HomeMy WebLinkAbout17645-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19452 Date OCTOBER 16, 1490
THIS CERTIFIES that the building ALTERATION
Location of Property 8045 PECONIC SAY BLVD. LAUREL, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 4 Lot 14.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Applacaticn for Building Permit heretofore
filed in this office dated NOVEMBER 22, 1988 pursuant to which
Building Permit No. 17645-Z dated NOVEMBER 29, 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 ENCLOSE EXISTING RAISED PATIO ATTACHED TO EXISTING ONE
FAMILY DWELLING WITH ROOF & WALLS, UNHEATED AS APPLIED FOR.
The certificate 1s issued to ELYSE BORAK
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-065704 - APRIL 7, 1989
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
roan xa s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(fHiS PERMIT MUST BE KEPT ON THE PREMISES UNT{L FULL
COMPLETION OF THE WORK AUTHORIZED)
Nn 1,17645 Z Date .~G
..?'.f l9. ..f1
Permission is hereby gra ed t ,
~
ct premises located at ....,r~...Q/l`,.~ ......7..-..~r.~?'1.~. ~~....,~'J..
. ...........................tf.G.^eL'~.
r.'~........ . .
Caunty Tox Map No 1000 Section Block Lot No......1~
G{~ t..
pursuant to application dated 19.d Cl, and approved by the
Building Inspectar.
Fee S
C-' y7~=~" .
~~~~6'~Iding Inspector
Rev 6/30/80
n ~ ~ Form Na. 6 7~~ .,,,'`J/
`~J( ~ ~ ~ E t i TOWN OF S031TflOLD / ~
~~i` BUILDING DEPARTMENT ~
i.? TOWN HALL c,L
' - ,,~,-Q 765-1802
B(_DG T ,
TOs~'Jn'f~%`- ~ -'"pry
APPLICATION FOR CERTIFICATE OF OCCUPANCY
.1. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
L. 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 Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1Z lead. ~
' S. 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.
8. For existing buildings (prior to April 9> 1957) non-conforming uses, ar 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 o£ 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. L'puated Certificate oY Uccupancy - $50.00 ,
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
::ew Construction........... Old Or Pre-exis~{ting Building
Location of Property....... .7~.~~G~~.,1:1:~~/Q.~~~~.~':.~,~
House• o Stre//et Hamlet
Onwer or Owners of Property....~Ir~-?.~....~ d!t ~ ~
County Tax Map No 1000, Section ..............Block................Lot............._........
Subdivision...+.^.~.... r ........................Filed Map........... ot..............._...... -
Permit No..~ ~ ~ ~ ....Date Of Permit. Jf . ~.....Applicant~ ' ~
~ ~rf-_
tealth Dept. Approval. ...................Underwriters Approval.........................
Planning Board Approval....~.~
Request For: Temporgary Certificate........... Final ticate........... ,
Fee Submitted: r
6Z.~.~IOFQ~
C0~.19N~~- APPLICANT
'l~ ~IS~
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACt<: 1
IU25U33 BUREAU OF ELECTRICITY
BS JOHN STREET, NEW YORK, NEW YORK 10038
Date 4PR11, U"1,73)$N APPBcationNo.onflle 61092989/$9 N U65'TU9
THIS CERTIFIES THAT
only tka aleetrlcel puipment as dsecrihed 6eloLO and introduced 6y the oppftesnt named on the aAoee application numhar in the premiwe of
BORAK, N/S PF.CUNIC BAY BLVD., /POf.£Y31, NATTITUCK, N.Y.
in thefolbtcinp lutrotion; ? Basement ® lst Fl. ? Ynd F1. .Sertion Block Lot
uNU examined on NARCH 17 , 19$9 and found to 6e in compliance with the reyuiremenG of thu Board.
gXriRE AGEi f!lHg1R5 RXTURK RANOES COOKING RECKS OVENS DISHWASHERS EXHAUST FANS
OUTIlTS INCANDlSClNT PlUOeltClNf OTNER AMT. K.W. AMT. K. W. AMT. K.W. NAT. K.W. NAT. N.P.
