HomeMy WebLinkAbout23625-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25603 Date: 03/20/98
THIS CERTIFIES that the building ALTERATION
Location of Property: 930 JACKSON STREET NEW SUFFOLK
,(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 117 Block 10 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 25, 1996 pursuant to which
Building Permit No. 23625-Z dated AUGUST 8, 1996
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 ALTERATION TO AN EXISTING NON-HABITABLE ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to ROBERT T. GOLDMAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N447729 03/16/98
PLUMBERS CERTIFICATION DATED 03/11/98 K & K PLUMBING & HEAT.
Bu ding I Spector
III Rev. 1/81
/ 1
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN }TALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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.
B. For existingbuildings (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.
C. Fees
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 - $20.00
4._ Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15¢.00/.,, Commercial $15.00
Date . . . . . \� ll a. . . . . . . . . . . . . . . . . . . . ..
New Construction. . . . . Old Or Pre-existing Building.....�gYv . . /r!
Location of Property. . . .. .. . . . . . . . . . . . . . . . ..�GI!4�7_60. hl .C�r. .. . . 17. W yG1t��P � . .•. . .
House No. pp''� �e Street ^,Hamlet
Onwer or Owners of Property._ rz IrR!l . . . . vot! ,1 !'11. . .
`;ounty Tax .Map No .1000, Section.. ... .. . . . . . ... .P,.1ock. . . . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . ...
Subdivision
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F .I ed Map.. . . . . . . . . . . .L Lo,tt.. . .�. . . . . . . . . . . . . . . . . . .
.Permit No. Y. .J�.L^/, . . . .Date Of Permit. . . . . . . . .. . . . . . .Applicant.06:�":� . . . . . . . . .
'i[ealth Dept. Approval. . . . .. . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate . . . . . . . . .
ee Sub
54 a.�# . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN OF SOtTTHOLD
i ;
e
OFFICE OF BUILDII.IC, INSPECTOR
y �+y F.U. BOX 728 !
• Wl. D C'► .{ TOWN HALL l�
Ri
SOUTIIOLD, N.Y. 11971
_u E R T i F I C A T I O N �S
T®'J9d9'vf'.`i-
Date
Buildin Permit No. 3 � i
owner
p @ase printf �- -
ti Ip Daae print)
I a°rtify that the so.tdnr used in the water supply systeyl P
,contains 18sg than 2J10 of 18 lead. '
r
t
LL � i4A 4
S•••. I _ X y
F
- x
tr
n
(plumber ,
( s aignatui@)
Sworn to beforo me this {
�. �day of .
19 C?v
Ifon { N taryPubli —
t ar/ 1{Lbi•ics Caunty LINDAJ.000FE5
NMM Public,State of N
SAE YorkNo.4822583,Suffolk j�
y T 31,,39 U fir,
Z4'
-H
L
v"s" may.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE
1001071 BUREAU OF ELECTRICITY
7 40 FULTON STREET, NEW YORK, NY 10038
Date MARCH 16,199$ Application No. on file 14675497/97 N 447729
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
3
ROBERT GOL3NAM; 930 JACKSON STREET, NEW SGTE°&'OLXT M-
in the following location; ❑ Basement ® Ist Fl. ❑ 2nd Fl. ve'1.R/OUT Section Block Lot
was examined on PARCH t0,1998 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESC Tj FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
17 21 17 15 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS
1 E 4 600
SERVICE DISCONNECT NG:OF - S E R V I C E
METER NO.OF CG GOND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. 19 2W 1 S 3W 3$3W 3 0 4W PER 8 Of CG.GOND. NO.OF HI-LEG OF HI-LEG NO.Of NEUTRALS OF NEUTRAL
i IW C? 1 s'_ i 4/0 i 2/E
OTHER APPARATUS:
3 TON ,QTR CONDITIONER-2-1
MCTORS: 1-E H.P. .13- H.P.
�P"AMBOAROS;1}-�1q C3R. 60
t1e.1�CL Y]A1=,R R�+�r6TERS°o 'v 1--4.5 K.W.
G c`a S CONTRACTOR LTC.#578 E L
BOX 210 ANN GENERAL MANAGER
$OUTFOLD, ITZ, 11471
per 'T
This certificate must not be altered in any manner; return to the office of The Board if incorrect.Inspectors may be identified by Their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
S A M U E L S &
S T E E L M A N
August 14, 1996
Mr. John Boufis
Building Inspector
Town of Southold
Main Road
Southold, NY 11971
Re: Goldman Garage
Jackson Street
New Suffolk, NY
Dear Mr. Boufis,
As per your request, we are writing to clarify that the new bathroom in the garage will
be connected to the existing sanitary system. This sanitary system is located
approximately midway between the house and the garage.
If you have any additional questions, please do not hesitate to call.
Sincerely,
Samu s & Steel )Architects
Nancy L. S elman, R.A.
ARCHITECTS
25235 MAIN ROAD
CUTCHOCUE,NEW YORK 11935
(516)734-6405
FAX(S 16)734-6407
M-1302
BUILDING DEPT.
INSPECTIO"
[ ] FOUNDATION IST [ ROUGH PLBG.
