HomeMy WebLinkAbout15760-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22681 Date
OCTOBER 27f 1993
THIS CERTIFIES that the buildin~ ADDITION
Location of Property 2080 DEEP HOLE DRIVE MATTITUCK~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 4 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 12f 1987 pursuant to which
Building Permit No.. 15760-Z dated ~L~RCH 15, 1987
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 2ND STORY ADDITION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to
of the aforesaid building.
ELAINE T. VILL~_NO
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-848731 - JANUARY 4~ 1988
PLUMBERS CERTIFICATION DATED OCT. 21, 1993 - BERTSAND PLUMB.&tLEAT.INC.
J ' .
Rev. 1/81
~Olt~ NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 15760' Z
Dote ........ ~'1 ...........................................
Permission is hereby granted to:
......~....~.~....5..~..-t. .................................................
.~ ......... ~: ........... :~.'......:..,....~ ........... _ · A
· ................. ,. ...............................
ot premises Iocoted at ...~..~..~..~.........~.?......o~....~....~.....~.?--,.~...: ...... ....~~-.~... .................
County Tax Map No. 1000 Section ..... /.....~...~ ....... Block ........ .~...~.....~ Lot No.....~..~. ............
pursuant to application doted ...... ~¥~/~..!..1L.~..~......L...~:.. ............... ,
19 .~.. . .~. . ,
ond
Building Inspector.
Fee $ ..~w~..~7. :., ,~., ,L~,. .....
approved by the
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTUOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
i fi OCT,2 l l99
. APPLICATION FOR CERTIFICATE OF OCCUPANCY T~??~,,;'~:~'i:,:~' :~
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6.- Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" 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 Building Inspector shall state the
· reasons therefor in writing to the applicant.
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy~- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
ew Co~straction.~g~: ...... Old Or Preexisting Building..i:i!~..~i~
ocation of Prope . .~.~.~...>..~.. ./¥~.
House No. Street Hamlet
nwer or Owners of ~roperty ...... ..
Ounty Tax Hap Ho 1000, Section. ....
...... lock ................ Lot ................
~bdivision '
.................................... Filed Map ........... Lot ......................
~rmit No ............... Permit ................ Applicant .............................
. Date Of
pp ova .......................
[arming Board Approval ........................
~quest for: Temporary Certificate ........... Final Certicate ............
~e Submitted: $ .............................
TOWN OF
OFFICI~ OF BUILDING INSPF. C'I'OR
P.O. BOX 728
TOWN HALL
~OUTHOLD, N.Y. 11971
76.5,1
~. E R T I F I C A.T I O N
Date October 21, 1993
Building Permit NO.
~p~ease print)
Pl~umber B~rtsand Plumbinq a Head_ting,
(please print)
certify that the solder used in the water
¢on~ain~ le~m than 2/10 of 1% lead.
sworn r.O bolero mo this
21~t day of O_c~tob~er . ,
19 93 ·
lqotary Public, Suffolk
EILEEN M, ROACHE
Notary Publio, State of New York
No, 4826942
Oualiffad in Suffolk County __
Commission Expires January 3L 19_~
~plum~er's signature)
Notary
County
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
88 JOHN STREET. NEW YORK, NEW YORK 10038
in the follo,,ing location; ~ Basement ~ 1st Fl. ~ 2nd ~. Section BIm,k Lot
~s examined on ~C~)¢r ~0 ~ ~ 987 and found to be in compliance u'ith the requirements ~f th~s Board.
FIXTURE
OUTLETS
16
IECEPTACLE$
32
SWITCHES
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FAN
FLUORESCENT VAPOR
22 15
DRYERS FEEDERS
TIMECLOCKS [JNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
Pauelboards :l~.21cir. 200amIm
I~G.F.C,I. 1-Smoke. ~etector
Track Lighting 24' 0" 8 Lites
E
NO. OF CC CONO
PER ,~
1
A. WG
OF CC, COND
~2/0
NO OF HI.LEG A W G,
OF HI-LEG
1
OF NEUTRAL
Electric Room Heaters: 2-2.0~,, 2--1.25kw, 1-1.0kw
Three "C' Electric Into
Route #1 Box 45M, Sound Avenue
Riverhead, N,Y 1190].
This certificate must not be altered in any manner; return to the office ~f the Board if incorrect.
COPY FOR BUlL.DING DEPARTMENT. THIS COPY OF
GENF~ MANAGER
Per ~
be identified by their
OUNDATION (1st)
OUNDATION (2nd)
OUGH FRAME~'''''~
?LUMBINGgj
iNSULATION ?ER N. Y.
STATE ENERGY
CODE
FI~;AL
ADDITIONA'L COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FOUNDATION ZND [ ] INSULATION
FRAMING [~FINAL
REMARKS:
INSPECTOR
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I$T [//J/ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[~FRAMING [ ] FINAL
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined.. 0,'k..~... ! .&'~. ·., 19~.
