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HomeMy WebLinkAbout10805-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-25006 Date MAY 2, 1997 THIS CERTIFIES that the building DWELLING Location of Property 1800 CENTRAL DRI~ MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 106 Block 1 Lot 29 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULy 21, 1980 .pursuant to which Building Permit No. 10805-Z dated JULY 30, 1980 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 ONE FAMILY DWELLING WITH ATTACHED GAPA%GE & DECK * The certificate is issued to F. ORNSTEIN & WIFE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 3/31/81-10--SO--51 RBT. VILLA UNDERWRITERS CERTIFICATE NO. N-514916 -APRIL 1, 1981 PLUMBERS CERTIFICATION DATED N/A *UPDATES CO Z--10448 DATED APRIL 9, 1981. /Buil/ing InSpector Rev. 1/81 rom~ ~o. TOWN OF SjOUTHOL~D BUILDING DEPARTM~N~ TO~N ~HALL SOUTH'OLD, N. BUILDING P,E~IT (THIS PERMIT MUST BE KEPT ON THE PRE~IS~S UNTIL ~u~ COMPLETION OF THE WORK AUTHORIZED~ N©. :~08iI5 Z Oate ...... ¢'"4 //'~"""""""~,t4~ /~ at premises located at ............................................................ ,....* ............... ~ ............................... ~-" ........................... ~.9..~.~.~ .......... ~ ................ ~ ...................................... .......................................................... ~ ..................................... ~,...~ ......... ~....~ ................................... ~o..~ T~x M~p No. ]~0 S.ctio~ ........ :. ~1~ r'"' '"'~ ........... ~Lot No .....f.. ................ Y pursuant to ~vv ............................................. ~,.-- ..... ~ ~bilding Inspector;.. F~,e S...~.~ ............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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, property lines, streets, and unusual natural or topographlc featu res. 2. Final 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. Commercia{ 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 and "pre-existing" land uses: 1, Accurate survey of peoperty showing alt property lines, streets, buildings and unusual natural or topographic featu res. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .... ............ New Building ..../,. ...... QId or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~.. ,~.~./). .... ~,.~. ,~. r~...~'/... ,~...',.. ~,4~../7/.~/~.~, .~./, ,~",~,. ........ House No. , Street Hamlet Owner or Owners of Property, .~.'....~...~./..~.~, .~, · ~..~..)~,~,~,..~//, .4~.,..~,., ~.~. ~,~....~) .... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~ j ' ~ · /t~.~..~.. DateofPermit..~/~...~/,~.z~/~pplicent..~,~.'.~'~, ,,~, ,~, .,~.~.~',,0¢.¢ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $.. ~..~...¢~, .................... Construction on above described building and~s~all applic, abl~/ ~'~' ~/ "/~/~ regulations. Applican t~.. ..... ~ .'~.~. ,'~-". ~.~:. ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10448 THIS CERTIFIES that the budding ................................................ 1800 Central Drive Mattituck, Location of Property .............................................................. House No. Street Hamlet County Tax Map No. 1000 Section ...1.0.~. ...... Block ........ ! ...... Lot ....... 2. .9 ........ Part of' Subdivision. Capt. Kirtd Estate .Filed Map No. 1672 .LotNo. .q conforms substantially to the Application for Building Permit heretofore filed in this office dated July 21, 19 80 1 ~ q 030. Z ..................... , ... pursuant to which Building Permit No ...................... dated ..... J. t.t il.y...3..0 ............... 19. q .0, 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 ......... Pr:ivato One Family OwellinF The certificate is issued to Pussel 1 Ilillman ..................... i oV,.'& '.t ,d itF ..................... of the aforesaid building. Suffolk County Department of Health Approval 3/3t/81 10~S0-51 Bobept /l. Villa P.E. UNDERWRITERS CERTIFICATE NO. iq 514916 Building Inspector Rev. 1/81 Form TOWN OF SOUTHOLD BUILDING DEPAKTM~--NT TOWN ~L 765-t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewrlter OR ink and submItted to the buildzng inspector with the following: for new bumlding or new use: !. Final su~vey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fznal Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical znstallation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used mn systmm contains less than 2/10 of i% lead. 5. Commerczal building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from archztect or engineer responsible for the building. 