HomeMy WebLinkAbout17053-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217290 Date SEPTEMBER 13, 1988
THIS CERTIFIES that the building ADDITION
Location of Property 880 SALT MARSH LANE PECONIC
House No. Street Hamlet
County Tax Map No. 1000 Section 68 Block 3 Lot 8.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 13, 1988 pursuant to which
Building Permit No. 170532 dated JUNE 2, 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 SUt~44ER BUNGALOW.
The certificate is issued to ELAINE AXIEN
(owner, )
of the aforesaid building.
SUFFOLK COUNTY BEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N031551
PLUMBERS CERTIFICATION DATED N/A
~ ~ W C~Z~!%C.~rW~V
Building nspector
Rev. 1/81
Foaas xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Dare 19.5!
N°- 017053 Z
Permission is hereby granted to: ~
. . . r . .
,.~,~..%...s~.........~....~.~.~....
,
/J~~}-+ /J~// ,
at premises located at ....~C7..~.V.....~ (...1~lff~.~4
...............................................7.
`~.„.U~......................................................................................
...................................................................A.....p/......................................................................................
Caunty Tax Map No. 1000 Section ......,K7.R.......... Block rr~~.Lot No......~.-.1........
pursuant to application doted 1 SY~.CJ.., and approved by' the
Building Inspector.
Fee $••a.i:..~J..(
~.f.'l.lt0a
Bu din~i/jfispector
Rev. 6/30/80
,
'I FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
tJiHOLCf 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-
torwith 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).
y 3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installs- ,
- 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 property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner asto 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 occupancy 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 $ 10 .00
4. Vacant Land C.O. $ 20.00 ~9
S.Uodated C.O. $ 50.00 Date..
NewConstruction,,,,,,OldorPre-existin Buildin ,~f1;>11,~,,,,, Vacant Land
(~~j~i 9 9
Location of Property .QA:a .......~!~.'~.i. ai!!Y~..Sh. /..¢C~~/iC~ ~l~ ~~9`5~
House No. ~ Street hlamle[
Owner or Owners of Property .
County Tax Map No. 1000 Section ~ P.......... Block Lot f!.'.'~
Subdivision ......Filed Map No. .........Lot No. .
ar~yj .
Permit No. 1./.d .J~.~A~Date of Permit ~,j~~~ .Applicant .~~'~.`.'~,L!`~"--"
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval
Request far Temporary Certificate .....................Final Certificate .
av /
Fee Submitted $ ......4? ~ , , . , , ,
Construction on above described building and permit meets all app ' ble codes and regulations.
C,n~~1'1,~40 '
ApPlicant.
Rev. 10-10-7e G~ n
0 ~
_ ~ ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS vAC~:
7`00037.4 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date S)••;YTEMBEi? ()2, 19RA ApplicarienNo.onfile 55323JR$1KS N Q3).55t.
THIS CERTIFIE3 THAT
only the electrice! puipment N descri6sd 6eklm and introduced by the applicant Homed on the shoos opplicotion numMr in the prensiaes of
MRS.N. AX):FN, Sl>UNnI) SHORE ROAD, PFC,ONLC, N.Y.
in the follotcinp locot p~y„S,y~,~~prtt~pt ~ Iat FI. ? Pnd FI. .Sertion Block Lot
Eeoa examined un AUtaU ~1~ 7. Y t? andfound to 6e in compliance uifh the nyoirententa of this Board.
A%TUM ACTiS fYY1TCNE5 R%TURK RANOES COOIIINO D[C%S OVlNS DISN WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUDIIESCENT v AMT. K. W. AMT. K. W. AMf. K.W. NAT. K. W. AMT. N. P.
1d 5
DRYERS R/RNACE MOTORS 1UTUM A/NIANCE !MOMS S?EpAI MCR TIME f]OCKS ENL UNIT (MATERS MULTI.OUT1lT DIMMlRS
AMT. K. W. dl N.I. GAS N.I. AMT. NO. A. W. G. AMi. AMP. AMT. AMTS. TRANS. AMT. N.I. SYSTEMS AMT. WAITS
NO. W 1!i
SlRVNk DISCONNlCT NO.Oi S E R V 1 C E
AMT. AML, ry1E METH I ~ ~ ~ ~ Sw S / SW ] X AW NO.OF U COND. A. W. 6. NO. OF NFLEG A. w. G. NO. OF NEUTIIAIS A. W. G.
EOIAr. Nsr a cc. c D. of NIaEC a NEUTSAt
~ 100 cR 1 x 7 2 ] 7
Oi11ER AMARATUS: ~
B.J. t;)scrxr.c co.
S'rTL,LNA`~F,R AVBNUF;
CUTCffOGftS, NY, 11.935
-
7J ~ ~
L'[('EN~P; NO. 2,57Q M Per r
This csrlificap must not bs altered in any monner; rNUrn to tM office of tFla Boortl if incorrect. lospxton May be. identifid bytheir creMMiols.
-
COPY FOR NUILDING DEPARTMENT. TENS COPY OF CENTIFN:ATN itfIIST ~ EE ALTERED JM M~.JAA,~IER_ ; 7
0~05`~ o To~~ra o~~ s~u~f~oz.n
OPF'ICL OP BUILDING INSC'ECT012
~ 7 = I'.O. T30X 728
~ TOWN MALL
`'O ~ t- SOUTI IOLD, N.Y. 4 197 t
Ce~F~s,~
~k~~:
To Whom This May Concern,
We arc unable to complete your Certificate
of Occupancy because of- the folloc•Ji.ng reasons.
