HomeMy WebLinkAbout17088-z FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
216974 Date
No......... June„1,0,,.1,988
THIS CERTIFIES that the building.....One,family,.dwell,ing........
Location of Property ..37302 R:O:W. off Cty. Rd. 1148 Southold
House No. Street ~ ~ ~ Namlet
County Tax Map No. 1000 Section 6.9 ......Block 4...........Lot .....9 .
Subdivision ...............................Filed Map No. ........Lot No. .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
,Sep,t,., . ] 9,,, , 1986, pursuant to which Building Permit No. 1 70882, , , , , , , , , ,
dated June 9, 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 .
MODULAR ONE FAMILY DWELLING.
The certificate is issued to ,JOHN B. SEPENOSKI, JR.
lowner,~~i~t) .
of the aforesaid building.
Suffolk County Department of Health Approval $7-5O-70, Nov . 4 1987
UNDERWRITERS CERTIFICATE NO N835994 Oct. 5, 1987
PLUMBERS CERTIFICATION DATED. N/A
Building Inspector
Rev. 1/81
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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 O J i~ U Jv Z Dare .%c
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Permission is hereby gwnted to: '
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at premises located at ~......:.......~......t.....~..~:........
.
77
County Tox Map No. 1000 Section Block Lot No.........1..............
~ _ ~ ' /
pursuant to application dated : ..:::............:.....1.........., 19:...`::., and approved by the
Building Inspector.
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Fee S•.. ~...r
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Building Inspector
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Rev. 6/30/80
FORM N0. 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-
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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate 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 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.OOALTERATION $25.00
1. Certificate of occupancy New Dwelling, $25.00, Accessory $ ]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ S 0.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 1 0 . 0 0
4. Vacant Land C.O. $ 20.00 ~~/0,~~~
5. Updated C.O. $ 50.00 Date.
NewConstruction,,,,,,OldorPre-existing Building Vacant Land
.y /t1 ~l ,~Q~...
Location of Property .3..7.r3r~...f.~........~^.~~.#.Z.~...... ~~~~":.4-......
House No. Street Hamlet
Owner or Owners of Property G~~.. ,K1 ~ .
County Tax Map No. 1000 Section Block , , Lot .
Subdivision (........Filed Map No. ....../...Lot No. .
Permit No.~.~~g~~ Date of Permit ~,~~Bd/..Applicant (/.,,f . ~ ~'G.f. 7r~7rL . ` y
//yy ` Gay%!"f'7l
Health Dept. Appr/o~v/al P..~: ~.d-.~0.........Labor Dept. Approval _ .
Underwriters Appfo4al . [J.3~. , ~ ! , , .Planning Board Approva{ .
Request for Temporary Certificate . . ...................Final Certificate V'-:-:........ .
Fee Submitted$.~.~.,Si,P,d,,,,,,,,,,,,,,,
Construction on above described building and p rmit meets all plicable codes and regulations.
App I icaRt . ,(.l~:~iv,'~) ...~1 .
Rev. 10~tOJ8 ~
G'G ~ f6ga~
IELD I,.sr~C:IuIJ ~~uATE ~ orrM~urs ~
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FOUtdDATION-_.. (1st) -
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FOUNDATTOtJ (2nd)
2.
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ROUGH FRAME & tviy
Q
.PLUMBING
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3. ~
INSULATION PER N. Y. y
STATE ENERGY
CODE
x
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4. ~
FIidAL
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ADDITIONAL COMMENTS: x
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lf}olu~l THE NEW YORK BOARD OF FIRE UNDERWRITERS
I ~ BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 70038
Dale Lac:'G.O~t9r m5r 1~8~ Application No. on file 31~$~~Y~gS i dr
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
:;ul~an kart, Pdorth Ri~o''--aII
~d (Old)1~t~couiaa, NS:
in the following location; ? B¢sement LJ Ist F'I. ? 2nd Fl. ,Section Block Lot
uws ex¢mined on $@p~FtRIk1t3Y Zlr 1~>$7 andfoundto 6e in compliance with the requirements q/this Board.