6. Submmt Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or bumldings and "pre-exmsting" 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 Buitdiug Inspector shall state the reasons therefor zn writing to the applicant. CA Fees 1. Cartmficate of Occupancy - New dwel!~ng $25.00, Additions to dwelling $25.00, klteratmons to dwellmng $25.00, Sw~m~ng pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certmflcate of Occupancy on Pre-~xistin~ Buildin~ - $100.00 3. Copy of Certificate of Occuoancy - .25¢ ~ Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building ..... ~ ........ Location of Property .............. ~ .................................................... House No. Street Hamlet Onwer or Owners of Property .................................................................. County Tax Map No 1000, Sectzou .............. Block ................ Lot .................... Subdivision .................................... Filed Map ............ Lot ...................... Fermi of ermit .... , ................ Health Dept. Approval .......................... Underwrlters Approval ......................... Planning Board Approval ........................ Request for: Temoorary Certmfzcate ........... Final Certica~e ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW WORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below a,td introduced by the applicant named on ~he above application number in the premises of in the flollowing location; ~ Base,ne,~t ~[~ 1st FI. ~] 2nd FI. Section Block Lot was exa,nined on i'/FrL~CC}~[ ~ ~ i(3~, and fou~td to be in compliance with the reqmren~ents of thts Board. FIXTURE q- -~ FIXTURES RANGES DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS TIMECLOCKS ~NITHEATERS MULTI-OUTLET DIMMERS OTHER APPARATUS. AWO OF cc COHD NO OF HI LEG AWG OF HI LEG 1 AWG OF NEUTRAL 3/O Th~s cerhficate must not be altered in any manner, return to the off~ce of the Board if lic~ 242-~ 1t Inspectol may be ~dentlfied by credenhals COPY FOR B~ILDING~ THIS COPY: OF~ ! ANY MANNER. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ............. .. ,.~..~..~..~_. ~....~.., 19..g..,~ proved ............. i .L No. /0 0 7__.-- Application r~o ................................. Dso roved a'c pp / ...................... ~.;'7;~)./ ................. ~.,..~_. .................................. ....................................................... (~,,~ ~..~...~../~, .......................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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 ofproperty must be drown 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 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 granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 name, if a c~fporation) ....... ...... ............. (Address of applicant) State whether applicant is ow~)r, lessee, agent, architect, engineer, general contractor, electricmn, plumber or builder. . . . Nome of owner of premises ...... ~.~.~ ....... .~..~.'.'i..~...~...~... .................................................................................. If apphcan]t js~a, "~'- '~J~/~--~c°rp°rate' signgtu~e/,~~of duly authg~/izedf~/,,.~ ,officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................. : ......... Electrician's License No. ~....../..~....~. ....................... 4o ~ .S'o~ 5-/ Other Trade's License No ............................................... //~' Location of land on which prgl~osed work wj~J be done. Mop No..Q.'.~..Q.~..'./?...~/..'.~.~....~.G~.~...~.. kot~ No....~.. .................. Street and Number .......... ~...~....~).......~.~ .................................................. ~.,.~.-.~..~.~.~...~./'~ .................. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ · b. Intended use and occupancy ....~.....~. .... (. ............................................................................................. 