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HomeMy WebLinkAbout17174-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217687 Date JANUARY 18, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING. Location of Property 4240 N. BAYVIEW ROAD SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 079 Block 02 Lot 3.1 Subdivision JAMES DAWSON Filed Map No. 7987 Lot No. 1 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 23, 1988 pursuant to which Building Permit No. 171742 dated NNE 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 ONE FAMILY DWELLING, WITH DECK AND ATTACHED GARAGE. The certificate is issued to MARIE SAYWELL (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-83 JAN. 1S, 1989 UNDERWRITERS CERTIFICATE N0. PENDING SLIP 1/6/89 PLUMBERS CERTIFICATION DATED MC SHANES PLUMBING 12/26/88 _ Building Inspector Rev. 1/81 nowt xo, a TOWN 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) No 017174 Z Date ~.,.u.->~....a9 ~9:~. Permission is hereby granted ta: ~e.:...~....... x..~. ~ . ~..A.,Q~!:,~c~..... ti 1.q~'~. r to .4%i^~r,~A.:u:..~...s'a......~...~QH:ka~A~....~.4!:a'.?Xr~'!'.`~.}..4:t.M-rR.......1.. at premises located at ................~.:........`~~(............~.........~.~:t~!~'~.4`~--................ ~:~.~..~.a-~:A....~.~.qqx1,~-~ County Tox Map No. 1000 Section .....0.x..1....... Block ......~.2-:,..... Lot No.....!~.~...,.......... pursuant to application doted ........~~l.e.rrma..,.•..c~.o'~•• 19~p..., and approved by the Building/I I~n^sp~ector, Fee $...4R.S c?.!.. . Building Inspector Rev. 6/30/80 u. f,~ „a L~ t ~-~..~a-~:~,~~~ . FORM N0. 6 ] ~,.~.i ~ ~ TO~NN OF SOUTHOLD 4, } z t ' JAN 18198,9 Building Department_ E, i' ~ "i f~ Town Hall rl~ .....,v:...,~1~ L`' z Southold, N.Y. 11971 tr•+ p - .i APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- 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 o~ Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 /a ` q Date 01 , , New Building //....Old orPre-existing B ildtiing(Y~)~,. ._s ~'V>acant Land . Location of Property .~f.~yv...._-., ....~..~!T~k:!L~. ~.,~.!!...:.......,,,edld House No. Street - Hamlet Owner or Owners of Property .~.J ~1/,~~,°~~,,,,,,,,,,,,,,,,,,,,,, County Tax Map No. 1000 Section - . Block ©.oZ. , , , , , Lot ~i/........ . Subdivision 7A!M~'S..l,~.f}WS~,~, , . , , , , . ,Filed Map No. ,L'o/t No. j...... . Permit No.O, ~~j ~ ~;1,~,~pa~te of Permit Us/~~~.~Applicant .~.'~C.~~~L.Y. ~:~~,f, , Health Dept. Approval ../,/.~/.b!~/~}'y~/,p, , , , , , , , , , , , ,Labor Dept. Approval . Underwriters Approval (!.l?p.~...........Planning Board Approval • Request for Temporary Certificate/ ......................Final Certificate - Fee Submitted $ Construction on above described building and per~mtit meets all appl{cabl~odes and regulations. Applicant.,~~,.1~.,.1'.,.y~~ Rev. 10~70~78 3~ ~9~ TEL. 765-1802 ~pS~fFUL/~~OG TOWN OF SOUTHOLD ti y'Ac OFFICE OF BUILDING INSPECTOR o ;z P.O. BOX 728 "O,y~~ SOUTIIOLD, N.Y 11971 ' 1 _ ~,<aN,., N . C E R T I F I C A T I O N ~ ` Date / `Z~ Building Permit No. - b ! ~ '7 Owner ''JAR ~ S A ~W e 1. . (please print) ~ r-,._"~,~leas~e.print) I certify that the solder used in .the water supply system contains less than 2/10 of 1~ lead. i~7cuc. ,".