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HomeMy WebLinkAbout8669-z~% FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-2030B Date OCTOBER 29, 1991 THIS CERTIFIES that the buildin~ Location of Property 2470 SIGSBEE ROAD House No. County Tax Map No. 1000 Section 144 Subdivision ADDITION Street Block 1 Filed Map No. MATTITUCK, N.Y. Hamlet Lot 22 Lot No. conforms substantially to the Application for Building Perr~it heretofore filed in this office dated JUNE 22, 1976 ~ursuant to which Building Permit No. 8669-Z dated JUNE 22, 1976 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 ADDITION & DECK ADDITION TO EXISTING ONE F~4ILY DWELLING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEIU~TH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 WILLIAM & ELEANOR PEDERSEN N-299910 - AUGUST 24~ 1976 N/A /Building Inspector FOE1V~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8669 Z Permission is hereby granted pursuant to opplicatlon dated ~J IJ 1~1 ~ 2 ~- ~'~ ~ ~ ......................................................... ~9 ......... and Qpproved by the Building Inspector. ~ee $ Building Inspector ! Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 certifyiug 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. ,,F°r existing. . buildings,, (prior to April 9, 1957) non-conforming uses, or buildings and pre-ex~st~ng 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. 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinuning 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 $15.00 Date ~.~...~..' ~Z./. f K . ~ew Construction ........... Old Or Pre-existin~ Building ................. Location of Property. House No. ~" ~ ~'~ ..... ................ ; .............. ~ ~ .~ .%~x~ ~.~.. ~ . ..... amletStreet Onwer or Owners of ~roperty ........................ ~ .......... ~ ......... County Tax Map No 1000, Section./~g .Block. /'. ........ Lot. rubd ivision ~ ............................... · · · · · Filed Map ............ Lot ................... ... Permit No. ........ ~ .~. [~..Date Of Permi~&~%~...Applicant~7..~.~_.~~ ~ ..... App Health Dept. royal .......................... Underwriters Approval ................~~ .. i ~ng Board Approval [~equest for: Temporary Certificate ........... Final Certicate..~ ..... ' .r mZ.. ....... ~ ~PLICANT ~ ',i THE NEW YORK BOARD ~OF FIRE UNDERWRITERS '~{ .... ,3.]C BUREAU OF ELECTRICITY 6 85 JOHN STREET, NEW YORK, NEW YOR'K 10038 "~, o,.e ~ovember 3. 1975 Applica~ionNo, onfile 827033 N ~2,~ THIS CERTIFIES THAT William S. Pederson, 2470 Sigsbee Road, Mattituck, L I SWITCHES ~URNACE MOTORS FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS FLUORESCENT Glenn R. Bradley, ' ]~ :' - :i:.. ~ ~orton Avenue, .' ... : . G ~N i~R Ai."~NiA NAGi~R , .4attltuek, L.I. ,, 11952 , ./ ;~ ' '" ' must not be al?red m any manner; return to the. off,ce of the Board if incorrect. Inspectors. may be identified : THE NEW YORK BOARD OF FiRE UNDERWRITERS ~'-- ak 85 JOHN STREET, NEW YORK, NEW YORK 10033 I,.,~ Au'gust 25, 1975 ~p,,l~c.tio,,,~o..,flt~ 815233 : N 2'~''~ '" THIS CERTIFIES THAT / ' '~' ~' ~ ~ W.S. Pederson, Sfgsbee Road ~2470, Mattltuck, L.I. in H. efotlowlng tocatlon; ~ .~,,,.~.t ~ ~t ~l. ~ ~.d r~. OU$ Side so~,~o., Block Lot ~.~..,,,i.~,~o. August 21. 1975 .ndfi, und to he ln co.,pllance wlth the requirements of tkls Board. 2/0 2/0 ~ Panelboard/s: !-16cir. 150amps.' '~ Glenn H. Bradley, ' _~_. ~'-F.- 3~, ~.0 u .~ ' 11 2 ' GENE'AL MANAGE,~z~, ..~n~be altered in any manner; rdturn ,o the office of the Board if [flcor~eO. inspecto;~ may be identified by.~eir credentials. I 3! ~ di THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 W.S. Pede~son, Slgsbee Road Route 25 & Peconlc Blvd., Mattltuck, LI ~ ...... .,,,i,.,do,, Augusg 19. 1976 "nd/°andt°bei"c°'"plia'cewiththerequiremen~s~FthisB°ard' FIXTURE t FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 1 I SYSTEMS NO, OF FEET E E R V I C NO, O~ HI-LEG AWG OF H-LEG NO. OF NEUTRALS Glenn R. Bradley Ho~ton Ave. Mattltuck, L.!. 11952 Lfc 1227 This certificate must r~ot be altered in any manner; return to the office of the Board if incorrect, inspectors may be identified b);]~"~eir credentials. TEIr. TdS-I $02 TOWN OF SOUTIIOLD OFFICE OF BUILDING IN~'PECI'OR P.O. BOX 728 TOWN I/ALL SOUTIIOLD, N.Y. 11971 OCTOBER I1, 1991 W[LLIAbi S. PEDERSEN 2470 SIGSBEE ROAD MATTITUCK, I/P/ 11952 To Whom This May Co.ncern, We are unable ~o complete your Certificate of Occupancy because .of the follo%¢ing reasons. /X_--/ An application for Certificate of Occupancy is not on file. (ENCLOSED) /X_--/ No Underwriters Certificate on file. /_--/ Thc check is (outdated/not on file.) /_-/ NO llea~lth Dept. Approval on file. /_--/ No final inspection has been made. this matter. Please con'tact our office on Thank you for your cooperation. Bui]dJ. ng Permit t~ 0 8 6 '6 9 Z Building Dept. ***/~/ Mo Pluml~er Sol. der Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ]INSULATION FRAMING [~AL DATE _/~///~;/~/ FORM ~qO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .. .