HomeMy WebLinkAbout13464-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF O~CUPANCY
No Z-23620 Date MAy 8, 1995
THIS CERTIFIES that the buildin~ ALTERATION
Location of Property 3940 W~STPHALIA ROAD MATTITUCK, NEW YORK
House No. Street Hamlet
County Tax Map NO. 1000 Section 113 Block 9 Lot 14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 4, 1984 pursuant to which
Building Permit No. 13464-Z dated OCTOBER 5, 1984
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 CONVERT ATTACHED GARAGE OF EXISTING ONE FAMILY DWELLING TO
BEDROOM & BATH AS APPLIED FOR.
The certificate is issued to
~%ROLD D. & MARTHA A. JONES
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
H-045327 - MAY 4, 1995
JAN. 31, 1995- F~%ROLD D. JONES
Rev. 1/81
uiiingInspector
I~OB~ NO. O
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 WORK AUTHORIZED)
N? 13464 Z
Permission is hereby granted to:
...... ...........
..~....~..:.~.....~..~~~i ....
~,_ ~ ,~ ......... .;;... ·
...~~....~....q:......!.!...~.~..~ ......
pursuant ,o application dated ..... .~.~.....~. ............... , 10.?..~..., and approved by the
Building Inspector.
Fee $.. ~.,~.~.,,~,~.,
Building Inspector
Rev. 6/30/80
Furm [,Io. 6
BUI. LDLNC DEPARTHENT -
TOWN lIMA,
765-1802
API~qACATION FOR CERTi[FICATI'~ OF OCCUPANCY
1995
A. This apPlication must be filled in by typewriter OR i,,k and submitted to the building
inspector with the [ollowi.g: for new building or new use:
1. Final survey of property with accurate location of all bniIdings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. u~ wnter supply and seuerage-dioposal(s-9 form).
3. Approval of electric~ installation f~om Board of Fire Uederwriters.
4. Sworn statement fromfplumber certifying that the solder used in system contairs
less than 2/10 of 1% lead.
5. Co~rcial building, industrial building, multiple residences and similar [
and ~nstallations ~a cert'F~,-~ -.~ ~--, .... ~ ~u~l~ngs
~. Submit Pla.ning Board Appfova1 of completed site plan requirements.
B. For existing buildings (prior ~o April 9 1957) non-conforming uses, or buildings and
I. Accurate survey of property sbowiug all proper~y lines, streets, building and
u.usual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is deuied, the Building Inspector shall state the
reasons therefpr in writing to the applicant.
C. Fees
I. Certificate of Occupancy - New dwelling $25.O0, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swiping pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2.Certificate of Occupaucy on Pre-existing ulldlne - $100.00
3.Copy of Certificate of Occupancy - $20.00
4.Updated Certificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - Residential $15.00., Co~ercial
New Construction ..... Old Or Pre-existiug Building .................
House No. Street Hamlet ' ''
Subdivisio. ................................ Filed Hap ............ Lot ......................
Permit No.. . Date Of Permit..~O~.~T ...Applicant..~ ......................
Health Dept. Approval ....................... Underwriters rowll .....
' ' ' App
?lanning Board Approval .....................
'~equest fo~: Temporary Certificate ........... Fiual Certicate. ~ .....
~ee Submitted:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
o~y $he eJ~trJcaJ equipment ~ ~scribed below ond int~uced by t~ oppllcant ~d on the a~ve application number in the prorates of
H~ROLD D.JONEo, 39~0 WM~TPHALEA ROAD~ POLE~.35 H~'ITUCK~
in the followlng location; ~ Basement
APRIL 03, 1.995
FIXTURE
'Ci~3TL~T S{ECEPTACLEE SWITCHES
3 5 4
[] Ist FI. [] 2nd FL O~T Section Block Lot
and found to be in compliance with the National Electrical Code.
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
OTHER
DRYERS
SYSTEMS
OTHER APPARATUS:
S E R
NO, O,~e~C~CONV
A, WG
OF CC. COND
C
AWG,
OF HI-[EG
3940 WESTPHALfA ROAD
HATTITUCK, NY, 11952 GENERAL
tl
This certilicote must not be oltered in on)' manner; return to the office of the Boord ifjnc0rrect, inspectors may be identified by their credentiois.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MIJ~T~IOT BE ALT'~ERED IN ~,NY MANNER.
Town Hall, 53095 Main Road
P. O. Box 1179
Southo[d, NewYork 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 27, 1995
Mr. & Mrs. Harold D. Jones
3940 Westphalia Road
Mattituck, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is (outdated/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 # 13464-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
CERTIFICATION
DATE:
Building Permit No. (~
(please print)
Plumber:
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
( Plum~ersJ~ igna~re )
Sworn to before me this
CLAIRE L. GL,L=~V
Notary Public. State of New York
No. 4879505
Qualified in Suffolk Couety
Commisaion Expires December 8,
County
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION
FOUNDATION
FRAMING
[ ] ROUGH PLBG.
