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HomeMy WebLinkAbout15771-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16008 Date.,,g.u.l.y. 31, 1987 ----*~''-'~'--------~'~'~'- *-' '- '~'~'~Tl41~t~PTll;Irtq~ha++llehu;ht;"~' ONE FAMILY DWELLING WITH ATTACHED GARAGE & WOOD DECK ~- Locationm¢Pmnar*v 1225 Jacksons Landing Mattituck New York House No. Street Hamlet County Tax Map No. 1000 Section 1 1 3 .Block 0 5 .Lot 0 8 Subdivision M/o Jacksons Landing .Filed Map No. 5280 .Lot No. 23 conforms substantially to the Application for Building Permit heretofore filed in this office dated January 28, 1987 pursuant to which Building Permit No. 15771 Z dated Ha r c h I 7, 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 ......... ONE FAMILY DWELLING WITH ATTACHED GARAGE S WOOD DECK WALLACE & GINNY MACOMBER The certificate is issued to ..................... .- -...~., .--------i'oW-b;~'~-~',~v~'~7~iXx of the aforesaid building. Suffolk County Department of Health Approval ....... .8.7.-.8.0.7.2.7. ......................... UNDERWRITERS CERTIFICATE NO. P E N D I N G PLUMBERS CERTIFICATION DATED: July 29, 1987 Building Inspector Rev, 1/81 FO~ NO. ~ TO~VH 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~ 15771 Z Dote / .~. '".)~o~ q ~ ............. ,o ..~~.~....~...~..g~¥~.~....~..~~0.:., ~. .... ~....~...~..-.. ...... =~........~ ...... ~.....~ ..... ~....,.. ........ ~.: .......... ~. ....... ~ ........... at premises Iocoted at ,.../...~....?~....~.........~.~...C~...~ ........ ~..Y-..~..~ ......... County Tax Mop No. 1000 Section ..g....):.!...~. .......... Block ..... ..~....~..~.. ....... Lot No ..... ..~....~.. ............ pursuant ,o application dated ......~. ~-.....~,.~. ......... , 19..~.].., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Bu i~ding Deparzmen~ Town Hall SouthoM, N.Y. 11971 TOWN APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This appJication must be f~lled [n typewriter OR ink, and sub~[ttad in dupJicate to the Bui[din§ Insoeo- tor with [he lot(owing; ;or new bui!dings or new use: 1. Final sup/ay of property with accurate location of all buildings, property lines, streets, and unusua; natural or topographic features. 2. Final approval of Heaith Dept. of wa~er suop v and sewerage disoosat--(S-9 form or equal). 3. Approval of electrical installation from 8o~rd'of Fire Underwriters. 4. Commercial buildings, Industrial buiidings, Multiple Residences and similar buiiding~ and installa- tions, a certificate of Code compfianca from the Architect or Engineer responsible for the building. 5, Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildinos and "pre-existing" [and uses: - 1. Accurate sum/ey of peoperty showing afl 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 [nspection of buildings or premises, or other pertinent informa- tion required to prepare a ce~ificate. / 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 S5.00 , o~res~ Ham/~t co,,,~ T~, ~, ,o..~000 s~o,~o~ .... ( / .~. .... '. ,~oo, ... ~.~.. :... ,o~ .... O: Z. ....... Health Dept. Approval ............. : .......... Labor Dept. Approval Unden, vHters Approval ............. , ........... Planning Board Approval .................. Reques[ for Temporary Certificate .... , ............. Final Certificate ~5¢ 7¢~1 "' ' ....... Fee ~ubm tted $ Construction on above described building and per~ meets all app~abl~es and reou lations. ~,~n~.. .... ~ .... :" ......... ?