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HomeMy WebLinkAbout17527-Z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17868 Date MARCH 22, 1989 THIS CERTIFIES that the building ADDITION Location of Property 2815 SIGSBEE ROAD LAUREL, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 6 Lot 3.1 Subdivision MATT.PARK PROP. Filed Map No. 801 Lot No.107A&115 conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 23, 1988 pursuant to which Building Permit No. 17527-Z dated OCTOBER 12, 1988 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to WILLIAM & ELEANOR PEDERSEN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-050512 - DECEMBER 16, 1988 PLUMBERS CERTIFICATION DATED MARCH 10, 1989 - WALTER GROGAN, JR. Building Inspector Rev. 1/81 FOSM NO. f 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°_ X17527 Z Date 198 Permissi i hereb gro ted to: . ~ ' ....1,~,......... 0 ct premises located at ....P.... StiI.... ...~K.! County Tox Map No. 1000 Section ......~22~~..1'0....... Block {pLot No.......~f....... pursuant to application dated ...~~'.r 19.CIQ., and approved by the Building Inspector. o~ Fee 3....sl.`~ ...~/v .........1~. . B ing nspector Rev. 6/30/80 X9S TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ ~ CG i I,~~_s_w.~.m. TOWN HALL Il SOUTHOLD, NEW YORK 11971 ,.LJ 765 - 1802 TOWNLUF SOUTFiOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE ~ l/~ . //c.J ll NEW CONSTRUCTION ..?S...OLD OR PRE-E%ISTIN,/G~BUILDING......1VACANT LAND........ Location of Property.~o~:r.. ~yl~:~/:........ HOUSE N~O~. / STREET / HAMLET Ovner or Ovners of Property!~/L~~~i11.~:~(:~fl~o~./Ce76~"'~~?~ County Taa M~~ayyp No. 1000 Section l~ Block ...ppSP Lot ..J7.~. Subdivision~,ci~Jl~:'r~~ ~?P~°.-~~C: Filed Map ..9.d l..Lot~ IA:~C/~I Permit No.~l~~~.z.Date of Permi[ ~~~~.Applican /~~=..1/T F. P Health Dept. Approval Undervriters Approval......._...... Planning Board Approval Request for Temporary Certificate Final Certificate .1 Fee Submitted: $ APPLICANT. `e%~ C~~e - 3l, es a. C o ~ i ~8G8 rev. 10/14/88 TEL. 765-1802 ~pS~EF~~~p TOWN OF SOUTHOLD ti OFFICE OF BUILDING INSPECTOR 5' c ~ P.O. BOX 728 ~ ' ~ ~ ~ 4 a._ ~ u' ~ TOWN HALL 0~' •__,~t:~ y0~~1 ~ SOUTHOLD, N.Y. 11971 s , + ~ 2 0 C E R T I F I C A T I O N Date n J'9 Building Permit No. ~~~~Q~/// Z Owner/~/~in~n .i- ~~.Ft7Ko~e 16d~.>OS6iu (pleasenprint) Plumber(,~A,LT,p l~^~~G;p,~ ,J,e, (please print) I certify that the solder used in the water supply system contains less than 2/10 of 18 lead. (plumber's nafu Sworn to before me this ~ D~ day of r'1n rc~ ~~~i~~ ~ 19 ~ Notary Pu is Notary Public, 56,}~,e County uNDAMcNALLY Naary P ~ie,~~N~wr~Ya~k¢~ COIIMIMN1011 ~'M.h111~ 7q,1~1 THE NEW YORK BOARD OF FIRE UNDERWRITERS I'F4°" InonueH ~ BUREAU OF ELECTRICITY - 83 JOHN STREET, NEW YORK, NEW YORK 10038 Uate 1)k('KMHt~H 'I.f;,14H8 APP(icationNo.onfile `i34929.88/it8 Pi i~5(!~S1> THIS CERTIFIES THAT only the sleetrlcel equtpmene as dsaerlhed helot! and introduced 6y the applicant named on tke o6ow app/icatlon number in the premises 4/ PEI)I;RSC)N, 281.5 ;iY(iAHr:k Kr7AU; ?NA'i'Y'i.'PUCK, N.,Y. in the fdlowinR locotio ~ ge.