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HomeMy WebLinkAbout17090-zFORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217225 Date AUGUST 25, 1988 THIS CERTIFIES that the building ADDITION Location of Property 1170 FOUNDERS PATH SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 64 Block 04 Lot 05 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 25, 1988 pursuant to which Building Permit No. 170902 dated SUNE 10, 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 E%ISTING ONE FAMILY DWELLING. The certificate is issued to ALEC E. ELAK (owner, XxxxxxxXxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NfA UNDERWRITERS CERTIFICATE N0. N027734 AUG. 12, 1988 PLUMBERS CERTIFICATION DATED N/A. ~ ~~, ~ 2.C~d,.~ ~~, , Building Ins for Rev. 1/81 gosas xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NQ 017090 Z Date .......+~ j ~.~ .................................... 19..4~..~ Permission is hereby granted to: ................................... ~............p .............................. ~ / ?........ ... ..~ .........•• ..ire.,,' -.......~. ~e........ •• ~...... ...... ct Premises located at .... ~.~.74? ....... ....... .. .. ............... ................................................. ................................................ ..G~...............~.~.......................................................... ................................................................................................................................................................ .~ Caunty Tax Map No. 1000 Section ...........~.~.. Block .............~. Lot No...........~-/~............ pursuant to application doted ..........~~.~.~? ............................, 19.~~and approved by the Building Inspector. Fee $~~ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y.11971 765 - 1802 APPLICATION FOR CERTIFICATE OF Instructions A. This application must be filled in typewriter OR ink, and submitted ~ 9~~ to the Building In~ec- 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 comp)-lance 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 ofcertiticateofoccupancy $ 5.00, over 5 years $10.00 /~ A.Vacant Land C.O. $ 20.00 ~- .~Pl ~7 F/~.. 5. Undated C.O. $ 50.00 Date .. ~'{x'.-~,/../.... .d... NewConstruction,,,,,~,/lOyldorPre-existing Building ............ Vacant Land {/~/ Location of Property ...I J ! v .................FFJG~~d~r~, .~,~ ........ ~~~ncZ~Q/~,t/~Y~ House No. Sheer Hamlet Owner or Owners of Property ...~~.~ &.Sf.... ~.^.... ~ ~.9 ~ . . . . . . . . . . .................... . County Tax Map No. 1000 Section .~. T:.- ~:":~r... Block Lot ............... . ............... 1 Subdivision ......lY.6YS . ~.. yd, d ~3. , , ...... , .Filed Map No. ~..83~f . ,Lot No . ............ . Permit No.l~b~.~.?: Date of Permit .(.-/O.~!APPlicant... JQ.~J'=t....~.-.. ~.~A~~........ Health Dept. Approval ................. . ......Labor Dept. Approval ... , .............. , .... . Underwriters Approval ......... . ..............Planning Board Approval ..................... , Request for Temporary Certificate .....................Final Certificate ... 1/................. . Fee Submitted $ ..... ~ 3 . ............... . Construction on above described building and permit meets all applicable codes and regulations. Applicant .......~Q~,-... ~:. ........................ Rev. 10-10-78 TEL. 765-I 802 TOWN O~ SOUTfIOLD OFFICIs OF IIUILDING INSPECTOR P.O. IIOX 728 TOWNIiALL SOUTIIOLD, N.Y. 1 1971 ~u,~ i ~ 19~r~ Kc~_~,~.~~R ~ aa~ ~~~ To Whom This May Concern, ~ ~ ~ ~~ ~ ~o We are unable to complete your Certificate of Occupancy because of the following reasons. /~_/J An application for Certificate of Occupancy / is not on file. (~/T No Underwriters Certificate on file. /~ The check is(outdated/not on file_.)