_~~./~..... TOWN OF $OUTltOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-lS02 CERTIFICATION Date 7/~ t~ Building Permit No. / (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber ' s(/s ignature) SWOrn to befor~m,e, othis Notary Public, NOTARY,PUBLIC ~'~0~, County OUNDATION ( 1 st) OUNDATION [2nd) OUGH FRAME & PLUMBING LUSULATION PER STATE ENERGY CODE No Y, FILIAL ADDITIONAL COMMENTS: 765-t802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [~/~NSULATION FRAMING [ ] FINAL REMARKS: INSPECTO~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [~"]/ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ~/FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION' [ ] FOUNDATION 1ST ]~ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ]FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL REMAR#S-.~~/ DATE SPEC~I'OR~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [~OUNDATION 2ND [ ] INSULATION FRAMING FINAL INSPECTOR ~ ~ /~ FORM NO. 1 TOWN OF SOUTHOLD JAN Ztl98t' BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined..}9~...o.~.../.."~.., 19 Approved . )0~.0:¢'...~... ! .'~ ·., 19~']. Permit No. ~.~.?.D../..~. Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 0. Tins 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 diagram which is part of this appli- cation. c. The work covered by tins 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. ? ...... .... (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or 1 . N~me of owner of premises .... ~../.~ hd .~..c...~.... ~...6. z~.~.F... Z~. ~...~..~./S. c-;~. ................. (as on the tax'roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate offifder) Builder's License No .... ]2... ?..'~..--. f~/. ~.. ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... / 1. Location of land on which proposed work will be done... ~ ..................... ~ ................ /~,~s'- '3U~<~;o~ ~,n~,~ ...... Z~..4.y./../.~-UCl< ~.W..~.. House Number Street Hamlet County Tax Map No. 1000 Section ...... /../. '''~ Block . .O.. _X.~. ......Lot O..~... Subdivision ~'~/~C/'C-~OA/~ '.].~.~.~..?i?.C?( FiledMapNo...-4~...~..~..©. .... Lot....~-...~. ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~//4 c/0 ~J T--,.. .. a. Existing use and occupancy ......................................... b. Intended use and occupancy .. C 9./'/.~T~'.°..c..T-['... ~..~..~..'~. !./7. I~. .... .~..//~?..h.~./..A{ .~.... ~..~).-~.C.' ./'.C~ 3. Nature of work (check which applicable): New Building ['/ Addition. Alteration Repair Removal Demolition ~ Other Work i (Description) 4 Estimated Cost o. 6 c) ~ , o ~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ........... Number of dwelling dnits on each floor ................ If garage, number of cars .......................................... .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ~ype 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 ...................... Numberer Stories ..................... 8. Dimensions of en~tire new construction: Front ..... ~. ~ .... Rear ...... ~ ..... epth 'i' .2....~.: .... Height / 6 Number of Stories ........ /. ......... ~ .D. ... 9. Size of lot: Front ....//40 ............... Rear ...... f. ~.$~. · ....... ~. Depth /..c~.2.. ~../. 3~....2 ..... 10. Date of Purchase .......... /',F..~F. ............. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ............... · ....... ~. ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: . i .............................. 13. Will lot be regraded ....... Zk/.o. ................. Will excess fill be rem6ved from premises: Yes No 14. Name of Owner of premises ~....,'~ ~ .CO.,.Tq..~..~.,. Address ............ j ...... Phone No ................ Name of Architect ....~ ....................... Address ............ j .... Phone No ....... U .~ ..... Name of Contractor ./~l.'~<'/.& .&.~..ns-f.~..Iff..{'..../.A/(~ddress .,'fl..X. g$.~.... ~i~.'