6 4 6
DRYERS RIRNACE MOTORS IVTWf AMIIANCE gM0lI15 S/lCIAI REC'?T TtAIE CIOCKS WNT NEATNS MULTI-0UTIET gMMlRS
AMT. K. W. OIL K P. GAS N. P. AMT. NO. A. W. G. AMT. AMI. AMT.' AMPS. TlANS. AMT. N. P. SYSTRMS AMT. WAT15
NO.OF iRT
SRRVICE DKCONNRCT NO.O! S E R V 1 C E
AMT. AMI. IM ~ 1 / ]W 1 / tW ] / ]`N ] / AW KR dCOND. OP ~
COND. NO. OP NFLEG ~:LLGC. NO.Of NFUtKAlS ~ ~I
Flf~Ul
OTHER ARMRATUS:
JXri18L1: LAMP SNLrRAR}:D BATR CEIi,1N6-L
moo'(
RANK'S E1,~CTR1C LIC.N26'15 E
12] SI{E)!:P PASTURE.' kD
SETAURET, NY, LL733 OBIIIRAI/
11 / '
Ptr
This carKficate must not be aherad in any manner, return fo 1F;e office of the Board if incorrect. Inspacron may be identified by their rndeMiols.
COPY FOR BINLDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER.
srrr,~, TEL. ?GS•18r,?
v
Olk~cL To~~rl or socr~o~.D
,?`'/~~~,yu ~ or•1~ICE c)r• ~u1tnFNC trrsrECrott
°J;,~[~~•r4 = I'.O I3OX ] 179
'„-~dl''~,~i'~'~ ~ TONN IIALL
'~~,y Q~ SO[JTFIOLD, N.Y. 1 1971
"''~'~l r~a 7~~
MARCH 3, 1484
To F•7hom T11is May Coriccrn,
47e arc unable to complete your Certifs.catc
of occupancy because oL the follo«ing reason:;.
An application for Certificate of pccupancy
iS not on f13c. ENCLOSED
-
/X7C No Under~•~riters Certificate on file.
/XX The checF: L:. (rnit<latecl/rut on file.) $25.00
Dlo 1lea].1.}l Dept. Approval on tile.
C:o :final ~nsl-~ect.ion has hee[t made.
Plc:asc contact our office on this matter.
Thank you For your cooperation.
lluil~]u.q Pcrmlt- jk 1 7 6 4 5 Z ELYSE BORAK-ALTERATION
IIuilc3inq Dcpt.
}~k/ / ilo Plumber :;older. Certificate on L-ile.
( a] 1 pn.rr~its in~•oly~ ng plum}~iny briny
insuc8 after ,1pri1 1,1984 )
h
SENT T0:
ROBERT BOHN
BOX 55
Peconic, N.Y. 11958
M+WitnYILY
-1::LD LI~J.LIi~~u;~ ~~Uh,c COMMCNT°
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ItJSULATION PER N. Y. . •
STATE ENERGY
CODE ~ ~
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ADDITIOtIAL COMMENTS: x
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765-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION i5T ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ] FINAL,--~
REMARKS : C.-~/
DATE y INSPECTOR
i
~1~~5
765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ~ ROUGH PLBG.
[ ] FOUNDATION 2ND [ }INSULATION
FRAMING [ ]FINAL
-~9- .
REMARKS: ~o
~ ~
DATE ~ ~ ~ INSPECTOR
~ S
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( j ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ~RAMING [ ]FINAL
REMARKS: R~~r~-,.~ 'ti
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DATE ~ ~1 INSPECTOR /
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. BOARD OF HEALTH
3 SETS OF PLANS
~ FORM NO.l SURVEY
' TOWN OF SOUTHOLD CEtECK .
BUILDING DEPARTMENT SEPTIC CORM
' TOWN HALL /,rtes ~,y~
SOUTHOLD, N Y 11971 NOTIFY ~
TEL.. 765.1802 CALL
~~qq MAIL T0: ~(T- 11
Examined 9 190..`!
Approved l1/~.... M.. , 1`X/U Penrut No. l ~ ` ~ ~ ` I
P' r
Duapproveda/c
1~ ~ 2 I~ i!
i
TOWN OF SOUTHOLD
wldmg Inspector)
„ APPLICATION FOR BUILDING PERMIT ff
' Date
INSTRUCTIONS
a. Tlus applicatton must be completely filled in by typewriter or in ink and submitted to the Building Inspector
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 adlommg premises or publi~_
or areas, and giving a detazled description of layout of property must be drawn on the diagram which ~s part of th
' capon.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this appluatton, the Building Inspector wdl rssued a Budding Permit to the applicant. Such
shall be kept on the premtses available for inspection throughout the work.
e. No building shall be occupied or used in whole or to part for any purpose whatever until a Certificate of Occ
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Btulding Permit pursuan
Building done Ordinance of the Town of Southold, Suffolk County, New York, and other appltca6le Laws, Ordina
'Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein de-
The applicant agrees to comply with all applicable laws, ordinances, in de, houstn code, and regulations,
admit authorized inspectors on premises and in building for necessary spectiO /
(Sign Lu~rje'-oi ap~phc$anllt,~/,ccor name, if a corporauo
~O /gO~c.. ; 5-~~~CO/G/C i
.
