HomeMy WebLinkAbout17068-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218966 Date APRIL 12, 1990
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 40E1 KING ST. trRIENT
House No. Street Hamlet
County Tax Map No. 1000 Section 26 Block 02 Lot 14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit hereto€ore
filed in this of€ice dated MAY 18, 1988 Pursuant to which
Building Permit No. 170682 dated JUNE 7, 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 ADDITIONS & ALTERATIONS TO EXISTING ONE FAMILY DWELLING
The certificate is issued to MARY J. & DIRCK W. BROWN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. PENDING SLIP 4/9/90
PLUMBERS CERTIFICATION DATED ROY TAPLIN 5 16 89
,l vl w.t+
uilding Inspector
Rev. 1/81
Posai xo. s
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)
NQ 017068 Z Dote 19.~.~
Permission is hereby grant d to:
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to ..~....°z?°.....G~f.~~r.~`-
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ct premises located ot ......~',~.Of1.....~.....l~.y.~c
..........................................Q~.................................................................................................
County Tax Map No. 1000 Section ...........wP..T..~o...... Block x:... Lot No.............~..f......
pursuant to application dated 19t~~, and approved by the
Building Inspector.
/ 00
Fee a'
ByY!ding Inspector
Rev. 6/30/80
~ r' p S~
D ~[]`~V~/[~',~~~~~;,;, Form No. 6
11y~~ TOWN OF SOUTHOLD
11~ BUILDING DEPARTMENT
TOWN HALL
F7LGG.~ Crt~k'.C.'.,. ~ ~ 7 65-1802
,..,.am,. ~ . . ,
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1~ lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory huilding $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00 '
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction......... Old Or Pre-existing Building............
Location of Property...~p6 ............Kl~:~.~......S1........... ~R,l~z.-'L~T
House No. Street Hamlet
Onwer or Owners of Property..~l.~~' ~.5~..~1v~..E'~.~~~-(...~:.., ~RO~-?~.~~.,./
.
County Tax Map No 1000, Section...'~~v........B1ock...L............Lot.. ~T
Subdivision ....................................Filed Map............Lot......................
Permit No ~7~.(e.°.........Date Of Permit. ~1.~.~~~.....Applicant~~l~~:4'p...r.~:.\S+~ral.-.:...
Health Dept. Approval ..........................Underwriters Approval........................
Planning Board Approval
Request for: Temporary Certifi~cpate........... Final Certicate...........
Fee Submitted: vlS......~~~.~3.......
~af9Z ~gk66 ..~--._l~~L
cAN~
Bo
TEL. 7GS-1802
~pS~~F~(K~o~. z®~wrr or scyu~~a~,~
r~ , OFFICE OF IIiJILDIi~IG INSPECTOR
~ ~ ,r` ' ac P.O.I30X728
i°r, ~'t ~ TOWN HALL ~ ~1~~`~ljl~s~'~`
4~~~ ~ ~~~''t- SOUTHOLD, N.Y. 11971 D ~ ~~w~~ ~'a
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61.pG. DBPT.
C E R T I F I C A T S O N TOWN OF SUUTNOGO
Date~~r
Building Permit No. 017068 z'
Owner Dirck and Mary Brown
(please print)
Plumber Roy Taplin
(please print-)
I certify thar_ the solder used in the water supply system
contains less than 2!10 of to lead.
Nr7 V
(plu tier's si nature)
Sworn to before me this
day of ~
C~ -~~r , ,1 c.,
19~. I~oLa#ry Public
Notary Public,~y`f'~'C7~K County ,P~`a3't WHtrk
380T~1E`d' f§,4~!!C«„ 5Yn#~ cf Nr*a Yc~i
Na. A126#13
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FOU1dDATION (1st)
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THE NEW YORK BOARD OF FLRE UNDERWRITERS ' -
BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK 10038 t
13"1' 7G,f99U 874E+3PRtt/NES N 3'lJ/67
Dale Applicotion No. on file -
THIS CERi1F1ES THAT
only the e/ectrkd squlpment a descrihed 6eloro and introduced 6y the applkront nomad on the ahooe appUeatian number in thapromian of
IttRi:K 8 PIOI.I.Y fSR,3WN, 4r11.3 If CMG !i1RP.P:1', PULP: RG, OtitL~Nf, N. Y.
