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Home My WebLink About30883-ZFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ball Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30893 Date: 05/03/05 THIS CERTIFIES that the building CENTRAL AIR-CONDITIONING Location of Property: 90 CAROLE RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 52 Block 2 Lot 4 Su]odivlsion Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 3, 2005 pursuant to which Building Permit No. 30883-Z dated JANUARy 7, 2005 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 INSTALLATION OF CENTRAL AIR CONDITIONING IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRED HRIBOK of Ehe aforesaid building. (OWNER) St~FFOLK COUNT~ DEPARTMENT OF ~]L~LTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'I'~U N/A 97478C 04/08/05 N/A Authorized Signature Rev. 1/81 Form No. 6 TOV~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 respousible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For e.xisting 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 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 building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 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: (check one) LocationofPropertY:C"7~) ~c{D(a ffC)~_~ ~~/~0~ House No. Street Owner or Owners of Property: ~(~'~'~d~C'!(-~.~ [-~ ~-'[ Suffolk County Tax Map No 1000, Section __ ~_~) ~--'-~_. Block ~'~C) ~- Subdivision Filed Map. Permit No. ~ ~-~- Date of Permit. Applicant: Hamlet Lot Lot: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ .,~ .Z'~. (,eX-~ Final Certificate: 'V~ Icheck one) / App' c~J, STgnature Issue Date 4/8/2005 Electrical Inspection Certificate Electrical Inspection Service, Inc. Application Number 375 Dunton Avenue 97478C East Patchogue, New York 11772 (631) 286-6642 Issued To: Mr. Frederick Hibok Street: 90 Carole Road Village: Southold Zip: 11971 Section: 47.388 Block: 522 Lot: 4 Contractor: Jeco Electric inc. (L) Town: Southold Lic. # 166-E Was examined aha found to be in compliance with [he National Electrical Code. _ Commercial '_ NV Defects Pool '--_ 1st Floor IX--Indoor ' Basement ~ Hot Tub ~X~ Residential ,Det. Garage X, Attic LJ 2nd Floor ~ Outdoor ' Addition ~ Survey Switches Receptacles Fixtures GFI Heaters A/C Fans 1 1 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace Oil Gas Circulators Smoke Detector Bell Transformer Meter Amps Phase UG/OH Jacuzzi Television CO Detector Bldg. Permit: Other Equipment I~ 30/220V raintight a/c disconnect 15/110V air handler disconnect Hugo S. Surdi President Rough Inspection: Inspector: Final Inspection: 04/07/2005 Inspector: John Mc Mahon [11 FORM NO. 3 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) PERMIT NO. 30883 Z Date JANUARY 7, 2005 Permission is hereby granted to: FRED HRIBOK PO BOX 730 SOUTHOLD,NY 11971 for : INSTALLATION OF CENTRAL AC AS APPLIED FOR at premises located at 90 CAROLE RD County Tax Map No. 473889 Section 052 pursuant to application dated JANUARY Building SOUTHOLD Fee $ Inspector to expire on JULY 150.00 Block .0002 Lot No. 004 3, 2005 and approved by the 7, 2006. gnature ORIGINAL Rev. 5/8/02 765-1802 BUILDING DEPT. INSPECTION [ ]FRAMING ~FINAL ~/~*:) [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ~ ~t~ DATE FI~LD INSPECTION REPORT I DATE I COM~LENTS FOUNDATION (1ST) ~ ~ · . ~ ]FOUNDATION (2ND) ROUGH ~G & ~ PL~G ~ ~S~ATIO~ PER N.Y. ~ STATE ENERGY CODE ~D~ION~ COUNTS ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~WN HALL souTHoLD;- NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. nor thfork, net/Southold/ Examined Approxed__ Disapproved a c · 20 Expiration ,20 PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the tbllowing, before applying'? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: i0¢5 { a_umean lane_ Phone: Building Inspector APPROVED AS NOTED APPLICATION FOR BUILDING PE~: J ] :/1~- B.P. # ,,-Df/ INSTRUCTIONS 765-1802 8AM 70 - M FOR THE : FOLLOWING INSPEC 7,ONS: a. This application MUST be ~ompletely filled in by typewriter or in ink and subrKt~ltl~tlO~u~ditlgFIfililttt~ with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. FOR POURED C,?~ ~RETE b. Plot plan showing location of lot and of buildings on premises, relationship tS. a~dffflfi~ p~fifilttg,~ioit 15BfilMBth'6ets or areas, and waterways. 3. INSULATION c. The work covered by this application may not be commenced before issuanc~.ol~lR~ldi~l~ir~iCTION MUST d. Upon approval of this application, the Building Inspector will issue a Building llFmCa~01flii[~tp~t~a~tOSuch a permit shall be kept on the prcmises available for inspection throughout the work. ALL CONSTRUCTION SHALL MEET THE e. No building shall be occupied or used in whole or in part for any purpose wl{ll~l~J~gatl~lStl~l~klflSP~[hP~l~&~q issues a Certificate of Occupancy. YORK STATE. NOT RESPONSIBLE FOR f. Ever5, building permit shall expire if the work authorized has not conmaencecP[~l~i~ II~T~[ii-~li}l~l:larr4q]~RS- issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, itt writing, the extension of the permit for an addition six months. Thereafter. a new permit shql be required. APPLICATION IS HEREBY MADE to the Ltuild~ng Department for the issuance of a Building Permit pursuap.~i~ilii 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 premise_s and-in building tbr necessars, inspections. · ' (Signature of applicant or name, ifa corporation) \, / , (Mailin'~'[ddress of applicant) __ / --' &V //ko I State whether applicant is owner, lessee, agent, ~chitect, en~neer, genera contractor, electrician, pimoer or builder Nameofownerofpremises ~d~]'c J'/ /~ - Cs off tile tax }off br latest deed) If~plicant is a co~oration, si~ature qf duly authorized officer ~ ~ {~me and iitl[ 6~o~orite'ofricer) Builders License No. [V'14 Olq W 0 o o Plumbers License No. Electricians License No. ~_).c~c_.Q) 1(~9 f___ Other Trade's License No. Location o2'land on which propos~ed work will be dotll~: House Number Street ' H~nlet County Tax Map No. ,000 Section4 Block 5~'Z , ~. Lot Subdivision Filed Map No. ~. (Name) Lot 2. State existing use and occupancy of presses 0nd~intende¢ ~se an,4 occupancy of proposed construction:v- a. Exisfinguseandoccupancy it~(Q57>'l(~ff)-/? ~ [/' · ' r ' b. Intended use and occupancy Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost If dwelling, number of dwelling units If garage, number of cars Addition Alte[ation Other Work d~_/')..-,~_ / A~ d' /(~~/" (Description) Fee g. OO (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify, nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Dimensions of entire new construction: Front ~'~ Rear c~_ Height --~ Number of Stories Size of lot: Front Rear _Depth Rear Depth _-~ 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO / 13. Will lot be re-graded? YES __ NO e¥~ill excess fill be removed from premises? YES__ NO ~ 14. Names of Owner of_premises Address Phone No. ~fArchitec~ ' ' --. , t Address Phone No ame ofContractorFv,4e£ F~,t'~r~nn/~/at~;~$ Address tfl? (~ ctyoat~ /g~Phone No.<w 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES__NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES__ NO__ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, xvith accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at l 0 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) \ ?O~LO~ O'( ~'~ )Y~'I f~ ('~ being duly sworu, deposes and says that (s)he is the applicant (Name of individual s'igning contract) above named, (S)He is the -- ' ' ' ' (ContractOr; Agent, Corporate Officer, etc.) of said owner or owners, and is duly author/zed to perform or have performed the said xvork 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 manner set forth in the application filed therewith. before me tbJ. s'x KATHL~EN [~ROWE8 ~ot~J Public, State ~SN~ w NO. 01BR604 r~ _~uallfled in Suflolk/~..assau County ~ommisslon E.~pims ~ay 30,20