HomeMy WebLinkAbout17644-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19690 Date JANUARY 29, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 1080 PINE NECK ROAD SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 8 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 10, 1988 pursuant to which
Building Permit No. 17644-Z dated NOVEMBER 29, 19$8
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 & DECK ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to BESSIE LaFRENIERE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-170098 - JANUARY 18 1991
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1/81
!'OSM 2Q0. f
" 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 X17644 Z Date ../~P t9.~~'
Permission is hereby granted to Q ~
to .
. ~r~......,.
of premises located at .....rQ. ..lJ.......(...G~t~..... ~i~P.`1~ .
~b~~G:~...
.........GG.............................. .
County Tox Map No 1000 Section Block ..........at........ Lot No , 0,,,
pursuant to appl~cat~on dot ~Q )9G~8 and approved by the
Eiwldmg Inspector. ~ ~9/~~
Fee ~v
L~
i~~/ B in I to
Rev 6/30/80
l
FORM NO 6 ~ ~j~'' J
TOWN OFSOUTHOLD ~ ~ 0~
Building Department
Town Hall
Southold, N.Y. 11971 TOb`JN OF SOUTHOLD
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted to the Budding In~ec-
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.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate 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 ex~stmg buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses
1. Accurate survey of pxaperty showing all property Imes, 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 $25.00
1 Certificate of occupancy New Dwelling $25.00, Accessory-$]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5 . 0 0 , over 5 years $ 10.0 0
4.Vacant Land C.O. $ 20.00 ~Q
S.Undated C.O. $ 50.00 Date .3. Z'.'. 1...........
NewConstruction„~, Old or Pr existing Budding Vacant Land
c ~J
Location of Property +.8..i . !.!J~..~4TCIt. r~A...~?o J,"r.a4q.4
: , ,
House No. Street Hamlet
Owner or Owners of Property S 3 ~ t:=, L A e~ ..a i e2'n-V"'
County Tax Map No. 1000 Section .Block Lot ...'~ri .
Subdivision .....Filed Map No~3!3 p . !...Lot No. ~ .
Permit No ~ 1 4'. Z Date of Permit Applicant ..!4-.! !r:l.~~. ~ V ! ~ A ~'~"S
Health Dept Approval !J ! . Labor Dept Approval ~ f ~ .
Underwriters Approval ........Planning Board Approval .
Request for Temporary Certificate .Final Certificate .
oat
Fee Submitted $ Z~..°... ~7...
Construction on above described building and permit meets a icable ccodes and regulations.
Applicant
a~ m-ioae
Qs-c,,'~11 ~1
co ~ 1~~0°Io
THE NEW YORK BOARD OF FIRE UNDERWRITERS YAr,F J
100109;1 BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK 70038
Date JANUARY 18,1.991. APP/icotionNo.onfUe b0103989/R9 N 1'101792;
THIS CERTIFIES THAT
only the electrical equipment a descrihed 6ekns and introduced 6y the applicant named on [he ebooe application numher in the premises of
11ESSIF; LA F'RENIERE, '10811 PT.NEN~ECR R2AD, SOUTHCH.D, N.Y.
in the following ktcation• ? Basem.ent L'~ /st Fl. ? Pnd Fl. Section Block Lot 9
JANUARY 1.4,1991
was examined on andfound to 6e in compliance with the reyuiretnents of this Board.
AXTURE RXTURES RANGES COOKING DECKS OVENS qSN WASNlRS EXHAUST FANS
OUTLETS ECEPiAClES SWI7CNE5 INGNDESCENT NVp1ESCENT OTHER AMT. K. W. AMT. K. W. AMT. K.W. AML. K. W. AMT. H. P.
