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HomeMy WebLinkAbout17543-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17913 Date MARCH 30, 1989 THIS CERTIFIES that the building ALTERATION Location of Property 10575 MAIN ROAD EAST MARION, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 31 Block 4 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14, 1988 pursuant to which Building Permit No. 17543-Z dated OCTOBER 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 ALTERATION TO EXISTING ONE FAMII,Y DWELLING AS APPLIED FOR The certificate is issued to I.ORRAINE MANDEL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE NO. PENDING - NARCH 21. 1989 PLUMBERS CERTIFICATION DATID MARCH 14, 1989 - MASTER PLUMBING 0 ~~ Building Inspector Rev. 1/81 roam xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N o ti 17 5 4 3 ~ Z Date ... ~~/~.9 ................ ......., 19Q. G1 Permission is hereby granted to: .la-ua~u.......S?',lei.,~~...~ ............................. y ~3 ... . . ~ ~ .... ~ . ...... ..... ........ .... ....... . .~'r..~ri ...,..Y.,1,~.........~i.~s~5~.. to ., , ...~.~...rr~~--.......~.-.~~~~~~.......~ .~~. ~~- ~`... ~`",...o ........................................................ ct premises located at ...,~1Q.„1~...~.ar ............ .... ......../.~..~........................................................ Counh~ Tox Map No. 1000 Section ........3~....... Block pursuant to application dated .......r~i~.....~y~............ ............................................................... .........T........ Lot No........./~r.... .........., 19.Q..g, and approved by the Building Inspector. Fee $...O..R~•:• D .Y i' B ng Inspector Rev. 6/30/80 TOWN OF BUILDING TOWN • SOUTHOLD 765 SOUTIIOLD DEPARTMENT HALL NEW YORK 11971 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE...h1CV~C~t.lb,. ~92s4.. NEW CONSTRIICTION .N/A ...OLD OR PRE-E%ISTING BUILDING.pR~ ..VACANT LAND r ...... Location of Property.....lA$I~J~~n.RaA~.........,.~~~,M~~n,,,,,,,,,,,,,,,,,,, HOUSE N0. STREET HAMLET Owner or Owners of Property.......~O,hjt¢,j.{1P~h1CCYLCtE2 ............................. County Taa Map No. 1000 Section ...,31, Block .4..... Lot .~5...... N/A Subdivision.....N/A . ............... Filed Map ........Lot...~~..... Permit No. .7.75C3.7....Date of Permit r~Q~19/,~~...Applicant ..~~~d~t.LohltA.ine__. * Health Dept. Approval ...N/~............ Underwriters Approval .............. Planning Board Approval .N/.R............ Request for Temporary Certificate ,N/,F~,._ pinal Certificate ................ Fee Submitted: $.... ..4 SD............ C APPLICAN .. ................................. *Pne C. 0. ~ z ]4236 2/14/&6 r"~~1.i64/88 ee ~~i~ ~~ 9~~ TEL. 765-1802 ~~S~EFOUr~O~ TOWN OF SOUTHOLD .y :`` ~c OFFICE OF BUILDING INSPECTOR ' ~,~„ P.O. BOX 728 ~' ~ TOWN HALL ~~ p , ~- SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date ~ O Building Permit No~`.r/~~Z! Owner-4j~-(2Z/Kp /Lt/~if~p/ (please print) ' Plumber (please print) ,' SC 1.i;c # 657 I certify that the solder used in the water supply system contains less than 2/10 of 1~-lead. (plumber's signature) PeteJe ' SaI.12,L'cu Sworn to before me