3. Nature of work (check which applicable): New BuiJdmg .................. Id' Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other ~ork .................................................. , ,~ ~- ~,._~,L- (Description) 4. Estimated Cost ...~'~(,~.~..:...~.~.:; ....... x.z ............... Fee .......... ..~..~....~ ......................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelli:ng units ...... 0...~....~..'~... ......... 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 ...~....~ ........ Numbe¢ of Stories ...,,~ ........................................................................................................ 9. Size of lot: Front ........~ ....................................Rear ......... J./.~. .............. z ........ Depth ..... ~...E~/~ .~...~. ......... 10. Date of Purchase ................ ,~.~../;..~..~...~.. .................... Name of Former Owner ............................ 11. Zone or use district in which premises ore situated .......... , ...................................... ~/~ .......................................... 12 Does proposed construchon v,Jolate any zoning law, ordinance or regulation: ....... *.:.; ............................................ 13. Will lot be regraded ..... .~...~...., .............. Will excess fill be removed from premises: ( ) Yes ( ~o 14. Name of Owner of premises ..~"..l~.~./~, .~... ......... AddreR.~..~.~.~.~...~//..~.~..~.~...~;ff. Phone Ix?~ ...... ~.~..~...~ Name of Architect ........ .'T,..,., L~ ..................................... Address ................................ Phone No ....................... Name of Contractor ~..~..-.~.: .,.,t...~..Y...~.'t ........... ..~,.. .......... · · PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Gwe street and block number or descmpt~on according to deed, and show street names and indicate whether interior or comer lot STATE OF NEW YOR (, ~ S S COUNTY OF ~_~.}....;~,, ........... '~ ' ...................... -~~..~...:....~.....~..?...~...~..,~.,( ..................... being duly sworn, deposes and says that he IS the apphcam (Name of individual signing contract) named. He is the ........................ ~.~ ................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is ~'uly authorized to perform or have performed the said work and to make and file thls application; that all statements contained in this apphcction are true to the best of his knowledge and belief; and tk.o~ the work will be performed in:the manner set forth in the apphcation filed therewith. Sworn to before me this ~ ........ of .................... .. -'.. . . ... ./ . - Nota~ublic, . ............................... ~"~7*'"'~ZC°un~ ......... / ~ ~;.....~: ,C ..... (S~gnature'~ .... r ofC"~*Z'~..__apphcan0. ' "~'~'~"~ "~ '~ ...... NOTARY PUBLIO,St~e.~f New Y~rk NQ, 52-8125850, S~ffol~ Coun~ Turn Expires Mar~h 30, [9~ SUFFQL?{ C~Cl SER~CES DATE H $ REF APPR© q£D - SUFFOLK DIST OWNERS A~D~ DEED L.-:'~, 3: ~EST HOLF-' LOT SUFFOLK COUNTY H~ALT~ DEPA~T~E~ The sewaze dls~sal snd ~ater ~uppl~ facilities for this location have been ~nspect~d by thJz department ~d found to be satisfac%o~,~ fl , ~ -, Chief of Genersl ~ine~rt~ Se~ices 4 ~4 ~ = a, fOf~O~c ' 5o~'v~4d ~¥fot~ 2"7, lg,~l LICENeaED LAND ~JII~VEYORS G"REE~T NEW YORK SUFFOLK CO. HEALTH DEPT. H.S. NO. tO STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES, {si APPLICANT sUFFoLK COUNTY DEPT. OF ' HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE; H. S. REF. NO. SUFFOLK CO. TAX MAP DESIGNATION: DEED: L. TEST HOLE STAMF SEAL ol LOT LOT '%. SUFFOLK CO. HEALTH DIE-PT. APPRovAL H.S. NO ..... ..-~-"' STATEMENT OF INTEI~IT ' \~ THE WATER SU~LY AND SEWAGE DIS~AL SYSTEMS FOR THIS RESIDENCE WILL CONFORM ,T¢ ' Q~ SUFFOLK COUNTY DEPT. OF HEALTN ~' SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY _ RODERICK VAN T~YL, P C LICENSED LAND SURV[YORS GREEN~RT NEW YORK ..% t)CCUPANCY OR IISE IS UNLAWFUL V, i'I'HI UT CERTIFICATE OCCIJPANCY APPROVED AS NOTED DATE: 7~'B.p. '~ ~. 'CEE: °c::-'~ BY: ~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION _ TWo REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4. FINAL _ CONSTRucTiON MUST BE COMPLFTE FOR C 0 i I I t i F~ RST- Fi..:ooR ' pLAN d ,i ~ (2 R'O'Sg -o S T_..CTlOlX, t~ ~ F R. OI\IT , ELEVATION,-