HomeMy WebLinkAbout17236-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219019 Date MAY 4, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 1980 HENRY`S LANE PECONIC
House No. Street Hamlet
County Tax Map No. 1000 Section 74 Block 02 Lot 02
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 12, 1988 pursuant to which
Building Permit No. 172362 dated JULY 19, 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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to GREGORY L. & MARNE LESSARD
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N047697 NOV. 29, 1988
PLUMBERS CERTIFICATION DATED GREGARY L. LESSARD APRIL 25, 1990
4'Z
Bull ing nspecto
Rev. 1f 81
soaas xo. s
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)
N~ 017236 Z Date 19.~~
Permission is hereby granted to: ,
~~~...--~.~.y..~'.........,
-I ' ~ A
at premises located of ....,1.~~... ,fr..~.....,~`7.
,,r~/~.. .,(dr.......
County Tax Map No. 1000 Section Block Lot No.................s~..-.-..
pursuant to opplication doted 19..~'~and opproved by the
Building Inspector.
O
Fee $.~~.1.. .r.ap
...........l
B ing Inspector
Rev. 6/30/80
t._ ,..,.r.~.»..,rr_.»_~.,.., a
\C"~ t.~~ ~-~\l,~! I'~"'„~ ~ Form No. 6
MAY '41990 ~ TowN of souTHOLD /°Q. 37y
~ BUILDING DEPARTMENT A2~
~ t,
~~•~..b.-~..~-...w..~-.,~ ..,,.'d TOWN HALL
Fdf.CG. Ut E'P. a I~~77
TOl/a~!t' ii%'.(iJT(If}t_~1 765-1802
t,,._,.,m.~--n-..... , .
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.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Codn 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
Ceri.iflcai:e of Occupancy idew dwelling $2:00, Acia~.Lions'tc, dwcll;...g $2.00,
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, Cotm/~tercial $15.00
Pate 3~J
New Construction........... Old Or Pre-existing Building
Location of Property.. / ~'0~ ~~~+?aey~S...L.~°.:............./~~: Con/ C...........
House No Street Hamlet
Onwer or Owners of Property.~~V ~/.!.c'!;•:"`:?-~-~.~
County Tax Map No 1000, Section....~J. ~ ~....BLock~~~.......°.?......Lot...?.~
Subdivision ....................................Filed Map............Lot......................
Permit No ................Date Of Permit.........e......Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted:
~ 3yyi ~ 5 ~~/so .
~Q ziyoi~ z
THE NEW YORK BOARD OF FIRE UNDERWRITERS F'At;N:
2utic>>n
DUREAU OF ELlCTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
N(}Vy:tgR}';h ?9.i9RN, 57'.31AR/:?t N t}+77f;ti`t
Date Application No. on file
THIS CERTIFIES THAT
only the elecertcal equipment w dsuribed 6elorn arul tntreduced 6y the oppNcant nenaed on the ohooe epplicatlon nuFnher in the premises of
GRk:$ 1'~Y:SSARD, HKNRY'ti IIANk:, 1~gi,t; #15, PFTt;t>NJ C, N, Y.
in thefolloscing htcation: ~ gam, t ? IM FI. ~ Ynd FI. Section Block Lot
N<>VE:NBk,R 1 ~~~tbk
uwa examined on and found to 6e in compliance with the reyuirementa of this Berard.
N%TWE R%TWES RANOB COOKIIIO DRCKS OVENS qSN WASHERS E%NAUST FANS
OUTLETS AYLES SWITCNK INUNDESCENT F1U011lSCENT
v NAT. K. W. AMT. K. W. AMi. K.W. AMi. K. W. MIT. M. P.
4 24 71 9 t~
gtYERS RlRNAC! MOTORS lYTUR[ AMUANCE ItlRRRS SM!CIAI REC'R TRAP CIOCltS REIL UNIT HEATERS ANllil-0UTllT gMMERS
AMT. K. W, pl N. P. GAS N. P. AMT. NO. A W. G. AMT. AMT. AMT. AMR. TRANS. AMT. M. P. ~
q
~T AMT. WATTS
SRRVIt= gSCONNlCT NO. W S ! R V I C E
AMi. AMP. TYPE 1/tW t/tW 7H TV 3/AW ~R;COND. OFD CG. NO.OF NbLFG O~~I~IK NO.OP NEUTRALS Oi ~fWEUf
1Al
1 ,200 Ck 1 K 1 ''?,l0 I '),/0
OTMlR AnARATUf.
