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HomeMy WebLinkAbout17159-z _ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19124 Date JUNE 8, 1990 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 450 PRIVATE ROAD #17 SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 81 Block 3 Lat 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 21, 1988 pursuant to which Building Permit Na. 17159-Z dated JCINE 24, 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 & RENOVATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANNE & MARK S. McDONALD (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING - JUNE 7, 1990 PLUMBERS CERTIFICATION DATED JUNE 7, 1990 - MARK S. McDONALD- Building Inspector Rev. 1/81 1 ]P08M NO. A TO1NN OP 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) nJ~ 017159 Z Date .........~...~/.Y.I.R~..a~ 19°. Permission is hereby granted to: X30 ~..,.I..a s~ .....~.:y..s..~.~ ~.7.~.... ee ~ • at premises located at ~ uV'. ....~?:?~!~a,Pr...~.. . Caunty Tox Map No. 1000 Section ......Q..B.~....... Block .......fl..`,~...~.7. blot No.....~ pursuant to oppllcotion dated ....~i1..1!Y.ll~..a~•.•• 19.Q..Q., and approved by the Building Inspector. Fee ?~.a~.:.. ""SS Building Inspector Rev. 6/30/$0 ~a ~~g Form No. 6 VA~~~ BUOILDING DEPARTMENT ~ ~ ~j~~ TOWN HALL ~UN r _ 765-1802 - - ° l31.t)Cb. tt)tl iC3f._q TOVy~f~ ~JrM"":""',,.o-sue.^' APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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: 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 Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1~ 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. 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 Oertificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00/, ~mm rcial $15.00 Date lJ. C~. r~~U New Construction...... Old Or Pre-existing Building......\.....(. {t I,ecation of property...~.~'I'rJa...........~3:tJ~l.,;~:2~....~?...........J0C~+~10I~............ House No. {1~ -SMtr~,eet ' / Hamlet Onwer or Owners of Property..~~?~ C.; ~r:~. r;~~~'A.~y County Tax Map No 11J000, Section.... ~~Block.....~........Lot....G~ Subdivision.....11..~1•'~ .Filce~d Map............Lot...................... Permit No...I.~J 5~....Date Of Permit..`/~~~v~..Applicant. Health Dept. Approval...~~A . ...............Underwriters Approval......................... - Planning Board Approval.....'.Y/.'~`~ ' Request for: Temporary Certificate........... Final Certicate.,/ Fee Submitted: ~ S Q,~ee,. 39 7 D,3 . ~ ~ ~ APPLICANT TEL. 7GS-1802 oS~~FOL~ ~Ol~' TO[~IPI 4~' S(3tITIIOd.33 f ~ OFFICE OF BUILDIt•IG INSPECTOR ^1~~ ~ ~ - 1.::~"~ P.O. BOX 728 '(J` ,,.,.`~.••s.-y..,-,~q ~ . °r, -~"!`m?~' TOWN HALL , i .,Q~~OI ~ SOUTHULD, N.Y. 11971 ~ ' BLDG. DEFT. TOWN OF 50UTHOLD C E R T I F I CAT I O N Date ~ ~ Building Permit No. ~ / f~_ Owner mA f ~ . Y~~NA~G~ (please print! P1L.;Wer~'~~AS~ S M~ ~ d(1~~ (please print) I certify thaC the solder used in the water supply system contains less than 2/10 of to lead. - (plumber's signature) Sw~ryn~ to befor^_ mme^ this ( "~`~dny of 1 ~V~-e_ ~ 19 ~U . Notary Pub il°~c i- 274tary Public, ~Ll`~~ 1 Fi County ~LQ~ ~Na 4850 CoN~?14Mh QonwnlaEgrke~sOsoamMt 8,1Y,S.~ ~,tr:'-rn:r,;- TEL. 7G5-t F,0? ~~\FFOIk ~ ~ l.