HomeMy WebLinkAbout17641-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20551 Date FEBRUARY 27, 1992
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 4100 YOUNGS AVENUE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 2 Lot 14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 23, 1988 pursuant to which
Building Permit No. 17641-Z dated NOVEMBER 28, 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 DECK ADDITION & REPLACE POST UNDER ERISTING PORCH WITB
MASONERY G ALTERATIONS TO EXISTING ONE FAMII,Y DWELLING Dt~i~iEL•T•?xG
The certificate is issued to HOWARD P. DICKERSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-074550 - JUNE 2, 1989
PLUMBERS CERTIFICATION DATED N/A
c
Building Inspecto~.
Rev. 1/81
!'OFFS NO, f
TOWN OF 50UTHOLD
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 a G 17 6 41 Z Date .,l/~~.~,P 1 W~.
Permission is hereby granted t ,
:!loQ..~ ...........Q~r..~..`
ro .~2~:G~~ . ~.Gi1Lrj....... . ,v.C~... ..........~L
, _
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.
vo
County Tax Map No 1000 Section . , c'..~, Block `,.Z...-......./.+QQLot No ,Y
pursuant to application dated 19.({,U.,, and approved by the
Budding Inspector. /
Fee $
1
~t~,+J,/,~..
, . . . . . ...1. .
ng or
Rev 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTb1ENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled zn 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 Pare Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. 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.
B. 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 features.
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.
C. 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 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.D0
Date .~~zG/9~~.
New Construction.....~Old Or Pre-existin~~g~~ Buildin~g1 ~7
Location of Property... yll:Q .................Jk4{s1 5.~1~C~au:G..........~i:~sY~PIP~..~.~.%.!/
House No1.~ S~reet Hamlet
Onwer or Owners of Property..lyo.Gt~C<!',c~.~ „(J~~~Q~$(l.??
County Tax Map No 1000, Section..?°.:si.~~...Block..P:?:~d........Lot..d,~'4~;OQp,,,,,,,,,,,,
Subdivision.....yy..//
...........................//..~~File//~~d Map..........././Lot...../..~......[.........
Permit No. Q~.l.C/..~G,l.2Date Of Permit.Il~4`.Y/.~.~.15 .Applicant../~`j dAAGt``r'RIF:~ ./.+r~[<,~fI,S.~':.
Health Dept. Approval ..........................Underwriters Approval./.l Q.~.yr~~U........
Planning Board Approval
Request for: Temporary,,~~--Certificate........... Final Cert'cate....~.
Fee Submitted: $~~./..~.~J.O
APPLICANT
cod. aoss~
_ _ _ _ _ _ _ _ . T _ -
_ ~
7~ 1
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
I000378 ¦UREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10088
port JUN$ 02,19B9 Application No. on file 62133889/89 N 074550
THIS CERTIFIES THAT
only the electrted equipment a dacrihed 6dow and introduced 6y tHa eppllcont nomad on the ehooe appBcation number in the premises of
HOAARD DICRSRSON, YOUNGS AVE., POLE t28, SOUTHOLD, N.Y.
in thefdlouinp location; ? Beaaesement ? Ixt Fl. ? Ynd Fl. U11T ,Section Block Lot
:,woe esamined on MAY I I , 1989 and found w 6e in cornpliartreuith [he reyuirementx of thb Board.
pXiUR! RXTUREf RA tX10RIN6 DECKS OVENS dSN WASNfES EXHAUST FANE
OUT1lTS ACVE INCANUEEClNT tlUOxElCENT OTHER AMT. K.W. AMT. K.W. AMi, K.W. AMT. K.W. AMT. N. r.
