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HomeMy WebLinkAbout12906-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate OF Occupancy No. z-15624 Date April 13, 1987 One Family dwelling with attached garage THIS CERTIFIES that the building ................................................ I5805 Main Road Mattituck, New York Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 115 . .Block I .Lot 3 Subdivision M/o Village Manor ...Filed Map No. 3669 .Lot No. 24 conforms substantially to the Application for Building Permit heretofore filed in this office dated February 28, 2984 12906 Z ........................ pursuant to which Building Permit No ...................... March 6, 1984 dated .............................. 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 GARAGE WARREN WALDVOGEL The certificate is issued to ..................... [oh;n'o'r,'Y~'~Yf~M .................... of the aforesaid building. Suffolk County Department of Health Approval 14 - s O- 18 N673834 UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: January 8, 1987 Building Inspector Rev. 1/81 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? 12906 Z Permission is hereby granted to: ............ ~..~...~.~.~. ................................................ ....~~.-dL......~.,~..,......t.t.~.~ ....... o~ p~e~,is~s,o¢oted ot...,..~....~..?...~,........~..,.....~...........~. ........ ..:...,...¥~-.~..,*.~-- ........ County Tax Map No. 1000 Section ...... .~..!.~.. ......... Block ...... ..Q~......)~... ..... Lot No ......~ ............... pursuant Building Inspector. approved by the Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y, 11971 ; ............................................... 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~-'~ ~ Instructions ~. This application must be filled in typewriter OR ink, and submi~ed ~ to the Building Jn~ec- tor with the following; for new buildings or new use: 1. Final su~ey of property with accurate location of all buildings, prope~y lines, streets, and unu~al natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and in~alla- 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 p~operty 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 requ ired to prepare a certificate. C. Fees: 1, Certificate of occupancy $25.00 -- BUSINESS $50.00 2o Certificate of occupancy on pre-existing dwelling $ 50.00 3, Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 . .~.~_. 5.Updated C.O. $ 50.00 Oate... ?. ............. New Cons truction ...... Old or Pre-existing Building ........... V~(cant Land .......... Location of PropertytYou,e/~' '~'~' '~' 'No. .... ~"~"/~z~/' ' ~' ~' .................... Str, et '~' ~"/~'~' ~'~/'<:~' ';~'/H I t, Owner or Owners of Property ..... ~-~/~'..Z~.~/.. h~.4~./-~..o.~Z- ......................... County Tax Map No. I000 Section .... //~ Block .~. Lot.. Subdivision .... .~..f~/.~.~.'.~..,~./~..~Z.'¢~. ....... Filed Map No~.~...~. ~....Lot No. ~.~. ........ Permit No./~..~.f..~.. Date of Permit ~./.y..~.Appiicant...~..~../~.<./~....L/4J./~.Z.~ ~ .~--r.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval. ~.~Z~q..~.~ ........... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....~-~..... ............ Fee Submitted $ ............................. ~L~/~'~ d,~dregulati°ns'A hcant ~~~ Construction on above described bu ilding and p~_t~ca/b/l~co . . .............. , . . , ./. . ..-. .................. Rev. 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Bnilding Permit No. /2 ~ 6 ~ ~-- (please ~rin%) (please ~int) Date I certify that the contains less than 2/10 of 1% solder used in the water supply system lead. Sworn to before me this Notary Public, ~~ County Notal~f N LINI~ J, COORi~R / Ot~ Rubllo, State o~ New ym,,,w THE NEW YORK BOARD OF FIRE UNDERWRITERS 1O00314 BUREAU OF ELECTRICITY ~t 85 JOHN STREET, NEW YORK, NEW YORK'lOO38 THIS CERTIFIES THAT only the electrical equipment ~ described below and introduced b~ tlw .ppHcan~ named on the above applicatiou number in the premises of ~aren Waldou~el~ Main Road, was examined on an~ found to ~ tn covnpllance ~t~lt the requtretnents of th~s Board, FIXTURE FIXTURES ; RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS FLUORESCENT 31 DRYERS SYSTEMS NO, OF FEET S E I C z/o 1 l-Smok~ Detector ·rack Ligh~mg 16Ft-0~2 Lights Electric Stillwat~ Avenue Cutchogue, N~Y. 11935 Lic. 2670~E GENERAl, MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ma/ be identified by their credentials, COpYIFOR B? LO NG DEPARTMENT THIs COPy O~ CERT!~!C~T;E ~U~T ~T ~E~L:rEREO {? ANY MANNER., FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd/ 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examine~ ........ Approved . .~.0~. ~..,~...~... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 · , I¢.4. Permit No.\ .&..c~..~.~.:.. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled 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 property must be drawn on the diaglam 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 granted 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, buildfng code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary in spe~/e~/3~t:' /~ (Signature of applicant, c¢._~corp ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... - herr .................................. Name of owner of premises ..... ~.. 4~P)CL'"~,'g,/... ~/~ .b/~57. ~. -~----~. · ' ' (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 ...................... ..... l . ?. . . . .................. £b ................ .m.< . ............. House Number Street Hamlet County TaxMapNo. 1000 Section . .~.~.. }?.~... Block ..... 0.~. ....... Lot....-..~...i.~..... Subdivision ..... .~./.~.~.~.~.~ .... /ff~. '.~]Cgt/~ ........... Filed Map No...~.d~.7 ..... Lot..~..~. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~..~.~...,~/~..~.... ,~..qfi:.~) .................................... b. Intended use and~ ,°ccupancy ....... / .~.~/~.~... ~ .~..Lff.~.~.~.~.<~..~.., . .......................... 3. Nature ofwork (check which applicable): New Building ...],~...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... . .~.~/ ~ <9. t~. (Description) 4. Estimated Cost ............................. Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ...... . ......... Number of dwelling units on each floor ................ If garage, number of cars . .. !... ~. ~.,,ff/~ ................ 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 ............... tteight ............... Number of Stories ..................................................... Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... 4.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... t?ight ............... 'Nuntber of Stories ..................................................... Date of Purchase, . ......... i .................. Name of Former Owner .... ~'w/f./~..4,'.,. d~.~..~'. ..... Zone or use district in which pr~mises are situated ................... ,,,~,~/~..~./~.. ~.A.,,(. ...../. ........... Does proposed construction vic [ate any zoning law, ordinance or regulation: ..... ,~.O..../.. ................. Will lot be regraded ........ AJO.. ................ Will excess fill be removed from premises: ~ No Name of Architect ........................... Address ................... Phone No ................ 10. 11. 12. 13. 14. Locate clearly and distinctly ali property lines. Give street and block interior or dorner lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether / STATE OF NE~ YORK, ,- - COUNTY O~ ...... ' ' (Name of indiv~'J'"~'s'~;~i~'g,,~--, ,~.. contract) ..... being duly sworn, deposes and says that he is the applicant above named. He is the ! f~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized to perform or have performed the said work and to make and file this application; that all statements cont lined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manta r set forth in the applicaiion filed therewith. Sworn to before me this ........... .... ..... Notary Pub!ic~.//. .'~.-...~O.., . .tf_~..my,{ ~. ~om ............ County ~ . '"-.1 (~ignature of applicant) Ol,~i~!£R: ,$UF'F. CO, H~AI..TH DEPT. APPROVAl. H.s. , LIC, ~ND sURV~YORg-GRE~RT. N. Y. SUFF. CO, DEPT. OF HEALTH SERV1GI~'& , ~, STATE,MENT OF INTENT T~'~T HOLE , , ~ ~ THE: WATER SUPPLY AND SEWAGE SUFF. CO. DI~pT. OF HI~AL"rH ~i~¥1¢_4~ ~; STAT~NT OF I~N? FOR__ APPROVAL OF, Cffil~UffiON,, , ONLY,, , , DATE: DI$~L GY~TEM5 FO~ THIS ]~--~"~ STANDARDS' OF ~UFFOLK CO. DEPT, OF B~LTH, APPROVED: .......... AppL{ CANT 1, ALL '~RJ< SHALL COMPLY ~I[TH THE NEI',I YORK STATE COFZSTRUCTION CODE, 2. THE NEY1 YORK STATE ENERGY CODE SHALL ~E CO~LIED WITR ON TIiE BASIS OF PART 5 (ACCEPTED PRACTICE AND IR PARTICULAR AS FOLLOWS:) 3. PROVIDE SEPARATE H~TIN6 ZONES FOR EACH FLOOR. q. ALL EQUIPMENT SHALL COIqPLY b!lT,~' THE FI'!E~GY CODE. 5. FIREPLACE g~PER SHALL HAVE A LEAK RATE OF LESS THAN 20 CFM,' OR BE FITTED WITH A DOOR, 6. THE KITCHEN EXHAUST FAN VE~!T SHALL BE FITTED" ' IT~ A DAIqPER OR BE NON-VENTI NG. 7, HOT WATER AND HEATING PIPES SHALL BE INSULATED TO R=q,6 MINIMUM. 8, ALL HEATING, HOT WATER AND ELECTRI~L EQUIPMENT SHALL COMPLY WITH THE NEW YORK STATE ENERGY CONSERVATION CODE. 9. INSULATE PER SCHEDULE. CEILING WALLS FLOOR SLAB EDGE WINDOWS DOORS TOTAL !'