I 5 2 1
DRYERS FURNACE MOTORS NiURE APPl1ANC! tEEDERS SPEgAI R!C'PT TIME CLOCKS Yll UN17 NEA7ER5 MUlil-OUTLET gk1MERS
AMr. K. w. at N. P. cAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. /VAT. N. P. SYSTEMS AMT. wATTs
NO.Of RET
5lRVICE DISCONNECT NO.OF 5 E R V I C E
AMT. AIM. TYPE EOlll?. 1 y 1M' 1 / tYY' 3 9 aw 3 X Iw OYFR BLOND. OE CC. COND. OF NI-LEG Of ~ H 'LEG NO. OF NEUTRALS OP 'NEUIOMAI
OTHER APPARATUS:
/
GARY AOROSK1 LIC,M2941-E G!~~~
A25 NONSF.LI, LANE
('tlTClf()L:UE, NY, 17.935 ONitlILL MANAGER
t1
Per
This certificate must not bs 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 OF C TI N:ATE MUST NOT BE ALTERED IN ANY MANNER.
TEL. 7G5-i 802
~p , Op TOWN OI' SOUTIIOLD
,F~~`~ y~c 01TCICE OF BUILDING INSPECTOR
o Je w~~: ~z., P.O. BOX 728
~ TONN HALL
SOUTiiOLp, N.Y. 11971
y0I ~a0 nngasc 20, 1190
Romeo Builders, Inc.
Boa llll
Southold, Hew York 11971 -
RE- BESSIE LaFRENIERE _
To 4ihom This May Concern, ,
We are unable to complete your Certificate
oi- Occupancy because of the following reasons.
An application for Certificate of Occupancy
is not on file. `
/l/// No Underwriters Certificate on file.
Tlie check is( /not on file.}
No f[calth Dept. P:pproval on file.
No Linal inspection has been made.
' PleZ~e contact our office on this matter.
Thank you for your cooperation.
Building Permit ~ I 7 6 4 4 Z
Building Dept.
No Plumber Solcter Certificate on file. '
( all pcrtnits involving plumbing being
i~sucd afLcr 11pri1 1,19B4 j
N
r
.
l 7 6 ~
acs-iso2
BUILDING DEPT.
INSPECTI®N
[ FOUNDATION i5T ( ] ROUGH PLBG,
~~o cf~
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]-F~I-N-AL
REMARKS: ~~-ti1~t o~~aerf',C.m~ D ~ ,
DATE 12 t q 8'Ss INSPECTOR
765-1802
BUILDING DEPT.
lNSPECTlON
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
FOUNDATION 2ND tNSUI.ATION
[~RAMING ( ]FINAL
REMARKS: ,-.~r4~Ca (M
C
r
DATE a d INSPECTO
T65-iS02
BUILDING DEPT.
INSPECTION
[ )FOUNDATION i5T [ ] ROUGH BG.
[ ] FOUNDATION 2ND [ SULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~
DATE ~ ~ D INSPECTO®C~l
765-1802
BUILDING DEPT.
G~ ~
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FINAL
REMARKS:
D
DATE INSPECTOR
-1::LD ILS:'cC==U;J IlUrtic ~I ~OMMGNT~
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ISSSSSLATIDhS PER N. Y.
1
STATE ENERGY
CODE
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FIiIAL
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ADDITIOh1AL COMMEPSTS: ~ ~
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p+vibi6M-GMi4gCjo fiflc Insctrctt-tC.c GA.
Seale: ~4G~=1'• and +FSe Sovtieoid Savings 13pa•ftt as
~ o= irt3vi AipG SvrJeyed -•.June > t97).
~ i3 = i4tG~ttUy4tGtt~' Vat1 tuy4 f SaH
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titcn~ed txlnd SvYV aYs
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tOHM NU 1 St1RV6Y
t ~ TOWN OF SOUTHOLD c-nt:tic - -~%4
i BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTrFY
TOVUBN OF SOti
HOLD SOUTHOLD, N Y 11971 CALt, • -)3y~ - ~'sY ~r -
TEL 765-1802
MAIL T0:
Exainuied ~ , 19~G1
Approved , ly7 r! Permit No ~7~~~~ p "'I
l / ~ a9~~
Disapproved a/c . .