r~t~ E.nit/"t i 3c./unr
in thsfdlauinR locati~gq;1_1, LJ.3 Bpe~r$ttfnt ~ lAt Fl. ~ Ynd Fl. Section Block Lot
tons examined on Att~•KK II1/~~~' t ~ and found to 6e in rnmplianee u•itk the reyuiremenM of tkb Board.
RXTUB RXTURES RANGES COOKIttO DECKS OVlNS DIEM WASHERS UST FANS
OUitlTE ACUiS SYVIiCMK INCANDESClNT iIUORElClNi aTNEn AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P. -
(t ~ r1 ~ ~ ~t ~ I J 3 -
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DRYERS RIRNACE MOTORS lIITURE AMUAtICE REDERS SMOAI REC'K ilAtE CIOCIIS ~ UNIi IIGIERS ANILII:OUIYT ORItMERS
AMT. K. W. ql N. P. 6A5 M. P. AMT. NO. A. W.O. AMT. NM. NAT. AMIA TRAM{. AMT. -N. ! ~O! REIT AMT. WATTS -
~ 3u 3 s E,PP
SERVX7 DISCONNECT NO.OF S E R V 1 G E
AMT. AMV. Tyre pWP, , Ar tw , O rv t a sw a,e .w NO. ~i
ycoNO. a cc
ca+o. Na oP n-ua ~ No. a NeunAts a 'NweunN '
1 3PO tN 1 X 1 7 1 2
OiME A~?ARATUS: _
U "hr' GI`.NIRA 1'UR 3RAN5V'r~:R tiN i 1 clt - 1. _ _
tib3 PNS:3-,E. ti. t'. ~
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SAGt. 5 LAl?i'.MANN 3NC, 1.[c.E;b.S9-li _
P. U. BOx 3'1LfT
SUUi;U)L.P, NY, 11973 OMEIRAlMAE1AOrl
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Per
chit csrNf'Kate matt cwt be altered in any manner; return to tM oHica of tha Board if ipmrncl.. n _m~a _bsidsMi(itd~by chair tndaMiab.
____--T--
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MY~6T-NOT /RLTER~ IM M~NR.
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KING STREET
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„MAP pF WILLOW TERACE SEC. ONE~~
SUFF. CO. MAP NO. 5407
~S
SURVEY OF PROPERTY
CERTI FI Ep TO
CHICAGO TITLE INSURANCE CO AT
TITI F NO 8708 -04616 - _ r~_ _ _ rnt~r
DIRCK 1yINSER BRC~W~ V CI'V 1
Prepared m accorsiancs wt h t minim~n
standards fer Ntl. wrvsys as .stablisMd ~ TOWN OF SOUTHOLD
,he I. I. A. I. s..n~ rpprov.d and adepts. SUFFOLK COUNTY, N. Y.
fur such use by Th. New Yerk Stab lenc
Title Association. I Ob 0 0 2 6 0 2 - 1 4
SCALE I"= 30'
~~~~oo AND F29~~ A U G 4 1 9 8 7
A
~
/ .9~.yo 49F~6~~QQ
F NE . , LIC. N0.49668
CONIC SURVEYORS & ENGINEERS, P.C.
516) 765-5020
P.0. BOX 909
MAlrl ROAD
SOUT~IOLD, N. Y. 11971
87 - 6 30
IIIIA Ii l1 111+ 1111 :\1,'1'11 J.
, .I 41~,'I'S OI~I,AN:i ~ . .
y FORM NO.1 SURVEY
' TOWN OF SOUTHOLD cnecK • • • • - -
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NoTlrv
;OUTHOLD, N.Y. 11971 CALL,
TEL.: 765-1802 MAIL T0:
Examined 19 pp"~{~ /
Approved 194 Permit No..