• ~ (A1a~hng addre of apphcant)
State whether apphcant is owner, lessee, agent, architect, engineer, g eral contractor electrician, plumber or b
Name of owner of premises . 1~-~-~. ~c.J.Q.~~. /`•X• ~ .
(as on the tav roll or latest deed)
1f applicant is a corporation, signature of duly authorized officer.
. . .
(Name and title of corporate office~r,)C
Builder's License No. Y •
Plumber's License No .
Electrician's License No . .
Otter Trade's License No . .
1. Location oC land on which proposed work will be done . .
House Number treet Hamlci
County Tai A1ap No 1000 Scchon ~.°.0• ~ • Block ....9 Lot ..~.7":.
Subdivision Filed Ala}~ No Lot .
(Name)
2. State eustmg use and occupancy oC prenus?es and intended use and occupancy of proposed construct~on•
a E~c~sttng use and occupancy • L ~~;1,"s~/,GGI,R%.t....... .
b. Intended use and occupancy - • rr• • • • • • • • • • • • ~ • • • ?r ~d'~
g, Nature of work (check which applicable) New Budding Addrt[o • - r• Altcrat[on
Repair Removal Demohtton • Other Work ~ .
(Dcscnptton)
. Z, Gr'7~''I>.
4. Est[matcd Cost Fee • . . . . .
(to be pa[d on filing thu apphcat[on)
5. If dwelling, number of dwelling units . Number of dwelling units on each floor .
Ifgaragc.nuntbcrofcars
6. If bus[ness, conunerc[al or coned occupancy, specify nature and extent of each type of use .
7. Dmtcns[ons of e~[stmg stn[ctures. [f any Pront . Rear . . Depth .
He[gltt NuntbcrofStoncs
D[mcns[ons of same structure w[th altcrat[ons or additions Front Rear .
Depth . lle[glrt ..........Number of Stones .
8. Dunens[ons~of
cntuc new censtruction Front . pth
Rear De
Hc[gltt . Nu[ttbcr of Stones .
9 Size of lot Front . .
Rear Depth
10. Date of Purc}tase .....Name of Former Owner .
1 I. Zone or use dtstr[ct to wkt[clt prem[ses are situated .
" 12. Does proposed construction violate any zoning law, ordinance or regulat[on .
13. 1Vd1 lot be regraded .........~(.a...... W[il excess fill be removed fro ,~rejm[ses' Yes N
14. Name of Owner of premises ,1=~/.S..°;', ,/,~~?f?f?~frddress .,.~C~.G~:!f ~!'.°1/ ~tt or~No .
Name of Arch[tect ..Address _ ...Phone No .
_ _
Name of Contractor . ~ ~ . ~ e?r. 3,~ '~D'`'`i'hone No. 7. f~ ~
:
, f .
~f~.....~... N........ Address .
IS.Is this property located within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM ,
Locate clearly and distinctly all buddmgs, whether existing or proposed, and, indicate all set-back dimensions fra-,
property fines. G[ve street and block number or descnpt[on according to deed, and show street names and rnd[cate whethe
rntenor or corner lot.
~,~f/ j<<.S Ti.~ c, ~ S' ~~'G'J /~a/L G /i Goic.- c !2 T~-
~u fir' aS,E" Sun. ,/2oo~c ~ ~RTio ~.~~~r1S,erC/c
S~~ ~GoT- g~~f1~E
7-od° d r/F/z Pd aec h
PoFch
22 i
.S
STATE OF NEw YORK, ~~o ~ r
COUNT' OF S S
being duly sworn, deposes and says that he is the appl[car
(Name of utd[v[dual s[gnmg contract)
above named.
Hetsthe
.
(COntie(.tOr, agent, corporate off[cer, etc.)
of said owner or owners, and [s duly authonzed to perform or have perfomted [he sa[d work and to make and file th
apphcauon, that all statements contaa[ed m this apphcauon are true to the best of fits ].nowledge and belief, and that tt
work w~l be pcrtonned [n the manner sM forth m the apphcat[on filed therewith
Sworn to bctorc me the
rr'
p~~. .dayyy of . 19 d~d
tiotary Public, n...~~. 1~/~:.... County ~
r, Ca,~'~,~!L~~ .
NEtENKDEYOE 7 S[^naturc of a
N0T4RY PUBLIC, Stale al New Yak ( ~ PPhcan
No 4707878, Suffolk County
Ferrn Exmrea kkrch 30,19__