~ t ~ (xt F(. ? Ynd FT. .Sertiun Block (.ot 1)~.r;Hilf:R 139~~R:; wee examined un undJound to 6e in rnmpliance wif.h the reyuirementa ql this Board. NXTYIR AUKS fYNTGXlS RXTIMBS COOR1110 DKKS OVlNf DIRK MASINRS UINAUST fAN4 OUTtRTS INCNtDES[!M rlUOMSCEM NAT. K. W. MAT. K. W. NAT. K.W. AMT. K. W. AMT. M. r. fi 1A 9 6 3 H' ftHNACE MOTORS NTUtl AMIiANQ IRpRS SlRgAIRRCK TIME CI.OOIf RRLL Y1Nf IMATRK MtlLT.OYNRT DIRAItIRRS AMT. K. W. pl N. r. GAS N. f. NAT. NO. A, W. G. AMT. AMr. AMT. AMR. TRANS. NAT. N, r. tpS ~T AMT. WATTS ~ to sRRMlf7 aRaofNlRtr s e R v 1 c R AMT. AW. TM! t w [W 1 w Tv S / xw S w AW NO. ~ Oi ~ G No. OF N4LEG no. p Nlu1RAU a '1 t1J~l OTNH At7ARATUk G.r'.C.i;-1 HOii r: i)i!:TF,CTt)it . - $O@' S h.T,P:C'I'R LC ",rate rer; 2p YOPt.AH Aeh,. FRttIII:N<;DAIiY,; NV', 1 1.'7 i'i tiNAL IMNAORR AI LU:r:NNe"". NI1. Piyg r: Per This gAificah must sot bs aRand in any manrNrr; Tatum to fM office of fha bard iF imorrM. Impactors Mpy ba idantifiad by [hair aadaMials. COPY FOR dU1LDINC OE~ARTMENT. TFRS COPY OF CERTfFIC~?TE iMlST NOT BE ALTERi~ IN ANY h1AlMIER. ~P~ , o ~G~N\G N P t X05 P ti~ ~ ~ ~o , o ~m ~ v 0 9t ~~OE N O^ O h e~ No ~ i _ JI e N U' - e 0'l r P Oa S U o ~ ~ $ A 2 u \ O 1 ~ ~5 . s V c ~ pJ~OJ~jfr ~ ~ \wO\J I~. U H , O ~ ~O Q sl ~ d 11.V M 'Q p j O O, e99O ~ 66 . , . • o~ \~6 ~ , ~ ~ . NOTES ¦=MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY AS MAP N0. 801. AevisloNS• YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAO, NEW YORK ~ ALDEN W. YOUNG HOWARD W. YOUNG PROFE6910NAL ENOINCER AND LAND 6URV EYOR LAND 6URV EYOR, N.Y.6. LIC, NO. 1261e N. Y. 6. LIC. NO. 466Y0 SURVEY FOR: WILLIAM S:-PEDERSEN & ELEANOR PEDERSEN LOT 115 AND PART OF LOT 107A OF ILIMENDED MAP DF MATTITUCK PARK PROPERTIES, INC." AT GUARANTEED YO: LAUREL SOUTHOLD SAVINGS BANK INTER-000NTY TITLE GUARANTY 8 TowN of SOUTHOLD MORTGAGE CO. SUFFOLK CO„ N, Y. e~ _ . SCALE: I~~ ~ SOI DATE: OEC. 2I, 1971 ~ 7u~... ~~~L7 ass-iso2 BUILDING DEPT. INSPECTIAN [v1" F . UNDATION 1ST ( ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMAR S: DATE ~ ~ INSPECTOR ~ ~/N'~L~.. 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ROUGH PLBG. [ ] F UNDATION 2ND [ ]INSULATION [ FRAMING [ ]FINAL REMARKS: DATE ~ INSPECTOR %1T~7 T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. ] FOUNDAT{ON 2ND [ ]INSULATION [ ]FRAMING [ ~ FINAL REMARKS: ~~r ti w` DATE ~ INSPECTOR ~ ~f 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~ FINAL REMARKS: DATE .3 INSPECTOR =TEED II:S:'IO=_u7 j~G„iE COMMENT° ~ 7 . ~ ~ }J _Hv r'OUtJDATIO"J ( 1 sL) - OUIJDATIOIJ (2nd) oaf CD.,~'J A/N.E ~ 2. z o ~ ROUGH FRAME ~ / PLUMBIN(Y p_~, -1 N H 3. a ra IIJSULATIOPI PER N. Y. • • i STATE ENERGY CODE x rr ~ 4. y FI,'JAL a E ADDITIOPIAL COMMENTS: x~• ' ~ x H \ . _ ro 9 H O m r -3 T b m .y H ~ >,"'r BOARD OF HEALTH I '"t 3.~2 ,,F 3 SETS OF/PLANS .re:. . ..,e 2iv:.i -^r1° FORM N0.1 SURVEY 1~F ~~rr r ~ts,-F t° i,.. TOWN OF SOUTHOLD CHECK ..11.~.~.~ Ja BUILDING DEPARTMENT SEPTIC FORM i • 70WN HALL i ' SOUTHOLD, N.Y. 11971 NOTIFY ` - TEL.: 765-1802 AIL T0: , Examined . . / Z......., 19 Q It° ' ~ - ~Qr~f! Approved z'......., 190/!. Permit No.~T?~'~. Disapproved a/c SEP ~ 3 ~43~ e~ 10WNLOFSOUT~'t10LD ~Bui g Inspector) APPLICATION FOR BUILDING PERMIT Date ...L 15~!~! 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 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 1 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. „~j'CAT~„y.(lt~, . ?..~1-1~(oP t..Gv~Sr.16C.~C-. (Signature of applicant, n e, tf a corporatton) 1~ . ..hn.:.~ . zc?.. • (Mailing address of applicant) State whet~he~rJ,applicant~is~o~wn~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I Name of owner of premises ~~.•L-f,l~(-~~. ~ . (~L1!•Q f.•~O(~, • • , ~ ~S~l.