HomeMy WebLinkAbout23926-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25395 Date: 11/26/97
THIS CERTIFIES that the building ADDITION
Location of Property: 135 PINE TREE RD EXT MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 98 Block 1 Lot 7.7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 28, 1997 pursuant to which
Building Permit No. 23926-Z dated FEBRUARY 19, 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to LOUIS E & BARBARA LAGRAND
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N431486 09/12/97
PLUMBERS CERTIFICATION DATED 11/20/97 PECONIC PLUMBING & HEAT.
//uilong In pector
Rev. 1/81
FORM 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
NO Y. 23926 Z Date ............... ... ..1.,�..........................
19. (-
Permission is hereby granted to:
...�!✓ 11j ?'.'..........................................
Q/., . � � ..... ......to ....... ......- ....... IJV .../
�..x.�s.�:�c✓. .....�./. ;.,�%�.... .... .. .... .
at premises located at 3� /�� ®�,.
f/..`!cc...... ................................... /
C14, .i:.. r`C?... ruc. ..................................................
........................................................................ ........... .........................................................................
County Tax Map No. 1000 Section .......1. ii ........ 1Block ......d2l........ Lot No. ....7..✓...........
pursuant to application doted ... ......�`/ .. ........... 19�/., and approved by the
Building Inspector.
Fee 5....1 ..moo.....
..... ......... /;n�s
.......................
..... .... ....
dor
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DF?ARTXENT
TOWN -4,LL
163-1302
APPLICATION FOR CERTIFICATE OF OCC MP,NCY
A. This application must be lled in by typewriter OR ink and submitted to the building
inspector with the Following: for new building or new use:
1 . .-nal survey of property with accurate location of all buildings, property Lines,
streets, and unusual natural or topographic features.
2. Fina'_ approval from Health Dept. of water supply and sewerage-d.isposal(S-9 form) .
3. Approval of electrical installation from Board of Fire Underwriter.
4. Sworn statement from plumber certi`ying that the solder used in system contains
less than 2/10 of 1a 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.
o. Submit Planning Board Approval of completed site pian requirements.
B. For existing buildings (prior to April- 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
L . 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
asons therefor in writing to the applicant.
C. Fees
1 . Certificate of Occupancy - New dwelling 525.00, Additions to dwelling 525.00,
Alterations to dwelling 525.00, Swimming pool 525.00, Accessory building $25.00 ,
Additions to accessory building 325.00. Businesses 550.00.
2. Certificate of Occupancy on Pre-e-xisting Building - $100.00
3. Copy of Certificate of occupancy - .25c,
L. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential
SL5.00�,aCommercial 515.00
Date . . . !`.'Cl�J't . �b.� . . .. . 7 . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Builldinyg�. .'. V . . . . . . . . . . .
Location of Property. . . r.� 5. . . . . . . . . . . . . . . .�lYut .J.!:•.L�N.,. . . . . . . . . . . . . . . . . . . . . .
House No. Street / Hamlet
Onwer or Owners of Property. . ! rJU `F q?"ri� Dla✓rc. . .�-� 1 o��1c`1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Kap No 1000, Section. .. . ./? . . . . .Block. . . . . . .1. . . . . . .Lot. . .�'. �
. . . . . . . . . . . . . . .
Subdivision^^..�. . .Q. . . . . . . . . . . . . . . . . . . . . . . . . .�.}. . . . .F/iled `?ap . . . . . . . . . ./....jLot
. . . . . . . . . . . . . . . . . . . . . .
Permit No. .d, �: . .. . . .Z .Date Of Permit. .46J��,1.�� . . .2pniicant. !. ! .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .UnderwritersApproval. . . . . . . . . . . . . _ . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Reeuest for: T_amvorara Certificate. . . . . . . . . . . Final Carticate. . . . . . . . . . .
.eo
Submitted: $ . . . . . . . . . . . . . . . . . . . .
' -S3 bOU }zPnLIC._NT
D
roe°S' o�
!D1997
Town Hall, 53095 Main Road y = = ragtj�(p)p�§I,5i1823
P. O. Box 1179Z.
+- T .L
Southold, New Yodc 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE: /*V -;f. 97
Building Permit No . -z
Owner: Zdv d/
(plea.-Ye print) q
Plumber: 222/1/C. 121, //l//
(please print
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
�
�
(P1 ers Si nature)
Sworn to before me this
oZo day of IJoU . , 19'1?
