HomeMy WebLinkAbout16785-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19130 Date JUNE 11, 1990
THIS CERTIFIES that the buildin~ ONE FAMILY DWELLING
Location of Property 5785 VANSTON ROAD CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section 118 Block 0t Lot 1.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEB. 26~ I988 pursuant to which
Building Permit No. i6785Z dated MARCH 10~ 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 REPLACE EXISTING ONE FAMILY DWELLING WITH NEW ONE FAMILY
DWELLING.
The certificate is issued to ANNE & THOMAS HIGGINS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HF2kLTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/8i
PENDING SLIP 6/11/90
PERFECTION PLUMBING 7/5/89
FOR~ NO. B
TOWN OF 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)
Date .~ .~....-/...~.. ..... ,
N-O16;785 Z ... :~..' .......................
County Tax Mop No. 1000 Section ........ ~/...~.. ........ Block ........ .O...L ....... Lot No....~../:...~...
pursuant to application dated ...~.~~.....];)~.~ ........... 19.~.~.., and approved by the
Building Inspector.
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTHENT
TOWN HALL
SOUT~OLD, NE~ YORK
765 - 1802
1197l
APPLICATION FOR CERTIPICATE OF OCCUPANCY
ATE o ~ . ' ~'~
~..: .~2..
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND
Location of Property.. .~ .... ~.o~..~.. . . ~.~j~. -..
HO l/SE NO. STREET HAMLET
O~ner or Owners of Property..~./t3...~.g~ '~' Z.~"
co~ z~ ~ ~o. ~000 s~..~o..]1~. ~o.~ ..e.g.. ~o~' .~ I'V
Snbdivig/on ....................... Filed Map ........ LoC ..........
~=~ ,,o..~.~" ~' /~/~ ~ . ' -
Health Dept. Approval .................. Underwriters Approval ............
Planning Board Approval ................
Request for Temporary Certificate ....... Final Certificate .........
Fee Submitted: $ ....................
APPLICANT
rev. 10/14/88
FOP~O. 6
TOWN OF SouTgOLD
BUILDING DEPARTMERT
TO~ ~LL
765- 1802
~PLICATION FOR CERTIFICA~ OF OCC~ INSTRUCTIONS
'~ls appllca~ion mus~ be~filed in type~iter OR ink and ~ubmi~ted to the Building
Inspector wi~h the following; for new buildings or ne~ use:
]. Final su~ey of property ~ith accurate location of all buildings, property lines,
streets, and unusual ~atural or topographic features.
2. Final approval of Heaith Dept. of ~ater supply and sewerage-dlsposal(S_9 fo~).
3. Approval of electrical installation from Board of Fire Unde~i~ers.
4. Sworn statement from ~l~ber certifying that solder used in system contains less
tha~ 2/]0 of lZ lead. ~
5. Co~erclal buildlnEs,[industria1 buildings, mlClpte residences and similar
buildinEs and insCalldclons, a certificate of code compliance from the Architect'
or Engineer responsible for the building.
6. Submit Planning
Board Approval of completed site plan requirements.
For existing buildings (~rior to April 9, ]957] nou-confo~ing uses, or buildings
and "pre-existing" land
]. Accurate su~ey of pr6perty showing all property li~es, streets, buildimgs and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect siEned by the applicant
and a cert~fimd abstract of title issued by a title company which shall
show single and separate o~ership of the entire lot prior to April 9, ]957.
. If a Certificate of O~cupancy is denied, the Building Inspector shall state the
reasons therefor in ~iCing to the applicant.
3. Date of any housing cqde or safety inspection of buildings or premises, or other
pertinent info~tion ~'requlred to prepare a certificate.
For Vacant Laud Certific~te of Occupancy:
~- ~ application for va~'ant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate o~ership of ~the entire lot prior to April 9, I957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor iu ~iting to the applicant.