An application for Certiti.cate o1 Occupancy
is not on file.
No Underwriters Certificate on file.
/ / The check is (outdated/not on 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 Pernu-t 1i ~ ~ Z
Building Dept,
/ No Plumber Solder Certificate on file.
( all penniCs involving plwnbi.ng being
issued after April 1,1989 )
~D S 3 ~ rss-isoz
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSULATION
[ ]FRAMING [ /.]'FINAL
REMARKS: C~c C ~ ® .
h m
DATE ~2,;
g8~ INSPECTOR
=I~i.D ihS:~~':iu:J ~~Dr,'iE ~ i;0i`EMENT° ~
- 'D °J
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H
y
^OUiJDATION (1st) ~f
- `y,.
~ d
FOUNDATIOIJ (2nd) m
2.
o
ROUGN FRAME & AA~~-
PLUMBIUG
ti
3 , x'
rh
INSULATIOP] PER N. Y. y
STATE ENERGY
CODE
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BOARD OF HEALTH
3 SETS OF PLANS ?
FORM N0. 1 SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
°,OUTHOLD, N.Y. 11971 CALL
TEL.: 765-1802
r~i MAIL T0:
Examined 19GaV
Approved .tG</.~:........, 19R~PermitNo..
Disapproved a/ic /
c===r7~~ • • •~?e•.... . .
(uildingector)
APPLICATION FORrrrrrr%%%%%%BUILDING PERMIT
Date . ~ 19v~
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
hall 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 the 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 authorized inspectors on premises and in building for necessary inspections. '
(~atu,
_ re of applica~~o~r ~na~m~e, if a corporation)
ailing addres o appli nt) ~o G
o2ss.~'~ov~v9s /~?e• .-~o~; , {,.19/~~
State whether applicant is owner, le e, agent, archit n~gineer, general contra or, electrician, pl r•o burlder.
Name of owner of premises
(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 ST BE SUFFOLK COUNTY LICENSED
Builder's License No. ~ G/~!l~~K .
Plumber's License No. ~j4... /~'G U~
Electrician's License No. {J•.Y:. ~:~e~.~~. ~GO
Other Trade's License No. ~0!~Gl• • • • .
1. Location of land on which proposed work will be done. .
. ...........F...:..
House Number Street Q Hamlet r
County Tax Map No. 1000 Section .~.C~ Block ......:'3........ Lot . d°. 3
Subdivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intend~ejd use and occupancy of proposed construction:
a. Existing use and occupancy ~Cl~ ~2~ UtiG ~ O GJ
b. Intended use and occupancy . ~4*?{~:~..li~~•~Q4-.-~f-.41-?~-•, , , , , , , , , , , , , , , , ,
3. Nature of work (check which app;licable): New $uilding Addition Alteration
Estimated Cost ~ ,al . Demolition ..............Other Work , .
pmo •••••••••••(Description)••
4. Repair Remov Fee..............
' (to be paid on filing this application)
5. If dwelling, number of dwelling units ~ Number of dwelling units on each floor .
If garage, number of cars ......p ~ .
6. If business, commercial or mixed',occupancy, specify nature and extent of each type fuse .
~r(~'
7. Dimensions of existing structurest if any: Front o[.d v~ , Rear ..a Depth ,fY'. .
Height /.c~. ~ ........Number of Stories l
N........
De th ,2, • , , • , h alterations~gr additions: Front ~j~0...?.......... Rear ~4 .
/ r~ a ....Haight ./`F. , / Number of Stories ..I.......~./~ /
rmensrons of ame structure wltction: Front /cry.. Rear ~o? ~ Depthv~ 7°, , , . , , , , ,
8. Hemhtsions entire new c Nu bier of Stories ~ .
9. Srre of lot: Front . Rear . /P~ ~ . epth
10. Date of purchase ~ ~ ..Name of Former Owner ~ Sa!U • , ,f~~,/ Pr, nl, , • , • ,
11. Zone or use district in which premises are situated . . . .
12. Does proposed constru~ct}'°n violate any zoning law, ordinance or regulation: .
13. Will lot be regraded .LV. ~ .....'i .....Will excess fill be remov d rom premises: Yes o
14. Name of Owner of premisesF~/1i.;!/1~Z../,7'k~./,P,t~/... Addresses.? T$',~DiY~J" f~'?G., ,phone No. 7t??~.- e3/,5, . ,
Name of Architect . l Address ~4.v .1~~ //~jL .phone No............... .
' y .....:................Address ....:..............Phone................
15. Is this property located w,
Ifs esfCSouthold Town Trusithin 300 feet of a tidal wetland? *Yes o
* tees Permit ma be required.
pLOxI' DIAGRAM '
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block n~rmber or description according to deed, and show street names and indicate whether r
intetior or corner lot. j
jl
i
STATE OF NEW YORK, S.S
COliNTY OF
• • • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signiiag contract)
above named.
He is the
(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 contai~ied in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn 1:o before me this
..........C . 3J~day oof/III'..~5'GL~j........., 19
Notary Publi , ........71 . County
NOTARY PU8
N K DE YOE! C~/~ . : t.
tIC, Stste of New York (Signature of applican )
i ND. 47678%6, Suffolk n
Term Expires Msrch 30,1
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