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HomeMy WebLinkAbout24474-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25382 Date NOVEMBER 25, 1997 THIS CERTIFIES that the building DWELLING Location of Property 4055 WESTPHALIA RD. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 13 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 9, 1997 pursuant to which Building Permit No. 24474-Z dated NOVEMBER 10, 1997 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 HEATING SYSTEM IN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BARBARA RAACKE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H057103 - SEPT. 26, 1997 PLUMBERS CERTIFICATION DATED N/A '7zool 2 Buil ng Insp for Rev. 1/81 i FORM No.3 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) Date.....NOVEMBER.....10........................... 19..g7.... 24474 L Permission is hereby granted to: BARBARA RAACKE .......................................................................................... PO BOX 816 ......MATTI,TUCK�NY...11952...................................... to.....INSTALL .A..NEW..HEAT,I NG„SYSTEM,.AS..APPL,I ED..FOR,,,,,,,,,,,,,,,,,,,,,,, .................................................................................................................................................................. ... ...................I..................... ............................................................................................................... .................................................................................................................................................................. ........... . ................ . ................................................................................................................................ at premises located at................4055 WESTPHALIA RD MATTITUCK ............................................................................................................... . ................................................................................................................................................................ County Tax Map No. ....4.7.3138.9 Section AA1 i............. Block ,...0013,._,..,,, Lot No. 018................ pursuant to application dated ...OCTOBER,,,,,... 9...................... 19.... 97„ and approved by Me Building Inspector. Fee$........75.00..... ........................................... ►... ............ Buil g Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CiRTIFICATE OF OCCUPANCY A. This application must bye 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 17 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: Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 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. Certificate of Occupancy on Pre-existing Buildi.ns - $100.00 Copy of Certificate of Occupancy - _ -25'C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .199 .7. . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building.),.. . . . . . . . . . . . . . Location of Property. V\ .� A.. ... . .� +Q. . . . . . . . .�1�AT'T.�.TU��". . . . . . . . . . . House No. p Street Hamlet Onwer or Owners of Property. .©ARJ?- ?R41S� . .P-AN�CK".IC. . . . . • • . County Tax Map No 1000, Section. . . 3 . . . . . . .Block. . . .1.3. . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . ?ermit No. . . . . . . . . . . . . . . .Datte Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . .NZA . . . . . . . . . . . . . . . . . .Underwriters Approval. W/N . . . . . . . . . . . . . . . . . . °fanning Board Approval.NIAN. . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. x. . . . . . . . Fee Submitted: 5 . .100.. . . . . . . . . . . . . . . . . . . . . . . APPLICANT A T THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE I 807984 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 BEEMAN MAGMAS Date sEFTE1'`1BER 26,1997 Application No.on file 1.4720697/97 H 4-057103 THIS CERTIFIES THAT p only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of BARBARA & ROBERT RAACKE, 4055 WESTPHAILA, RATTITUCK, NY in the following location; El Basement ❑ Ixt Fl. ❑ 2nd Fl. Section Block Lot was examined on SEPTEMBER 19,1997 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. 1 K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. M.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE PElDERS SPECIAL REC'PT TIME CLOCKS "LL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL M.P. GAS M.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. M.P. NO.OP FEET SYSTEMS AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP. TY►E - MITER EQUIP. CC COND. A.W.G. NO.OF MIAEG A•W G. NO.OF NEUTRALS A.W.G. EQUIP. 1 A'2W 1 0 3W 3 13W 3,I AW NO.O PER! CC. ND. OF MI-LEG OF NEUTRAL OTHER APPARATUS: HEAT & HOT WATER-1 OIL BURNERS-] U ,/ *NO VISUAL DEFEM "An ele <rical survey has been Mn de bf the__eY4�- 4 electrical equipment in tine premises indicated." "No obvious -unsatisfactory condition was found. L L i BARBARA WOKE V GENERAL MANAGER BOX 815 HATTITUCK, NY, 11952 ftpe This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be 1&ntified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL ( ] FIREP&gCE & CHIMNEY REMARKS: A2ZI 4 DATE �� INSPECTOR .u� D LS BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . OCT – 9 TOWN OF SOUTHOLD SURVEY. . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . 'toKM.DEPT. SOUTHOLD, N.Y. 11971 -"M OF S0UTI40LD J TEL: 765-1802 NOTIFY: D �� CALL . . . . . . . . . . . . . . . . . . Examined. ....., 19 Z � MAIL TO: . . . . . . . . . . . . . . . . . . . Approved....1.�.., 19/..� Permit No. ............. .................................... Disapproveda/c .................................. .................................... etr(InidiI pol � APPLICATION FOR BUILDING PERMIT Date. . . . . . . . . . . . . . . . . 19. . . . INSTRUCTIONS a. 'n-tis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector witt 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 application. 