The URL can be used to link to this page

Home My WebLink About16828-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17337 Date SEPTEMBER 22~ t988 THIS CERTIFIES that the buildin~ ADDITION Location of Property 1155 OLD HARBOR ROAD NEW SUFFOLK~ N.Y. House No. Street ~amlet County Tax Map No. 1000 Section 117 Block 3 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 11, 1988 pursuant to which Building Permit No.~6828-Z dated MARCH 17~ 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 ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED DOROTHY SARGEANT (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A N03166~ SEPTEMBER 6, Rev. 1/81 1988 Bulldlng Inspector FORM NO. 0 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) No- 16828 z Permission is hereby granted to: ~x~, ~/~~....~ ........................... ~...... . ...~~~.~.....xx~. , ~o ~~~.....~~.....~~4,....~...~.~......~m ...~..:...~ ...... ~......~..~....~.~: ......... ~.~, ........................................... ~, ~,,,~ ,~,.~ ~,.....,~ ...... ~~.....~ .............................. tttt .......... ...... ~ ~.r ............................... c~,~ ~ M~ ~,. ,~o~ s~,~,, ...... ZZ.Z ....... ~ ......... ~. ...... ~, N~ .......... ~ .......... p~r~.t to ~ppli~tio. dot~ ......... Building Inspector. Free $.........~..~../..~ Rev, 6/30/80 FORM NO. 6 ~ TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPA Instructions ~ A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building In~oec- tot 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 pzoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Certificate of occupency New Dwelling $25.00, Accessory,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.vaoant ,.and o.o. 2o.oo 5.Updated C.O. $ 50.00 Date. ...../.--- .... New C ohs f~ruc f. ± on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of PropertyHou,e ~ ' '~' ' 'No. .~.~. . .~. .~. .t~. . . .~.~.~ ...... Street Owner or Owners of Property County Tax Map No. 1000 Section .... (.~..'~ ...... Block . .~ .......... Lot..0.~' ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No/.'~ ,~[~... Date Health Dept. Approval ........................ Labor Dept, Approval .................... Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. PP '' 'q,¢ ..... ~< ..,"d'.~..~..~"~.~C,. ,¢'(.~'7 .................. Rev. 10~10-78 FOUNDATION (2nd) 2. ROUGH FRAME / PLUMBINU INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: IRED PLUMBER CERTIFICA 1~ON ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUP,4h~y If copper tubing is used for water distributing system; piping shall be of types K or L only, New York State Department of Environmental Conservation ~OO= =9, Stony Brook, NY 11794 ~//7/~ A review has been made of our ro o ·' ' ' " submitted, 9.f ~nv~ronmen~al conservation has determi ,~epartment -, ,. . ned that the a~l ~ pro3ect is: - P _ Greater than 300' from inventoried tidal wetlands. ~ Landward of a substantial man-made structur~ ~v%(~,~,% ~ greater than ]00' in lenQth which w~ ......... ~uc~e~ prior to 9/20/77. .. Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. L~sted in Part 661.5 of 6NYCRR (Tidal Wetlands Land Use Regulations) as a use not requiring a permit or notification letter Of approval. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional Permit Administrator TOWN OF SOUTHOLD OFFICE DF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $0UTHOLD, N.Y. 11971 ~., To Whom This May iConcern, We are unable to complete your Certificate of Occupancy because.of the following reasons. ~ An application for Certificate of Occupancy is not on file. _~/. No Underwriters Ce'rtificate on file. The check is(outdated/not~fi]e.)~f3 '/5/ No Health Dept. Approval on file. /5/ No final inspection has been made. TEL. 765-1802 Please contact our office on this matter. Thank you for your cooperation. ~uilding Permit ~ ~ /~.~.~ & Z Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing bsing issued after April 1,1984 ) 765-'~802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION :~ND [ ] INSULATION [ ] FRAMING [~'~INAL DATE 765-1802 BUILDING DEPT, INSPECTION [~,~'FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FIIUNDATION 2ND [ ] INSULATION [ ] FI~AMING [ ] FINAL REM~J !RKS: .__~~~/~ ~)/~ ' DATIr~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION [~]~RAMING [ ] ROUGH PLBG. 2ND ~'*i~SULATION FINAL DATE INSPECTOR ./~UILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ~ ] F/OUNDATION ZND [ ] INSULATION / [/] FRAMING ,r. ]FINAL REMARKS: /~ ~~ DATE ~//,~//~? E 1001093 IIU~AU OF ~ ,, ~4 ~ ~ , B5 JOHN STR~. N~ YORK. NEW YO~ 10038 ~ppl~a~i~ No. oriole TH~ CE~FIES THAT ~ examifl~ ~ ~ Ist Fi. [] ~nd FI. ,~,e~t/on Block and /o~nd to be in Compliance with the requlrement~ o~ this Board. MOTORS ~uflJ~ AFftJANC! ~ TIMI CLOC~ I~ V I C E GARY DOROSKt 420 MO~$}II.I~ InN. CUTCHOGUBI, NY, 11935 I, iC~$E #0. 2941 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY $OUTHOLD, N.Y. 11971 ~t/.,.. t._~.~.~.% .~Z~.,~..