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HomeMy WebLinkAbout14213-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14279 Date March 14 .................................................. 19.86.. THIS CERTIFIES that the building .. 9B.e...f or~.~,Y..d?.e..~ .~.~.n.g .. ...................... Location of Property .~.200 SUMMIT DRIVE MATTITUCK h~'No. ' ...... 'S'~/e~i .................. Har,,let County Tax Map No. 1000 Section .... 9. 9 ......Block .... 2. .......... Lot ...... .1.3 ......... Subdivision . .C.A.P.T....K.I..Dp..E.S.T.A.T.E.S' ..... Filed Map No..1.6.7.2,...Lot No ...... 7.7. ...... conforms substantially to the Application for Building Permit heretofore flied in this office dated · .M a y..2 ~ ............ , 19 85. pursuant to which Building Permit No... 1. ~..2.1.3. Z. ............ dated ...Aug....23 ................. 1985., 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 ......... .Qr~e. £.am ~-J-,~..dw~.L].~[ag .......................................................... The certificate isissued to ...... Yg.aSSL2A~.,. ~ ~,~t~ A~.O.T..~.~ fowner, I~.I~ YoK Y*~I~'X'~ ........ of the aforesaid building. Suffolk County Department of Health Approval ..... ~ 5 .--.S.Q T ~ 15... ~ {.~./.~ ~ .................. UNDERWRITERS CERTIFICATE NO ............. ~ 7 2.4. q 3 ~ .... S/.5./.$ ~ .................. ?lumbers Certificate March 12, 1986 Building Inspector Rev. 1/81 l~OB~ NO. ~ TO~VN OF SOUTHOLD BUILDING DEPAP. TMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 14213 Z DateJ / ...~r~ ......................................... ,9..~.I.~-' Permission is hereby granted to: ~, ...... ~,~.~.~.,(z~.a....Z/.~.~ ............. ...... ./....~....../~...~ ........ ~ ..................... .... ~'.~~....~:..~....z~ to ......... ,~...~.Z~....~....~...~.~.~.~ ............. ~ ........................... ......... ~..~L~.....=.=..~~.~.~.. ~.~~:~....~;~.... at premises I~ated at ....~ ......... ~.~.C~ ...... ~., ................. ~ .............. ~ .... ....................................................................................................... ~.~~.~ .... ...~Z...~..~.~= ...... /~.z.~ .................. ~z...~..:z~. ............................... co..~ T~x ~ ,o. ~ooo Se~t,o~ ..O:2~ ....... ,,~ ....~ ........ ~o, ,o...~Z~ .......... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May C ncern, We are unable~to complete your Certificate of Occupancy because ,of the following reasons. /_--/V~ An application for Certificate of Occupancy is not on file. ~ ~ /~/ No Underwriters Certificate on file. /~/ The check is(outdated/not on file,) No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit ~ ._/__~_~ t ~ Z Building Dept. ***/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FIELD INSPECTI~ COMMENTS FOUNDATION (~st) FOUNDATION ROUGH FRAME & (2nd) PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercia~ buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Amhitect or Engineer responsible for the building. 5. Su bm it Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~pert¥ showing alt 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 anv housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1,00 4.Vacant Land C.O. $5°00 New I~uilding .... ~ ...... Old or Pre-existing Building $15.00 Date...~.. @J~-~. ............ Vacant Land ............. Location of Property .. Street Ham/et Hpuse No. Owner or Owners of Property County Tax Map No. 1000 Section .... ~.~ ....... Block .... ~ ........ Lot .... I~. ........ ,~,~,s,on ~t~....~.t~.. ~;J~ S...,,,e~ ~,, ,o...~0~.%..:o,,o.. 3:7. ....... Undo~ritors ~pproval ~]~¢ .~ta~nin~ Board Approval ............. ~equest for Tomporarg Gortificate ..................... Final Gertificate .... ~. ................ Construction on above described building and permit meets all applicable codes and regulations. ^pp,icant. C~..~ ~.~: ~.~... 2~..~. ~ ............ C.O. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~J~D(~,.L BUREAU OF ELECTRICITY ~ fl~(J 88 JOHN STREET, NEW YORK, NEW YORK 10038 ~)ate ~:U~ ~, 1~6 .~pp",ation ~'o. o,,~',e 3598'J6/8~ N 7 3 4 ~ 3 8 THIS CERTIFIES THAT only tke e~trical equipment ~ described below and introduced by t~ applicant named on the able application nu~nber in the premisos of ~'~ ~s~, N/S S~i~t I~ 200' W/O ~et. ~iv~, in thefotlowlng location; ~ Basement ~ 1st Fl. ~ 2nd FI · oectton Block Lot and found to be in co~npllance wltk the requirements of tkis Board. FIXTURE OUTLETS 26 DRYERS EECEPTACtE$ 47 SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT SYSTEMS E OTHER APPARATUS: 1-G,FoC,L 5.,-~oke D~tc~tors E R V I C NO OF CC, COND PER ff A W, G. NO, OF HI-LEG OF CC COND. 3 AWG. OF HI-LEG NO, OF NEUTRALS A. WG OF NEUTRAL 5 TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. [ ~ ~1% (please p~int) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plUmber' s signature) sworn to before me this ~ day of %o~c,L- , Notary Public,~ County Notary Public 7G5-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ~ST ~/~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION /~ FRAMING [ ] FINAL INSPECTOR Memorandum from BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN ]IALL, I~OX 728, $OUTHOLD, N.Y. 1197 765-1802 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,, SOUTHOLD, N.Y. 11971 TEL.: 765-180;: Examined. 1 Approved, .. ::. '_' No. )isapproved a/c ..................... -- ..... ~ ....... iii ........................ ~' ................ --~...~/(~..~f~?..:-- ' ·"~... ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Buildingffnspector, with 3 ets 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 ~r afeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. , 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 hall be kept on the promises 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 hall 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 5uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulat~ons, 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 [dmit authorized inspectors on premises and in building for necessary inspectigns~. [~ · ........ (Signature of applicant, or name, if a corporation) (M~iling address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or.builder.. ....... %.9.~.~.T·a.~..T.[.~ 2.~ .... ~..~.~..V.~..7...~:q.~,..U.~.~.~.~._.. ................................ Name of owner of premises . ~.~lx-) 1~ ¥.©.-[T.I S .... .V. tac~.l L,I ~t~) I ~..Z .¢..o.o-. ~ .i .Q .'~. '.~...~..?.o.c..'~.6 . .e4~.ck. ",' b/t,l.,c~lt, tflDh$I /~ -~ f)~0r~/£~ (asonthetaxrollorlatestd~ed) XJ o If applicant is a corporation, signature of duty authorized officer· (Name and title of corporate officer) Builder's License No ...... .~.~..-~. .............. Plumber's License No ..... .~ '.~-..~.~.~.. ~ ........ Electrician's License No..~fi .~.. ~. g.[~C~'.~.¢~.. Other Trade's License No ...................... Location of land on which proposed work will be done...~-~.~t.~.-~./.t5).... 15!I)~.... ?..~..~. .............. I 'P,, d>O su ~ ~.t~ .'9.~.~.'~ ff... . ..~. ~..T,'%. k ."~....C~. House Number Street Hamlet I ~-~ County Tax Map No. 1000 Section ..... .c}.~ ......... Block .... ~. ............ Lot...~. ~ ...... . .. :.5.,.. FiledMapNo..[(~ ...... Lot ............... Subdivision .... "(Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .V.(;~%..O~. B.?... A..~ ............. b. Intended use and occupancy ... I..~.qL~_.l./.'}/ .... .~.q ~J. g.e~. ................................. 9. 10. 11. 12. 13. 14. Nature of work (check which a~plicable): New Building . .' ..... A( dition .......... Alteration .......... Repair ...~jjjjSWem?val .............. Demolition .............. Other Work ............... Estimated Cost ..... 0 .................. Fee . If dwelling, number of dweiling~ units .... 1..