2ND [ ] INSULATION
[ ] FINAL
FlgLD'%NSFECTION
FOUNDATION
(1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
~ODE
FINAL
COMMENTS
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O, BOX 728
TOWN tIALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
This is to advise you that the job under building
permit no. 1346,4~ issued to Harold Jones
on ___L~ZS/-R4 _ for A!,ter_~dliPD is completed
a final inspection has ( ) has not ( x )'been done.
and
In order to complete this file, it ia necessary that
n Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a cheek
for i $25.00paynblc to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy ia to be mailed, and
arrange with tills office for an inspection (late
Occupancy or use in unlawful without a Certificate of
Occupancy. Please. help us to clear up this matter so that
legal action docs eot have to be taken. '~-.
Thank you for your prompt attention.
Very truly_y~,
Victor Lesaard
Executive Administrator
VL:gar
encl.
'FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
~amined ~..~'- ..... , 19~''~.
,proved O.~ ..~. .... } 9]~ ~..~..q~C~ -~ .
I . .Permit No ...........
sapproved ale .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Received ........... ,1
a. This applichtion must be completely ~led in by typewriter or in ink and submitted to the Building Inspector, with 3
s 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 promises or public streets
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
tion..'
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
all 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¥
all have been granted by t~. ~.e Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
tilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
te applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
inspections. ~..~
mit authorized inspectors on premises and in btlilding for necessary.~.~~...... ~.: ..... ~; ........
(Signature of applicant,/St name, if a corp ation)
(Mailing address of applicant)
[ate whether applicant is owner, lessee, agent, architect, engineer, gefferal contractor, electrician, plumber or builder.
a~ne of owner of premises .. t~t~ O. t.~ .... ~,...~.~...~.~ t~.7~..~.0 .... ~. ..... ~ ~4.~.. ~. ......
(as on the tax roll. or latest deed)
applicant is a corporation, signature of duly authorized officer.
(Name an~ title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done'. .................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ...... ~..~ ........ Block ..... ~. ........... Lot ..........
u,-'~'~) ................ Filed Map No ............... Lot ...............
Subdivision
· State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ~.~:,~./.~ 1~/~..~.~. .......... ~; .o3.../..~ .~..~. ~.. ~ .... ' ....
Nature of work (check which applicable): New Building ' Addition ' Alteration
Repair .... ,. Removal ........ Demolition . ~.
, · ........ , ....... ........... Other Work ...............
tim d CO
Es ate st ......... Fee . .'
. . ~" (to be paid on filing this application)
If dwelling number of dwelling u~its ....... ./..(..~.~'..~'~JNumber of dwelling units on each floor ................
If garage number of cars
ti.'~.l~l~'Ulyii~ed 9ccupancy, specify nature and extent of each type of use ...................
~~L~}esdfany: }*rent.... 07.6,.......Rear ... ,.5~2,. ...... Dept~'..a;~
H~i~,~ ~~. ~'.~; 7. ~,~!~J~ber of Stories ....... ~.,~. ,/~ ............. : .......
Dimknsi0~[[ i0~d~ctht¢ ~ith alterations or a~d~l~i?ns: J~ront .... O7.'~, ........ Rear .... -~..~. .......
Depth ...... ~,a.,?~.. i~,.~,~ i Height. /y~,<.q,,~ ....... Number of Stories .,,~.r~.~,
Dlmeaalmls.,o,,f,-!~;-~e, well~ns~imctlon: Fron ./.~ ~. ...... Rear . ~.~.-' .~ ...... Denth ~.~..?.~.
Height ct.~i:};~-',';.~fNu~bbr of Stories . · ~.'~'.~. ........ 'i 'ii.' ....... ~.. ~.. ' ...... "
,,. ,- ~. ...... ~p,9. p ~' ...... . .....
S, ze 0f~Ib'~t2~r6"fl't ...~L.,..~. .......... Rear .... ~.~.~.~...~..~. ...... Denth ...-~.-/.c~.'..~.7. ......
Date of Purchase ...-i~..~'. ,..'~$.. ! .~. ~P. ~. ....... Name of Former Owner . .~. ~.~.~/~....~..~4a...)~ ....
Zone or Use district in which premises are situated ........................................ (.....
Does PrOPosed construction violate any zoning law,, ordinance or regulation; ...... .~..~. .....................
Will lot be regraded ..... ,~.. ?~..:._......&... :_.... ~; Will exc~s f~ll be~removed fr.om premises: Yes (~
Name of Owner of premises /~1~./~ B.. I), .g]~l~O.. Address /~/.4~..tlcJ~.~. ~t/~l~. Phone No. ~.~. ~.--~.~/,,1~"~.
Name of Architect .~ ..... .~.~..~..,.,~.~...4,44r~ . ~ .... /~T'/~TO~t, Phone No ................
Name of Contractor ' Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
)perry lines. Give street and block n~mber or description according to deed, and show street names and indicate whether
crier or comer lot.
~TE OF NEW YORK,
UNTY OF .................
.... ,0,
(Name of individual signin
we named.
S:.S
~ ................ being duly swqm, deposes and says that he is the applicant
contract)
isthe {~) .~.~. ~/~,
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is dulyj authorized to perform or have performed the said work and to.make, and file this
hoar,on; that all stat.ements contained m th~s apphcatmn are true to the best of his knowledge and belief; and that the
rk will be performed in the manner set forth in the application filed therewith.'
om to before me this i .
.
......
tary Public ..... ~.~.L~.<-.: ........... County ' .
..............
m~v~ e ~ " ~' (Signature of applicant)