Loading...
HomeMy WebLinkAbout12733-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southo~d, N.Y. Certificate Of Occupancy No. Z1257~ Date ... June 25 1~.4 THIS CERTIFIES that the building . 7 7.~.e.w...d.w.e.Z. 1..i.n.g. .............................. 2035 Theresa Drive Mattituck Location of Property House No. Street Hamlet County Tax Map No. 1000 Section ...1.1. $ ...... Block .... '1.6. .........Lot 015 Subdivision.. P.~p./rl. qJ~9. ~.~9t.% .E.s. t~.~ ,'.s., .Fried Map No...4.2.5..6, .Lot No..5..9 .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated hucjus,~, 30 19 .8.3 pursuant to which Building Permit No. 12733 Z dated ...... .~q¥ .e.m,b.~.r...4 .......... 19 .8.3., 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 ......... g ~ivag9 one.-family .d.w..e:l~l~n.c~: The certificate is issued to ....... JO~I.N.q. I~.I. ES.NE.R (owner, te.~'o'r of the aforesaid building. Suffolk County Department of Health Approval 13-$O-141~ 6/25/84t UNDERWRITERS CERTIFICATE NO N 641964 Building Inspector Rev. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST IBE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12733 Z Permission is hereby granted to.~_~.~ · .. .... ~.~/..~..~....<.F~ ........... :~..~. ......... Zm.~ ............................. ............. ~.~.~.~.~r...~ ............. ,o .......... c~.~.~.~.~ ....... ~.......~.~...,.~.~.....~.../..~.~-- ~ .................. at premises located at ..~. '~..~...~...-~..i ...... ~~.~.~ ....... ...~.....~...1 ............................................ ..... County Tax Map No. lO00 Section ..... .//..m~... ....... Block ......./.~ .......... Lot No...~../...~..'~.. .......... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $..' ./ ....... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in 'typewriter OR ink, and submitted,~t~to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, propertV lines, streets, and unusual natural or topographic features. 2. Finaf approval of Health Dept. of water supply and sewerage disposal-iS-9 form or equal}. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "pre-existing" land u~s: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2, Certificate of occupancy on pre-existing dwelling/ land [[se 3. Copy of certificate of occupancy $1,00 --Fre-Lxxsting C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ............ . Vacant Land ...... Loca,ion of Property ............... -~ ..... · · .~, .~~ .... ,.,,h .,.,. ~.,,o+a~l ~, ...... ~ ............. ~or ,,.t. ~..~ ........................ Request for Temporary Certificate ..................... Final Certificate ....................... FeeSub~itted ~ ....................... ...... CD ~ [ aS?S- Construction on above described building an..~permi/t~ee/~ ail applicable codes and regulations. U [~ ].o00sso THENEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY li=l · ·EEJO"NSTREET,.E VYOR ,.E VYOR ,OO.8 in the followlng location; [] Basement [] 1st Fl. was exa,nlned on April 23, 1984 [] 2nd Fl. Section Block and found to be in compliance with the requirements of this Board. FIXTURES RANGES - FLUORESCENT Lot SYSTEMS E R V -I C NO OF CC. COND~ 1 OTHER APPARATUS: ~o or 1-F l--G. F. I. ~ 1-~qr~ke Detector. Pu~tre Appliance Feeders: i-3~10~ 1-3~S AW.G OF CC. COND. NO. OF HI-LEG OF HI-LEG NO. O~ NEUTRALS A, W. O. OF NEUTRAL ~.AoT. Elec%ric P, 0,, Eox Wes~ Islip, N.Y. llT°~ !F(a.~,~.~,~,~/~eT~~~,~r~.Tr,~.~.~~ This certificate must not be altered in any manner; return to the office of the Board if incorred. Inspectors may be dentfed by their credentials. OP OR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ' '~ ~FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ?E FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 2ND [ ] INSULATION [/~ FRAMING/~-///// [ ] FINAL INSPECTOR 76S-1802 ~ BUILDING DEPT. INSPECTION FOUNDATION 1ST ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOT/CE OF DISAPPROVAL File No ................................ To~.~.~ .J.~..~ .~. ........ ....~. >C.....7~..~. ................. . . . &~/~. ~ .~. . PLEASE TAKE NOTICE that your application dated ... ~... ~ ......... 19 ..... for pe~it to construct.. ~...~/~. · .~ t t/~r~ ~ .................. at h~uso No. ~ ~tr~e~ : ........ Ham/er co~.tv ~a~ ~ap ~o. mOO S~tio~ ... 7~ ...... mo~k ..... Z.~ ...... Lot . 0.~ ...... ~,~,o~~~ ~,,~d ~ ~o .... ¢~ ..... ~o~ ~o...~P .......... is returned herewith and disapproved on the following grounds .., ~.~... ~Z~... ~.. ~... ~..E. ~...~/~ c.... ~:r~.. o~. ~~. ~ ~ . ~. . .~~ .... ~. ~. . . ~. .~r.. . : .... ~ ~- ~ ~ .... · ...... ~{~.~;; ............ RV 1/80 ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ................ ,19... Permit No .......... Disapproved a/c..~/..~.. ~.~. ~.....~. ...... ../. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely fffied 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 pwperty ~ust 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 Occupancy shall have been ~ranted 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, bt~ildini co4t~, housing code, and regulations, and to admat authorized inspectors on prermses and m buildmg for necessary/m~pi~c~nsf ) . , or name, if a corporation) (Mailing address of applicant) State whether apglicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~.~...~... '~..~.~. ~.~.~..~. ............................. . ............. (as 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 ......................... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done. House Number Street Hamlet County Ta~t Map No. 1000 ~iect~on/~.~...'. 2~ .......... Block .~. ............. Lot.. ~ .......... Subdivisi~.~~. ~~... Filed Map No. ~:~ ..... Lot. ~.~ ........ 2. State existMg u~ and occup~cy of prem~es and intended u~ and occupancy of proposed construction: a. Existing u~ and occupancy .'. ................................................ Nature of work (cheek which ap ~licable): New Building // Addition Alteration Repair .............. Rem( vel .............. Demolition .............. Other Work ............... ' (D ripti ) 4. Estimated Cos ..... ......................... Fee ............................ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling finits .... ~! .......... Number o f dwelling units on each floor ................ number of cars ~' ' If garage . ,-.~. ;. 6. If busines.s, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Heiglit Num~ber of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. ' Depth i Height Numberof Stories 8 ..... Front Rear Depth · Dimensions of entire new construction: .......... , ................................... 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 14 Name of Owner of premises ' .... Address ........... Phone No ....... Name Of Architect ~ Address Phone No Name of Contractor i Address Phone No PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc~ humber or description according to deed, and show street names and indicate whether interior or ( orner lot. ¸.2 STATEOFNEW~RK// ,~/. ,o o ('~;~I~~],~.,~ ~, ,,,~,~ ~~,~ .......... being duly sworn, deposes ~d says that he is the applicant above named. He is the ............ I ......... ; ~ ................................................................... ~ j (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~y authorized to perform or have perfo~ed the said work and to m~e and file this application; that all stqtements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~e~ in the m~ner set forth in the application filed therewiih. Sworu to b~fore me this ; .o.[ 52-03~9~ S~uffolk ~un~2 f~ ..... ~ (Signature of applicant) LOT ~i LOT .59 HO.O' THE'RF$,~ 0 SURVEY FOR JOHN MIESNER ~ AT MA TT~TU~K . ~ SUFFOLK COUNT, Y, N.Y. REFERENCE~ o~P .o~ C~ZE~ LAND SURVEYOR N.Y$. LIC. NO, 28T~5 RIVERNEADI N.Y. LO)' $0 /$,2 LOT $9 LOT SX I15, 0 L O r ,~9 SU FF I10.0' CO. 'T~X M,~ P NO. JUN JATE , . H.D. ~ew~ ~i~~ ~g~ ~e ~tiafae~e~. ~e¢ ~f ~1 ~eri~ SURVEY FOR I / ~ ~ , ' , ,:,' :,. , % /I ., ~ / f II 't-7 ,' / . :J',' - .JJ , . , , ,.~~~ ~~- _ ....... ,, , . , ~ - -S 8 ~ 0 ,. , ~ I~ ~ 4 - - _ z. ~ ,,, ,,,J% ~ , , . J ..... ~' - ~ ........... % .... '--F" ' ' :"' >"" ' ,'(/:~" r,'?' , ';, . ' ' '. ," ~ ' - DuN D,~ .~ Q.N ,:, r ,,~ ~copper lO&i'n~ ~'~ u.~d for woter distrikuting system; p/ping shaN be oF types K or L only II I REVISIONS I G,¥P. ~[~. '~Y'P. ,r TL-1 0 - SEC ~ Il '-0" 74.25 3~46o 1483.75 2062.25 H 1483,75 + 3546, 1000o - .I RI OMT LE F-T ELEV, TYP. ~,ol~.t~ TY P TYP. F_LEV.