HomeMy WebLinkAbout16819-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17432
Date OCTOBER 20~ 1988
THIS CERTIFIES tkat %he building. ADDITION
Location of Propert~ 19855 MAIN ROAD ORIENT
House No. Street Hamlet
County Tax Map No. 1000 Section 17 Block 1 Lot 11.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 7, 1988 pursuant to which
Building Permit No. 16819Z dated MARCH 15~ 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 OVER EXISTING ATTACHED GARAGE.
The certificate is issued to
C.W. THOMPSON
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED 7/25/88
N039273
MICHAEL DAWSON
Rev. 1/81
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)
N°_16817 z
Permission is hereby~rartted to'
.~.~.~.~.~...7~....~ ...........................................
,o~...~.~.~:.;.~...~..~~..~..~... .....
~"'"~"'"~~'"'~:::::"'~ .......................................... : .......... i ........
at premises located at ...... x..~...v ........ :: ....... ~.~;......'.~-'~ ................................................................
County Tox Mop No. 1000 Section ........... ../,..,~,. .... Block ................ ... ',~g Lot No. ....... ./../,~, ~ .....
pursuant to opplication dated ..... ..~.../~.. ...................................... , lg.~.g~., and approved by the
Building Inspector.
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N,Y, 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ --- to the Building Inspec-
tor with 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, a certificate of Code compliance from the Architect or 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 p~operty 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certif~cate of occupancy New Dwell~ng.$25.O0, Accessory';S10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
NewC°nst;z'ucti°n ...... OIdorPre-exisdngBuilding ............ Vacantkand ........... ..
Hou~ No. ~;tre;t ............ /Yam/et
Owner or Owners of Property Co gJ ,
County Tax Map No. 1000 Section ....(~, .I,~.. ..... Block ...... t Lot.
Subdivision ................................. Fired Map No ........... Lot No ..............
Health Dept Approval Labor Dept Approval
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... ~ .............
Construction on above described building and permit me~ts all appticable, cg~s ancJ~e~d'rations.
Z'- '- ....
.^ ~ , Applicant ........... ~ /~-'~-'~."''~ ~
m d c, '-'";,7 ' .............. .............
Rev. 10.10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date
Building Permit No.
Owner C, ~-~, 7~/+0'~ ~~/~'/ (please print)
Plu~er ~/~ ~
' (please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber' s signature)
Sworn to before me this
,~.~/~day of ~L/c; ,
Notary Public,~c~J~O~. // County
Notary Public
UNDA lC DAWSON
No~W Pu.b, lic, State of New
r~o. 4694688
T Qualified In Suffolk Cou~tt~f ~- ~
erin Expires March 30, 19
TOWN OF £OUTtIOLD
OFtqCI'.' OF BUILDING INSPECTOR
P.O. BOX 728
TOWN IIALL
SOUTIIOLD, N,Y. 11971
July 6, 1988
TEL. 765-1802
R & R Home Improvements
& Building, Inc.
Box 676
Greenport, N.Y. 11944
Re: C.W.
Thompson
To Whom This May Concern,
We are unable to coalplete your Certificate
of Occupancy because .of the following reasons.
/_-/ An application for Certificate of Occupancy
is not on file.
/~/ No Underwriters Certificate on file.
/~/ Thc check i::(outdated/not ou file.)
/~/ No Health Dept. Approval on file.
/-~/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit t~ I 6 8 t 9 Z
Duildlng Dept.
**~/_~/ Ho Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME~//
.PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDIT%ONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST I- ] ROUGH PLBG.
FOUNDATION 2ND [ ] ~JLATION
FRAMING r//] FINAL
REMARKS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST ~- ] ROUGH PLBG.
FOUNDATION 2ND ~NSULATION
[ ] FRAMING
FINAL
DATE _ ~////~//~r(~/
/
INSPECTO~
765-1802
BUILDING DEPT.
INSPECTION
],FOUNDATION 1ST [ ~ROUGH PLBG.
j FOUNDATION ZND [/~ INSULATION
FRAMING
FINAL
DATE~ "~/'¥/~ /(~ INSPEcToR~',:~~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
~ ,~OUNDATION ZND [ ] INsuLATION
FRAMING [ ] FINAL
REMARKS:
DATE, INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~ B5 ~HN ST~. ~W Y~K. N~ YORK 10038 ' ~
THIS GEKFIES ~AT
~WESII.~:Y I'HOHPSON, HAtN ROAD, /POIE ~Ot [, OH[~:NT, N.'(.
:-::::' ENERGY CODE
~:'~ :
. :.
1) ~T!NG ~P~ ~ ~ 7813.23 - 75% ~F.
2) ~TING ~OLS ~ ~ 7813.13
~ 45 ~ 75 D~ F~IT.