this day of /~i4~C'.l-E , 19 ~ - N ary Public Notary Public, uFFCc-/~ Count ANCY T. FUSCO y NOTARY PUBLIC, Siete of New York 4882475 Qualified In Suffolk County Commission Expires Jan, 20, 199 THE NEW YORK BOARD OF FIRE UNDERWRITERS rAG~ 1 lOtN)h$3 ®UREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date APR1L 7.3,aA89 APPlicationNo.onflle 61.1~l0289/89 N Ofib9'!3 THIS CERTIFIES THAT FERNI9' NO. 17543 Doty the aleetrkd puipment a desedbsd below and introduced 6y the o,/tpllcant nomad on the abode opplicseton number Jn the premises of }°PTY.R NTLL~AR, 1055 MAIN S'C. (kT. 25) , fi, lfARtUN, N,X. in the fdbwinp location; ®8wement © /st Fl. ®Ynd FI. Section Block Lot awa examined on MARCH 21 , 1.989 end found to 6e in compliance with the reyuiremend of this Buard. BXiuRE tX171E7E ACIB EYYIiCIIlS 1 NXT 11CANOtSCENT IlilDelSCtNT OTNER RA AMT. NOK K. W. COOKING DECKS AMT. K. W. O AMT. VlNS K.W. DISNW AMT. K. W. EXNAU AMT. ST FANE N.I. ~ a .~~ 22 ~ 1 1.2 t r' DRYERS EURNAC! MOTORS RI7YM AMIIANCE RMERf ENOAL RECR 71AIE CLOCKS EEtI UNIT NEAiERS MUUI.OYM DIh1ERERS AMT. N. W, ql N. I. GAS N. I. AMT. NO. A. W. G. AMT. AMP. AMT. AMTS. TRANS. NAT. N. P. SYSiMIt NO. t)f R!T AMT. WA115 ~I ~ r) t11)n SRRVN7 gfCONNlCT NO.O! S E R V 1 C E AMT. AMI. iTP! ~, 1 f t'M 1 / tW 7 / SW 7 / AW ~' KR 8CON0. Of CC LOMD. ~. Of N4lEG Gj~XI Ito NO.OF NFUTIUl3 Gp 'NWEIITGXAL OTMRR AMAl1A7O5: F;L)C,. RUUN AEATISRS:I-7.5 K. M,. G.k.C.I:--5 tiMUKIs Dii7'N(:TUR:-1 '1RACK LIGHTING:-11 t,I,NNN k, BRADLf:Y I'.U. BOX 6~'J. i.Allkk;L, NY, I i_9Ak 1.IC.fi'd27 / `j~%~ OENRR/ MANAGER Thit prKficaM mutt not ba altarad in atW mannarl rtturn b tfw office of Ms Boord if incorracl. t1 dl/ Per wy be idaMifiad by Moir cradsatials. COPY FOR EUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT 4E / 7~y~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ FRAMING [ ]FINAL DATE ~ INSPECTOR !?rye 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: DATE ~ ~ `I INSPECTOR /~ ] FOUNDATION 2ND [ ] 1 ULATION [ ]FRAMING ~ FINAL ~ ~ ~~~ 765-1802 BUILDING DEPT. 1 NSPECTION [ )FOUNDATION 1ST [ ) ROUGH PLBG. ] FOUNDATION 2ND [ ]INSULATION REMARKS: [ l FRAMING [~NAL iSijLD I::S:'EC:iU:i ~~Unic. I ~ i;OC1MENT.°. ~ 1 . - I '0 G m ~ a ., -- ~ G -3 r0U1JDATIO*J (1st) __ - ~~ ~ 1 ?OUtJDATI0IJ (2nd) m `~ 2. 1 / ~~ .`~~ o C , ROUGH FRAME ~& V ~ PLUMBING G , , 3 f y ~ y y . ~~ m IIJSULATIOPI PER N. Y. y~ STATE ENERGY / ~/ CODE '~"' 1 . -- ~ x a ~ y 3 ~ FI;JAL - a -- / ~1~C ADDITIONAL COMMENTS: ~~ m x ~ .c._.. . / Q ~ x ~ _ w a A O i m\ H~ v m ^o H ~ FORM NO. 1 •, TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined . I.P~~g......., 19C~r.GB Approved ...~8~~9....., 19Q(,). Permit No.~7~~~.~~ Disapproved a/c/% ................................./. . BOARD OF HEALTH ..~......... 3 SETS OF PLANS .'.......... SURVEY ..................... CHECK X1.3%4,3 ............... SEPTIC FORM ................ NOTIFY 3~-~/ CALL .~1~~~-~:~:: ~~-.o~..... MAIL T0: y J• ..y. ....................................... L:/ ~~Q~~ ui g Inspector) BLDG DEPT. TOWN OF SOllTHOLp APPLICATION FOR BUILDING PERMIT Date .... ~ C T ..Lt.