f/~f ~ ,
ildmg Inspector)
APPLICATION FOR BUILDING PERMIT
Date , 19
INSTRUCTIONS
a This apphcatton must be completely filled in by typewnfer or m ink and submitted to the Building Inspector, with
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 adaommg premises or public street
or areas, and giving a detailed descnption of layout of property must be drawn on the diagram which is part of this appl
capon
a The work covered by this apphcahon may not be commenced before issuance of Building Permit
d Upon approval of this apphcatton, the Building Inspector will issued a Building Permit to the applicant Such perms
shall be kept on the premzses available for inspection throughout the work
e No building shall be occupied or used ]n whole or m part for any purpose whatever until a Certificate of Occupant
shall have been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Butldmg Department for the tssuance of a Buffdmg Permit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Regulations, for the constructron of buildings, additions or alterations, or for removal or demolition, as herein descnbed
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t~
admit authonzed inspectors on premises and m building for necessary i~}specttons
(Signature of applicant, or name, if a corporation)
(Malting address of applicant)
State whether applicant is oo`wner, lessee, agent, architect, engmee~ general
con-- tr electrician, plumber or builder
Name of owner of premises D2S.~t6... . ~c~F recx 1e't'?~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authonzed officer
. /`~.~C ~ . ~ .
(Name and title of corporate officer)
ALL CONTRACTOR`S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No ~ 3 ~ S 3 .l'4 ~
Plumber's License No
Electncian's License No . .
Other Trade's License No
i Location of land on which proposed work will be done
House Number Street Hamlet
County Tax hiap No 1000 Section 7 o Block ~ Lot . a ~
Subdivision Filed Map No 3 ~ Lot y
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction
a Existing use and occupancy c7~^-` ~~-:~^~-~~`l ~~?s-~`"^'~
b. Intended use and occupancy .uu-v- ~sFw-,JL~ e~-~-'-t-~.~u^-5 ac~'.o2FP~e-4?~5..
3 Nature of work (check which applicable) New Building Addition Alteration
Repur Removal Demolition .OtherlVork
(Descnplion)
4 Estmtated Cost ~ ~'jO Fee
' (to be paid on filing this application)
5 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 DmTenstons of existing structures, if any Front ~ `Y .Rear b Y Depth . ZZr . .
Height 1 Number of Stones
Dimensions of same structure with alterations or additions Front ~y Rear . 6 . .
Depth ~ ~ Height . ~ . Number of Stones l
8. Dimensions of entire new construction Front ~ Z ~ Rear .I 7t.. Depth if `
Height ~ ~ t _Number of Stones . ! . .
9 Size of lot Front ~,DS r`j~r Rear .l°~ ~R~'. Depth 15.E `Z,p.
10 Date of Purchase Name of Former Owner
1 1 Zone or use district m which premises are situated
12 Does proposed construction violate any zoning law, ordinance or regulatron N~?
13 Will lot be regraded N~ Will excess fill be removed from premises Yes
14 Name of Owner of premises Qass,~. 1.~, FCF-w`e~ .Address . ~1~.N~~ 2.t.S~ Phone No ~~5~,
Name of Architect Address Phone No . _
Name of Contractor C~.owr-~ ~~r-~~~~ ...Address ~~F 1}«. Sa~.*.:t-rt•~ Phone No. ~6t'2-G75.
15. Is this property located within 300 feet of a tgidal wetland? *Yes No .X,,.
*If yes, Southold Town Trustees PermitPLO~ DIAGfZAM ed.
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property fines Give street and block number or descnption according to deed, and show street names and indicate whethe.
tntenor or corner lot
St¢ w`c,~
STATE OF NEB' OR ~ S S
~OLNTY OF
I
'~,~~~r ~ ws-.,.7 being duly sworn, deposes and says that he is the applican,
(Name of indn idual signing contract)
toove named tt
ie is the 4r~7~ 1`~~
(Contractor, agent, corporate officer, etc )
~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi
ipplication, that all statements contained m this application are true to the best of his knowledge and belief; and that th~
Nork will be performed m the manner set forth in the apphcatton filed therewith
Sworn to before me this ANN R OLSTAD
_ NCTA RY PU2LIC, Rata of New Yo
~ ~ ~ day of ~~'h,-.yU-f 19gU N= 4%~az2~
- ' i~a'ihed m Su1fo!k County
vota>~}•~ Publ ~ t-~.~--~o ~ ~ County a
~i, ~ .f' ~i~; ~~9 rz.,~ rte..,---. .
(Signature of applicant
4,