~6giins Dio~mhe?C0
a
`i~d
w
TEL. 7G5-1802
~gS~FF~l1,'~~l% TOWN OF St)yTTB[Od,D
1 OFFICE OF BUILDII•IG INSPECTOR
o ~ P.O. BOX 728 ;
~,~,-----__.°^-----~~,...n
~ ~ ~ ~ TOWN HALL i ~ iw
O~~ O~ SOUTHOLD, N,Y. 11971 k' ~f;
'~~l r~ ~b~j(~~, AUG 3 p 1~9.8g ~ ~ I
alD~ s~cai )
TOWN OF gpU7HGl~ p
C E R T I F I C A T I O N
Date /
Suildirq 1Per/mit No.~[7 Gh~O
Owner ~ {71i4,C'GO
(please print)
Plumber ~,~Jr~ n /
i~It'O.Vlc1C
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead. ,
(plumber's signature)
Sworn to before me thi¢s-
`~~'day of G[~s'1 J
19S,L! Notary Pub is
notary Public, ~G~~'~~~ County
CIAiRE!_ Of.E4V
Ndary Pu6fio, Sate of Nor York
No.4878506
QuafNled in Suffolk Crwnty
Commisean Expires December 8.18_.__x'
-I~LD I;.S:c.::~u;] ~~Ui.::. ~OMMLNT°
1. R. ~
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=0UIIDATION (1st) ~
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=OUNDATIO[1 (2nd) _ m-
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?OUGH FRAME"&
PLUMBIN~ ~
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ItdSULATIOPf PER N. Y.
STATE ENERGY
CODE I _
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FI;JAL
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ADDTTIOPIAL COMMENTS: x `
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G ~O T65-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 15T ( ~ ROUGH PLBG.
( ] FOUNDATION 2ND ( ]~ULATION
[ ]FRAMING [ FINAL
REMARKS:
DATE ~ INSPECTOR ~"~'V
~ 7~ ass-iso2
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ /J ROUGH PLBG.
[ ]!FOUNDATION 2ND [ ]INSULATION
[//J( FRAMING [ ]FINAL
REMARKS: ~~'c
c'~
DATE ~ INSPECTOR
r
~y ~ BOARD OF HEALTH
4 ~'~,e..._ - 3 SETS OF PLANS -
FORMNO.1 SURVEY
~ 2 TOWN OF SOUTHOLD CHECK - • • • - • • • • -
BUILDING DEPARTMENT SEPTIC FORt1
~"`"°~~:~i,;
D~Pt ~ TOWN HALL
7pWN0FS0UTH0LD ~ uOUTH0LD, N.Y. 11971 NOCALL
TEL.765-1802
MAIL TO:
Examined Y__ d~~jj. 19
Approved ..Y~~if~J'....., 19 Permit No ~76~~
Disapproved a/c .
. .
~/J~~
• ( ilding Inspector)
APPLICATION FOR BUILDING PERMIT
Date ..Z. 2 . u~l. I{
f
INSTRUCTIONS
a. This application must be completely filled in by typewnter or in ink and submitted to the Building Inspector, w
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 st
or azeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ,
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 BuIIding Pennit to the applicant. Such p•
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occup
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Depaztment for the issuance of a Building Permit pursuant t•
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein desc~
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an
admit authonzed inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is. owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or bui
........1~'~~~'~
Name of owner of premises . M~• !~-~~U~.M~G~? .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SIIFFOLK COUNTY LICENSED
Builder's License No .
Plumber's License No. .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done .
.4[70 ~[or.~- t.4,t~ ......tic...... _
House Number q Street Hamlet
County Tax Map No 1000 Section .1~7 Block Lot .
Subdivision Filed Map No Lot -
iName)
~2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction
a. Existing use and occupancy sttiiCa~...F~ I1,•-`f' .~~~~•-~h.~ • .IQk~.1T1~iI..~.. .
b. Intended use and occupancy .l
.4!Q~.-r..NQ~..l~t.
3 Nature of work (check which applicable) New Building ? Addition Alteration
Repair Removal Demolition Other Work
(DcscrFSion;
4 Estimated Cost ~1Y~/J~•••. ~~lYy.~?.•.`r. Fee ,
` (to be paid on filing this application)
S. If dwelling, number of dwelling units Number of dwelling 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. Dunensions of existing structures, if any Front Rear Depth .
Height Number of Stones
Dunensions of same structure with alterations or additions Front .Rear . .
. . . .
Depth .............Height ..Number of Stories
8. Dimensions ot;enti~e new construction. Front ~ « Rear Depth . ` 9°.
Hrmht " ;f , ..Number of StonPC - • • •
.
9. Size of lot Front . ~~~r• 137 ~,.F~S !s~'t}}t .
. .
10. Date of Purchase ........Name of Former Owner
1 1. Zone or use district fn which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation . ~
13 Will lot be regraded Wili excess fill be removed from premises. Yes
I4. Name of Owner of premisesl•~/~`(, .~l,U I~•t!~~.Q.. Address~Z.~l~4fJ7~r.~:I~f~Phone No. ZIZ.•.~, ~J•"
Name of Architect .(3AT~S. . Addressl~9~'.JF~~-~.>~P~I4f.-Phone No 7Z1tr:'.(e~.3.
Name of Contractor C~?C'~ . ~~~.G~-... ....Address l5zr. ~ P}~one No ~f,~ :'.C~7°f.~~
15. Is this property located within 300 feetyyof a tigidal wetland? *Yes .il... No
*If yes, Southold Town Trustees Perm>_tPLOTDIAGKAMed. ~7.l,~jZTY l'S Wi4-[faL T
RE'Stt~tlc..E l5 INL•aND~
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dunensions fi
property fines. Give street and block number or descnption according to deed, and show street names and indicate whet
intenor or corner lot.
STATE OF NEW YORK, S S
COUNTY OF . f~t.d4--
being duly sworn, deposes and says that he is the apple
(Name of mdSvzdual signing contract)
above named.
He is the ~~•!-i!-l-~X-7' .
(Contractor, agent, corporate officer, etc )
of said owner, or owners, and is duly authonzed to perform or have performed the sand work and to make and file
application; that all statements contained in this application are true to the best of firs knowledge and belief, and tha
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
. 2.z- . day of i~.. 19~
Notary Public, p,~,l/1,~rF:t~-2r. County
. . . .
1 Lu.If, ~ e1
~y!p~uM ~ (Signature of apph
~wc lol=il /gq