HomeMy WebLinkAbout23919-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25024 Date MAY 6, 1997
THIS CERTIFIES that the building ACCESSORY
Location of Property 440 MIDLAND PARKWAY SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 88 Block 2 Lot 12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 5, 1997 pursuant to which
Building Permit No. 23919-Z dated FEBRUARY 13, 1997
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 ACCESSORY DECK WITH OPEN TRELLIS "AS BUILT" AS APPLIED FOR.
The certificate is issued to G.O. ARMOND
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
qwh�
Building Inspec or
Rev. 1/81
FORK NO. f
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)
N9 23919 Z
Date FEB....1.. .................
Permission is hereby granted to:
G 0 ARMOND
................................................................................
BOX 101
................................................................................
SOUTHOLD, N.Y. 11971
................................................................................
CONSTRUCT ACCESSORY DECK WITH OPEN TRELLIS "AS BUILT" AS APPLIED FOR.
to ............................................................................................................................................................
................................................................................................................................................................
at premises located at .....440. MIDLAND PARKWAY SOUTHOLD N.Y.
...................................................................a..............................
.................................................................................................................................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section 88............ Block 2 . Lot No. .......1 2......................... .........
pursuant to application dated .......FEBRUARY 5 19 97, and approved by the
Building Inspector.
Fee $........35:00
..... .... . ... ...: ....... ...................
..
B it g I for
Rev. 6/30/80
J 3U=ING DEPART WNTi ( o a
TOWN a__ZL '"D)c Hs,(
763-i302 Soo't-kvf ell CilY
" APP
6_ LICATiON ,OR C..'ZT_==CATE Or OCCTJPAJ"TC`_'
� BL�G.IDEP7
A. �_s _ A r_+- g pus be Filed in by typeTNL_ter OF ink and submitted 'co the � i bu__dina
inspector with the following: for new Or neCa use:
i . F i nal survey of .property with accurate locatnCn Of all Ou'!dings, ?rODert:J 1i_leS,
streets, and unusual natural or coocaraphic features.
2. Final Approval from Health Dept. of water supply and se*aerage-distosal(S-9 fora) _
� . ADprOVal OL electrical inStallatiOII from Board of rife Underwriters.
1. Sworn statement from plumber certif7ing that the solder used in system contains
less than 2/10 of iZ lead.
5. Commercial building, industrial building, multiple residences and sear buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval or completed site plan requirements.
B. For existing buildings (prior to Apra? 9, 1957) non-Conforming uses, Or buildings and
`•'pre-existing" land uses:
. i . 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 'aspect signed by the applicant.
r
I=_ .
a Certificate of Occupancy is denied, the BuLding Tasnector shall state the
reasons therefor in W-rising to the applicant-
s
i . Cartif icate of Occupancy - New :welling S25.00, Additions to dwelling S25.00,
Alterations to dwelling S25.00, Sv4_zmning ]Col $25.00, Accessor:J bu_?ding ]25.00,
Addisions to accessory building 325.00. Businesses 350.00.
2. Carti=icate or Occupancy On Pre-exis'=Ig 3u .dinz - �100.00
5 . Copy Oi Cartificate of Occupancy - .25C.
'. Updated Certificate of Occupancy - 550.00
5. Temporary Certificate of Occupancy - Residential S15.00, Commercia-T S15.00
Data . . . . . —?/6 3/q_;.. . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . .rr.//Old O,(r�Pree-ecisting Building. ._ .K. . . . . . . . .
Location of Property. . . .( =�•�. ..!. .l�(3�.'�^.�! YL{, _ . . . _ . .�. . . .
House No. /Street Hamlet
Onwer or Owners or Property.. .. �.m n .C :� . . . .. . . . . . . . . . . . .. . . . _. . .
. . 4 _ .. . . . . . . . . .
Gouncy Tax Map No 1000, Section. . g�. 8. . . . ...Bloc'_�.. . .���. . . . . . . .. . .... . . . .Lot . . . . . . . . ... . . . .
Subdivision. . . . . . . . . . ... . . . . . . . . . . . . . . . . . .. ... .. .Filed Hap. . ... . . . ... .
;.:�
, - . . . - - - - - - - - : _ . . . . . . . .
Peit 'To Permi . . .3pT_cat . . . . . . . . . . . . .i
`eal_h Dept- Approval. . . . . . . e.. . . . . . . . . . . . . . . .Under-..-r=tars Approval. .11G/ r'=:. . . . . . . . . . _ . . .
alarming Board approval. . . . / :. . . . . . . . . . . . . .
Request for: Temporaryy Certi ficate. . . . . . . . . . . _inai Cartic_t.. . . . . . . . . . .
t ����
Fee Submitted: � . . . . . . . . . . . . . . . � ...
. ... . . . . . . . . . . . . . . . . . . . . . .