~l2 'i'f)N ABC i3t,1f?' ii7'fN A1N NANbL7~:)t--}
F. Nf f7K,W: 1}MPP,F,C9'OK : - t
'I'H [M YUKK F:1,f:C9"k i'l:
l
Y.O. 8DX 4H
11 n
i,,Lt;p:NSh NO. 348kf: Psr
This certificaN must not be ahsrod in any manner; rNurn to 1FIe office of the Eoard if incorrect. Inspstton may be idsMifNtd by 1Flsir credentials.
DOPY POR EIpLDING OEPAItTMENT. THIS COPY OP CERTIPN;ATE ARKT N~ ALTERED MANY
~O~U~~a~ CO/' TEL. 765-1802
TORN OF SOYJTIIOb,D
p ,.r.,,
' . : c OFFICE OF BUILDIi•7G INSPECTOR
;T, P.O. BOX 728
SOUTHOLD, N.Y. 11971
Cpl ~ ~b
D~. C E R T I F I C A T I O N ,
~
J MAY --4 ~p
!
I I
Date ~.5 f~
t
Building Permit No. `~,~3~0
Owner ~t21'r~o6L~~' j„~SS!^>2~
(please print)
Plumber ~enEro2Y ~1=SSA~~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
_
si na re)
Swoq4r~n/.~to before c this
day of ~~1,~_,
19~,
Notar! Public •
Nn t
,~~`iio, ,~p~t,~r.
LAURIE E. t3RAE8
Notary Publlc, State o1 New York
No. 4821818, Suffolk County
Term Expires September 30,18 `~l?
'r'1ELD IGSPcC:iUN IllliiTn ~ ~OzKMENT~ ~
-o
1. m
H
OUI3DATION ( 1st ) \tl1
c
FOUNDATIOIJ (2nd) m V
2.
o
ROUGH FRAME A4 / r
PLUMHINR'
y
3 , e~ ~
rn
I1ISULATION PER N. Y. y
STATE ENERGY
CODE
x
a
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4 ,
~ L ~
FIidAL ~'i~
q~~ a
ADDITIONAL COMMENTS:
.
x\
b
H
9
H
2
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b
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ro
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~ ~~~FF(1Lk ~ TEi.'7G5-If.01.
~O ;.~-~,~^.~?:'i•, T'OZtrP1 (.3I' SOU7'IIOL~3
ftf.. r'~~i
! r;+94P~attt~~tir ;t~ OFf'iC[i ()P I3IJILUINC: IidSP(:CTOR
~"n~ .1: ~ '('Ott [J 1IALL
t~;~w~~f/°~w~~'~~j SOUI'ilt~i.U, N.Y. 11971
~~,:~r.::r.% d
April s, 1990
GREGORY & MARIE LESSARD
BOR I38
PECONIC, N.Y. 11958
To tv}u~m This May Concern,
t•7e are unable r_o complete your Certificate
of~Uccupancy becau~c of the following reason.
An plication for Certificate of Occupancy
is no nn file (ENCLOSED)
to Under;~riters Certificate on file.
/ / •rl checi; .is (~41RYcBXJRt~t oa file.) Szs.oo
i:o 'tcalth Dept. Approval on file.
I:o final inspection has been made.
I']en:;e contact our office on this matter.
Thank yoi,r for your cooperation.
Duildin~ I'crmit !I I 7 2 3 6 Z
Duilcli. cI UcpL-.
r
fto F'1 ~m er Solder Certificate on file.
( a1 p rmit-s involving plumbing being
i~sucd zfter April 1,19fl4 )
d ~a' ~
765-1802
BUILDING DEPT.
INSP'E~TIOIH
[ ]FOUNDATION 1ST (ROUGH PLBG.
[)FOUNDATION ZND [ j INSULATION
[~RAMING [ 7 FINAL
REMARKS: ~ ~
.~._.._.~s~~..~~
,k
'4.
x
~ DATE ~ ~ INSPECTOR
BOARD OF HEALTH
D 3 SETS OF PLANS
FORM NO. 1 SURVEY .
TOWN OFSOUTHOLD CHECK
.JUL. ~ Z BUILDING DEPARTMENT SEPTIC Fart .
