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Home My WebLink About12861-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCuuPANCY No Z-20830 Date JUNE 25{ 1992 THIS CERTIFIES that the buildin~ Location of Property 29325 MAIN ROAD House No. County Tax Map No. 1000 Section 102 ADDITION Street Block 2 CUTC~OGUE~ N.Y. Hamlet Lot 12.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 25, 1984 pursuant to which Building Permit No. 12861-Z dated FEBRUARY 7~ 1984 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 PROFESSIONAL OFFIC~.~ADDITION & DORMER ADDITION TO AN EXISTING ONE FAMILY D~.ING. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL DEPOT ENT~n{PRISES~ INC. (owners) C-28 - APRIL 2~ 1986 UNDERWRITERS CERTIFICATE NO. N-743962 - APRIL 9~ 1986 PLUMBERS CERTIFICATION DATED APRIL 15~ 1986 - J. LIZEWSKI Rev. 1/81 FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ' (THIS PERMIT MUST BE KEPT ON THE PREMI.$F.~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) '4t 12861 Z Permission is hereby granted to: -- ~-~ ...... ............... ?~/~z.....~_~.~.~. ................... ........... .~.~.~__~,~= ...... ~...,.~. ........ ~.. ~...~...~~....a~ ~.~ ............. ~ ...................................... t._. ........................................................................................................... ~.~~..~.~.~ c~ ~x ~p No. ,ooo ~,on .... /~. ....... m~k ..... ~ ...... ~ No....~.~:.L.. pursuant to application dated Building Inspector. Rev. 6~30~80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY mo 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 1% 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. Submit Planning Board Approval of completed site plan requirements. 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 " New Construction ........... Old Or Pre-existing Building. ,.. Location of Property .......... : .................... House No. Street Hamlet County Tax Map No 1000, Section...l.~...~. ..... Block..~...~. ......... Lot..~.t~A ............ Subdivision .................................... Filed Map ............ Lot ......... ,. ............ Permit No. . Date Of Permit ...Applican .... Health Dept. Approval..-C ..-'- ~..~- .......... Under,writers _Approval. 2.-~.~..~.~- ~ .... Planning Board m roval pp .... Request for: Temporary Certificate ........... Final Certicate....~%. ...... Fee Submitted: $...~..~j..~..~. ................ q .... .................. G.F.C.I.-9, S~oke Detectors-3 Track Lighting-20'0"- 3 lites Panelboards;1-11(cir.)12$a~ps., 1-12(cir.)125amps., 1-24(cir.)100amps. NOTE: This is a partial~ not a complete certificate. Jody Pumillo lic.#2300E Pat Lane Mattituck, N.Y., 11952 7~-,- - CO_PY~F~ R ~UI~,DING DEPAR~ENT. THIS CO~ OF CE~IFIC~E MUST NOT BE ALFRED IN ANY MAN~ER. TOWN OF SOI.TT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner ~°~fea~se 7'pr intL~-~'~/) Plumber ~(p~e~ase~print) ~- I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /~- day of ~ , 19 Notary Public,~ County i (.~.~mb~ ' S s~nature, Notary Public FIELD IN~FECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & ?LUMBING INSULATION FERN. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM lq'O. S TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N, Y. ORDER TO REMEDY VIOLATION //(owner/or aut]~e'rized a~t of o,o,o~ner) (address o~ owner or aut~rized agent of owner) PLEASE TAKE NOTICE there exists a violati&n of: Zoning Ordinance ...... ~../~ ............ ~her Applicable Laws, Ordinances'or Regulations ............................................ et premises hereinafter described in that ...~...~~....~...~~~ (state character of violation) ............................................ /~ ~o~o~ o, ........... ~~ ..... .~..z~.=z.¢~ ............................................. {Stoto *~c/ion or ~ro~r~ph o{ ~pplicoble ~ow, ordin~nco or re~ulotion) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the ....... ...~....W.~...~.......~...~.....~... .................... dayof ....................................................... 19 ........ . ~<;77 c~,4/~ The premises to which this ORDER TO REMEDY VIOLATION refers are situated at ~.....~.~..~......~./~.~..~.~........~ ....... County of SuffOlk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute on offense punishable by fine or imprisonment or both. Building Inspector 'FORM NO. 1 TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEFTIC TOWN HALL NOTIFY S.OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... FORM ............. : Examined ................ , 19... Approved '1 ................ 19... Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TO: Date .................. ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~$ets of plans~ accurate plot plan to scale. Fee aceordin~ tc~ schedule. b~ Plot plan showing location of lot and of buil~ing~ on premises, relationship to adjoining premises or public streets or,areas, and giving a detailed description of layout o'f property must be drawn on the diagram which is part of this appli- cation, k. · c. The work covered by this application may not bffcommenced 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 applieaat agrees to comply with all applicable laws, ordinances, building code, ~ousin~ codA, and regulations, and to admit authorized inspectors on premises and in building for necessary '.m.~ ~. (SOhature~f ap .icant~¥ name, if a corporation) iling address ~ State whether applicant is owner, lessee, agent, a~hitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.I..~~. ................................................. [/ [ N ~ /] (as on the tax roll or latest deed) If applicant ~~,,o f duly authorized officer. ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No... 't' .............. ,~-' ' ' ' Electrician's License No.3~_g~r.~..... ~.. Other Trade's License No. K.~...~.. 1. Locationoflandonwhichpr_,oposedworkwillbedone...~.......