HomeMy WebLinkAbout23011-z F 4.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24481 Date JULY 8, 1996
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 380 WICKS ROAD NEW SUFFOLK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 110 Block 8 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 7, 1995 pursuant to which
Building Permit No. 23011-Z dated SEPTEMBER 13, 1995
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 SUN ROOM ADDITION AND ALTERATION TO AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to JOSEPH & MONIQUE ROBIN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING JUNE 28, 1996
PLUMBERS CERTIFICATION DATED N/A
i ing Inspector
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 WORKJAUTHRIZED)
Date .. .... . .......................................... 19.F
NP 230111
Permission Is hereby granted to; ,(
.......,v....� ....L..... ..............................
- .` ,3..... ....................I...........
.......................
to ... ........................ � ... .... ...-................ .. ...
..... . .. .. .................... .,�.-.�....l~ -..�'or
. .... . ? ...... ... . .... ... . ....
.. .�/. .. ... ... ...... ....... ......4e-':�?......... . . .... r ... .........................................................
..................................................................................................................................................................
..................................................................................................................................................................
at premises located at......... u.......1 a......04.4 r........................................................
...................... .........................................................;; o .................................... ............
o :
County Tax Map No. 1000 Section ......... � ..... Block.......... ............. Lot No. .j........................
pursuant to application dated ......................... ......... . .., 19...�4/and approved by the
Building(Inspector.
Fee$./.11�.....�...........
Building Inspe or
Rev. 6/30/80
® Form No. 6
EAn c,�k :�"J
• A
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN MALL
I 765-1802
�S vl�) (t ,s7 APPLICATION FOR.CERTIFICATE OF OCCUPANCY
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 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.
6. Submit Planning Board Approval of completed site plan requirements.
3L. 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 Buildins - $100.00
3. Copy of Certificate of Occupancy - _ .25rz,
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . .I . ... . . .. . . . ... . . . .?'K . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . ���..... . . . . .
Location of Property. . ,.AJ 9. .�n7 �cI . .K.0ill?. . . . . .NLW, sU1:P, <'. . . . . . . . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. . A.�VIO h1.1.9 11 L. .�f2,0131/�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . !P . . . . . . .B1ock. . .e. . . . . . . . . . . .Lot. . . I 7. . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . ....... . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No.. . . . . . . . . . . . .Date Of Permit. . 9/ /7v . . . . . .Applicant.•JOS/ P( /j:R0.0I"�/. . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $ . . Q.Q. . . . . . . . . . . . . . . . . . . . . /
LICP�V
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Town Hall, 53095 Main Road $ • Fax (516)765-1823
P. 0. Box 1179 y Telephone(516)765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
June 24, 1996
Mr. Joseph Robin
23-43 36th Street
Astoria, NY 11105
To Whom This May Concern:
We are unable to, complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not. on file. (Enclosed)
xx No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 23011-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
d $"( -Z
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001093 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NY 10038
Date JULY 03,1996 Application No.on file 11535896/96 N 390441
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
JJOSEPH .ROBIN, 380 WICKS ROAD, NEW SUFFOLK, N.Y.
in thefollowinq location; ❑ Basement ® Ist Fl. ❑ 2nd F'l. OUT Section Block Lot
was examined on `NN' 28,1996 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER MIT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
1 6 3 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. I AMPS. TRANS. AMT. I H.P-' NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC.COND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP 1.0 4W 1.03W 3,0'3W 3,0'4W PER.0' Of CC.COND. NO.OF HI•LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
PADDLE FAN-1
MOTORS:1-F H.P.
G.F.C.I:-1
DOROSKI ELEC. INC. LIC.11k2941-E . �T
425 14ONSELL LAM ,
CUTCHOGUE, NY, 11935 GENERAL MANAGER
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.
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [�
[ ] FIREPLACE & CHIMNEY
REMARKS:
(Ut Ar 41-? Lc __v -7
DATE � INSPECTOR
,65.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ NSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNEY
REMARKS:
DATE � INSPEC
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ RAMING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
DATE d INSPECTOR
30
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATIGN.iST [ ] ROUGH PLBG.
[ ] FOU ON 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
e y
65-1802
BUILDI
NG DEPT.
[ F NDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
e
v
DATE C INSPECTOR
-r
765-1802
BUILDING DEFT.
NSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ � FRAMING [ ] FINAL
[ j FIREPLACE & CFIIMNEY
REMARKS:
_ CX�
DATE �� ��IhfSPECTOR
DING DEFT.
,l, 'SPECTION
r
r
[ ] NDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATES INSPECTA� ��
FIELD INSPECTION E2f:POR'I DATE -------------- -_--__COMMENTS
----------COMMENT-_-________________
n-- -- �--- — -- ---------- — �L`�—=t--- y lam'FOUNDAT ION _( I ST)
FOUNDATION (ZND)---- II // c``==_------'- '�== _- - sl
ROUG}I FRAME & 11 54
�_!"o xf cj
PLUMBING I --i—
Ir--
LIN
` I _
R t ii� e
INSULATION PER N. Y.
