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
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....... ,, , . , ~ - -S 8 ~ 0
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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.