3) ~T~ ~TING P~ 7813..31 ~U .38.
4) PIPE iN~TI~ 7813.19
5) ~ - ~LE ~S.
6) ~N~U~ION ~ ~ N.Y.S. ~ CODE.
BOARD OF HEALTH :~....
FORM NO. 1
TOWN OF SOUTHOLD '
BUILDING DEPARTMENT SEPTIC. FORM ..............
TOWN HALL
SOUTHOLD, N.Y. 11971
, TEL.: 76~-1802 CALL 7;:'~ ~ ~'~'
MAIL
Examined ~ 19 ~ = ...... -
Approved ................ ~J 19~gPe~it No../k~(.7..~ .............. -llll
Disapproved a/c ..................................... - ~ ~ ~''~
................................................ ~ ~ TOWN OF,gOU~OL~
APPLICATION FOR BUILDING PERMIT
Date..~.~..~ ...... 19~
INSTRUCTIONS
a. T~s application must be completely filled in by Wpewfiter 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 pl~ showed location of lot and of build,ds on premises, relationship to adjo~ing premises or pubUc streets
or areas, and giv~g a det~led description of layout of prope~y must be drawn on the diagram which is pa~ of this appli-
cation.
c. The work covered by t~s application may not be commenced before issu~ce of Bu~d~g Permit.
d. Upon approval of this application, the Building Inspector will issued a Build~g Pemit to the appRc~t. ~uch pemit
shall be kept on the premises ava~able for ~gpection throu~out the work.
e. No build~g shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy
shall have been granted by the Building Inspector.
~PLICATION IS HEREBY MADE to the Building Dep~tment for the issuance of a B~lding Pemit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or
Regulations, for the construction of build,ds, additions or alterations, or for removal or demolition, as here~ described.
The applicant agrees to comply with all applicable laws, ordinances, buQd~g code, housed code, and regulations, and to
admit authorized ~spectom on premises ~d ~ build~g for necessa~ inspections.
(Signature of applicant, or name, if a corporation)~
. .. 7h
' (Mailing address of applicant)
State whether applican, t is owner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder.
........... [3.,,. . ,. l b. e. .~. ........................................................................
Name of owner of premises . ~.,..~...-...'~.O 1¥~.{~.O/O ...............................................
(as on the tax roll or latest deed)
If applicaX~ is a corporatl~n,~gn, atur~,o~duly authorized officer.
ALL ~CTOR.,,'~S }(IUST B?~i~SgFFOLK COUNTY LICENSED Bui~er;~[i~se 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 ........... , ................ ~ ......................
...... .o ........ ..................
House Number Hamlet
County Tax Map No. 1000 Section ..... ~. J..~ ....... Block .......... ~ ....... Lot .... .~. }1, ¥
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 ....... t...~.~-'3, o[ ...... ~..~. ?. -~.- · .........................
b. Intended use and occupancy ....... [....~..~..vY~.. t .~.~ ..... .~..~..$).~..~..~...t~ ..~,..W/;z0~..~ ~.~.~, .....
3. Nature of work (check which applicable): New Building ' .. Addition .......... Alteration · I/......
Repair .............. Rem6val .............. Demolition .............. Other Work
I (Descriplinn)
4. Estimated Cost ..... , ....................... Fee .....................................
~' ' (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits ......... ~, ..... Number of dwelling units on each floor.. ~ ......
If garage number of cars ~ '"- .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....................
7. D]menmons of existing structures ~f any: Front ............... Rear .............. Depth ..............
Number of Stories
Height ......................................................................
Dnnenmons~a~c'"~t~ru~elure with alterations or additions: Front ................. Rear .................
Depth ~ Height Number of Stories
"-8. Dimensions of enti/e new construction: Front:::: .~:~.~..~: Rear .... 5T ..... Dept.h ... :7. ~:! ......
Height .... J..'Z.. ....... Number of Stories .................................
9. Size of lot: Front ....... ~.<z3~..~ ......... Rear ...................... Depth
10. Date of Purchase ........... -- c; .-....'~..~.lC...V~..~.... Name of~Former O~wner .........................
11. Zone or use district in which pr~mises are situated ..... ~.'~..~.~.g. ¢..~W~...~..~... ' ' . ...............
12. Does proposed constructinn violate any zoning law, ordinance or regulation: ...'.~..O. ........................
13. Will lot be regraded ......... i ................... Will excess fill be removea~ from premises: Yes No
14. Name of Owner of premises .('.,.~.:..'~lJ~o I~,~(~$.o.~... Address lYIngS..1~....~}'l~,.~.~. Phone No.. ~.~-~ .'T..~-.~.~/.'--
Name of Architect ......... ,~ ..... ; ........... Address .................. Phone No ........