(plumber s signature) Sworn to befor me this 19~. ~p y blic Notary Public County WILLIAM SUFFOLK CNTYCEX~l~ > ~ _ ~ _ - ",~~,~~~~D lAry~~ ' t - ~ ~ ~ ~ ~ x ~ ~ LoT ~ .~d,~?' + Ek : ~ e~ ~ I 1p~ 33 e90 P,F ~~NBW YO 'yi _ _ ~ SIM(~E FA I 4 ~ uarr: J~8 " . rte.. ~a. A~ Tiw sews ~ '~po and water suppiy,facilities for 1fiAs bcation have been ir~speeted by this Departmeflt end/or Q _ ead fo€~~d, to~~bo aatief esq. ~ cess~m/ 6iief. ~reey d W " ~ h4~n~a~ert~it 4, ~ ~9 ~ ~ ~k ~ ~ . ~-s_ ~ ~ ~ d t r_ srb.. ovoye I Fraar.^ % . y~~ ~'9N r ~ ~g. ~c a X989 ~ l~, y~~ITH FpT ~1 ~ ~ ~FR~~~S 1da// ~ ,f. ,i ~ , ~ ~ 3i<2~79~' ~ i / O, ~ ' ~9~,.~i s~/i' , iM 7 ~ ~ ~ ~ ~ ~ ~ ~+d~l''f~~ ~!~'f+EStlll.~~''~'EL,~.5~~"lZG 1~lmt'Y+~~ ~ I° ~ ` `~'s9`¢i~R+if?~;~"~T~~ C'H/,c'~4sc ~t~d".~.r+6~3Pi14k4+>v"d" ~~igrf+jY - ~ s~iiiee l~orpw otr ~e, i9d~ ,pr'" . a- ~sd ~ r 31.1: x..e- c'lELD I:;SP~C';iU:~ ~~llnT~ ~ ~OaKMENT3 r- 1 . o? ~ ,J ~ ~ H FOUNDATION (1st) _ n C FOUNDATION ( 2nd ) _ 2. ROUGH FRAME & d PLUMBING t ~ u~ ti H 3. ~ ~ H INSULATIOPI PER N. Y. ~ STATE ENERGY CODE ~ _ A r O 4 . y FI;JAL i(p~ o ADDITIOPJAL COMMENTS: x P" /o f' ~ ' x .b i° y N H ,.Q O 2 oa ..O ~ ~ M ~ ' ~ r N _ H ~ O I d oG 'Tl (JJ H 17/7 ~ ass-ssoz BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: DATE ~ ~ ~ INSPECTOR ` ~ 765.1802 BUiLD1NG DEPT. M NSPECTION [ ]FOUNDATION 1ST [ }ROUGH PLBG. [ v]~FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE ? ~ INSPECTOR _ /7~~~ ~~-s~Z BUILDING DEPT. INSPECTION (~j FOUNDATION 1ST [ J ROUGH PLBG. [)FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: E ti s ~f i DATE < o2~i INSPECTORS , l~r~~ T65_1802 BUILDING DEPT. f NSPECTeON ION 1ST ROUGH PLBG. [ ] FOUNDAT f ] [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING (]FINAL REMARKS: ' 0 ' DATE 0 2-tI / INSPECTOR M ~ _ _ ~ i l~i7S~ su~rL~INti ter. i [ ] FOtlNQATNtiN iST [ ] RQYi,~N PLBG. [ ] Rt1iN~lfAT~ON ~ [ ~ULATION i [ ] 1~1!'AMINiA (]FINAL I DATE ~7 ~ il~l~CTOR ~ ' ~ ~ r/JLLr./~D. BBl4'.~'k7f- .Zi 2 6 .,a,~c,~ ,~,o.9~F ' . N Z/' O3' 'E' ~ ° /2 . ~ ~ ~ for 1 ~ LaT Z b d.~mr.C°Ci~ r3z f3sl~ L't5 T't~^~S."1dC ~'34"i. O.~' '3° a~r.nV ,@ i ~~AS~ A i~ra ~~:1 „ 2~~~~ s t~t~x~ c~ a ' :i • Qq'tJ/tQS SQpt10 to ec~~, ~a xs ~.~c l~r~., c$f",,.,:z•~ o ~t ~ COV@/" tU 8.ta t1j(C~~r~;~i ° try era;~:~t:e°• " ` ~ Y ~i( 11 a ~!d`f 6 . ~ ~ ~ , " ~fOIK COIRItt DEPARTMERT OF 11EJILTN SERYtCES c~ ~ `b ~ FOR APPROVAL OF COKST6tiC'[IaN DF ~„e~~ f S;neie Famiiq Residemx Ortly ~ ~ P~ ~ QAtE NS ' ~ n ~ .~~ti; C ~a ~ - ~ ~ APPROVED ~ ~ ~ ~ ~ W EXPIRES iW0 YEARS FROM OATE Of APP At ~ ~ X ~ ~ b ~ q d c~3c•z9 /30.00 S/SG',3~ .Uoe~~h' P,1r~Y~'r~'~c•' ~'dgo JUN 8 1988 alsv.~r e- /ol . 7 ~ gC. DEP Al.1~'fD.f+. C.G/F.r+aPOlt•~e'~1~/EC~•9Y1~ELG .9,r/is~ h~' ` rt' ERVIGfS ~~T./it~fl•..'