~..~'~'~. ~ ~., 19/'~ .........................//~ ~'~" ~'~" Pr ,t o Approved ............. bx~'./-...... ............ , 19 ........e m' N ..................................... // O~sapproved a/c .... ~ ..... :. ...... ~...::.,~ ................. ................................................ iiiiiiiiiZ.'.'."i ii .;i;iiiiiii .................. (Building Inspector) Application No.....?..',~,..,~,.,~... ........... APPLICATION FOR BUILDING PERMIT Dote ..... ~.~.~.~_.....~ ............. , ]9.:.2..~ .... INSTRUCTIONS a. This application must be completely filled in by typewriter ol~ in ink and submitted in triplicate 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 issue ci 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........ .................. (Signature of applicant, or~ame, if a corporation) ......... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ..¢..~.~.w..L.....~...~...¢~.~.~. ............................................................................................................................ Name of owner of premises ..... ~.~.~..~...~,~.S ......... ~..~.~.~:.~ ......... ~.,_....:H.~.~.~.S~.b. ................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................... ..~...0. ........................ ? Plumber's License No ................... : ............................. Electrician's License No ............... ~ ............................. Other Traders License No ............................................... Location of land on which proposed work will be done. M.~p No.: .......... .~...g...l ................... Lot No ...... .~.....~.jIl~ ...... Street and Number ................................................ ~..~.......?...~. ............................................................... Municipality State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ............................. (.,....~. .......~ ............................................................ b. Intended use and occupancy ............................. ~...~ ........ ~.......~....~.~ .................................... 3. Nature at work (check which applicable): New Build~ng.. ................. Addition .....:.~...... ..... Alteration .............. Repair .................. Removal .................. Demolitior. .................... Other Work ................................................... (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 .................................................................................................................... g. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ ...... ~.~.~ ....... '.....~...?..~..~.. F. ................. Name ~ 10. Date of Purchase 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 14. Flame of Owner of premises ........................... il...i..; ................ Address ....... ;.~......~ .......... ¢...;, Phone No ................ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... ; ......... ',...!....;....~ ...................... z,. ...... Address ....................... ~ ........ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or corner lot. ..c, TA'I'E OF NEW YORK, COUN-FY OF ..... ...................... .~-~'lcL./~,,...]].e.D~.-IL~ ................................ being duly sworn, deposes and says that he is the opplicom (Name of individual signing contract) above named. Fie is the ............................................... ..o..o..~..~.~..8...~.~.o..~ ......................................................................................................... (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 belie~; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... 22Z3,cl. ........ day of ............................. ~Tt~e......, 19~... -,, : , ..,,' .,,, Notary Public, , ..................... ~.~.~.~:. ............ County .................................................................................................