~ag~~ / / No Flealt-h Dcpt. Approval on file. /_/ No final inspection has beets made. Please contact our office on this matter. Thank you for your cooperation. Building Permit i! 1 "1 O ~ O Z IIuildiny Dept. ***/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) THE NEW YORK BOARD OF FIRE UNDERWRITERS vnc,"' i 100Q727 BUREAU OF ELECTRIETTY eS JONN STREET. NEW YORK. NEW YORK 10038 fa :+x~*,s>, .,,:~;;(K.~ Apt.OS9` 12.;1.086- ~ " 562(?2fS88/88 N 0?7'/ 34 beta Application No. on file THIS CERTIFIES THAT only the electrical equipment a descrihed hebFO and Introduced by the applicant named an the shone application numher in the premises 4/ A1.LC;. B, FII,pK JR-, FnUN7)AiRS P 'r@, St)IiTHq(~I?, fl.Y. A r~ -, in [hefollou•inR k]catigp;~ ~ Baneptent LJ IPt FI. ^ Ynd Fl. Sertion Blcek Lut l U l 1 99f tf une examined on and found to 6e in compliance with the reguirementa uJ thu Buord. RXritE RXTURK RANfiff COORIteO DECKf O DISH WASffERS E%ffAUST FANS OUTIETS DTACIES SWITCNFS INGNDlSCEM nUORFSClM v AMT. K.W. AMT. K.W.. AMi. K.W. AMT. K.W. AMT. N.P. as 7 7 1 'r DRYERS FURNACE MOTORS IUTURS ANtIAttCE RRDERf fFICIAt tIRCR TIME CLOCKS RNLL UWT XEAIERf At11lTI.0UTIET AMT. K. W. dl N. 1. GAS N. P. AMT. NO. A W. G. AMT. AAa. AMT. AMPS. iRAtef. AMT. N. P.. SYSTWS ttO. tM R8T gMMERS AMT. WAlT3 SERVICE DISCOFNlECT OF f E R V 1 C E AMT. AMP. IYP! F, 1 / t`M 1 / ]W 3 B ]W ] R KW NO.O~COND. C C6 OND Np. pP N4LEG p ~~~ N0. q NEUTRALS Gr NFUAAI OTNlR ARMRATUS: c,.e.r..r:-1 ~~ NALfL R. RURNti ~ 7.75 TONW NAHHgN 1:ANN; - SO[31.'NOI,D, NY, 7.1577 ~~ 71 L7(:P..NSE )Vtt. ?q2-y; Psr J Thit drtificate mast not bs altered in any manFror; return ro the office of fhe Eoard.if iacorred.. InspMors may be identified by chair cndentiah. -- - - __-_ COPY FOR WILDIW6 DEPARTMlNT.11RS DOPY OP CERTIPN'AYR iRlST N4T 4E A4~ RI ANY MANIER. I~ r'1~LD It:S: ~C:.i:,+ j~JF,i~, j „OMMENT^ ~ ~~ H FOUNDATION (1st ____.__ c~ FOUNDATION (2nd) __ _ _ ~~ 2. __ ~ ~ ~~ ~ ~~ 0 ROUGH FRAME & ~ _ /O" PLUMBI NG i ~' p ® ,'. <~ ti H 3. ~ ~~ I1ISULATIOPI PER N. Y~ i • • '~ STATE ENERGY CODE ( I i ,.~ x ~ 4 ~' / © G G~ ~. ® ~~ ~ W=~ r~n~ . r' P ~ H FINAL ~~ ~ ADDITIOPJAL COMM NTS: z ro x t4 A"i ' m x ~, b~ H~~ ~"-7 ~`;a Y. W . p ~ ^O ~\~ I T I [ 1 a~ 0 m rss-isoa BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUND ~N 2ND [ ]INSULATION [ RAMING [ ]FINAL REMARKS: DATE UJ ~ INSPECTOR ~ ~~~~ ~ 765.1802 BUILDING DEPT. INSPECTI~JN [ ]FOUNDATION i5T [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [)FRAMING [~NAL REMARKS ~ ~~ Vr/-!h ~~ DATE ~~~`~ INSPEO'TOR~f ~ti%~ C~!~J_~ G 7~ ~~ 7Cr5-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] UGH PLBG. FOUNDATION 2ND [ INSULATION L] [)FRAMING [ ]FINAL REMARKS: __c~~~--~-~ ~~ 4 DATE ~ ~ ~ ~~ INSPECTOR ~~aQ~ ~ ~~-~SOz BUILDING DEPT. INSPECTION [FOUNDATION iST [ ]ROUGH PLBG. [ FOUNDATION 2ND [)INSULATION [ ] FRAMINQ [ ]FINAL REMARKS: "`/iO'!.l~A a ~ ~-~-~ l ~ E / ~ DATE ~ ~ ~ INSPECTOR ~~ U - C y ~ ~~: ~~ I_"al~~d. ;~~ "-- YAY A ~ Yf!!A FORM N0. 1 llllffii L P~7W TOWN OF SOUTHOLD BLDC3. DEPT. BUILDING DEPARTMENT TOWN OF SOUTHOLD TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . 6~ •v ........, 19 pQ, U Approved ...~d~l ~ ......., 194 Permit No. !.~r~.~~.,Z~ Disapproved a/c ..................................... BOARD OF HEALTH .. ....... 3 SETS OF PLANS .!~......... SURVEY ....~~ ............... CHECK ......'~ .............. SEPTIC FORM ................ NOTIFY CALL ..................... MAIL T0: ~`~ ~~ ~ ~ (Bu' mg Inspector) APPLICATION FOR BUILDING PERMIT ~~ INSTRUCTIONS 1 Date .~CtC j..~~.~°......, 19.~.Y a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 gets 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- ~ation. 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 admit authorized inspectors on premises and in building for necessary t ections. (Si nature of applicant, or name, if a corporation) ..fix ~9~. .~w~ o. ~~...~ .~f :~....... . • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... Name of owner of premises .... ~~ee..../~ .. ~/.~ /.1.. • •~~ %• • • • • • • • . • • (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. .. ~:~ ~'~ ~'~ Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trade's License No . .................... . 