~ ~,O~J. Approved ............... · .............. ~ ~) '~ ' ~ Disapproved a/c .................... .... : ............. IlUjl' qllll ""- lgl t, /1111 .................................' .... ';; gl,,- uJl ........ ,,,, ~ (B~ding Inspector/ -- ~P~klCATIO~ FOB BHI~I~G PERMIT Date .~A~B. } }., ....... , 19 ~. INSTRUCTIONS a. Tiffs 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 tiffs 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. i No building shall be occupied or used in whole or in part for any purpose ~hatever until a certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H~R~Y~he Building Department for thee issuance offal:Building Permit pursuant to the Building Zone Ordin~.~.~uthold, Suffolk County, New York~,,and .othey applicable Laws, Ordinances or Regulations, for the constrt~l/~ buildings, additions or alterations, or' for tdmoval 'or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance~,'buildhflg,c0d~, housing ~ode, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary~~ ' -'~'~7A~o~ ~ (j[,~ · ~c-r¢ ... T .~~... uc~.~ ~ ..... ~ .... ~ .. r .~ .~ (Signature of applicant~ or name, if a corporation) .o.! ~.. F.%r.~..o.r..~.o....,. ~..w..s.u.e..fg.~,' ..~y..! ~. ?.~.~.. (Mailing address of applicant) State whether applicant is owner, lesse~chitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. Ma:.a,. H.o. vxl an.cl.. ~Dor.athy.)..Sarg.eanb ................................... (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 LICENSED Builder's License No...O.w.n.e.r. .................. Plumber's License No, .I~.a.t.~.~ .~.u??..P..1.u.m.b.i..n,b... Electrician's License No. G.a.r.y.p.o.r.o..~ .~.~.. ?..2 .9.4.!- ~ Other Trade's License No..T. J:..m..G.r.a..5'. ?l.a.s..o .ny.l( . I. Location of land on which proposed work will be done .................................................. 1155 Old Harbor Rd. New Suffolk House Number Street Hamlet County Tax Map No. 1000 Section ... 1.lb ........... Block . .~ ............... Lot... 9 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .R.o.~ ~_ (;l.ay~t~ i ~ % ...... : .......................................... b. Intended use and occupancy Residential / with addition 3. Nature of work (check which apl dicable): New Building ' ... Addition...X ....... Alteration .......... Repair .............. Remo ral ............ Demolition .............. Other Work ............... (Descrip~tion) 4. Estimated Cost ... $.9.,.500 ......................... Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units...............1 Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed[ occupancy, specify natur, e and extent of each type of use ........ Height .... ~d~ O. ....... Numl~er of Stories . . . c~. ......................................... · ......... Dhnensions of,same struct~ur/o wiih alterations or addid, Bns' Front ~ O. ~'' Rear ~0 >' ' -- 8. t ensmns of ~t'e~n~w~stmctmn: Front .... ~)~.~..' ..... Rear .... .~.~. Depth . J. [ . .[. ~... 9. Size of lot: Front ........ 1.?~..; ....... Rear ......... .IJ.~. ......... Depth ...~ 8 ........ [ .~! .J... 10. D~teofPurchase 1.1.9.7.~ .... "..i.' ............. Name of Former Ow~er R±chard Scot:t:± 11. Zone or use district in which premises are situated ...... J'5.%.si dc rvt~ ~ v ' 12. Does proposed construction violate.any zoning law, ordinance or regulation: .. ('h.q> ........................ 13. Will lot be regraded ......... ~ .'xl~ ~ ............ Will excess fill be removed from premises: ~fes'~) No 14. Name of Owner ofpremisesBo~t~y ~ar.~oan.t.. Address Old..HarD.c~r .R¢.,.N~Phone No.7.3.4-:6'27o..~ ...... Name of Architect .......... ~ ................ Address ................... Phone No ................ Nmne of Contractor ......... i ................ Address .... : .............. Phone No ............. 15. Is this property located Within 300 feet of a tidal wetland? *Yes ..... No .X *If yes, Southold Town TruStees Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY i OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY PERMI~ INCLUDES APPROVAL TO REMOVE EKCES8 FILL FROM ABOVE F'REMISE$ BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOl. CONSTRUCTION APPROYaD AS NOTED} NOTIFY' B-UII_DIN(~ DEPART0~ENT A 765-180:2 9 AM TO 4 PM FOR THE FOLLOWI'NG INSPECTIONS: lh FOUNI~ATION - TWO REQUIRED, FOR POURED CON~,RETE 2. RE)U~-H'- FRAMI.NG & PLUMBING 3. INSU,LATION 4. FINAL - CON'STPIICTION MUST BE Cr"MPI.'ZTF FOR C. O. ALL CONS'TR~1CTION SHALL MEET THE REOIffRFMENTS ~F THE N.Y. STATE CONCTRUCTION & ENr:RG¥ ~'ODES, NqT RESPONSIBI E F OESIGN OR CONSTRUCTION STATE OF NEW YORK, S.S COUNTY OF ................. I (Name of individual signing contract) above named. ' being duly sworn, deposes and says that he is the applicant He is the , I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl authorized to perform or have performed the said work and to make and file this application; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Sworn to before me this 1 ...................... day of 'i ........... , · · · Notary Public ................ County HELEN K DE V0E I~01'ARY PUBLIC, State el NeW Ym'k No. 4707878, Suffo k CouotYG,'~ ~erm Expires March (Signature of applicant)