[ j F UNDATION 2ND [ ] INSULATION
[
FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
0477
REMIA KS:
100,0007
DATE B / INBPECTOR2ff-,���A
�
BUILDING uepr.
INSPECTION
[ ] FOUNDATION iST [ ] R GN PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACES CHIMNEY
REM RKS•
DATE 9 �< s _INSPECTOR��
T65-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ j,� U"N
I 1 FRAlII11NKi [ ] FINAL it
[ ] FIREPLACE & CHIMNEY
REMARKS: IQ
za
DATE 9/)--aq7 -INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ j FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ jIySULATION
[ ]
FRAMING [✓ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: �
DATE /Z �L � INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ �ILATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CFIIMNEY
le
REMARKS:
Zy
'ea,- J�E
Ile
459
DATE INS
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CFIIMNEY
REMARKS: D1<-,g C c?,
DATE � '-� � INSPECTOR ,e�����'��jG�
10
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FONNDAI 1014 ( IS'C) it
1"WRIDA I ION (2ND)
---- - - -- - - --- - - - - - -`----
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11I.11MBINt:
INSULKI'ION PER N. Y. _ II
S I'ATTi. ENERGY
CODE
/� j
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------------.._ - - ---- -�--
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171 NAi, I! Iffell.._ ._
_-- -_ - --- ---u __;� - --- x-
AUDI - ---- (OMMT'NS
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9
BOARD OF HKA1 Ill
g i u FORM NO. 1 3 SETS O�.ANS � . .
TOWN OF SOU'TNOLD SURVEY ... . . .qq
. . . • . . ' .
r i BUILMING DEPARTMENT CBEcy t. .Ola. • . . . . . • . . . • • • . • .
,. TOWN IlAld, SIiPTIC FORM .. . . . . . . . . . . . . . . . . . .
2 u SOUTHOLD, N.Y. 11971
1^dgGnEPTS4)49Tr1OLF1 �_ '1'E6: 7G5-1802 NO-1'IFY: �^
19. � P1Ai1, TO: . . . .
19 Permit Pkr. ................ ....................................
Disapproveda/c .................................. .......................................
•................•.......................... .... ....
. jp�/e
ilding Inspector)
APP J,A'TION FOR BUIU)ING PERMIT qq
Date. -uIJIl� . 2`r. . . . , 19. .1.6
U
INSTRUCTIONS
a. This application mist be curipletely filled in lry typewriter or in ink and sulnmitted to tine Building Inspector with
7 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan slxiwing location of lot aryl of mildings on premises, relaticnrsirip to adjoining premises or public
streets or areas, aryl giving a detailed olescriptica of lay,ot of property nust be dracm on the diagram which is part of
this application.
c. 'file work covered.by this aprilication nny. not be cumneoceol before issuance of Building Permit.
d. Ilpoa- approval of this appiication, the IAiilding Inspector will issue a Building Permit to the aiifrlicant. Such
PC.oylit shall lie kept ca Che premises available for inspection throtoicut the work.
e. No Ixrilding sliall lie occupied or used in wlxile or in part for any panrpose wiiaCever until a Certificate of
lkagkarcy shall have ]leen grnntecl fry the Ikulding Inspector.
AL'PIXATION IS DEREBY MADE to rile Ikiilding Department for tine issuance of: a Building Permit purmiant to Che
lknilding 7xw Oriirvmce of tine Trym or Scatliold, Suffolk County, New York, and other applicable Eras, Ordinances or
Regulations, for the constriction of mildings, aokiltions or alterations, or for removal or dernlition, as Herein
descriliecl. 'Ilre- applicant agrees to carply with all. applicable laws, ordinances, liuii]dingIncasing code, six]
regulations, and to whit authorimil inspectors on premises aryl in Ixplure
necessary os ;cticas.
(. f applicant, or m'sole, if: a corlorat i oil)
i `i35
.2235-C��1�1.�.,. I1
Ct�-ch,c�.y�.y.�
(Mailing aoklress of applicant)'
State rdietlier applicant is owner, lessee, agent, � engineer, general contractor, electrician, phonier or milder.
...................................y,..................... ...- .............................................'..........
..--•-
Nave or. owner of premises ..ma k..... 5..obkirrisn............................................
(as ou the tax roll 0 latest deed)
If applicant is a corporation, signature of duly autliori7ec1 officer.
........................- ....................
(Noor: arxl title of corporate officer)
Builders license No.
Pludiers License No. .........................
Electricians I,icei>_se No. .....................
Ocher Trade's License No. ....................
I. location of: land on wliidn proposed work will lie obrie..............................................................
............................ ! '�.. c� ...:................. . -.: �� ..:-
OL
Ibuse Nudier Street Varlet
(knnty Tax Map No. 1000 Section .....117....... mock .---1Q..-.----- lot :.....(0.....,...
fxalxlivisioil ............ ........................ Filed Kip No. .......... Int ..::...........
(Na,v)
2. State existing use and occupancy of .premises aryl interxleil use aol occupancy of pilposerd ccasi-ruction:
a. Existing use aol occupancy -- $ � M Y31 '� 1 .. --G��................
b. Intemleil use arc➢ occurmticy ---Gti�..............•----•----.................................:......