1. Location of land on which-p/roposed work will be done . ................I................................ . ... ~.~ J. ~../.4LC;/!7CY•G'.r'J ..V.u ~ .............CJ.U`.ol.1.110./Cl................................. House Number S,,t//reet Hamlet County Tax Map No. 1000 Section ......~9. `f ~ ........ Block ....... ~......... Lot .. ~ ........... . Subdivision ..................................... Filed Rlap No. .............. Lot .............. . (Name) 2. State existing use and occupancy of premise and intended us~eQa~n~d~oc/cupancy of proposed construction: a. Existing use and occupancy /le.~. ~• • • • • • v""„'-'e'ec".-~,-d .............................. . .....6. U b. Intended use and occu ancy .........~G%'~ ................................................ P 3. Nature of work (check which applicable): New Building .....~..... Addition I...Y ..... Alteration ... , ..... . Repair .............. Removal ..... , ........ Demolition .........',.....Other Work .......... , ... . (Description) 4. Estimated Cost~~ ddl/, ~ .......................... Fee .......~.J............................. . (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 ............................... . ... .I 6. If business, commercial or mixed occupancy, specify nature and extent of each ~ype of use .... , . , . , , .. Dimensions of existin structures if an Front ... 02~'. ... Rear ~.. Height Number of Stones . , , , , , , , , Dimensions of same structure with alterations or dditions: Front , P2~ , !: !;I ' ' Depth .~5~6,^ , , .. , . . ~`~~ Re`r ~~! .............. Depth ...`f.:7 .. ..............Height ...................... Number!of Stories .................... . 8. Dimensions of entire new construction: Front ... /.~- ..... , .. Rear . , .~.'Y......... Depth . /,6, , , , , Height .. (~ ~, , , , , , , , ,Number of Stories ..../ ........ 9. Size of ]ot: Front //,'t ! ................ Rear ::Name of Former Owner's Depth . ~.`/. G !......... . • ...... 10. Date of Purchase ............... . .......... . ............................. 11. Zone or use district in which premises are situated .......................'................. , 12. Does proposed construction violate any zoning law, ordinance or regulation:`:?~~ ........................... . 13. Will lot be regraded ... n/• ~~~ • ~.., ~~~c~ QVed from remises: ,Yes No 14. Name of Owner of premi,- se,~ff[ek. , , Addressxcess fill be rem///`7th s°~~ one No ............... . Name of Architect ..Address ...................Phone No. . Name of Contractor ~~/:U~2~:~ .~.~~d~...... Address .G.6.J,"~QOSe, 4`~ce<. Yt~ , ,phone No. ?~:r'~j 6/, ~. , ,' , , , 15.Is this property located within 100 feet of a tidal wetland? *YES.,,:NO ~~. *If yes, Southold Town Trustees Permit may be require~;d. PLOT DIAGRAM !, Locate clearly and distinctly ail buildings, whether existing or proposed, and, property lines. Give street and block number or description according to deed, and sl interior or corner lot. ~~ .~ ~~~ ~~ ~ +i ~~ `' ~ t • ~ v_ 13~ -I i ~- s lA ~~3~ cate all set-back dimensions from street names and indicate whether ~/ ~+ ' STATE OF NE~~Y^~(~0'" "t~~ S.S COUNTYO ••••••••••••••"' bein dul sworn del ~" "~r~ n ~ • •~' • ~ /" s`~• • • • • g y oses and says that he is the applicant (Name of individual signing contract) above named. I He is the ........ , r~rlj[,?'j2,Pf,1/ (Contractor, agent, corporate officer, etc,.) of said owner or owners, and is duly authorized to perform or have performed the isaid work and to make and file this application; that all statements contained in this application are true to the best of h'is knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . ~~P. .. ...... .day of . `~.cs~] ............... 19 ~`~'' I .• taryPubiic,~ ~>.~„,~~ct~c<~-CL~............ County ' /~, ,,, NotaryPU Ilo, ~ e df New Y ( Nq, 4822583, Suffolk CountY~O (Signature of applicant) Tartu Exbires Decembni"St,19._„