~..., 1~ INSTRUCTIONS a. Tlus 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. Ut3on 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 oE.a 8gilSiing,.P.ermit.pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other a~pii~ab~e'I.aws; Ordinances or Regulations, for the construction of buildings, addifions or alterations, or for re;rtoval sudeatrol3tion„asherein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cvdp, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections-: ,- -T,~~tfT.,..,~)tt+".tssr: ,c , _ , (Signature of applicanf,°bt'name; tf a~corpotanon) .,. ~_.rt17~j'='{)YPIr - it .p~(I,;{fie+11:J? , .,'. . ~ `/ j h1R~ N ~7...Ttr. j~.k:~y~rABtFBI.••t ,jl `+'/ ........... (Iviterliite h~id'reSs o't1{a~Splic~ant~"`'.~. . ~ . State whether applicant is owner, lessee, agent, architect, engineer, general con'traCtoc~Tel~ctrician;~plumber or builder. .............................................................. i]'.'~.A a'iH'S ~,a.,~~.., ..~,..~a ... Name of owner of premises . , L OF,i~ A I ~ ~ M /! N ~ L L_ ' ~ F + ti ,~+'T . 7' . .. .`~_.1 f 1 ,... y rry .. . .. •., (as on the tax roll or latest deed) ,;. ~ ~ ., ' If applicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of corporate offiicer)* Builder's License No. ...(~~^ ~ . ~`n:a~°~''... i /.~/ . L Plumber's License No. . 1'ti~~dt~ ~~~ ~~~ Electrician's License No. ... °..:/"''q~ ............... Other Trade's License No .................. . 1. Location of land on which proposed work will be done . ................................................ . .....I .C. S., 5 ..............M.P I N k'C N ~............~-:~_'T 1"I }~lZ (Ot~( House Number Street Hamlet County Tax htap No. 1000 Section ..........~?... ~ :: Block ...... ~, , , , , , , , , Lot ......~~ ........ . Subdivision ..................................... Filed Alap No. .............. Lo[ .............. . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... 0 ~ L....~.A ~YI I t_Y, . _ . D~J t (.,J_I N. CY- .................................... b. Intended use and occupancy ...: SA M t - C' N k (_/~ Ni 1 L ( b W L L,L-.f ~ G- . . 3. Nature of work (check which applicable): New Building .....•..... Addition .......... Alteration v Re air .... ••~ ... . P • • • • • ......... Removal .............. Demolition Other Work ...... .;' • , • • • . .............. / C? 5 ~~ (Description) 4. Estimated Cost ................. . ~ ................... Fee......................... ............. - (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~.'~.N. ~ • • . 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 ..... ;3• ~ • . , ... Rear .... !. Height .....°~.~' ~, , • • , Number of Stories ...... • • • • • • • • Depth .. ;f; ~~; , , . • • • I/~ E ...................... .......... Dimensipns of same structure with alterations or additions: Front ~ • • ~ • ~ ' ' ' ' ' ' • ' SA M l~ Rear .................. Depth ..S :.................. Height......... ................. .......... ............... 8. Dimensions,of entire new construction: Front ........ , Number of Stones ...... . Height ...... Rear ............... Depth ` Number of Stories ............................ ............... 9. Size of lot:. )~ront ..... ..I.°:?~....... Rear ...................... Depth ...................... . 