`ca 'I'!~~t~N (3r' S()TJTIIOI.~ / , C16~,:v1b~p2t~~ Orl'1CIi Ol~ fiUILUING IIJSPECTOR ~ .';a~)~ a-' P,O. 110X 723 ; R1 wok .~1,t~~~ r 'l'Ot{ N 11AL.. t', ,y <•~r SOUI'IIO..U,N.Y. 11971 n J ~ ~(I 'i~:~ April 30, 1990 Mark McDonald _ Box 1258 Southold, N.Y. 11971 To P7hom This f4ay Con :ern, t t•,'e arc, unable to complete your Certificate ' of Occupancy because of the following mason:,. An ,-application for Certificate of Occunancy is not nn file. (13NCrOSSD) /_-?1 CIO Unrler:aritcrs Cert-i£icate on file. 1~`I'he check is (cl(~t3'c~ilnot on file.) $25.00 i.n 'tealth Copt. Approval on file. L'a final in;:pect:ion has been made. _ P]enne contact our office on this matter. Thank you for your. cooperation, Building Permit 1E 1 7 1 5 9 2 *""iw'1 11o P1!:mbcr Solder Certificate on file. ( all permit:; involving plumbing being i~:;ue<1 after April 1,19II9 r'li:LD Ii:S:'~CTIU;J ~+UkTE ~ %OaKhlEN7S --~--f d Y \ H u`) _ _ .,,p FOUS]DATION {1st) c FOUNDATIOW (2nd) _ c~ 2 . ~ it, z P,OUGH FRAME & ~ ~ PLUMBIN~ V ti ~ 3. ~ ~ b ISJSULATIOPI PER N. y STATE ENERGY y, _ b CODE ~ A ti o c H FIidAL r_ ADDITIONAL COMMENTS; uo . - I c~ x ro•~ N H H ~ O z x c~ A r ~ H x ~ rh ro H I S C T4iE NEW YORK SOARD OF FIRE UNDERWRITERS # ,,(~rT~r~d BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10036 (li3S~N; 2(l,.1K3913 ~+R2fJCl5~g(8t3 a+l 2.bt~T3t7 Date Application Nu. on file I ti THIS CERTIFIES THAT onfy [he electrical equipment as described below and introduced by the opplicont homed on the above applicotion number in the premisda of ~1d6I~ & "MARK iYt°Uti~1:T,i~, 1>falVtl't'R' Rl',/P11t~f37.~' PY',R17_, 5l>i)T(LcIS,Ur PJ.Y, in the ollorcin lxot' e ent ~ /st F'f. ~ 2nd Fl, Section Block Lot f a ,`R~VF; ~.la'~~ ti uws examined mr arzdfound to he in conrplionre uith the rwyuirernen is q/'this /toard. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLVORESCENi OTHER AMi. K W. AMT. K W AMT K.W AMi. K W AMi. H P, I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEOER$ SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET' DIMME $ AMT K. W. Oil H. P. GAS H P AMT NO. A W. G. AMi AMP AMi. AMPS TRANS. AMi H. P SYSTEMS qMi. WAITS NO.OF FEET t 3 M ii L SERVICE DISCONNECT NO.OF S E R V I C E • AMi. AMP. TYPE EQU V. 1.9' 2W 1 ,e' 3W J,B' 3W 3,9 CW NO. OpER ~COND Of CC. CONp. NO OF HI-LEG Of ~M LEG NO OF NEUTRALS 0 ANEU RAL OTHER APPARATUS: ` K3.T4'f{k:Af,t,,t'V~ R1~2. RF;1? R_PY. Al`l', (}I+3t,Y°~~ 'PItAC'K Llt~H'TLIVtr;-°1 l.. ~S~R ~R;Lf+;C'1'R7C !,'tC.fk35f~6^P) rliNaiifRY R(ifll,i'1VTK t'., 'iftilUidt)Otl R,L~;i2T} GENERAL MANAGER fln~fl,f'tiLAU(:h;r PTY, 7J.7A21 7t Per This certificate must not be altered in pny manner; return to the office of the Board if incorrect. Inspectors moy be identified by their credentials. COPY FOR BUILDING DEPARTMENY. THIS COPY OF CERTIFICA7 MUST NOT BE ALTERED IN ANY MANNER. l 71 rss-is®a ~aurI.DING DEPT. 1 NSP'ECTIQN [)FOUNDATION 1ST [~j OU PLBG. [ ]FOUNDATION 2ND INSULATION [ ]FRAMING [ ]FINAL ' REMARKS: _/O~-~ c,~c~~ t~ ~'j /jy~~ 4 1 DATE ~ ~ ~~t INSPECTOR ~j 765-1802 BUILDING DEPT. 1NSPECTIC?N [ ]FOUNDATION 1ST [ ~OUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL / r q REMARKS: ~Jk . ~~`v='v - ~ I i _ r l 1 v INSPECTOR / DATE 4, . u fl , `r 1~/~~ 7ss-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 SULATION ING FINAL [ a FRAM [ REMARKS: f k f G l l ' DATE ~ INSPECTOR i _ ~ ~ BOARD OF HEALTH 3 SETS OF PLANS FORM N0. 