OUTLETS ECEPTACLES SWITCHES FIXTURES M u RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
- INCANDESCENT FIVORESCENi ygPDt MIT K W. AMi K.W. AMi. KW qMi. K W AMi. H P
DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MUlil•OUTLET DIMMERS
AMT K. w. all H. P GAS M p AMi NO. A, W. G. AMT AMp. AMT. AMPS TRANS. AMi H P, SYSTEMS Amt wprrs
NO. OF FEET ~
SERVICE DISCONNECT NO.OF 5 E R V I C E
METER NO. Oi CC. COND A. W G A. W. G. A W G
AMi AMP TYPE EDUIF 1 •6' RW I d 3W 3 $ 3W S jf 4W pER % OF CC. COND NO OF HbLEG OF MbIEG NO. Of NEUTRALS OF NEUTRAL
1 150 LB 1 X 1 2/0 A 1JO
OTHE A P RATUS•
~cs~u~ux hvcnes N.Y'e~. aghrov~ad
~/~C~
& S Eloctric G~/~~
fax 115
SOUt2101G~t N'% 11971 L~Cp S7~Fi ANAGER
11
Per
This certificate must not be altered in any manner; return }o the office of the Board if incorrect. Inspectors may be iden ifled b 'Itheir credentials.
COPY FOR BUILDING DEPARTMENT.. THIS COPY OF CERTIFICATE MUST NOY.BE ALTERED IN ANY MANNER.
~~_,i-«.-
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21 ' il"
FORM N0. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOtD, N.Y. 11971
p ~1 TEL.: 765-1802
Examined.. ~ ,19 C/. (7 Received...........,19...
ApprovedG/~iI?'r!C. • . ~1...., 19~~Permit No.
Disapproved a/c .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT 9
Date . • • • ~ 9 • 19
INSTRITCTIONS
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 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
p essa_ry inspec 'ons.__ - -
admit authorized ins. ectors on premises and in building_fQr rt~c f ~ ~ S - r . -
(Sign ~ re of applicant, or name, if a corporation)
!`S°?c...!~.a
.......~~.~~Ni~r~:y d,9s~.v
(mailing address of~applicant)~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
C'' Ira.[u:e Y
Name of owner of premises ~ ° ~ k ~3, `se pPn~ ~ -r ~ ~j '
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~ N R ~ ~ ~ ~ 1 J.~r
Plumber's License No. i..l
Electrician's License No. . s.?~ ~
Other Trade's License No . .
1. Location of land on which proposed y~~ky~ill be r~,~.~,.~Lf .
House Number Street Hamlet
County Tax Map Nor1000 Section Block ~ Lot • • • • • • . • • .
Subdivision J er, ~ J.lf';~ 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 ....~'9-~`"°'T?b~-• •
b. Intended use and occupancy • ~'!"J..
k e
-
3. Nature of work (check which applicable): New Building ~ Addition Alteration .
Re air ~ /~o.~. ~ ? . . . ~ O~ Work . • (Desc i....... .
4. Estimated Cost , • . Removal DemolitioFee , , , , , • ~ ~~yy 7 ription)
p ........l.r. /
(to be 1Said on filing this application)
5. If dwelling, number of dwelling units Number of dwelling unit's on each floor .
Tfgarage,numberofcars
6. If business, commercial or mixed occupancy, specify natur and extent of each type of use ./~,1:1e ~'s /{'1.......... .
7. Dimensions of existing structures, if any: Front 3 ° 'rGpnagz ~aRear N,~y?e,3o, /~F?K~R)t.ta' Depth ~a:'YJe a ° ~G,/anA,h, 9°'
Height H':":~...~Y' . G~«?n.3~.'~Iumber of Stories ...l~r ``d'? ~ ~!aSv Ja ...6 ..~r`wt
. ix
Dimensions of same structure with alteratrons or additions: Front . Rear .
De th Hei t , Number of
P gh ud" yyl (Stories ............p ,
8. Dimensions of entire new constructron:~Front Rear ...............Depth ..~Yt'.......... .
Height . ~ Number of Stories . I„ • • , • „ .
• ,
9. Size of lot: Front ....ice.. e?d C........ Rear , . 3!!.......... Depth ..~Y, ....S6a .
10. Date of Purchase l.9~~ Name of Former Owner . ' . !3~..~-f,t'?N~f.~c.......
11. Zone or use district in which premises are situated ..~S.k~~!?l~ :'r`:L . (.I,?:v.,r,ia!ar'7rrr1, , , , , , , , , , , , , , , , , , , , , , , , ,
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded Will excess fill be removed from premises: Yep ~-DTo~
14. Name of Owner of premises ...S~p4N's f:1........ Address Phone No........l......
Name of Architect wv N.? . ............Address Phone No............... .
Name of Contractor ,5~~?N.e s Address '....Phone No........... , .
15. Is this property located within 1.00 feet of a tidal wetland? * Yes No
* If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly ali 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 sho~y street names and indicate whethdr
interior or corner lot. ~ '
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STATEOF~IEW R S.S YN.S ' ~
COUNTY OF.
bein dul sworn de o ~
• • • • •~/~~51~2,yz~. ww~a-~~.C .,t.. 1..,. g Y P ses and says that he is the applicant
(Name of individual s gning contract) ~
above named.