~ES:
CERTIFICATE OF OC~CY - New ~elllng $25.00, Additions to ~elllng $25.00,
Alteration to ~e~ling $25.00, Swi~inE Pool, $25.00. Accessory building $25.00
Addition to Access'ory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupamcy om pre-existing dwelling -
3. Copy of Certiflca~e of Occupancy - $5.00 - over 5 years - $]0.00
4. Vacaut Land Certificate of Occupancy - $20.00
Updated Certlflcat~e of Occupancy - $50.00
6. Temporary ' · ~
Certificate of Occupancy - $25.00 Residential
$50.0~ Co~ercial
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BO)~ 728
TOWN HALL
SOUTHOLD, N.Y. 11971
CERTIFICATION
Date
TEL. 765-1802
Building Permit No.
(p 1 ea~'~ print)
Plumber :~c/~O
· (please prlnt)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
Sworn
Notary Public,
to before me tkis
FOUNDATION (1st)
FOUNDATION
2.
f2nd)
ROUGH FRAME &
?LUMBIN~//
3.
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [~SULATION
FRAMING
REMARKS'~
FINAL
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION AND [~SULATION
FRAMING
FINAL
REMARKS:
DATE
~//~ BUILDING DEPT.
I ISPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ;ZND [ ] INSULATION
FRAMING
FINAL
DATE ~?~///I INSPECTOR
765-~802
BUILDING DEPT.
INSPECTION
[~FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
FINAL
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
~/~'OUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ]FINAL
"'MA"KS.' ~~
DATE
INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS
l 1/!)05.78 BUREAU OF ELECTRICITY
I--- 85 JOHN STREET, NEW YORK, NEW YORK 10038
Oe~' JUNE CI§, ]990 Application No. onfile ~/~]~9~/~ N 1,~68
T~I~ ~E~IFIES THAT
THONA'5 HIt;GINS, VANSTON ~OAD. POL~: 1152, CU1CHAOIJ,~;, N.Y.
in lh~ follo~inf~ locetion; [] B~sem~nt [] I,t FI. [] 2nd FI. GA~ S, ection Block
was ex.mined on H A Y ~ ~ , ) 9 9 0 and found to be in compliance ,'ith the requirements of this Board.
Lot
6~. 58 e, 5 66
O~YERS FURNACE MOTORS FUTUI~ AI~IMANC~ ~ TIA~ CK)C, KS UNiT HEATIIIS MULTI-OUTU~T DIM/~RS
SYSTIMS
SIRVIC! DISCOflNICT S i R V I C E
"ri( KE t)ETECTOR :-2
S1EVE'~, - ' "'
· E[E./) E. AJ
P. , BOX 1268
S0OlHOtl), NY, 11971
This certificate mast not be altered in any manner; return to the office of the Board if incorrect. Inspectors nmy
COPY FOR BUILDING DEPARTMENT. THIS COlbY OF CERTIFICATE MUST HOT BE ALTERED IHAHY idM4HER.
'FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ~.iZ4,~..} .0...., 19 ~.~. '.'
Approved .~. [.0. .... 19~ Pe=it No.~ ¢~ ~'~
Disapproved a/c ...................................
...........................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH
3 SETS O~.~ANSo ''.Oj~--.
SURVEY ,.. ~ .0~.~.~-~
CHECK ~-.-%-
SEPTIC FORM ..~./~ ....... :
NOTIFY
CALL ......
Date .... .~..~,....~,..~, .~.., 19 ~.g
,' 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 tlie 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 auth°rized inspect°rs °n premises and in building f°r necessaT~i' '~'~-t-t-~f~' ' '~. [~Og~ ~
(SiCnature of~'a~;me, ifa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder·
...... ...... .... .... r>c 9.a ........................................
Name of owner of premises . .'~.~.o..~. 0.~.... ,q~'..g.~ I'1. ~ ..... ~ (.~..&.I.E..~. ....................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) ·
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSEB
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
..... .'5. 7. 47 ....... .-co..,... .,,. ,? ........................ .............
