HomeMy WebLinkAbout17117-z
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18547 Date NOVEMBER 8, 1989
THIS CERTIFIES that the building ALTERATION
Location of Property 22040 MAIN ROAD ORIENT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 017 Block 06 Lot 09
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 8, 1988 pursuant to which
Building Permit No. 17117-Z dated JUNE 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 ENCLOSURE OF A PORTION OF EXISTING PORCH (NO HEAT)
The certificate is issued to ALFRED W. & ELIZABETH H. ROSE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-099969 - OCTOBER 30, 1989
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
crows 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)
N ~ 0 71 ~ Z Dote .,l+C1.d1R+.....1..~ 19.A..~
Permission is hereby grante to:
.....1~.~
ZZo O
at premises located at ...............1...............'.'..1 ~'r~...~`?...........~.!~:Y.`.+:ld!...................................
County Tax Map No. 1000 Section ~ ~ 1....... Block .......~.b..... Lot No....6.~.
pursuant to application dated ........~..~:~•.g••••••••••••••••••••••, 19.4...., and approved by the
Building-- Iynspector,
Fee y..,S~.:...
c~!.JL.
Bu ding Inspector
Rev. 6/30/80
L ~ ~
FORM NO. 6
TOWN OF SOUTIIOLD j
BIIILDING DEPARTMENT
TOWN DALL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
I. Fiaal survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final approval of IIealth Dept. of eater supply and sewerage',-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Undek-writers.
4_ Sworn statement from plumber certifying that solder used inl,system contains less
than 2/10 of 1Z lead.
5. Commercial buildings, industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from Che ArchitecC
or Engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requilcements.
B. For existing buildings (Prior to April 9, 1957] non-conforminguses, 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. A properly completed application, a consent Co inspect signed bq [he applicant
and a certified abstract of title issued by a Citle company'~which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of buildings dr pzemises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
I. An application for vacant Land Certificate of Occupancy sha>l be submitted,
and a certified abstract of title issued by a title company 'showing single and
separate ownership of the entire lot prior to April 9, 1957Isha11 also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant;.
D• FEES:
1- CERTIFICATE OF OCCUPANCY - New'Dwelling $25,00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $SQ.00.
2. Certificate of Occupancy on pre-existing dwelling - $100'.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years $10.00
4• Vacant Land Certificate of Occupancy - $20.00
5. Updated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $,/~00 Residential'
$50.00 Commercial
ev. 10/14/S8"
mutr, ~ ~c~
e..
TOWN OP SOUTUOLD
IIUILDINC DEPART?LENT
_ TOWN HALL
SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY '
DATE
NEW Cp:ISTRUCTION ._...,,OLD OR PRE-E%ISTING BUILDING......pACANT LAND........
Loca[ioa of Pro erty„?,~;d-~'~ ~ (a~7~ Z~/
p _ ....._.....~~~tC!~~
UOUSE NO.
sTREET
q NAMLET
Ovncr or Owners of pro ert /IL-~`~~ If ~~L~~ '
Coua[y Taa Map No. 1000 Section .t9~~. Block .~t:,, (J
Lot~....._.._
Subdivision Filed Map ........Lot........_.
Pcroi[ :10.~~,! Date of Permit i1
//~~~_.Applicaat !!U.f~YI~/~~ IZt35~-..
Ucal[h Dep[. Approval Underwriters Approval.._..,,
PlanninE Board Approval '
Request for Temporary Certificate
Final Certificate
-UC)
pee SuUaitted: Z-,'-~'..`_
APPLICANT ~:J;i/,'eti_C ~-v~2-.
. . . . .
rey. 10/14/88
~-.3~5'7y
C0~ jssy~
~~-~~~lh,T?J TEL.7C5-1807
~~~FOr.,~~~, To~rnr or sou~uoL~
z~,;~ ~ t
:i~~~;~ Y.~ =1c OPfK:G Ol: BUILDING [NST'ECTOR
o ~ P.O. BOX 117 9 ~ ct
' ~O t- SOU7'I OI_D,iN.Y 1 1971 ~t ~ ~ ~ U`
Jv~ i 4~
June 30, 1 ,
g>,OG
S0~°CNp4"~"~~
ALFRED 6 ELIZ. ROSE ~Owy~OF_
BO% 292
ORIENT, N.Y. 11957
`Po t9hcm This, May Concern,
47e are unable to complete your Certificatn_
of Occupancy because ,of the following reasons.