He is the ~crx~.,e~~_............................... .
(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 contained in this application art; true to the best of hid knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me t~~h~~is pp
...........p~~r..L~,....dayof ........,19~~ i
Not Public, ~ , County US
Notar~ryy~Pub~g~o}N~gW'yo~ (Signature of applicant)
No. 82-812660, SuMolk Co~up~y
TermExplrespoZOber8l~te x~ `
' ~ SUFFOLK CO EAL H DEPT APPROVAL
6 I 1 ~ ~ONSrrLUCT}ON `A~P_LtGATtON_. HH.S.TNO.
5 ~ -
• P,4~:GEl. NO. 2
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SINGLE A 41LY DWELLING ONLY ~
` , ~ ~.A~> f<!AI> U~= i;~ET-c~FF~ EXPIRES TWO Y S PROM DATC OF APPROVAL
1817 PiZE~Af~~'Q F~Orz
_ _ .._2$5.64... i tJ 45 ~ F _ TA.TEMENT OF INTENT
- p._
~ 4 ! ' ~ ~ J ; c r t THE WATER SUPPLY AND lEWA6E DIlPOSAL
. _ I , .
- ~ J ~ ~
I _ _ _ - ~ ~ ~-~L--~ ~ -I t SYSTEMS FOR THIS RESIDENCE WILL
tp. CONFORM TO THE STANDARt1S OF THE
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voo~ ~ .ol{ i. ~ SUFFOLK Cl~ D~PT~ F~T~H SERVICES.
3 ~ tSYY F¢ ~.tp n ! ~Jl:_i-Fdv:_i,> ISI /I~ f(~
A (CANT
I UWN vF ~.x~U I`F•l~~i U, `.J'r'.
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a' SUFFOLK COUNTY DEPT. OF HEALTH
tq f~iE 4 ~ ~ SERVICES -FOR APPROVAL OF
J NI _ CONSTRUCTION ONLY
• ~ NG i ~ ~ DATE:
GAft~E L
~ ~~17
2.0 I _ M. S. REF. NO r
tl ~ : r_nv ¢oAC~ ;,;fg?,t20 Sa.F'f~ ~ _ _--L.F rpA;L, $£t9\ / APPROVED:
i ~Z . ~8.360)~6 I ~ MtOU ~ T~ i
~ ~ V SUFFO CO TAX AP DES16N ION•
N ' N ? 01 ZQ E._ ' _ 307.'7 _ ~ Ii iD ~ / 3,,;;'• ~ DIST. SECT. BLOCK PCL.
iJf I~JOO 06y 4 9
`r M\, , r. ~ L,~,{y.2. OWNERSADDRE~:
~ . dr , ~ ~ I P.O. 80X 120 _
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II- t ~ !°k)H',. F ~E:.n-t E' t;i DEED: L./o8~j3 P. 3&{
(65.t24'
~ ss~ .4:,~.e _ to A:; /
, ~F1 ~ 1~~ . ~ ~s ho~i.M ~NwMiM N W~Nk'll
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x;. _ ? I I ' SUFFOLK NfY DEPARTMENT DP ~ . . ~ "I~'2 - -
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L?t'~~=+ .-lAt iv - _ ~ GwranMSMirakdlwo~nNioann
- DWELLING ONC? ~ aMV m uie ww" Nr vrl~wn tlr ewvq
'r'-' DATE ~~~Z G k w.s..a, aw m hr natrn a ~
- - _ - REF. ND. j~-».~L. tmr ea"ge"r, pwmin~mx.eonw eM
the sewrge dcs~osal a1M wafer ~ 1en°'"~'""""k"""'~"'°'"'~"d
wPPIY facilities hIr Mlis w m.....n... w We ~ iMF
WA~'4;2 S<JPPL.I" d SEWAGff DISPOSAL 5`f~"f'EMS have beenlnsPectedbythisDeWttnlerltand/ar ~ r~Vt`.::EU mac:,, B, F~S~sP'~,5, NiBf!?IUM w„~.,.Gw.M+...«.n«w~.k..w
~ ies IId foil tO b se • 3StAVEI. aasaNonNtnYYiCeireraWeeawq
TO MEET SUFF. CO . NEIL.TH O~'T. 9TANQ4fdq ~ b~
b~' ~ FEB. ~ 7~1QP.~7-c - -
wZ . 1/ - a±f of Bureau of Washwa .~nraget. M _ _ I i' K Yq ro9
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