~i Phone No...2:..~ocf...,q.>.g..~.'~_~ 15. Is this property located withinl.00 feet of a tidal wetland? i* Yes ..... No .~.. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and property lines. Give street and block number or description according to deed, and s interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S ..... .A... (Name of individual signing contract~ above named. indicate all set-back dimensions from ~ow street names and indicate whether ....... being duly sworn, d'eposes and says that he is the applicant He is the .................................. (Contractor, agent, corporate officer, ~'tc.) of said owner or owners, and is duly 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 ............ ..... No 4707~ ,'~, ~'o' [~u ~[-7- ~' ~" (S~gnatu/z~__ of applicant) ,~O~S ]0 ~ a~o . ~ 5t~te ~ such use by ssodt~6°~' ~te A LOT 16 N.88 3440 E. LOT 17 ~' LOT 23 The water supply & sewage disposal sys- tems for this residence will conform to the standards of the Suffl k County Depart- ment of Health 5crv,~ 155.00 0 S.88o 22 \ AREA : 22,425 SQ.FT. EXPIRES TWO Ye-tR~§~ F~u,v, ~ CERTIFIED TO: WALLACE 'MACOMBER JACKSOh/'S 192.00' mm LA h/DING .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH S~RVlCES S.URV EY OF ,o, ,,~,ov,~..~ ~%~]~ co~-~,,~,o, o~ LOT 23 FILED MAR. APPROVED ~ ~ '~ ~ ' ~ ~T (( ~ " ,o SCALE I~: * '~ )~]) DEC. 30, 1986 ~ FEB. 2, 1987 ~P~0NIC SUmVEYORS ~ ENGINEERS, P.C. (516) 7'65 - 5020 28, 1969 FILE NO. 5280 MATTITUCK P.O. BOX 909 MAIN ROAD SOUTHOLD, N.Y. 11971 THE LOC~ITION OF WELLS 4ND CESSPOOL SHOWN HEREON *4RE FROM FIELD OBSERVATIONS AND O/iTA O~T. CIINEO ~ROM OTHERS. 86- 796 LOT J 7 CERTI FlED TO: WALLACE MAC OMBER (5~6 ~ ~.0. BO~ 909 MAIN ROAD SOUTHOLD ~ N.¥. LOT 16 N. 88°$4'40"E. 153.00' S.88° $4'40" W. LOT ~ LOT 2 2 192.00' AREA : 22,425 SQ.FT. JACKSON'S LANDING S.URV EY OF LOT 23 "MAP OF JACKSON'S LANDING" FILED MAR. 28, 1969 FILE NO. 5280 AT MATTITUCK TOWN- OF SOUTHOLD SUFFOLK COUNTY , N. Y. I000 - 113 05 - 08 SCALE I'= 40' DEC. 30, /986 1C. NO. 49668 ~RS .~ ENGINEERS ~ P, C. Prepared in accordc~c¢; witi~ the mimm~ standards for ti'~o survoys as established b~ the LI;A.L.$. and approved and adopted for such use by The New York State Land Il 9 71 litle Association- 86 - 796 LOT 16 ~ N. 88°34'40" E. 153 ~ o ,,, ..... -~ m ~e~ ~ S.88° 34' 40" W. 192.00' AREA = 22 425 SQ.FT. , JACKSON'S LANDING CERTI FlED TO: LONG ISLAND MORTGAGE CORP. WALLACE MACO~BER SURVEY OF LOT 25 '~ ; "~P OF JACKSON'S LANDING" levite ~'/S.-~F' FILED MAR. 28, 1969 FILE NO. 5280 Prepared in ac~rdanc, with the minimum A T MA TT I T U C K standards for title suwey* as e~ablished by the L. LA.L.S. and approved and adopte~ TOWN OF SOUTHOL'D for such use by The New York State I~, ,,t~.A,,o:i.tlo.. SUFFOLK COUNTY , N. Y.  ~y SCALEI"= 40' DEC. 30, 1986 ~ FEB. 2,1987 ~o~;~ . · . P.O, ~OZ 90~ THE LOC~TION OFWELL$ ~No CESSPOOL SHOWN MAIN R OAD HEREON ~RE FRO'M ~IELD OBSERVATIONS AND D~T~ OBTaiNED ~M OTHERS. SOUTHOLD~ N.Y, 11971 86 - 796 ~UFFOLK COUNTY HEALTH DEPARTMENT tlMGLE FAIW/LY DWELUNG ONLY H,D. }tEF, NO. -_ ' ,~ DATE ..... , JUL ~? 1~8[~c, -~s - LOT I ? roi ~f S.68° 34'40" W. LOT 22 E~otton AREA = 22,425 CERTI FlED TO: LONG ISLAND MORTG AGE TERRA ABSTRACT WALLACE MACOME]ER JACKSON'S CORP. SO.FT. I- i 92.00' SURVEY OF LOT 23 JACKSON'S LANDING" 28~ 1969 FILE NO. 5280 MATTITUCK OF SOUTHOLD "MAP OF FILED MAR. TOWN P,O. BOX 909 MAiN ROAD SOUTHOLD~ N.Y, 11971 LIC. NO. 4966,5 ENGINEERS , P.C. SUFFOLK COUNTY , N. Y. lO00 - 113 05 - 05 SCALE I"= 40' DEC. 50, 1986 FEB. 2,1987 P~epared ;n c~c¢or~ce w~;'h the minimum Title THE LO~aTIO~ OF ~E~ HEREON ~RE' FROM mlELD OBSERV~T/ON~ OaTA 08T~INgD F~M OTHgR$. 86- 796C