Disapproved a/c
(Building In ector)
APPLICATION FOR BUILDING PERMIT / ~g
Date
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 inay 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 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 inspect'
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.........~(f~~~~:~ ....................................,.,1......................................
Name of owner of premises { QC- C ~ ' ~°~4'~'" • • • • • • • • • . • • • • • • " " " " " " " " "
...fl ~Y .
(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 SUF9FOLK COUNTY LICENSED
Builder's License No. . ~~,/..~t• • • -
Z
Plumber's License No. • .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot ~T .
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 ~~S'!0~_A/C~c
Q~'SiQ~ C'am'
b. Intended use and occupancy
i
3. Nature of work (check which applicable): New Building Addition . Alteration ~ i
Repair Removal Demolition i Other l~~ork .
Des p
4. Estimated Cost ~/!~c ~ Fee I' cri Lion)
` (to be''paid on filing this application)
5. If dwelling, number of dwelling units ....Q.N,~ Number of dwelling units on each floor , , .
If garage, number of cars . . .
6. If business, commercial or mixed occupancy, specif~g~tur6 and extent of each t fp6of use .
7. Dunensions of existing structures, if any: Front ~ Rear ..5.~.-:... , Depth . ,5~..-::~-..... .
Height ...............NumberofStories...........................i............................
Dimensions of same structure with alterations or additions: Front .S7 ~ ,
De th Hei ht ~ , ..Number of Rear .,,5'.7..`.6. .
p 2. g G
8. Dimensions of entire new construction: Front 7.. ~ Rear , , ,~°7 : Stories ..7.?r!'Q .
r 6 "`...Depth .
Height . . .............Number of Stories , .
9. Size of lot: Front ~,7•. Rear ~~8: g Deptlt ~~i~~. .
10. Date of Purchase Srp'.i?T..9.. <9~7 p '
• • • • • p . Na~ f F nner Ow~er i?7~~'r~G, , /,3.~?Ow!i!', • , , •
1 1. Zone or use district in which remises are situated , ~~Sr.p.~"a/T /¢G' .
12. Does proposed construction violate any zoning law, ordinance or regulation: ./l./,O • , • , , , , , , , , • , , , • , , , , • • , , ,
13. Will lot be regraded Will excess fill be®s,~e~move'd ~~frp,m>".p~~emises: Yes fs~ o
14. Name of Owner of premises ,~~ReGC. ~`~1+9/L~ddress .L/q,Q .~/"'N, S°7' ~`.':'K'iione No.~23 s~.S"S~H
Name of Arel~itect p~S.1~,4~N.~... ~QR/~4N. ~.`~:~Address ..-~,1f. 3!O . ~?!-:~:'!~Phone No. .
Name of Contractor So~~:,(Sa~I..4~P.~c. .Address . . ~ ~SZ
~c
1~+~sQ.. ,~/...Phone No. . .
15. Is this property located within 300 feetppof a tigidal wetland? *Ygs No
*If yes, Southold .Town Trustees PermitPLO'I'DIAGKAMed
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.
~ ,
'I
iTATE OF NhW~~
J~~L
~OUNTY OF (G... S.S II
• • • • • • • • • ~ ~ • • • • . • • ~ ~ . being duly sworn, depo~es and says that he is the applicant
(Name of individual signing contract)
above named. I
ieisthe .............................................................1...........................
(Contractor, agent, corporate officer, etc.)
if said owner or owners, 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 hisknowledge and belief; and that the
vork will be perfonned in the manner set forth in the application filed therewith.
iworn to before me this
9... ..day of ~I . 19
dotary Public, G~..P~.... UD~, . County ~ I ~ G
NOBIkY PUBLIC, St+te of New Yak
TamF+xgi~~Me~~h30,1LSG./ (ignaturedfapphcant)