DRYS FURt'IACE MOTORS lUTLM AMl1ANCE 1'pOERS SFlpAI pC'FT iIAH CU%KS Rltl UNIT HEATERS MIAIFOUTtET DIMMERS
AMT. K. W. Oll H P, aA5 N. I. AMT. NO. A. W. 6. AMT. AMr. AMT: AM15. TRANS. AMT. N, r. t~ ~T AMt. WATTS
SRRVIQ plfWtVNtCT na.W 5 E R V 1 C E
AMT, AMr. TTt! 1XTM 1/TV 3/1W 3,I AW NO. ~~COND. Of ACWCOND. NO. Of N4LEG NO.OF NEYnA15 ~NEURAI
I X I 3 1 5
OTtNp APNIRATUS:
,c'o'C
5REVS'S SLS.I3TS. ALBSRT. LIC.1R349d'S
P.O. BOX 1268
SOUTHOLD, NY, 11971 - o1RntA~
i 11 fr"'
~ Per
This esrtificate mast not bs altered in any mamler; return fo tM office of the Board if incorrect: Impactors ma f!e identified by t it cradeMiak.
FOR BWLDING DEPARTMENT. THIS COPY OF CERTIFIG'TE MilST NOT BE ALTERED iN ANY MANNER.
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BOARD OF HEALTH
3 SETS OF PLANS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTtiOLO, N.Y. 11971 NOTIFY
/ Q? Gt TEL. 765-1802 CALL . , .7~ ~.:.5 :?.`'t y.... .
Examined ~1~4.... yL/ MAIL T0: u/~•,~ ,II,C..~z~G
19U ~ ~ df ~c /
Approved..~~~~.. ,19~~PermitNo/~~~,~~}~, ~ ,~i~ ~Z~I~~i~
Disapproved a/c ~ ~ _
. Y~ ,
~f~~ UL1~ ~Z~~aW ~ ~
~~~~~f/~~/ TOINNL(OjF SOUTF{0 0
(Bu g Inspector)
~ ~ ~'4 ~ 1F~E APPLICATION FOR BUILDING PERMIT
fOll1lMIIIgB NiI~ECf10N~
t. F~UgD/a10N l1NQ~1{lIRED Date• 15F
F01! P41NIfeCONd1!!E
2. I!t)[l1~1 -lMMIN~ ?I ~AB1Nf3 INSTRUCTIONS
a. i11SiN.11~10N
4. F1N+~I4usap~~~.~~pletely filled m by typewriter or m ink and submitted to the Building Inspector, wit
~ sets ~ ~ Ian to scale Fee according to schedule.
~-b. $tiD4lEi~f lot and of buildings on premises, relationship to adloming premtses or public str
, owe ~ei'~tion of layout of property must be drawn on the diagram which is part of this ap
c
~}y~ ication may not be commenced before issuance of Building Permit.
DE ~~JFon~~~~~ ton, the Building Inspector will Issued a Building Permit to the applicant Such pei,
shall be kept on the premises available for inspection throughout the work.
e No building shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupar
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
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buIldings, additions or alterations, or for removal or demolition, as herein descnb.
The applicant agrees to comply with all applicable laws, ordinances, buildin code, housin<ti code, and regulations, and
admit authorized inspectors on premises and in building for necessary mspe ions ~
(Signature of applicant, or name, tf a corporation)
~ q /
..~/L%~i.y~~4~.~~yys. !XdG:..~~i`~~iv~i~.~v~:~.~1.5:71.
(IClailmg address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builds
C' G4 t7 r:~ .
Name of owner of premises . ~p S~: it .1~. ~!C - .
(as on the tae roil or latest deed)
If applicant is a corporation, signature of duly authorized officer
OC~UPA~C~( OR
(Name and title of corporga7te~o~fficer) ~ry ~i~(~t~s~! 4L
Builder's License No. mss... Ey v„7~,ww
~ ~ s q i 6.~
.
Plumber's Ltcensc No ~A~
Electrician's Ltccnse No ~~~~~~!`11i~71d~
O[herTrade's License No ~~Is+t.~~~~ ~""t C'~~y
1. Location of Land on w}uch proposed work will be done f, .v.:+~
fS •
~ ~ ..lJ...
House Number Sfreet Hamlet
5 Block t/
County Tai Map No 1000 Section Lot....~.T
Subdwision Filed AIap No ,
. Lot
(Name)
2 State eeisLng use and occupancy of prom//ices and intended use and occupancy of proposed constnic[ion
a Existing use and occupancy ..~5lF(N.~ s $
. .
l
b. Intended use and occupancy - •'~t ! Y`:"' • • • • • • • • .