~...~.~..~...~v...~..~ ..... ............ .... ....... .......... ............. County Tax Map No. I000 Section . /! .O..'~. .......... Block . ~)...~. ........... Lot. ~).t .~,. ! ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existi use and occupancy ............. b. Intendled use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .... t~(J6) Fee (to be paid on Filing this application) 5. If dwelling, number o f 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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... '-- 8.Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... 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: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No t4. Name of Owner of premises .................... Address ................... Phone No. ~..~..L./..-4o ~.~ 0 Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address .... : .............. Phone No .... z~, ......... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No 1~... ~If yes, Southold TOwn Trustees Permit may be required. PLOW 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 comer lot. STATE OF NEW ~'Ij~R[v . z S S ' COUNTY OF.~ .... ~' ~ .... ~-..c~,~~f' being duly sworn, deposes says that he is the applicant and dual~ing on~ac~ above named. ~ .... a. ~;~ ' c;;:~t~* ~ ............................................... ...... (Contractor, agent, co,orate officer, etc.) ~'8~ ;'~}~ ~ t~ of said owner or ownem, ~d is duly auto,ed to perfom or have peffo~ed ~e s~d work and to m~e ~3' file ~s application; ~at ~ statements cont~ed ~ ~s application am tree to ~e b~st of his ~owledge and belief; and that the work will be perfomed in ~e m~ner set for~ ~ the appHca~on filed therewith. fiwom to befo~ me thh Notary Public, . .................. xCI...~-~County . . Term ~r~ ~31, 1~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined/~t/~.. ~.. ...... , 19~..ff' Approved ~'~..~'...-I ........ 19~.. Permit So.t(d .c~.. ?.~ Disapproved a/c d~..~.~-~. '.~)...~.. '..~'. ........ -- ~1~.~ ~ ...... ~(Building Inspector) -- ~(- APPLICATION FOR BUILDING PERMIT ~ INSTRUCTIONS a. ThJ sets of plan b. Plol or areas, ar cation. c. The d. Up< Received ........... 19... application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :~ accurate plot plan to scale. Fee according to schedule. plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- work covered by this application may not be commenced before issuance of Building Permit. n approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit t on the premises available for inspection throughout the work. shall be keg 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 applic~tnt agrees to comply with all applicable laws, ordinances building code housing code, and regulations, and to admit authir/zed inspect°rs °n premises and in building f°r necesi~.k~"~' - - -"'iq '~· ''~'~-.~ ~ -r ................... ($ikn~i[~;~fibplica0t, or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ....................................... Name of owner of premises. '~ ~ '~' ~(a~'~''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..'~.o.. ~.. Electrician's License No.. ~...'. ~../2.~ Other Trade's License No ....................... 1. Location of land on which proposed work wiil be done .... .--.O.~.222....hY-.'z.~.:..~-~.~'.~....~...t{"~.f.~...t~?' .... ~'~o ~ ~ tree ~----]~'~-~ mlet Zr ...................... ....................... .......................... County Tax Map No. 1000 Section .... f..Q ? ....... Block ..... .~...'~.. ...... Lot ..... .~../. ~. t .l ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State-existing use and occupancy of pi-cruises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~.t?:tca~_...' .~. :24~.~.~-,,~.~-.'' ..................................... b. Intended use and occupancy .................................................................... 3. Nature of work (check whichtapplicable): New Building .......... Addition .......... Alteration .......... Repair .............. Re~noval .............. Demolition .............. Other Work ............... 7.~.? (Description) 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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............ Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ......... . ............ 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. 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 ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No. -1..~..~..-..~.Z. ?. ~. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 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 comer lot. STATE OF NEW Y .Q~RI~/ S S COUNTY OF . .~.: ..... above named. He is the ........... . .~.~..'d,. ~..~-~ ............................................................ (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 wdl be per?ormed in the manner set forth in the application filed therewith. Sworn to_before m.~ this ~omml~lon Explre~ March 30, 19~' Notary Public, ..'~-.~....~.-:.~ounty ~...~.~, . ~} ..... .... '~' ~ iin~[u;e' ~ f ~pli~a'n't, sworn, deposes and says that he is the applicant THE NEW YORK BOARD OF FIRE UNDERWRITERS ,~-001381 BUREAU OF= ELECT'RICIT¥' I 'kl 85 JOHN STREET, NEW YORK.,NEw YORK 10038 THIS CE~IFIES THAT ' in the follouqng I~ation; ~ Busement ~ Ist FI. ~ 2nd FI. ' ~tion Bilk ~t DRYERS ~ FURNACE MOTORS ] ~TURE AP~IANCE FEEDERS ~ffCIAL~'PT I C E G.F.G.I.-9, Smo,ke Detectors-3 Track Lighting-20'0'- 3 lites Panelboards;1-11(c~.)125amps., 1-12~cir,.)125amps., 1-24(cir.)100amps. NOTE: This is a partial, not a complete certificate. EXHAUST FANS- ' DIMMERS ~t.[ ' W*TTS Jody Pumillo lic.#2300E Pat Lane Hattituck, N.Y., 11952 ~hscertfcate-us, not be otered,n any ~onner, return to the office of t · ' : he ~a~d if'incorrect Inspectors ma~ 7f,5-~se2 BUILDING DEPT. FOUNDATION "ST ['J I PIRG. FOUNDATION 2ND INSULATION [ ] FRAMING [ ] FINAL REMARKS'- ~ DEN'T-AL OFFICE