Name of Contractor l~ ~ ~... 'i ~¥' ~.0 ~ ....... Address ~...0.: ~.#)q .~. '~ {;.. ~/~ ,. Phone No. ~.~.. ~/.': I ~i i
15. Is this property located iwithin 300 feet of a tidal wetland? *Yes ..... No ~ '
· If yes, Southold Town TrBstees Permit maybe required.
i 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 corner lot.
STATE OF NEW YORK, ! S.S
COUNTY OF ................. ~
............................ , ................... being duly sworn, deposes and says that he is the applicant
(Name of individual sigfling contract)
above nam ed.
He is the ..................... ~ ...................................................................
i (Contractor, agent, corporate 9fficer, etc.)
of said owner or ow~ters, and is duly authorized to perform'or have 'perfonned 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 mann0r set forth in the application filed th.erewith.
Sworn to before me this
Notary Public ....... z~-~..~q..~ t~ffZ/d~. ·-· .... County
' ! fl£tE~ K. DE VO[ ,, -k .......
- NOTARY PpBLIC; Stste o! Hew Yog ~t)
Ilerm Ex,res March 30,19-,----/
1
GENERAL NOTES,
1. CONTRACTORS WORK
2.
4.
5.
! I
,-6
OCCUPANCY OR
USE IS UNLAWFUL
RF.~UlR~
IS TO CONFOR~ TO ALL LOCAL ORDINANCES
AND NEW YORK STATE BUILDING AND ENERGY CONSERVATION
CODES. LATEST EDITION
ELECTRICAL AND PLUMBING WORK SHALL BE COVERNED BY ALL
NATIONAL, STATE AND LOCAL CODES. LATEST EDITION
CONTRACTOR SHALL VERIFY ALL FIELD CONDITIONS AND DIMEN:;IONS,
COOPERATE WITH OTHER TRADES AND COMPLETE THE WORK IN
A~CORDANCE WITH THE BEST STANDARD PRACTICES.
AIL DIMENSIONS ARE NOMINAL AND TAKE PRECEDENCE OVER
8GALE. ( DO NOT SCALE DRAWINGS ) ALL ABBREVIATIONS
ARE STANDARD.
ALL ITEMS OF WORK ON THE DRAWINGS ARE NEW UNLESS 0T~ERWISE
~NDICATED.
WITHOUT CERTIFICATE
OF OCCUPANCY
APPROVED AS NOTED
NOTIFg St~fLDli',lG DEPAE'~E~T AT
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO
FOR POURED CONCRETE
BE COMPLFTE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REOtllRE~ENTS OF THE N.
STATE CONSTRU~ION & ENERGY
CODES. NQT RESPONSIBLE FCA
DESIGN OR CONSTRUCTION ER~OR~
6. ~ROPRIETORY NAMES IDENTIFYING ITEblS OF WORK ARE USED
~OLELY TO PRESCRIBE STANDARDS OF CONSTRUCTION.
7. ADL WOOD FRAME CONSTRUCTION SHALL CONFORM WITH THE
AMERICAN INSTITUTE OF TIMBER CONSTRUCTIONS "TI~ABER
CONSTRUCTION ~ANUAL" LATEST EDITION
8. ALL WOOD F~ING MENBERS SHALL HAVE AN ALLOWABLE
~"XTR~4E FIBER STRESS EQUAl5 TO OR CREATOR THAN STRUCTURAL
GRADE DOUGLAS FIR, Fb = 1450 P.S.I. Fv = 95 P.S.I,
9. DOUBLE ALL FLOOR JOISTS IN ALL BATHROOM AREAS BELOW TUBS.
10. DOUBLE ALL HEADERS AND OR TRIMMERS AROUND ALL JOIST
OPENINGS.
PROVIDE SOLID BLOCKING IN ALL JOIST SPANS IN EXCESS
OF 8' - U".
1%p o¢ FL Tg
12.
15,
DOUBLE ALL FLOOR JOISTS BELOW BEARING AND PARALLEL
PARTITIONS,
ALL INSULATION SI[ALL BE KRAFT FACED WITH VAPOR BARRIER
FACING WAP34 SIDE OF HOUSE.
ALL WINDOWS SHALL BE INSULATED GLASS AS MFG. BY ANDERSEN
OWNER SHALL PROVIDE SAFEGUARDS-(PLANTERS,SCHRUBS OR
OTHER PROTECTIVE MEANS) TO PREVENT INO13RY CAUSED BY
CONTACT WITH OPEN CASEMENT WINDOWS.
CONTRACTOR SHALL CLEAN ALL DOOR AND WINDOW GLASS AND
~EAVE ALL FL00RS, WALLS AND CEILINGS FREE OF DEBRIS
I~EDIATELY PRIOR T0 FINAL C0~PLETION.