~illlle~f.P'r111fG'~t" " ri!~_ r Q~/~Y.C1&JJ+t'6O 70 ~ G'.yitf~o T/7z6' /.t//~tGE• lbira~vr?si ~ ~ ~ , ~ " ~ v>n~ x - ~ - ;'9T~ 336,p6 , ~ J~EE f'~'~~ ~ - ~ .e4. a :T'^_ r a - m..; w"R~P'F?~_,....~..R. ~6:m~.'.A 17114 C O. THE NEW YORK BOARD OF FIRE UNDERWRITERS PA<:x 1 r~ 1'007-387' •UREAU OF ELECTRICIT' 55 JOHN STREET, NEW YORK, NEW YORK 10035 Rote ~rANUARY ]9,7989 ApplicettonNo.onjtle 5997.50A9/89 N 054:470 = TNis cERTiFiES TNAT only tM sHetrksl pulprnant ~ dncrihed hebte snd introduced by the spplicsnt.nsnsed on the shove sppHestion nuwEher in the premtKes 4I AYilIK71, NAR1l;, N. RAYYI:FN ROAn, SQUTHgiln, N.Y. to tMJelb~einR bmtbn; ~ Bssenrent ~ tet Fl. ®8nd FI. GAR/ATTJC'/f7tiT Serttun Bbck lot test ersenined on JANUARY 06 , 7989 end ound to 6e to com Tones Leith the r f pl eyuiremenMq/th48usrd. N1nuRE Aar tboRlNO t>EClcs o wASltws Intluunr tuts W1tE1E NCAItpOCEM r1110tlIClM OTHER AMT. K. W. AMT. K. W, AML C.W. NAT. K. W. AMT. M. r. 30 5 46 23 7 72.7 7 7.?. 3 F' owec RJMIkq MOTORS IUiUM A/RIANq 1YRRRR flKYAL RECIi 11AN Cl6CRE qtt (NMi 1NA7ERS M1N1401R1rt DIRARAERS AMT. K. W, ql N. r. OAf N. 1. AMT, NO. A. W, O. AMT. AMI. NAT. AMIt. TRANS. AMT. N. r. ~E. ~~E~~- AMT. WATTE 1- 30 1. 1 fi0U f/RVlCR pS00lBwyLT NO.OF S E R V 1 C E W~~p~ NAT. AMI. TnR ~ 1 / tW 1 / 7w 7 / ]W J / AW NO.ONCC, qVD. ~ ~ W. l7HD NO. q N41E0 01 NO.Or IIEOIIIAIS d ~NEUTtAI 7 $00 CR 7 x J 3/0 7 3/n ° "'xnTC>tts:s-~ N.P.,7-7 N.P. G.P.C.]:-6 sx<7xr, n7s~rr•:r,TOR:-7 aonY PtrNJl,r,o PAT LANP7 NATTJ:TIlCK, NY, 7.195?, ]1 ~ C,f.(`NNSR NO. X300 e; Pn ~ iltit certificate IRUtf not Is. aNRnd in qtly matRler; return to the office of tM Roord if incorrsN. n bs ideTMHisd bf' tlNir. endetNigk. '';x tnIWNG DEPART T. TRIS COPY OF CERTiF1GTE AUST NOT iE AITERlD IN BOARD OF HEALTH / . - 3 SETS OF PLANS FORM NO. t SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT 'SEPTIC FORM 7• • : TOWN HALL NOTIFY .°,OUTHOLD, N.Y. 11971 TEL.: 765.1802 CALL pqq MAIL T0: Examined 194 0 Approved ..X.StiY1.R•..a~.g.., 19~.d. Permit No. ~ .7l.?`~'~z. ~v ~ ~ L, ~ Disapproved a/c D ,.NNd 2 3 1988 (Building Inspector) 8lD $ EPT, p APPLICATION FOR BUILDING PERMIT Date 19 .cp7l 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 street< 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 pazt for any purpose whatevef until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment for the issuance ot` 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 tc admit authorized inspectors on premises and in building for necessary inspections. Signature of applic nt, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ~~.~".I. ~ e• . • . ~ ~ ~ (as on the tax roll or latest deed) If applican is a corporatio/n,~, signature of duly authorized officer. (Name and title of corpo~fic ) . ALL CONTRACTOR'S MUST E SUF OLK 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. ~1~5„ / ~ ~~f G!J..~( ,/l . . . ~ K.(~ ................../.~l ~.f,~.A~(S/,PInJ . ?.