~tg4 [[.y. Number of d~ If garage, number of cars .... i ..... I .......................... If business, commercial or mix6d occupancy, specify nature and extent Dimensions of existing structures, if any: Front ...... ......... Real Height ............... Number of Stories ................... Dimensions of same structure with alterations or additions: Front ... Depth ................... i. · · Height ........... . ........... Dimensions of entire new consfruction: Front .... .~..~.'..~ .... Rear Height ...[~: :~r ...... Nuraber of Stories ...... Size of lot: Front .... JO..O!:i ............ Rear .... Date 6f Purchase .......... ~ ................... Name of Forme~ Zone or use district in which premises are situated .... property lines. Give street and blocl interior or corner lot. r.~.~ ~ (Description) (to be paid on filing this application) elling units on each floor ................ each type of use ..................... ............. Depth ............... ........... Rear .................. tmber of Stories ........ ;' ' t ', ii ....... ."J..~.*. . Depth . .31.6 .... ...... Depth ...I.X. ?.0.[.~ ! ........... )wner ............................. Does proposed construction violate any zoning law, ordinance or regulal Will lot be regmded ........ !...t~.Q .............. Will excess fill Name of Owner of premises ~:i' Name~ of Architect ......... ~ .................. Address .................... Phone No. Name' of Contractor .~.~}4f) .~..~ ~ K~O.~ ........ Address B0~ BOg. g~) ~.. ~ ~lO~hone No. P~T DIAG~ 'i Locate cle~ly ~d distinctly ~l bu~d~gs, whether existing or : number or descfi[ Lon: ...~.~ ....................... ~, ~e remov~l from ~p..remises: Yes ~ 7.: and, indicate all set-back dimensions from and show street names and indicate whether LOT Lot .,~ STATE OF NEW YORK, COUNTY OF ................ S.S % gl, INIT reed the said work and to make and file this best of his knowledge and belief; and that the 4th. (Signature of applicant) of said owner or owners, and is d¢ly authorized to perform or have perfo: application; that all statements contained in this application are true to the work will be performed in the mantlet set forth in the application filed there, Sworn to before me this J Notary Public, . ....... ~..~.-...~.~. ?..tgi-....... County HELEN ~ DE VOi ', ,' NbIA~tY I~UBLIC, State of ~ew Yor~ NO. 4707878, Suffolk Count~. ~e~m Expires Matc~ 30, 19~/ ........ ......................................... being duly ~ yom, deposes and says that he is the applicant (Name of individual signing contract) above named, j He is the ..................... ..................................................................... (Contractor, agent , corporate o 'ricer, etc . ) j DEPARTMENT OF HEALTI'I O? LICENSED LAND SURVEYORS GREENPORT NEW YORK H. Sm NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SER¥iCES ~ FOR APPt /~AL Of DATECONSTRUCTION ONLY: _.~.(/~ ~C..C SINGLE FAMILY DW~ ~N~v ~FFOLK CO. TAX M~P ~SIGNATION: TEST MOLE STAMP SEAL z:o/ 77 ! ' -,-% d./vCz¢' / 7- STATEMENT OF INTENT THE- WATER SUPPLY AND.SEW.AGI~ SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANQARDS OF 'THE SUFFOLK CO. DEPT. OF HEALT.H APPLICANT SUFF(~LK COUNTY DEPT. -OF HEALTH SEEDY t C ES--- FOR A PPR'OV A[ CONSTRUCTION ONLY DATE: - H. S. ~EF. NO.: APPROVED: ' sUFfOLK CO. TAX MAP O,~T. s~cT. OWNERS ADDRESS: DEED: HO~LE IL JL AI PI O D AS NOTED DATE:'~/'~/~;" B.p. '~~ FEE ~,.~Z q'~ ~v NOTIFY B~LDING DEPARTMENT 765-1802 9 AM TO 4 PM FOR TH[ FOLLOWING INSPECTIONS: L1, FOUNDATION - TWO REQUIREr FOR POUR£D CONCRETE 2, ROUGH - FRAMING & PLUMBINC 5. INSULAT/ON 4. FINAL h CON'STRUCTION MU~I ~E COMPLETE FOR C. O, ~ILL CONSTRUCTION SHALL MEN ~T.~"~' ~'C~i~'~"T'~C'T'[~N' & ENERG'~ CO'~'~. NOT RESPONSIBLE FO~ DESIGN OR CONSTRUCTION ERRORS / '70 LO" .,~ LO ', / d'- ....................... _'~ ?_L P? ?0'-0' ii Ill I I i PLUMBER CERTIFICATION' ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATE. SUPPLY SYSTEM CANN© EXCEED 2/10 of 1% LEAD copper tubing is used ~or water distributing em; piping shall be Ws L only ,-,{: types K or ~