An application for Certificate of Occupancy
is not nn fi7.c. (ENCLOSED)
*IO [Jndercoritcrs Certificate on file.
/o// 'i'he cliec:F; .i:: (~I5~74I4~:I~R~aot on file.) $25.00
No tleal.t-h Dept. Approval on file.
No final insi~~ection has been made.
Pleasr.. contact our office on L-hi~ matter. -
Thank you for your cooperation.
l;u.ilclinc7 rcrtn.i_t'. 1 7 1 I 7 Z
I3uilclinq Dept-.
*`k/_/ tlo I'lumbcr Solder Cert.ificatc on file. '
( n1.1 permits involvi.nq plumbing being
i.^.sucd aft.cr ~1pri.1 1,1984 )
THE NEW YORK BOARD OF FIRE UNDERWRITERS '
ntin"7 i
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK ]0038
i3t`9'OH1~,tt si), Matra 0,r<3Yh1 ff S) tl Ki Pt (l y)°-~:>6'+
Date AppfiraHon No. orz file
THIS CERTIFIES THAT
only [he electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
,L.I,x`t~+;1F i2<s;;~;, f=Xt~ltd Ite)A f}r L'1a7~ pdtS laT3`l'; 19.Y.
in thefollowinq loea~IP~'t,f9,~ ~a(Se.~te[Atl ~ 1st F'(. ? 2nd FI. Sertion B(oek Lot
uns examined on and found to be in cornplimrre with the requirernerzts q(this Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
ECEPTACLES SWITCHES
CUTLETS INCANDESCENT FLUORESCENT OTHER AMi K W AMT K W. AMT K W qMi K W AMT. H P.
I ~Y . l L I~
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELI UNIT HEATERS MULTI.OUTIET DIMMERS
SYSTEMS
AMT. K. W. Oll H. P. GAS H P AMT. NO. A W. G. AMT. AMP AMi gMPS. TRANS. AMi H. P NO. OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
PMi AMP TYPE METER ~ RW I 0W 3 $ 9W 3A' 4W NO. OF CC COND A. W. G. NO Of HbLEG A W C' NO. OF NEUTRAW A W G.
EQUIP. PER $ OF CG COND OF HI-lEG OF NEUTRAL
OTHER APPARATUS:
(d`i3flPb; tl`L;)t ;>{i}2f'ii f)lQf.`~ I
AId9"t94Tk A. !i?lN,4F;ph: .f,li'.~].'R.i~,~-~; ~
P:11'C3~T Ilci:l}
L>iF i.P:S'd9', 4~.(Y, L I iIL,"i
.OEN Al AOER
1.yj
Per ~ _
This certificate must not be altered in any manner; return }o the office of the Board if incorrect. Inspectors may be ~d~tifi~d by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
' ,~trr7r`,, TEL.7C,5-k80~
~~~~FFO~~y"~~o T0~'N Ur SQUT'~OLD
,?'!-:'~7 buy~~ Y,4 ~c OI'f'1C}; OC: BUILDING INSI'I:CTOR
h~ pr~;~4 ~ I'.O. BOX 1 ] 7 9
~ TOWN BALL
~',`Y~~. ~O f fi`t` SOUTIIOLD, N.Y. 1 1971
A~~p~ ~3 7,a .
<~~1~,...
Sune 30, 1989 n
ALFRED 6 ELIZ. ROSE
BO% 292
ORIENT, N.Y. 11957
To Pihcm This May Concern,
4Je arc unable r.o complete your Certificate
of Occupancy because of the folloc•ring reasons.
An application for Certificate of Occupancy
is not on fi].c. (ENCLOSED)
/ / Dto tJnderrrriters Certificate on file.
'i'he c:1~ecP: .i:: (~1G$Sk~i$~,ot on file.) $25.00
D:o llea].th Dept. Approval on file.
D:o final insk~~ect.ion has been made.
Pluae;r.. contact our office on this matter.
Thank you for your cooperation.