3. Nature of wo~rk~(check which applicable) New BuIldmg Addition • • • • Alteration .
Repair .V......I. Rem'loval ,l, , , , , , , ( Demolrtron Other 1Vork .
~[t'~RL~ /'L~I~~~ Oe5']S Nvti~ei r.•+L.~t ~-~"""I CPYx d~iT b~["Ck f~C'~k rYY~'L ~J ~61~ }C Z6~x3'C~Ye~~i/l~~~fbesenPt101
,,~~//~p~c,u L.'...~ 5/7~'<~xc/c.^r G.>i'><~( 6C~1~6.~6"~~,~'' rlN~n lfCr/ -G'C<kkY~lrc/v<%r~l~c ~,tb/~'tclYr<i~{</.Yl1r 2XCJockS
4. EsflmatedCost :'rJ.~:~l~,.~K4a~µ't<1~Saf'~4orr+ufillk~:*....... Fee
~/b;.d-ec3foFdnon (to be paid on filing thrs 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, spec>fy nature and extent of each type of use .
7. Dmiensrons of existing structures, if any Front Rear Depth .
Hesglt[ Number of Stones .
Diniensions of same structure wrth alterations or addrtions Front Rear .
De ......Height Number .
8. Dimensions of entire new construction Front Rear De
t~h ,~TAQ . .
Hergiit ...............Number of Stones . .
J~'1' . .
9. Srze of lot Front Rear yy. y~~„~ . .
10. Date of Purchase 7~~£? ...............Name of Former ~ ~~gfi.-p°
1 1. Zone or use district m which premises are situated . :y~g'!1 q'1,
yt~'~.±!p9 . ~
12. Does proposed constructron vrolate any zoning law, ordinance or regulat~o~,•,,; • . • ~IKKI'3
13. Will lot be regraded ..,fir:' . Wrll excess fill be removed~l3~91F.M!~M!l~ts ,
14. Name of Owner of premrses .............Address ...a4F.~R.`+'~i~•~~•"•
Name of Architect .....Address Phone ~
Name of Contractor .....Address Y^ ~ ` . ~44~'1~ ~ F .
15.Is this property located within 300 feet of a tidal wetl
*If yes, Southold Town Trustees Permit may be req~~i'e'd~-~~
PLOTDIAGI2AM VN 3N3 M
V;)it3N3 ,K M~URI~CMK1~ 9TaT?
Locate clearly and dtstmctly all buildings, whether existing or proposed,~,ill,in~~~#ei•b~11du>~'Si§fons
property fines. Grve street and block number or description according to deed, ~~hc~~t~eE°I rt'ST~d~3i7~Iic`~e~e wh•
interior or corner lot.
4 ~ Ewa" 3~"~. ~
~ ~0 3'r ~NaC~~- Jd ~ G
a ~ b / ~ ~ .1 kS~a ~l (O 1~ X b ~ ~ /7 1<~w...,. l7 °lv
~ _ _ _ - (2 }c 8 f-~c cat e rs l
/ ` ~ I Z. /z xb ]-aC k5 o/-+v/ e i ~~u ~-5!<~-e [~I
~ r Uf ~CW f-t ?aO~£ l,aw~[c'~ 'koc~•.~a Y~~C'x ~ ~f+Lta_1-L7 ~oC ~54,/ ~J 1 Jd0/
~ ~ ~-d l`2r1~~tG2 v~uT`F><M1~ ~o5~s
STATE OF NEW YORK, S S
COUNTY OF .
being duty sworn, deposes and says that he rs the app
(Name of mdrvsduat signing contract)
above named
Hersthe
.
(Contractor, agent, corporate officer, etc )
of said owner or owners, and rs duly authorized to perform or have performed the said work and to make and til
applscahon, that all statements cont.rmed m this apphcatron are true to the best of lus knowledge and belief, and th
work wdi be performed to the manner set forth m the apphcatson filed therewrth.
Sworn to before me this
Notary Publu, ~.4~.?~-~...... County
HELEN K DE YOE " ' '
NOTARY PtIBIIC, State of Nerr Yak (Signature of appl
No 4707878, Suffolk Co"unh~ ~
Terns Expsres Masch 30,1./