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 issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throtAgJiout 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 IiEI - MAIZE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Iaws, 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 build' for nece-sssaryyyi�n ions. ..... .. .e .���•.. ............... UNDERWRITERS CERTIFICATE ( ignature of applicant, or name, if a corporation) REQUIRED (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...O.tvA/. ?:.:..................................................................... M�TEO. > A ACACe Name of owner of premises fa ..................'. '... �2�0.. (as on the tax roll or latest deed) •�' AT NOfN� 0 if If applicant is a corporation, signature of duly authorized officer. 7-IM 9 AM TO 4 PU /OR THE � — ............................•--•-•--..................... 1 - '� MpINRED (Name and title of corporate officer) pmv��110111 _. AOm - Nam •A,IIIIIIIMMIG _. 104 Builders License No. ...N./.A'................. 4. FINAL - N MUST Plumbers License No. ...lR Rv,SIu s BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET Electricians License No.Npp....&OJU.G.G ...�N 8tt41A1E3S THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION S ENERGY Other Trade's License No. VIA.............. CODES. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done.......................DESIGN.OR CONSTRUCTION•ERRORS ... ... .... .. . ..., X..,t . . . -:........................._... � � i ... House Number Street Hamlet Canty Tax Map No. 1000 Section ..11�......... Block ....13 ........ Lot ....ff ........ Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy ofpromisespromises and intended use and occupancy of proposed construction: a. Existing use and occupancy ../�.G�.a/. T �...C�K G.......?:.-199DAMM....(...4A.Ti.... b. Intended use and occupancy ...SAME ....ASVE........................................... Q 3. Hature of work (check which applicable): New Building .......... Addition .......... Alt ation Repair ............ Removal ............. Demolition ............ Other Work 11AVIS77AN � /Q�..�r.. (Descrr t 10on r/gA77u&• m0 fill 4. Estimated Cost ..:300A.:............. fee .................................. (to be paid on filing this applcath'1oni+� 3 5. If rkaelling, nanber of dwelling habits ...../...... Nuuber of dunelling units on each floor ..l............. Ifgarage, number of cars ...................................... 6. If business, mm►ercial or mixed occupancy, specify nature and extent of each type of use.......... 7. Dimensions of existing structures, if any: Front................ Rear ............... Depth ................. lleiglht ......................... Number of Stories ...................... Dimensions of sane structure with alterations or additions: Front ............... Rear ............... Depth .................... lleigl►t .................... Nnber of Stories ............... 8. Dimensions of entire new construction: Front ................ Rear ............... Depth .............. lleih4ht ......................... Number of Stories ..................... 9. Size of lot: Front .................... Rear .................... Depth 10. Date of Purchase ............ Kane of Former Owner .V&FR �EE.T.TE....L E-V 40e It. Zone or use district in which premises are situated ....Ql?�.�.)D.G*.J.J*Je..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .W..N.E....Z'P...A4X. KV L&LGM-b 13. Will lot be regraded .J&/A.............. Will excess fill be removed from premises:/V�A YES NO Iii. Names of Owner of premises [ ARASA ,g..jeMcar. Address 34...4Nk3 A.R'*.... Pfione No.u/814AI.. Name of Architect- ...NIA........................... Address .............................. Phone No. .............. Name of Contractor ..#/A........................... Address ...............................Phone No. .............. 15. Is this property within 300 feet of a tidal wetland? * YES .......... NO ../YQ.... *IF YES, 901MKHD IOWN 1IlUS'1MS PEitlrf MAY BE MgWRI-. PI.OT DIAGRAM locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-baric dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 03T�ON to OSA r A T143UT MM 006Njf 1 W0" 14T MA &" & Qf MA it Mt-OK 03A1tJi01M 0 • i�o I t 11 Nowal stntF I1X@UUfNt •f 't 1lG��t�Ay1403 • JIIiAt!k .i 'M I 3JA 8 FtO1T FiT2N00 .1JA l4-4 T ...................being duty swum, deposes. and s�i s that' he is the appl.icanL (Nano...c�G. 1' � '51 .10 ���{{'�. oa— . H ` . h 3 .dxrve nut<ht�ci� n�+ � }t3N;'e'.k1t?iUU , " 1c��317 LL Ileis the AoI '1 4.... .......................................... ............ (Ccn►tractor, agent, corporate officer, etc.) of said saner or (hnhers, and is duly authorized to perform or have performed Lite said work and to make and file this appl icaLio►h; LhaL all statements contained in this application are tnue to thebest: of his luxvwledge and tx?lief; and that the work will be performed in the nonner set forth in the application filed therewith. %K)rn to be cera me Lhis .......... k ....day of iz Notary Public .. ............ .�G X:... ....... HELENE 0.HORNE (Signature of Applicant) Not..ry Public,State of New York No.4951364 Qualified in Suffolk County C;19Commission Expires May 22,19 LW- R MAP AT wEST.Pt4P SIA AVENUE- — - j ,57�'o4dOE. ►58.80 <1665-45 M.YO'J 3d3 AVE.-- TOWN OF 5OU '-:G° r" 'o 4tX LLI \, N lu 3, V i A5 SURVEYED MAP. 10 11989 _ i1FE=Cd�:T)W-1,0AP. DATA IOW-1 13.- S9e LIG.LAND SrORVEY0R5 - GtzEEkPG({' , N.Y. .9 U IL fn J.. ■ [ LAI x ' �. 68. and 68V Oil-Fired Boiler Manual r Includes: • Installation • Start-up Service • Parts 68 BOILER ` REAR FLUE OUTLET 68V BOILER TOP FLUE OUTLET AD ALL INSTRUCTIONSBEFORE To the owner: Installation and service should be performed by qualified contractor, To - all instructionsboiler for Any claims for damage or shortage In shipment must be filed immediately against the transportation company by the consignee. Part No. 550-110-494/0487WP