HomeMy WebLinkAbout21831-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23065 Date JUNE 24, 1994
THIS CERTIFIES that the building ADDITION
Location of Property 785 FISHERMAN'S BEACH ROAD CUTCHOGUE, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 111 Block 1 Lot 31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 29, 1993 pursuant to which
Building Permit No. 21831-Z dated DECEMBER 14, 1993
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 A CARPORT ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to JOSEPH GOLD
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N306157 MARCH 3, 1994
PLUMBERS CERTIFICATION DATED N/A
lding Inspec or
Rev. 1/81
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) CC~~
N Date 19...f....
21831 Z
Permission Is hereby granted to:
~!bi... 4e....'.......O, !3oX...../.. 9.(e.
.49z?!4 ....,........llS
to Czll f T~ft.C ~ ........F.. 5~.~
l FC: ~i?G Ci?E-r........... !./~.......!„/{?~j........
~
.~I 'lf.~C:f_iJ.......... '
.
Z91,
..............................~........................................................................C............ .
at premises located at............ 0~` 7.......... r. sf?fiP. ? 4^x,5...... / .£j ~C1..../~
err..c~.0.f
County Tax Map No. 1000 Section 11Z............ Block ...........!........pp.. Lot No. ~
pursuant to application dated 19.....7.1..., and approved by the
Building Inspector.
Fee $.....~f
.pe...........................
tiding Inspector
Rev. 6/30/80
4 TORN OF SOUTHOLD iS ( L
BUILDING DEPARTMENT 1 J
TOWN HALL 1994
765-1802
L. TC BLDG DE-P7~
~ ':VNOF
APPLICATION FOR CERTIFICATE OF OCCUPANCY -~---gO_0TH0LD
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 li 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 building $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 $15.00
Date . C. . lc2AlJ/lr.`/
New Construction .......v.~... Old Or Pre-existing Building..... / /
Location of Property... nr . ..................5` .7:~~.. .U L..... ~Yf 36 UGC ~
Of----
House No..~ I Street Hamlet
Onwer or Owners of Property ...(;Q..`.~
County Tax Map No 1000, S(eec~pptiion''..~.''..JJJ....... Block 1........ Lot...,T3/
Subdivision ~'~PR~.~~ ~.•-sp ti+c ~ .Fiiled Map...19A~ ....Lot... ! CJ3 Permit No...q~ Date Of Permit ......ApplicantffW0?r.
F'FZOcv ,.ice.-a
ifealth Dept. Approval LJ ,N ................Underwriters Approval.........................
Planning Board Approval..~\Y~7
Request for: Temporary Certificate........... Final Certicate...$!:.....
Fee Submitted: a;s..?/
PLICANT. .
e1W-/_-a30tP z
i
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE'
1001093 BUREAU OF ELECTRICITY
8S JOHN STREET. NEW YORK. NEW YORK 10038
Date - MARCH 03,1994 - ApplicatilmNo.onfile' 95615494194 N 306157
THIS CERTIFIES THAT
only the electrical equipment et described below and introduced by the applicant named on the above application number in the premises of
JOSEPH GOLD, 785 FISHERKANS BEECH ROAD, POL806, CUTCHOGUE, N.Y.
in thefollowinR location; ? Basement ? Ist Fl. ? Pnd FL OUT .Section Block Lot
was examined an FEBRUARY 2 8 , 19 9 4 and found to be in compliance with the National Electrical Code.
FIXTURE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS AQK SWITCHES INCANDESCENT nuOnEtCEW OTHER AMT. K. W. AMT. K. W. AMT. K.W. MIT. K. W. mt. N. P.
7 3 7
DRYERS FURNACE MOTORS FUTURE APPLIANCE INORRS SRCIAt REC?T WAR CLOCKS RU UNIT HEATHS M n OUTIRT DIMMERS
AMT. K. W. cu M. P. GAS H. P. AMT. NO. A. W. G. AMT. MV. AMT. MNS. TRANS. AMT. n P. fTOWF REi AMT. WATTS
NO.
SERVICE DISCONNECT NO. OF S E R V 1 C E
AMT. AMP. TYN OWF I A TW I A TY t / T4 3 A AW NO. Or l. *COND. OP CC. co D. MO.OF 141.126 W NO.Of maTRAl3 OF P W. PAL
OTHER APPARATUS:
CARPORT-1
MOTION SENSOR-1
G.F.C.It-4
DOROSKI ELEC. INC. LIC.#2941-E
425 MONSELL LANE
CUTCHOGUE, NY, 11935 GOIN IMANAGO
11
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
lp,r'I' ECT'C:N IJD„TE II - COMMENTS7OU11DATION (1st)
c d-
FM4DATION
(2nd) m
2.
z
o
ROUGH FRAME &
PLUMBING
H .1
3 . a Qi.
m
INSULATION PER ff. Y. y 1 p
STATE ENERGY
CODE
coo
4.
`t
FINAL
C-S
ADDITIONAL COMMENTS: m r
x
a
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
( ] FOUNDATION 2ND [ _I (INSULATION
[ ] FRAMING FINAL
REMARKS:
DATE G INSPECTOR
i,.i• : I: ILn son'ey Is a vlolullon of
i. o:. ..1•: • 'd,,
...n tJew lwk Slain Iiducalloo Low.
.1•-5Y~.11',b . Ccpias o1 Ibis verve ma not Lsaoring the land swveyvi s Inked , ''i seal or ern bossed seal shall n.,t be conside•
" - od to be o valid copy.