House Number Street Hamlet
County Tax Map No. 1000 Section . . . } .~.~ ........... Block .... [ ............. Lot... [ ? ~ ............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Nmne)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . o~e ~:8~.~, ~ESt~e-10f--P- "'
b. Intended use and occupancy ~.VI.~. ~'~ikl t i~.~ ~.% type ~0,..~"' '
3. Nature of work (check which applicable): New Building .......... Addition .......... Alterat~n ..., .......
Repair ............. ' Removali ........ Demolition ............ Other Work
i (Descnp~mn)
4. Estimated Cost ~. j Fee
~ ~ (to be paid on filing this application)
5. If dwelling, number of dwelling units .... ~.. ~4.ff ...... Number of dwelling units on each floor ................
If garage, number of cars ...... ~ ..............................................................
6. If business, commercial or mixed occupancy, spegify nature and extent of each type of use .: .'7:. ..
7. Dimensions~g strUct~es~ ii' any! FrOnt: ..... ~ ........ Rear .............. Depth ...............
Height ......... ~'es ....... I ................................................
Dknansions ~ture with~alter~additio'ns: Front .......... Rear ...............
ber of Stories ...... ....." ' '
Depth... ~~t~ .[!:l~ ...... ,... ~m
-' 8. Dimensions of entire new construction: Front ..... ; ~.;..' .....Rear ............... Depth ...............
Hesght ................ Numbe:r of Stones ......................................................
9. Size of lot: Front . .,q..~.~,~7.,~,,.~:~.. '.. ..... Rear-.~-, .i .q .'J.%~ .~.. ~ ...... De~th e~..~,~..~_...
10. Date of Purchase ....... ! ................ Name of Former Owner .:'-~.~. ~.t~...~:LO.~.~. ~ ....... q..
11. Zone or use district ih which prem?ses are situated .....................................................
12. Does proposed construction violat~ any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ...~-.~ .... , .................. Will excess fill be removed from premises: Yes No
14. Name of Owner of pre~gl~ses'~.~1~t~ .~MIRF, .~./~.G./AJ.~Address I~..~.~.l~ ?~Je~. ff~.,~C~hone Nol~l.b.~..'~q ~,.~o~l.~..t
Name of Architect ~ Address Phone No
Name of Contractor ' Address ' Phone No
15. Is th±s propert:y local:ed w£th~n 300 feet ot~ a t±dal wetland? ~Yes ..... No .....
~If yes, Southold Town Trustees Perm~Lt maybe reclu±red.
! PLOT DIAGRAM
Locate clearly and distinctly all b,uildings, whether existing or proposed, and~indicate all set-back dimensions from
property lines. Give street and block nfimber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK.,
COUNTY OF .................
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract
above named.
He is the ...................... i ..................................................................
.'~ (Contractor~, agent , corporate officer , etc . )
of said owner or owners, and is dul~ 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 manne'r set forth in the application filed therewith.
Sworn to before me this ,I
............... oO~ ..... day of...~.. ............. 19.
Notary Public ......... ~. .
... County
(Signature of applicant)
~AP AI'dElqDEP- JULY
2'78.0
220'
p 1~4. FLeo ~
FIREPLACE
DETAIL
i~opub~ FUUF__,
biMoK ~-. ~ i-tF. IVl!~ ~-.
EN1E Iq~ FI L.b.
SEAL
0
0
0
FULL BASEMENT CONS"[
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,
//
C,E~'~E~,r.,I~'rr-
~,r,..,r~,O~.j'( _. ~.,,..,.,. ,,is,,-,,,u,~,g
~ ~%~ lystem; piping shall be
PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE
CERTIFICATE OF OCCUPANCY
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED 2110 of 1% LEAD.
LAU N DR¥
__B_~._E A K FAST'
R_OQ_M ?,~
.... Ho?'
.... 4~' FA L
SEAL
L
[~EDROOM¢2
CLO.
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II
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~2'. O~/BUILD~ ~E RESPONBI~ FOR ~L I~S~CTION8,
: ~F-., Io,hJ .~
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