Notary Public , Countv
c
tZ �'
IRIS R.BEGORA
Notary Public.State of New Yak
N'a.0224C44751
0d'Cwad in Suffolk County
udu;si
CodExpuesJamary31,19
o��gOFFO(�-c
O
Gym
Town Hall, 53095 Main Road y x Fax (516)765-1823
P. O. Box 1179 u- nr Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
Matthew Hallock
4365 Wells Road �i 1 IQ97 j
Peconic, NY 11958
BLDG DEPT.
Re: Lagrand - 135 Pine Tree Rd. Ext, Cutchogu T WN rQn"TH
SCTM#: 1000-98-1-7 . 7
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
/ xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 23926-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
oSur:Fotk
Town Hall, 53095 Main Road y = Fax (516)765-1823
P. O. Box 1179 Telephone (516)765-1802
Southold, New York 11971 Oy • ��
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
Matthew Hallock
4365 Wells Road
Peconic, NY 11958
Re: Lagrand - 135 Pine Tree Rd. Ext, Cutchogue
SCTM#: 1000-9B-1-7 .7
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 23926-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ /FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE-1 INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS.
DATE J I / INSPECTOR izutmc �A
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST OUCH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[MING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: C
r
G
DATE / INSPECTOR l
Ora
765-1802
BUILDING DEPT.
INSPECTION
[ F DATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
vk.
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DATE ,�8 7 INSPECTOR
3
THE NEW YORK BOARD OF FIRE UNDERWRITERS 7rs ?
1 Oil.).0121 BUREAU OF ELECTRICITY 7� 7
II— 85 JOHN STREET, NEW YORK, NY 10038
Date SUMMER 12,1997 ApplicationNo.onfile 7. Y4"?Iilr4I1!:!7 1# 131�t
THIS CERTIFIES THAT
only the electrical equipment of described below and introduced by the applicant named on the above application number in the premises of
UMIS LA CRUTI, PINE TREE PStCOTCHOGUE, NY
in the following location; ❑ Basensent d let Fl. ❑ 2nd Fl. OUT .4ertion Block Lot
was examined on SEPTEMBER 09,1997 andfound to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES IINCANDESCENTJ FLUORESCENT OTHER MMT. K W. AMT K.W. AMT K.W. AMT K.W AML I H.P.
4 4
DRYERS I FURNACE MOTORS I FUTURE AFPUANCE FEEDERS S►FCIAL REC'PTTIME CLOCKS BELL UNIT HEATERS MULTI-OUTLETI DIMMERS
AMC K.W. OIL H.P. GAS H.P AMT. NO A W.G AMT. AMP, AMT. AMPS TRANS. MMT H PNSYSTEMS
0.OF FEET "T.t. I WATTS
SERVICE DISCONNECT 140.OF S E R V 1 C E
MITER No GF I:c coND. A.w G. A.w.G - A.w c
AMT. AMP TYPE FODIP. I X 2W 1 X]W ]X 3W ]X Kw PER) F`CIM&1DNO.Of HI OF W-L Na.Of NEVTRAR OF NEUTRAL
OTHER APPARATUS
PADDLE FAN-1
!-ROTORS; 1-F H.P.
G,F.C.I.•-3
11
PAUL R. BURNS LIC.# 1897-- INA
l_ LPO BOX 1061
SOITPHOLD, NY, 11971^0932 GENERAL MANAGER
Per
This cartificote must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentiah.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
If lllll<Il IIP IIhnLI11 -1 ... . . . . . . . . .
- _ FORM NO. 1 3 SETS 0F�{'t.nNS. . . . . . - • - -
. . . . . . . . . . . . . . .
TOWN OF SOUTnvLU SURVEY .✓. . . . . . . .
. . . . .
BUILDING DEPAR'tMRN'f CNECReZ.�.ff. • . . . . . . . . . . . . . . . . .
r� TORN I1At.1. SEPTIC FORM . . . . . . . . . . . . . . . . . . .
;;,ON28 . _� SOUT TOLD, N.Y. 11971
TEL: 765- 1802 NO•l'IFY:
MAIL TO . . . . . . . . . . . . . . . . . .
19.C�.� Perm!L No. .............................
D;.^.approverl a/c .............. ..................... . ............. ..............
.............................................
.... ..... . .... . ....