Ilu.ilc]ing Pcrm.i.t-. 1 7 I 1 7 Z
Duildinq Dupt.
Uo Plumber :;older Certificate on file. '
( a7.1 permits involving plumbincl being
insucd after April 1,1984 )
6 ~ 7 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS:
DATE o2l INSPECTOR
r'lELD Z.:SPEC::U,J ~~DATE ~ ~OaKM€NZ° a ~
-o ,J
~ h
~ ~ ~
H
FOUIIDATION (1st) -
w
m
FOUNDATZOtd (2nd} _
2. z
o p
J
P,OUGH FRAME & ~
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U
PLUMBING
' 3
ti
H
3 .
rn
ca
INSULATIOC! PER N. Y. y
STATE ENERGY
CODE ~ 0
a
4. ~ - ._~y
F I iJ A/.,
p -
z
ADDITIONAL COMMENTS: ~ ~
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~R-(^i ti .7 irk l1N:Y TJ Tf:: F 11+ '!c/ i
'IS ObESA'.ID. P:: 10 iN~
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' TITLE CCt.'.Fh.: f, ' ' ! ~ ?.G4Y-'?N
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' ' `iUFibN. Gu.::vs:T::.3 A'T I.LI 7]~+&~?<§
~ + 1
~ .a ~ +
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~ r`~ T
' r~ /
~r c,.~GfC(~~d? 7'~"f`~<r 7 ~ 7"i7~ Ci91L ~?C7Q
C%/ /e' '.Y_~'1 t ~ ~ rr`\ / /+T-!C /!'1..:~ t'".'a Y.+~ C' ~~.-.-~:'d)1 ~/1 t 11! L:j
r
L,'' - d'i%LJf'7L.fLt^!=I'7~' fir.'-lY1j'C`;?r'<'J ~~1C/~'67'?~-%~c-'~ j,Y /.,,~`~r?f„}-'.
P - / f'~~!'i l.:r F'~e? ,."t.7lzr~r_"r•rr- r V_G~7-~1-'i^'/L;.lir~ ~
v C-!'"( i. f ~ ~ 7'zt k' i'r?c? :"7 °S ///J"7• .jdl~7 c/ 1 ~~T ~ C"'
c
.^F" 5 ~ar~ o~~o'f ~I i..^- YL°ti' i?(~•~.?4'"'~ /~lfE'ti'4/ ~'~Y
I r M
.L,.
BOARD OF HEALTH
s.. .....s......
~ ~ ~~Ir ~J~ y{
~~'aCGa~G?~ ~ t,_~~_3, i t' 3 SETS OF PLANE
{L/I Y...= mx ~ ~ FORM NO. 1 SURVEY
e~ y~i I TOWN OF SOUTHOLD CHECK ~...~~~.-E,. • , , , , , , , , ,
~p~AB G~ BUILDING DEPARTMENT SEPTIC roRM .
' -~.~J{ TOWN HALL
BLDG.OEi'7. SOUTHOLD, N.Y. 11971 NOTIFY
TOWNUFSQO,,U~THOLD TEL.:765-1802 CALL ..~:~.~~..~7~/.......
Examincd.~..th$~..t.~.,19~8 MAIL T0:
Approved ~ 19 g p Permit No.. ~ `7,(,~ 7•~ •
Disapproved a/c
1 ..c .e,~o, cK-..... .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . 19 .
INSTRUCTIONS
a. Tlris 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 ]rave been granted by the Building Inspector.
P
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~,spectors on premises and in building for necessary inspections.
i~' ' (Signa "re of applicant, or name, if a corporation)
" ~ ~ .Yh~=~;-.~~.~..
~K,, ~ (Mailing address of applicant) ~~95 ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
D./.~la./.<.:4
.
Name of owner of premises .~L~?.~1=d~.~..•.~~`.EL~.z~:y3~.!C:~..~:. ~~~5~.
(as on the tax roll or latest deed) ~ . ,
If applicant is a aorpc~;,aC,jon, signaaure of duly authorized officer.
~a i t,r. •
~.P. .,'.F.'{r.;~.
Nax~e~ t~c~C't~'o~~~~o to officer 's "
~~~~pp t s a ~x•4r•. s._
Builder's ~ti~~l~b~~~~•.~,~. :?e~ `~k~,yq~?,''tt,.':,3.~.,,;"' .