PLI.CLNE_,
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] �INULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: „ LA
DATE 3 ; S ' INSPECTOR
FIELD INSPECTION REPORT DATE _— ----- COMMENTS W
II
H NJ
II II H
FOUNDATION ( 1ST) �
--if
FOUNDATION (2ND) II
----------
II J
9
l
1
ROUGH FRAME & if
n
II �
PLUMBING
II
I,I jj
II II
if ii cn
H
INSULATION PER N. Y. —j
STATE ENERGY
CODEif
II 'I
if
If
I�
II II
FINAL II tl
if
ADDITIONAL COMMENTS:
t=i oQ
z W
H �Q
H
z
x
H
_ x q
x s
r�
b
H
Washington Heights-Inwood �PRES
Ambulatory
Care o Z
Network 3 ��
Corporation °�c C
Columbia-Presbyterian/Urgicare Center
21 Audubon Avenue, New York, N.Y. 10033
(212) 342-4700
e �
FROM Panasonic FAX SYSTEM PHONE NO. Jan. 31 1997 02.11PM P1
r
IibALYS) ()I' Stl?A1:1'LI - .. -
- - - - - - - - • -
FORM NO- ( 3 SYTS OF PLANS - - - - - - - - . . . . . .
'SOkiPd Ole SOl1Tli(11..i)
SURVEY . . . . . . . . . . . . . . . . . . . . .
BUILDING 0LrT?ART1-lEN1' COECFC . - - - - - • _ -- -
TOW14 HALL S1:PTI,C FORM . - - - - - . - • - - - - - - -- . -
S(3U HOLIt, N.X. 11971
'S"r.A.: 7 b 5-'1 8 02 NOTIFY:
1a CALI. - - - - - - - - - - - - - -- - - -
MAILTO: - - -- - - - - - - - - - -- - - - - -
L�ancfli'aS�R. f _
Permit No_ ..................... ...........
Disapproved a/c .............................
(1 (ildins Yr�pc tor)
APPLICATION FOR BUILDING PERMIT
Date. . .. . . . . . . • -. ly<
INSTRUCTIONS
•IONS
a- This appl.icatian m2mst b2 stt:mr,.ie--T.v:ty iial+�'.. a by izi ink and r dtted to ii.,- Ii::i diUg T..r-51-Ic ,u
3 gets of plans, aomwate blot plaD to scale. Fee'ar.cos-dirlg to Schedule.
b. t?iot plan wing location of lot and of buildings on premises, xeiatimmhip to adjoining Premises or.public
€►lreei:s or --seas, asxl giving a derailed descriptinun of 1syaSC of Inropaety cswst: be dr:xam tx1 the diagram wFtith is part of
this application.
c_ 91te work gyred by this awl ictation may not be c xmu--rscPxi before issuance of Building Fe::znit_
d- Ufx-ae approval of this appliclatiun, E2W- Building Inspector will issue a Fkmildim F>enait to t1u: applicant. Such
permit shall he 3uept on the pr4maises available for irzspection rhroughOur the aoek.
e. ±io building stall be oGcupiF;i or used in -�"Ie or in part for any purpose.whatever until, a Certificate of
occupancy shuill Nwe bi-en granted by the iuildlirg Tnspector.
APF'1.I.c"" Is 119REM MMIE to t1w. Ruildima Department for the it;ts+Aaxace of a Building, Permit pursuant to the
Ruilding.74ne Ordins ocia- of the Tcwn of Southold, ar.ffolk County, New--Yorlt, and otlmr applicable Laws, Ordinances'or
Re4pslations, for the caastruction of buildiengs, additions or altnratioma, or for remwal or demolition, as herein
ek--Frcritu-A. 11be oppl.icatre.•. af,:cma to comply With .411 applicable law-9, nrdiantuices ding code. Ftou�'nII, ccxle, and .
r�.lations, and Co admit andiorized inspectors on promisee ward in Wil - in c ns.
- or f_ _ ��- •-
(Si�naturn of a I t, a r t
,��/.p..�:.ia ee •aeYui live Y aoYra��,ffs '-�
(l•Saa7.zng as of applicant)
State applicant i owner, @Ssee. agavit. architect, enQineer. Wneral contractor, electrician, pl T or builder.
Name of owner of premises ........ .... _•-_ G �/yZL 0lG ._.. --
(as on the taut roll or latest deers)'
If aVniticsnt is a corporation, zignatvre of ckily aaithorize-•di officer.
......................
(Nme and title of rorpcwate Officer)
Builders License No_ _________________________
P1.xd,e=s t:.i� tan- - ------------------
Electricians License No. .....................
Other Trade's License No.nc- .-•-. _ ( /
1_ Iation of land on which �.yed work will be done......_ZA/�/�...__. !
----•-.........I..................................._............ .... ...
V' House Diumber Street -- ...._._-... ............. . . ...
Hanaet
County 9 tt•.x limp Eda. 1000 c ctic7n .. Fe.a., Block .. =•- 7eoF_ C
i Subdivision ... ------- _
(tv } ......... piled Roap nD. ........ ....... lot ---.. .........
2. 5cate icg vtyg an4 occur
A&Aw-y of P"W i acnc7 intae>i case %�� /
a. PSci st i. use era occu�.y ----------- (/ r raP4 con�s[ Lion:
b- rnrended use and pcc
�a y �
� ............. .. • ...... ......... .. ..... .