1 SURVEY . TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL uOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765.1802 CALL a ~S D, . MAIL T0: Examined ~ 19 $ B • ' Approved 19~~. Peermit No. ~ ~ ly~ ~ ~ Disapprovedaic p~ ' BLO©. E7'T ~ TOWN OF SOUTFYbLD (Building Inspector) , APPLICATION FOR BUILDING PERMIT Date 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 specti (Signature o applicant, or name, If a corporanon) (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..t"lN~.~.•~~ f'l~r~" •~~-.V.d!~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. ~~ZgQ~~ Plumber's License No. 2~.~•/~-7~ • • • • • Electrician's License No. . • ~ • • • • • • Other Trade's License No . . I. Location of land on <w-h-i~c~h proposed wor ~'1'S7b~e d-ocn-ems. ~..1.... ~.•t.•~......r. ^.~..~............t . , . YJ-(.V:?~~~ .4+~'r i'/Jl'-ria~SC lO.tw'I'.. ~F.•... ~Z3~-Y1~~GI......... . House Number Street Hamlet County Tax Map No. 1000 Section ~ Block Lot ...I.~ . 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 ..~C ~~m~~l} • • • • • . b. Intended use and occupancy . • •J•1 • • • • • . ~ . 1 3. Nature of work (check which applicable): New Building Addition ..K....... Alteration . Repair Removal , . , Demolition ..............Other Work , . (Description) 4. Estimated Cost Fee . 5. If dwelling, number of dwelling u (to be paid on filing this application) hits t/ Number of dwelling units on each floor , „ , , , , , , , , , , If garage, number of cars 6. If busi ess, Commercial or mixed'occupancy, specify natule and extent of each S,ype of use . . 7. Dimen P B exiting structures# if any: Front , , ~ Rear , Depth : , , , , , , , , , Dimensi s of t..c.~rNeu`ml~er of Stories Z . h alterations or additions: Front Rear i~ . A } Hei h ! Num .Height ...7r.~ Number of Stories . 8. Dimen + of entire n~~c'o~nst ~ction: Front . Rear , Depth , , . h~,,,~~.-. . g er of Stories , , . . . 9. Size o r'nf Rear . epth . 10. Date of Purchase ..t.~2.~''J.r~1~ . . . . . . . • Name of Former Owner Ab6!"'F . J1~'NM 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: .hCT . g 14. N unle of Owner o d remises , ~ • ~ ' ' ' ' Will excess ~fil_l `b.e removed ro mises: Yes ' ^'n~e.~•.rno!•k-~"ddress ....~tX. 1T.S,$..... o e No. s'16'~ 2~~~ . N•une of Architect~r4!nt~$,`~ 5-tps(mo+.., . , , , ,Address ~?+!~.~rd.C:wlY.l~to~,R-Phone No.,.t le~~..~k~.~?.. , N<•mte of Contractor~YaCl.~ ~Vw.Tl~?t", . , , , , , , ,Address ~0~~?*DO.~'i. ~?j..... Phone No:JP~.3i 3:5~j.:.. . ~ PLOT DIAGRAM ~ Locate cleazly and distinctly all ,buildings, whether existing of proposed, and, indicate al] set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and htdicate whether+ interior or corner lot. STATE OF NEW YORK, S S • • • F ' `~`J~ • "~+'g 1 • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual si n'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 mannet set forth in the application filed therewith. Sworn to before me this .day of',.. , 19 ~!P N(ot~ary Public, ~ , , County ~INDA'J. COOPER • . NNo 4822683 Suffo k CB uo nry~~ (Signature of applicant) Term Expires December 37,18.