~ • • • • • • • • • • . , • • • • • (as on the tax roll or latest deed) !f applic t is a rporatio , sip duly authorized officer.. . l-~ Name and title of co orate officer) rp Builder's License No. ~•~4'.~ •~~..pN'.~.......... . Plumber's License No. ...1.~o,arJ I ~ ~ , Electrician's License No. ~.`I'1. • • • • • • • • • • • W Other Trade's License No . . Location of land on which proposed work will be done . . . . House Number y Str~cen[ Hamlet 3 r 1 ~ `F' I / County Tax 19ap No. 1000 Sepction Block ~•QQ. , , • , , LotS.:•}~-, • , Subdivision .~'..~'..~r k PCb .•.~C Filed ~[ap Na. ,lJ.! r • • . Q Lot ..I6I!} I ~5.. ((lame) State existing use and occupancyGof prremises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~,~.1(~•~L(z`...~AN.I, .R~S ! ~ b. Intended use and occupancy . S~.`!t~. • • • t``"`"•~R°•pv'\, , S urn *~~aoM ~`7-¢ ~ 30 / STi~Z, , AD1~ ~-t"~cx~-t r~ 3. Nature of work (check which applicable): New Building • • • • • • • • Addition •'~3 Alteration . Repair Removal Demolition • Other work . (~~2 (Description) VI ' . 4. Estimated Cost~?:.t © <`s'``~ Fee . (to be paid on tiling this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor . lfgarage,numbcrofcars 6. If business, commercial or mixed occupancy, specify n~[ure and extent of each type of use . 7. Dimensions of existing stnic[ures, if any: Front .:~:'L Rear ..~-o. ~ Depth . , . • , , Height Nutnbcr of Stories . Dimensions of same structure with alterations or additions: Front Rear , . Depth ...~i-LgJ:~ . . Ilcisitt I Number of Stories ~ . 8. Dimensions of entire new construction: Front Rear Depth .3~........ . Hcigltt Number of Stories 9. Size of lot: Front ...L~.~'v •?.°j............ Rear I4: ~'.°.3`I Depth . ~5? s. S . 10. Date of Purchase .............................Name of Former Owner , . 1 1. Zone or use district in which premises are situated . ' 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. will lot be regraded ............................Will excess Gll be removed from premises: Y s N 14. Name of Owner of premises .......:............Address ...................Phone No.............. . Name of Architect ....Address ...................Phone No.............. . Name of Contractor ~~.'f~'-: ~lD+~..(~>Dbti=T...... Address p0.~:.:1.°...~•"•~.: • • Phone No...~.7~~%~'.: . IS.Is this property located within 300 feet of a tidal wetland? *YES....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 fron property lines. Give street and block number or description according to deed, and show street names and indicate whethe. interior or comer lot. D~..~}~~ I Tom' PLY'i PERt471T l.'s';`.r i±rJrr. k;~'~E?\'A,, ;rJ REI'.50vf EnCESt Ftt.L FRC~~' :?va(?'Jf vr'?S:r'~<«c i3Y REGF:.Sf1lP~ic"; i.D~ DktVFtN,~t CON57AtiCTIOPS CirSSb~Ot]1 COl~tSTHUCTIt7M C.~.eJAR Ct3Ne UCT h' ".......rte.. - wTNkR ~=~~~~'j3 . 4 STATE OF NE1)+ S.S COUNTI' O~ . 1 . .L~ . • • • • 11f1,11~(r; , V-• A~A~ U• , • , , , • , , , , , , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the _ ontractor, agent corporate officer, etc.):-t` of said owner or owners, and is duly authonzcd o per orm or have performed the said work and to make and tle 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 fordt in the application filed therewith. ' Sworn to before me this r Notary Public, v ~ ' . " ~ County ~ " C r/L~/. " S/ . . ctv~/ / CLAIRE L OLEW PP N~YNrwYak (Signature of a IicanU Qwlffkd in Suffolk Coumy Qf~ Commission Fxpiras baemnber t$.""