���OM Panasonic FAX SYSTEM PHONE NO. Jan. 31 1997 0® 08PM P2
i1
N�,lnr@ of (c:ix>(�k wllic}+ (1171)lt[_»t)le)1 rfeW 1ir71}<.IInT; .._. Aciclifl(rl .. . Alter is
TTc'lxtir Kerr <t1 Ihkm)Iitirxi .. ........ 01:11er' Fk>rk
(p/ (rk:scri pt'ion)
Est:iltuted Cost __ .. V.......... ,. . a ,o . . ... . ...... ........... ....
(to ix- paid on riling dais applicclticxt)
if rAael l iTt1„ Ixui)er of dwell ira, vrlit7s . ........... tk.Ti)er of thA-T l inr rmi.Cs cx, each Flcx)r ... .......... ..
Ifgarage, mnber of cxiru _................................. .__.
If lnssiness, crzmme..rrial or mixed OCLIApaTDcy, .5 .ci fy ruit.tir a arul C-sctcnt of csnciT�;yjx' of us r ......................
biom ior+s of existing st'ruatrat-ets, i c'. arty: 1?ticcx,t.. ......-.. Rear -......_. . Depth
1.
TkAght ......................... Wni)Pr of Stories
Alnlennion3 of sa„e strimminp with alteratic)us or Xk}itions_ Front lte»r. . . ............
Depth .................... llaig)it _........... tJtrrri)er f: £: orse.
Tlinwnsi.cxss ee'n'ire t> Ccm�snt'n tia1: 1rcxlt: . .. (.`!'�/I.�.� .,[ ica*�. ifr�` Ll. fit' '• �!�__..
lieil+jlt � _.` � !P!n b&Rri+wr, a! 4T;n'rie .J. `...........
I
size or lot:: uycrlt e `f. . T ey,, . SD- .K/ _ Prh .i
I. DuLe cy( Ptsrci,o-),Se .-_-0 €Lar.2 e76° 1'vc,r,gr tAn)e I_�_vl• -.. .._._......
. ..
]. Zcww- or uqe district in %Atich pre)nises »1e it ta)sc=e<} ....,. �t�4!t�ti.!� -.. .... ......................
2_ Dc 17mPosed cosint"rurticxt viola any rzrnir)g lea, orclirl,wx:e or mrcAlxticsrs: _•.._ ..........
3- Will lot 1)e mgracled ....._.. n. _ ilrrx/s'Jess fill 1>e resl iY' firc ,s/ �
/i_ Nm)es of Owner of premises O.d_ `^:5!�... hr3cireKv _ + � 1 1 !'1e�
.r11,rl,e nr Ardiitezi' _..-- ..._.......-.•------ Arkl:ess ... ---- •-•.... .............. ['l,ocm'blo.
1iclrrae of Cwltr ictor ..._ ..._.... _......._.....hilot,e Nc). ..............
S. Is this property witbin _3M feet » ticGli 1a iliaruc}? � Yl:„S lap ..�..
*jr Y1-9, I-)[TIIKKJ) -1UNN -1TdJG1lxS P1,q -1T MAY W!, FZC-gT[m-)-
l'l.oT DIAGRAM
IAxat'e clearly arxt distinctly all lx)ildings, %Amatlter emisting or proposed, and irxlicaLe a1.1, set-back dimensions
:roan Property l i:,eF. Give street and block ,n7niw-r or description according 1:o deed, and sklow street nem,e9 aml irxlicaLe
al Teti Ter interior or corner. -lot.
JL
W/VX Vim; p-
srnll. OF rA;,W YUlt1C, Ss
UAINVY Or
fil�,-•��/yj+�d�f ,pp,pp jL 1� °w scx,rr), dem)-es arxl "Yr,'that ]PC is Use 'Ritlicant:
(N><T>e cT[ ira}.i.viJval. .i,_nit.,g ccml c t)
»1x)ve rsstT�c4, c"
u
SiTe i5 101c. ..... ... l't//Yh'i2 _-•••--...
(Cosst ractor, nE3ent:, cArpr)rSte of Fiver, etc-)
elf ^lid exnxr or c)ort,er :+Ix1 is duly a,7tT,elci.�.cl Col :r.f()r,r1 or 1�rve 1Tcrl'c,rr1,> t] l:},. aai.el work orml to "wake arx} file 111i. � '
tr711t..;RtrTe;c1 i.-1 t:h.ir, ap pi icat icn, arc true tc1 U,e t)rst of hi.g krx.,wl.ecll�e 77s7i7 l>n].ii:P; lric}
I.Iust the wcTtk will },ca perfatlnPel in the nt�rltler :eIL T.'or.th in the.al,pi.ic:Atitn, f.il.ecl tt,erew%tJ+_
.worn LCA 1>e(.oiP.�L6' thi a
�--••--
NoLary P+sblic ... .....•__
MICHAEL.S.�ROMBERG
(VOTARY PUBLIC,State of New York
#02BR4833055,Suffam C60t
Term Expires to 0, 19�?
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