STATE ENERGY
CODEii
u - — —I
Il� H
II II
u
FINAL
------------------ADDITIONAL COMMENTS:
H
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BOARD ' OF HEALTH . . . . . . . .
FORM NO. 1 /1 SETS OF PL.XNS . . . . . . . .
TOWN OF SOUTHOLD (SURVEY . . . . . _ _ . . . . . . . . . .
BUILDING DEPARTMENT /Criect: . . . , , . .
TOWN HALL / SEPTIC r• ORN . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 r,ar 1 FIt ;
/v 19��/ CALL - - . . . . . . . . . .
Examined PIA I L TO ;
Approved . . . . ./ ., 19 (Permit . . . . . . . .
. . . . . . . . . . . . . . .
. . .
Disapproved a/c . . . . . . . . . . . . . : . . . . . . . . . .
1. . . . .
(Building Inspector)
PLICATION FOR BUILDING PERMIT
Date . . ... . . . . . . . : . . .. 19 >'
INSTRUCTIONS
r
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witli
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 stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app:
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 perm
sliall be kept on the premises available for inspection throughout the work.
e. No building sliall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant
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 tI
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances (
Regulations, for the construction of buildings, additions'or alterations, or for removal or demolition, as lierein describef
Ttie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary spectio is.
All
(Sion ture of ap' licant, or name, if a corporation)
P P )
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises r L�Sf?.1�. .1. . . t�a.�l �. . .. . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
t' f)
(Name and title of corporate officer)
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . SEP ~ 7 1995
Plumber's License No. . . . . . ... . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . .
Otlier Trade's License No. . . . . . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work will be done.
I.louse NumberCb Wtci!<5 Street Hamlet
CoLinty Tax Map No. 1000 Section . . . : . . WAD . . . . . . . . Block . . . . . . . . . . . , , , Lot . . ./7. . . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . .*... . . . . . . .*. Filed Map No. . . . .
(Name] Lot . . . . . . : . . . . . . . .
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy r5. . . . . : . . . . . . . . . . ;�'SI":; t 1p1-:;j.-
b. Intended use and occupancy . . . . . . . . . . . . . . . ... ....
3. Nature at work (check which applicable): New Building
. . . . . .
Repair • • • • • • • • • Addition . . . . . . . . . Alteration . . . . . . . . . .
p • • . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
4. Estimated Cost 7,46m d (Description)
. . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling, number of dwelling units nN a. EYAm. 147..... Number of dwelling units on each floor . , , , , , , , ,
. If garage, number of cars . . . . . .
. . : . . . . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of.eaclt type.of.trse. . . . . . . . .7. Dimensions of existing structures, if any: Front . Rear
licight . . . . . . . . . . . . . . . Number of Stories • . . Depth . . . . . . . . . . . . . . .
Dimensions of same stricture with alterations or additions:'Front . . . . . . . . . • ' ' ' •
Depth . . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . .
Height . . . . . . . . , Number of Stories .
8. Dimensions of entire new construction: Front . . . . . Rear
.Height . . . . . . . . . . . . . . . Number of Stories
9. Size . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . .
of lot: Front .��� (. . . : . . Rear. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .
10. Date of Purchase ,d,�'7;obP�2 Zq, ' ' • • • • • •�• • • • • • • • Depth If.'. . . . . . . . . .Igac7. ._. . . . . . . . Name of Former Owner w.rLL✓rr:xr. . . . ..� F.�ryi�. . . . . .
11. Zone or use district jn'w}iicli prernises are situated . . . . . .. . . . .
.12. Does proposed construction violate any zoning law, ordinance or regulation:. . . . . . . ..a
13. Will lot be regraded Will excess fill be removed from premises: Yes
14. Name of Owner of' rernises r.(.7SF_ ff . irZclth/ , sTvar N
Name of Architectr��/{WF_ T� / /daW<✓. Address 22: 3.3LrG,.sT .�yo� hone Ngrf�r8)7L t �:crr , . �,
. . . Address i�z �e�;r`s;>7��, ��er✓pe�er`Phone No.�c;T� :r,✓-,�
Name of Contractor . Address . Phone No. . . .15. Is this property within 300 feet- of a tidal wetland? *Yes.. .$rr. . . .
*If yes, ' Southold Town Trustees Permit ma be required. No. x . . . . . .
y y
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.
STATE OF NEW YIK„ `k S.S
. �?. �. a . . . . . . . .
being duly sworn, deposes and says that lie is the applicant
(Na re of individual signing contract)
ibove named.
=le is the . . . . . . . . . . . . . . . . . . . . . . . .OW.a IN.' . .
(Contractor, agent, corporate officer, etc.)
)f 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 trice 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.
;worn to before me •this
. . . . . . . . . . . . . . . . of. . � } . . ., 19
40t.ary Public, . . . . County
ROSERT 1.S . . . . . . .V .C�. . . . . . . . . . . . . . . .
NOTARY PUSLICCST'e.o fN.Y.
(Signature of applicant)
No.4725089.Su olk County
Term Expires May 31, 19-,(o
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