I. Mince of txak (dteck tAtidl afI)licable): R--w lkn'lldinlf ........ .. tnklition .. ........ Al Cer<tt ion ... ..
Ikautir Itauoval ............. Delo[it.!on ............ Other Unk ...................................
' (Iksc:ript ion)
4. Fst.hilatetl /nsC ...3 j 8e)0.............. fee ....... ... .......... . ............. ............ .
(to Ile staid on filing this spill let%[]ion)
'i. Ikoiter of ckaelIing units co each floor
if ckxalinl;, rxnher of tkaelling uniCs
If garal;e, unber. of crus ..l ip.. ..................:.._.....
G. 1f Ixtsiness, cxxnerclal or wixed occupancy, specify natore azul extent: of each Lyle of use....... . ...... ........
t 1 qn 2w
7. Niwe:nsions of existing stnu:Lrnes, if ally: Flout— ._l.J.. . ._.... Itear .... .. ....
it
rk.dner of Stories . . :... ....1 .�'—... .., ... .[� IT
—
I
of Sane atrtwtore with alteratiOns or c,<kli Lions: Front ......�-.E-.. .... Bear .... .. ......
r�77 ff {{ � �
Ikpl It ... .I..�......... [[eight ... ..Dr�.`u .:..... .. lk,rl r of Stories .. ..j 2�.......
It. Dimensiats of enLire lace[ catstrrua:ion: Fnulr hear Depth . ..... ........
He iVjn: M+dner of Stories
9. Size a[ hit: Front: �a . 1.. U.D.... 1?enr ...1 .�?e.<.�. . .. Ikplh- .. ..�.�'1. ...........
01
Ill. Ilene of t\uchase Naae of F000er (leane��r}}..1/.�7,�}��L :�..... .....................
ll. Za to or use dint:rico in tAtidl preaises are sinnatecl .....1.- o ....... ............... ................. . ...... ..
12. Ikx:s puti>nsed cxxtstnx:Ciat violate ally uxtfng law, ordioisue or regal aeia�; . ...no...............
Ill. Will for be regratlecl ......no..........ywill excess frill Ite rc�ikwed Fran premises: YES �]
W. Nares of. Qatter of�pretnises 1�.1�.q��t�tl �KJI(.tit�6'Yvklress .............................. luau: No. ....�..../.�.,.�..�`.,._..
Nine of 9�, 1..'" kiress .z�',e�-�J.T`+�. c�.P)�. �...
rine of Cnluractor ................................... tuklress ... ..... . ... .... ...............Phone Net. .... .. ... .. ..
15. is tills profterty within 3OO feet. of a nidal r,eLlatulY * YES ...X.— It) .. ........
*IF YES, SOl1D%IT) 'RAM 11141SWS IlKlurr IiAY Illi itia tlie).
PLOT DIAGRAM
locate clearly and distinctly all Ixtilding.9, vAtether existing or prolnsed, atul itulicate all sec-I>acic dimensions
flan property limes. Give sfreet Bull bloat t■niner or description according to deed' atxl show street runes atxl itulicate
,Acether interior or corner lot
:ifRlli ()F rYlJ YOILK,
... .. ..... .. .. .. . .. .... . ... ...... . .. ..it:iol; duly hactrn, dep>ses mal sayer that he is the app[scall[.
(Naao of itulividual signing contract)
Fdx)ve tuned,
Ilein the ........ .... .. . ..... . ...................... ... ... ............ ..........................
(Cstut:ractor, ngeuL, corirorate officer, et(:.)
of said (moe-r or anx:rs, atul Is duly Rothorizcd Lo lterfonu or have Ixirfonied Lhe said rxok unit to mike anti file this
appi icatiou; that: at.I stateneots contained in this application are tine to the Itest of his knowledge sullbel ief; atxl
I hot Lhe work will he. perfornecl in the nonuer ret: for lh in the appi.icat:ion I led Lhere tdl.
[;:Bean Lo Ix,f/ore ge this �7
_. .. �-. ...day of ..... L .. 19.. �.. .
Notary Politic ...,....�j '.. .:�t '•--
(Signalitre of AppLica.0
LIMA FORWcH
NftY Public,SWo of New York
MAMA Suffolk County
Term Err kW SW.3.1117
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- - - --T- _ SECOND FLOOR PLAN FIRST FLOOR PLAN
SCALE 114" = 1'- 0" SCALE : 114" = 1'- 0" -
EAST ELEVATION
SCALE : 1_144"=0"��
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- EXIST GIApI�G>4RD.+ da !� tylx ti„onD A�Pugp
FIRST &
`1ArTS P" SECOND
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_ — — - -- - IL - - - - - FLOOR
- - - _ PLANS
NewBUILDING
- • ELEVATIONS
Sheet No:
. 9 s
NORTH ELEVATION SOUTH ELEVATION
WEST ELEVATON 1
SCALE 1/4" = 1'- Q" SCALE : 1/4" = 1"- 0" SCALE : 114" = 1'- 0" o+ I
3