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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)