' Approved .~/~..0-/~Q4. !.~..., 19 ~. Permit No.../..~.7.['..
TOWN OF SOUTHOLD
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 3/6/87 19
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
o~ areas, and giving a detailed description of layout of property must 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 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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections·
R.O.K Inc
(Signature of applicant, or name, if a corporation)
Box 977
~ Hampton Bays, N .Y. 11946
........
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or uil r.
Name of owner of premises Mr &' Mrs Villano
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
..... .h.a.r.d..9 :. ?.r. ?.s.. ...............
(Name and title of corporate officer)
Builder's License No. S..u:f.f... 8..9.9.1.H.I. ............
Plumber's License No. P1487 ............
Electrician's License No .......................
Other Trade's License No. NA .............
1. Location of land on which proposed work will be]d~ .'.D.e.e.p..H.o..1.e..D.r.i..v.e.,..M..a.t.t.i..t.u.c.k.,...N...Y.: ..........
· .1.9.5.0. ............ D..e.ep..H. t2J-.e..Dr£.v.e ................ Matt±.tuck ..............................
House Number Street Hamlet
County Tax Map No. 1000 Section .1.¢.3 .............. Block . . . .4 .............. Lot .... 3. ..............
Subdivision..I'I3, ................................. Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy One family .d.w...e.13.J:n.g'
b. Intended use and occupancy . .S.a%n3¢..o,s...al~9.v.¢...g.~..~ ...............................
3. Nature of work (check which ~pplicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition . .--.: .......... Other Wu~k ...............
i (Description)
4
Estimated Cost 80, 00 Q, 010 Fee ......................................
~ :~ ~ ;~ , (to be paid on filing this application)
If d ' · ~ · 5 Number of dwelling units on each floor.
5. welling, number of dwelhn units ............................. ,.
If garage, number of cars ... tN,~ .......................................... ; ...................... '.
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .N~ ..................
' 18'6" ~o. ~.. , ,,
7. Dimensions of existing structures, ifany: Front ............... Rear fY..~. ......... Depth ~2.4 .Q ...... ~
Height 14 ' 0 ' Nu~mber of Stories 1 .....
Dimensions of same structure With alterations or additions: Front .S.a.m. 9 ............ Rear . .s.a.m.e. ............
D +h same I 14~i~h, 24 ' 0" ....... Numbe[ el, Stories. 2
ep ............................. ~ ....... 46',k',/ ............ ~ ~ b"' ........
·.. Rear ............... Depth . .~ ..............
8. Dimensions of entire new consltruction: Front . .fY./ ...... 38 6
Height . .24: .0.". ....... .Number of Stories ... 2..., .................................................
9. Size of lot: Front ~ 0 ' 0" , Rear .58 ' O.9.".... Depth .Z~ 0 :..
10. Date of Purchase .. 1.9.67.. ~ .......... ......... Name of Former Owner . Rabbit, s ....................
11. Zone or use district in which premises are situated ....... l~9~i.c~n, gi.~% .~gJ:.J, quJ-.%ural ..................
12. Does proposed constructlon w01ate any zomng law, ordinance or regulation: .I~q .............................
13. Will lot be regraded .No. .... 2..., ..... , ~.. ........ Will excess fill be remove, d from premises: NA Yes No
14. Name of Owner of premises . .~..1.a..~.n.e, .V..J..~..L.a.n..o.. AddressD.~*P..I~q~..e..D.r. ~¥.e.. Phone No..2.9.~ ."9J,45 .....
NameofArchitect S.t. even' G~ Tsontak±s Address Roanoke ~ve R±v h 727-7411
............................................ P one No ..............
N~ ofC,,ntr~ctor R.O..K~i Inc ~r~s~ Box 977 H~mptonoh~ ~^ 728-5710
I5. Is this property locate~ withinli00 feet of a tidal wetland.* {~Y~s ..... No .....
~ If yes, Southold Town Trustees Permit may be required.
! , PLOT DIAGRAM
Locate clearly and distinctly' all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and bloc ~ number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, iS.S
COUNTY OF '
......... RichoX. ct. 0....K~n~.g .................... being duly sworn, deposes and says that he is the applicant
(Name of individual s~gmng contract)
abow.· named.
He is the.. ' ........................................ '.
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his knowledge-.and belief; and that the'
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
Notary Public ..... ~..~:.., . t~..~-.~.~. .... County
HELEIq ~ ~ ~E
N~A~ PUBL C,~ d ~ Y~
N0 4707878,~Suffolk ~un~ ~ (Signature of applic~t)
~ Term Ex~iros Ma*ch 30,