('/.J...........~Q.f~ ,T./-f. ®ti-T~....!1!jV•... House Nwnber Street Hamlet County Tax Map No~1000 Section Block d. Lot . Subdivision ......~/,f,E/.1'/~'.S•... ,/7 d. /I~ Filed Map No . Lot . ( ame) 2. State existing use and occupancy of`p/renmises~alnd intended use and occupancy of proposed construction: a. Existing use and occupancy Y .~7.C 7! y ~ . b. Intended use and occupancy ......~.~~~.~~•.~~.1.'~..G~.1~,~~/~f ( p,i 3. Nature of work check which a plicable): New Building , Addition Alteration . Repair Removal , Demolition , ..........Other Work . (Description) 4. Estimated Cost . .l~p.Q..Oc~Q .<?9?..... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling µnits 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. Dimensions of existing structures, if any: Front ...............Rear Depth . Height .Number of Stories . Dimensions'of same str[}ctu th alterations or additions: Front Rear . Depth ":.4~u ....Height Number of Stories . pemhntsions of ent~~e~new Y truction: Front Rear ~ ~ Depth . berofStories...................,/....................g................ 9. Size,oflot: Front Rear ......~:a ..a~?.b...... Depth . ~~'./.g .7s~......... 10. Date of P.~~~sh~}... Name of Former Owner . 11. 7,one`~isf remises are situated .....~j . 13, Will lot be re raded •ate any zoning law, ordinance or regulation : 12. Does ro osed construction viol Will excess fill be removed from premises: Yes No 14, Name of Owner of premises SfJX6?-!ti°.4,L,-. Address ...5.4 f'.T,fro~~, ,/ll~hone No . . . Name of Architect P P Y ~ . • . • • . • Address Phone No. Name of Contractor :.~.4°.!L L~d~-f 4.!-1' , ,Address ..~`°'.X, ,f~3, f! . /ffJT7': phone No.. ~Pn.~ :'.~6`j.'?~ 15, Is this ro ert located;withirt 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly a111, buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block,number or description according to deed, and show street names and indicate whether interior or corner lot. I i STATE OF NEW YORK, i S.S COUNTY OF ~jj !9 C~! . • .~.'..g!~. e being duly sworn, deposes and says that he is the applicant (Name of individual si Wing cont act) above named. ' He is the .................4..P/.t!TO.Z ?`.F~ % dDe:.................................................. (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 manngr set forth in the application filed therewith. Sworn to before me this I ........................day of.....................,19... Notary Public . County ~ (Signatur of applicant) 1 ~i~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. (]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ p> DATE / INSPECTOR ` a d/o~'.N ~i~.;~ddT' v ~t~r ~ ~ ~ A 01 l~1 u 6 ~ Y q ~ N gt0 ~Ary4 x ~ ~ * < p * ~ ~ ~ N ~ 193696" v ~ i •~.ry~w YDA /3a+vo' N9.~PP,~~rc I3~/ B ~ ~ 7 ~'f r G'4/~.tie"d'ca~-s~':~e~/EG,f,9~la'6.~~. F~i.~ lil~c%G+ ~ d~raoc' ~ ~~I~~ Tc ~ C'.,~ic.A~c Ti7z~' f.~. .~/s' ~ s~.vv~Arrnc~Le,~~iev Jae~%~~.y%BB ~ os~. ~ ; L~'1J~%1~1~'2"Fjl~'+bFB ~ ~'„~C m. -7 ~oZ-3.! t s. r