Plumber's License No. f4ti~ elf#a~i'#'z'"x~~ ~~``w'
Electrician's License No~~?'!~?.'-.':-:~......'..... .
Other Trade's License No . .
1. Location of land on which proposed work will be done. . ~.z ~.fli~ • { Fal/T
Flouse Number Street Hamlet y
County Tax Map No. 1000 Section ~ 1.%........... Block Lot .
Subdivision FiledAlap No. Lot...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing , • , /~/;5~•IJEry~C7,~- .
o use and occupancy
,
b. Intended use and occupancy FS! ~f= ~ • • • • • - .
3. Nature of work (check which~,applicable): New Building Addition Alteratign , , , , , ,
Re air
P ~ Removal Demolition
0~ ~~~~(Descri pti on )
4. Estimated Cost..:1-~C7p', Fee
5. If dwellin number of dwelli ~ (to be paid on filing this application)
g, g units Number of dwelling units on each floor , , , , , , , , , , , , . .
If garage, number of cars ;
6. If business, commercial or mined occupancy, specify nature aPd extent of eachaype of use ; , , , , , , , , , , , , , , ,
Height fires, if any: Front , Rear Depth .
o ............N mberofStorics,,,,,,,,,,,,,,,,,,,
rmensrons of existing struct wrth alterations or additions: Front . Rear , . , , . , , , , , ,
Depth Ilciglrt .
• • • • ........Number of Stories .
8. Himensions of enhresne
v constructioq: Front , , , , , , , , , , Rear , ......Depth
eight Number of Stories . ~ ~ • " " " " '
9. Size of lot: Front Rear . ......................Depth.......................
10. Date of Purchase
'•"'••••;•••••••••••••••....NameofFormerOwner
1. Zone or use district in which p'Iremises are situated . • , , • ,
12. Does proposed construction violate any zoning law, ordinance or regulation : . . . . .
13. Will lot be regraded Will excess fill be removed from premises: Yes No
14. Name of Owner of premises , , , , , , , , , , , , , , , , , , gddress . .Phone No. .
NamcofArchitect....... .................Address.•.~••.••~~~~~•~~•,PhoneNo...••.•.~~~~~•~~
Name of Contractor ......Address...•.~.~•,,,,,•~~~,Ph n
IS. is this ro o eNo
Y
If es So thold Tow tad within 100 feet of a tidal wetland? *YES....NO....
* Y , ~n Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and bloclf number or description according to deed, and show street names and indicate whether
interior or corner lot. /
N"` ~ / /~t~'c~ , )~Lv ~n1~-~. ,J~ ~ d~'^R!/ a„M1-e.~o-,.ee..,~.~
AI'PItUVED AS NOTED '~I ~ p~~rti,,~FD UNDERWRITERS CERIIfICATE '
nrTE ~ 7 8N s.P rJ t i / P,~~~v3v~r REQUIRED
NpTIFY RIJIL.DING DEPARTMENT AT
766 1802 9 AM TO ~ PM FOIE THE
FOLtOWIaVG INSPECTIONS.
t. FOUNDATION TWO RE:OUIREEI
FOR POURED CONCRETE '
NSULATIONAMING R PLUIV~BING QCCUPANCY OR
~4. FINAL CONSTRUCTION MUST USE IS UNLAWFUL
6E coMPIETE FoR c.o. ,WITHOUT CERTIFICATE
ALL CONSTRUCTION SHALL MEET OF OCCUPANCY
'fHE REOUIREMENT$ Of THE N.Y.
STATE. CON TRUCTWN A ENERGY
STATdy~~E1R~BPONB184B I fOR
CoUNI~~ Rp CCSF~B'~IiUC110N ,ERNS
' T" ' ' ' ' ' ' ' ' ' ' ' • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing 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 contained 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 Tiled therewith.
Sworn to before me this
Notary Public, , 7f, ; , ~q,(((///~1;~ , , , • , , , County
EN K. DE VOE '
.......(.5.......Pp....
URIIC, State of New Yolk
@ou Si nature of a licant)
Term Expires MArch 30, }9~ s