TOWN HALL
BLOG.I)EPI: ~OUTHOLD, N.Y. 11971 NOTIFY
TOW/N~OFSOUTHOLD_~ TEL.:7G5-1802 CALL
Examinud.,l /..........,190®~ MAIL T0: .
\pproved . 19~?~. Permit No~~~~~,~ ,p~v~
Disapproved a/c Cl, f~_ vi
~ y~A'~
(B~ng Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~ . 15~~
INSTRUCTIONS
a. Tltis 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
Re;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Tlie applicant agrees to comply with all applicable laws, ordinances, buil g code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary insp ons.
s
(Sign re a a ~ r name, if a corporation)
!~°.•....°k /3 ~ . ,„~~,EGan/iCi .vi./. //95
fr-oi3~i
' (Mailing address of applicant) ,
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
O WNW!~
Name of owner of premises ~.'r~'.E'~°.?y .fi J%F?{?NC • ;L;EsS.92~
(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. e^~~'~ -
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
I. Location of land on which proposed work will be done. ~~~.^!~y~;f
-N ~
House Number Street Hamlet ~
County Tax blip Na. 1000 Scc[ion Blbck ~ 2.
Subdivision . Filed btap No. Lot .
(Name) a -
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . ~.~~5 i~~•.~T~Y
~b. Intended use and occupancy .~'~-.E`S iD~ yi,c y, , , ,urt;4!~y , F~4eG~e>u..... • • • . • . • • • • • .
= e r. ~p
3. Nature of work (check w•hich'!iapplicable): New Iluildin 4~
.
Repair g Addition . r.,.C~~ ton .
kttoval Demolition
Rc .=Ot~~V~trk
4. Estimated Cost `~~5 'i2~ ~~-y~• . • • • . • ~ j f .~~D~ 1 ion)
Fee .
~ tto be paid art.l?~~pPS _thjs,apgi}~atiori~
g ^ g units , , , , , , , , , Number of dwelling units on each floor .
If dara,lennumbe of cars1Vell' .
6. If bustness, commercial or miffed occupancy, specify nature and extent of cacti type of use , , ,
7. Dimensions of existing structtires, if any: Front , , , , , , , , , , , , , , ,Rcar • ~ ' ' ' • ' ~ '
Height Nymbcr of Stories . Depth .
tmenstons of same structure ' ' ' ' '
with alterations or additions: Front • • ~ • ~ • • ' ' ' ' ' ' '
Depth Rcar..................
^ ! IIeight Number of Stories .
Dimensions of entire new cons,[ruction: Front , , , , , , , , , , , , , , , Rear , Depth
Nu
Hei ht tuber of Stories . ' ' ' ' ' ' ' • •
9. Size of lot: Front. j Rcar
10. Date of Purchase ........j Depth
Name of Former Owner • • •
11. Zone or use district in which iremises are situated • , . , ~ ~ ' ' • • • • ' ' ' ' ' ' ' ' ' ' ' • '
12. Does ro
p pose construction vi
0 olate any zoning law, ordinance or regulation: , , . , • ~ ~ ~ • • ~ ~ • • • •
p • • • • • • • • • • • • . , , Nill excess fill be removed from premises: Yes No
14. Name~of Owner o d remises . ,I„ , , , , , , , , , • , , , , ,Address ...................Phone No.
Name of Architect ,Address . • ' • ' • • ' ' ' ' ' ' ' ' '
Name of Contractor. '•••••••••••••••••PhoneNo
P p .y .......................Address .......Phone No........... '
IS. If tess Southold Tow ted withitt X00 feet of a tidal wetland? *Y);5....NO..,.
* y n Trustees Permit may be required,
PLOT DIAGRAM
r
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether
interior or corner lot.
.~~d
-•~-~.-y~_
•
~
STATE OF NE1V YORK, '
COUNTY OF . S.S
' • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
[Cc is the ......................I....
(Contractor, agent, corporate officer, etc.) ~ • • • • ~ • ~ ' ' ' ' '
of said owner or owners, and is duly,,authorizcd to perform or have performed the said work and to make and file this
application; that all statements contaijtcd in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the manner;;et forth in the application filed therewith.
Sworn to before me Ittis
t~~~p~ day o~f/.'~ .n.. , 19
'Mary Public, , . , , lcc!.. l\.•I!..M~.Y.°:~.... Count
HELEN K DE VDE ~ "r":Y .
NDTARY PUBLIC, State of NeMYak (Signature of applicant)
Term
fxgia?MiuhN30 1~.
~ I I