•k, y.• Guarantees or cwhficalions indicated hereon shall run only 10 the '
person for whom the survey Is pre ehalf to the
pared, and on his b
in le company, governmental, agency and lending Institution listed
heroon, and to the asdgrwes of {he lending Inultution. Guarantees
IRia j' or cenllicanons are not handewble to addlllonal Institutions M
{1Y,:,1' 1
" '.r • r.11 .1, of .
•F i y sabsepuent owners. '
;.lpror:.
'k hr J. s
y~~~~`,• ra '
a.
u l TOWN OFF SOLITNY. `l4J+AR~`gl R
i,r
O q / P. 'tqn .
a y~ d + r: s; Ic.
414i it ~ J1I .
lay":''; 0 • /
Ilk~ 4.. , .
o ry
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Ali* V
Lit. \ 0~ a:..
aas,f ii ` •i. 'p~ I 1 •'I
.4, 1
Is.
sa : h •`:443}IU S(~,j~s41. :iy.'
41,;' `t
F:I:. All distances to wells.and cesspools are
+r' by location from house owners and field
`:~`f:` observations, since most wells and cess- -
\+,.poals are not visible these dimensions
s, cannot be certified.
,
7qf •i
pdsl 1
~!VEY FOR REFERENCE Y I`
q EPH b1 J.ANET GOLD PccCNIC WM~w IKS INC. `''';`„F
.SYI FILCO AP
y ft•i .+a.l p;; ti
I SAU POINT
$4; oe~ `teP NI~ ' :r',,:...;•: ;h,11.,
N~ QF.S.OVTHOLD EUARAN EE 0
, ~'~^LK COUNTY, N.Y. cHICA TL N ao !'AN?r 'r:"-'+'+
;i+I! JOSEP JAN l0
"L£+t l°e 40, ~ „'lt+ d 5:y 41"i~r
t j y t f'O <8' o 't,' i~~J sFt n l i
Irk;,
17.
A G:'31 ` 19 T: R YO 1;}..r^ rS,t tJ
Y[ LOC.N LSOM
i' RI *616 4 1h Y :rl..i.ar.,s..nn•-=n^r.=^ _.____-_aassu^•^~ra::.: ___~___.-___-_~_:S-_^^.~T.:~,'J_"'^" - 1'~~Sl+.._......1
BO,1RO OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY _ .
Z g BUILDING DEPARTMENT CtIECK
TOWN HALL SEPTIC FORN
i.
. _ SOUTHOLD, N.Y. 11971
{ TOWN OF sOu TEL.: 7651802 t:OT F'f ; _
. 7 .
^ C A LL
Examined .....~L/~ 19 tt T0:
Approved 19p? 7.3. Permit No.. P W
Disapproved a/c
(Bui in~/lnspector)
APPLICATION FOR BUILDING PERMIT
Date /11(-1/9) 19...
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 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 Oe'cQpa
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 inspections.
1IJdII~aJri?E3c!~t~s°ti.~~
gcg~ ~re o~ifcapplicant, or name, if a corporation)
cca,.~ N _y
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. 0~ F y~h- I... .
Name of owner of premises
- (as on the tax roll or latest deed)
If aOlicant is r g ature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. .......ss~v......... .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done
~ ...............~SI,~.t2 mgr s. F' CLIA o.yu-r
House Number Street Hamlet
County Tax Map No. 1000 Section ~.I........... Block ........Q.1....... Lot.... 3.~
Subdivision ...........Filed Map No. Lot ..L~
(Name)
2. State existing use and occupancy of premises and intended use and, occupancy of proposed construction:
a. Existing use and occupancy ~IJ1 C).. j~ 4 I . • • .
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Y Alteration
Repair Removal Demolition Ot yo
Wescription)
4. Estimated Cost Fee .
(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
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Front ~S: Rear x...4- Depth .1 /
Height ~W Number ofStories .
Dimensions of same structure with alterations or additions: Front _'S S..°...* Rear ? .
.
Depth ....J:( . . Height Number of Stories
"
8. Dimensions of entire new construction: Front ......~71 Rear 11...(e..... Depth , 021
Height Number of Stories.
9. Size of lot: Front I
Rear .......5.4...UI........ Depth ..'2'/421
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated 72~ .c CC } 9'l
12. Does proposed construction violate any zoning law, ordinance or regulation: A40
13. Will lot be regraded E? Will excess fill be removed from premises: Yes No
14. Name of Owner of premises w~s Address?~ .~,'SI P?Y' i', a ~&A.~Phone No.73 y. . 63 7~
Y~av ~
Name of Architect . . . . . . . . .....Address . . . . . . . . .
. . . .Phone No....... . . . . . . .
Name of ContractorLl7~1R0rJtat3 iA 074k Address4K'W*AC47AAC, Phone No. -73. Y.._2Y.7
15. Is this property within 300 feet of a tidal wetland? *Yes.......: No.........
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
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.
S:
STATE OF NEW YORK, S .S
COffNSY OF .
O being duly sworn, deposes and says that he is the applicant
(Name of individual signing cdrftract)
ibove named.
'{e is the
(Con ct gent, corporate officer, etc.)
)f said owner or owners, and is duly out onze o 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
vork will be performed in the manner set forth in the application filed therewith.
;wom to before me this
6e:-
.....day f... 19
f
4tary Public, County ,
i JOYCE M. W MNS
Notary Public, Sate of New York r~
No. 4852246, Suffolk Courmf (Signature of applicant)
Term Expires June 12,1
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76534802r9, AM-10,14 PM FOR THE
3 - - - - FOlL0VVtNG INSPECTIONS:
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