10. Date ofPat'Chase ••••••••••............ ""'•••••••••••••••••.•.....NameofFormerOwner 1~'de7,a, Lcn/C.- 11. Zone or use digtiict in which premises are situated .......... n RE 5 r il - • • • • • • • • • • • • ~ ~ • ' ' ' • ' ' ' ' ' ' ' ' ' • ~N7/ttr- - i~t:.niC_C~7U icA` 2. Does proposed construction violate an zoning law, ordinance or regulation: ...... ~ 0 .... 13. Will lot be regraded ...........!`! ~ ..Will excess fill be removed from premises: Yes ............ 14. Name of Owner of premises ...1-:.. M/+lv ~ I, t_ • ,Address y'/3.M~!iN. ~ , ~ ~?~~~'!?? phone No..`f77.:.z a, ~3 Name of Architect ...........................Address ............ ~ • Name of Contractor .......... • • • • • • • Phone No ............... . ................Address ....... .......Phone No.......... . IS.Is this property located vithin 300 feet of a tidal vet land? *YES....NO.... *If yes, Southold Tovn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all 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 comer lot. 3~~, _. I i I AP D AS NdIED DATE:~~ ~ B.P. 11 ~ a j NOTIFY1~ O~E• AT 786-1802 8 AM TO 4 OR THE FOIJ.OWINGINSPECTRNUS: ~ .5'~ L ~l - '-/-l,y 1. FOUNDATION - TWOREQIBRED FOR POURED CONCRETE 2. ROUGH - FRAIWIIYG i PLUMBING i - 3. INSULATION I L - ' 4. fINAL - CONSTRUCTION MUST a 8E COMPLETE FOR C.O. d ALL CONSTRUCTION SHALL MEET v ~t THE REQUIR6YIENTS Of THE N.Y. STATE CONSTRUCTION 8 ENERGY _ i 'f D CODES. NOT RESPONSIBLE FOR ~ 'u DESIGN OR CONSTRUCTION ERRORS a i.ti ° _ ~G v ~^- ~ - ~ i Ifr7 STATE OF NEW O Ain i`cND COUNTY OF .. ~~L~2J/(C~¢~,~. S.S ~ ~ ~ 5 7 y- .....1_v2(l~~ti(~ .M~.~17cL ' ' ' ' ' • • • • • • • • • • • • ... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..... C,Q;V?;.e;~ e:T pK_/b iN~£ 2 (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 +/ork wdl be performed in the manner set forth in the application filed therewith. iwom to before me this /~ ............ ~ ~/ .........day of .....~%.C%f-o-(l:-z.c....., ~'~ ~ ]9... lotary Public, ,~{,l.;Q.{Tl~.-~ ~,l.t_,~cc1K 2 ... ~ .. ...... County ~~`~°~,' ~ - SUSq;.;ta• 1. P ~ .~i1CGNE 7 NOTARY ?Uii4C, &!; rc of New York ~~ Nc. aaazrv~ ... ?Y.f, ~.. ~ .~Z''L'G'LL.` ~ If//// Quali£ed In Suffolk Count' p `~ (Signature of appliCan t•) Commission Expires Ian. 20, 1969 d~ ~~~ ~ ~0~~ ~8.v / !~ / 0 57 5 1J'la~.~~ ~~ ,~ /~rrN~~~ sr3c.3 / - i'7'_ F~ lvra.k~-;,., f7i l..r:RlaCrce wa ~s ~,., ~..s ^`~~..~ !,. ,. ' ff ~~~;•N. ,.// ~,~, d "fz 1 c~ wr'n^ 3`~ i w.~,, ,J 1 1 1~., ~~:,~„ ~ , `,. _.... I `____... _. l _ i ~ j Ze l.enC~ p ~4-t---~f---K-~_ j ~ r ~ ~~ , ~~---__ ~ ~~ ~ ~ K oaaaK aetno Is u..a to ~ diattlbuttnp ~~ Mv~no shall Da ~M~aaKorLon ~ t ~ ~_~~~ ~,,. , ~_ J O V ~ ~ ~~ w 1--- ~" I`~.^' "(tea P,QQ~,`~;ti~ ~~~~ pL /' ~_ ~__ Ly f ;-r 'B nTM ...1.. ~~ I~ I ~.: ~_,~ . L ---- _ - 1 I PLUMBER CERT/fM..4T10N ON LEAD CONTENT BEI SORE CERT/fl~CilTEOrf OCCUPANCY r ,r „r: ;:,., SQLDER USED /N NEATER ,,,. S~/rPLYS1~STEM GWNOT I, i ~~_T I •~I\ ~, ~' .__ _- 9h«ri ~ ~+ ~~~~ ~/ ExcEEO ~~o a ~x cEAa pi Rn.~ ~' . ~... P~ .. ~F.~ 2..n ` 1 9 ~./ ~ ~'~!,- ,d~ c1 rr~~~ . ~ n ~~ 1 /~ n ~C`in I. Gtv~ uc,. lh t ~ (~-r ST r~oo FIRE i~.r+e,~ r nFru~„ f