(Ikni Inn _elor)
APPLICATION FOR BUILDING PERMIT
DnLP. To-." R. . . . . , 199
INSTRucrloNs
a. 'This application mint be completely fillccl in by tylxx-Triter or in ink aril sdxmitl:ed to 11re Building Innporlo
3 sets of plans, nevornte plot plan to :,tale. Pee ncconliny to schedule.
b- Plot plan sixuwing location of lot and of Ixrildings cn premises, relationship to adjoining premises or Ixiblic
streets or wrens, and giving n detailed description of InyouL of property must be Olrmm on the disgran which is )vnrt. �
this applirntion.
C_ the work coverrcl Iry thin npplicat:irnn vey not Ire rcrs'nocxl before issnnve of Building remit.
d. Upon approval of this npplication, the Building Tnspector will issue a Iluilding Permit to the applicant.. Sir
permit slrnll be kept or the premises avaiinble for inspection throughout the work.
P. No Ixrilding shall be occupied or used in whole or in pvnrl. for nny pin-pose whatever until a C'•erLificate of
Occ-npnw;y :.halt. Innen been grated Iry Ute Tknilding Inspector.
APPI.XATION IS IIEIs HY WE to the Building Departrmnt for the issance of a Building Permit pormnnt. to the
Building 7<ne Ordia-MCP Of Lhe Town of Southold, Suffolk Canty, New York, sixi other applicable Laws, Ordinances or
Prinuinticns, for due construction of inildings, wklitlots or alLerntions, or for rtxrroval or demol ition, as herein
described. lite applicant agrees to comply with all applicable laws, ordinances, building wile, horsing code, awl
regtllat ;aril:
ions, anxl to awLlnrized inspectors on premises awl in inildinp for necesss�(Jary ia
n. lirs,./J
(Siginture of nppl icon[, or nam, if a corprnat.ion
Nil ing acklress of appl.irant)
Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricinn, plumber nr Ixti
r...............................L...................................................................
.
Nam of Owner of premises
(as on the tax roll or Intent deed)
IF npplicant is a corporation, sigivitom of (Ily aul.lxrrized officer.
...............:..........................................
(N.-Pr nixl title of corporateofficer)
Builders License No.
Plumbers License No. .........................
AlecLvicimns License NO. ......................
OLher Trwle's License No. .....................
I. Location of lawl on winicli prgns(d work will lx done...................................................... ......
...... .5.................P,�e-.Tc� R�.4xvl." ........................................--.............
Ikxuse Mldrer Streett Wx"Iet
C:cxnty Tax Mop Ila. ICXX) Section ......1. Bl cx"k .... Icrt ...7T..7
Sulxlivision ...................................... Pi Ied Map No. ............... tat ...............
(N.-1m)
7. slate existing use and o-.cupuury of
p-reuse-s Onrxl iateixled usp arxl cxtagp�loy of proposed construction:
a. Existiog urse incl occupmxy ...sJ.+ (/ .. !- j...... ..
b. lntetxkvl urs aril occmupntwy .............................................................................
,Rt TTCO2.i7F.':`^9
IIuY rn,a✓}e+;!r'2.oil:s.`+rrr•KN j
y:rr;.w.1 rFuri`i�2 r;±tt`ut,rrr,.i"i
tcnCii:CAO?,FC•.t;rA
.t+~YEWr.Un.C,ni snj
I Rhone til` nark (e:lxxk kAni[lt algdicah e): N-m Ikiildina ... .. ... . . luklit ion ... Y.. ..: AlleraLiun .. ... .. . ..
14e1wir ... ..... .. .. fiemrnral ..... ... Da"A iLiorn ....... ... .. Outer Wotk
/Mvim............ (Detieription)
I,. I: t.tn
akiteil Omt ..�.�1 dW
^..... fes ... ............................. ........ ... ...
(lo kx: lucid of filing [ilia applicati[xn)
5. If thin Iing, uinlxer of (6aelI iry, units .... ... ... .. Uldier of A,el Iilia [arils at each floor . ... ... .........
If aarage, nxanlier of Cara ....... . .. ........................ ... .
6. If 1xish"s, mui ercial or ntixtxl occulwtwy, specify nature will extent- of each tylie of use... ..... ........... ...
/. Niaxensiom of exist-ilia sLnx:Lw es, if ally: Pi-cmi . .... .... ... .... Itear ... ............ Dulith .. . .. ..... .......
11[eials: . ..... ................... Mdxer of SLoriLS ..... .. ............. ..
I)ineusiats of slue stricture with alterations or ixklilious: Front .. ... . . .. ...... hear ...............
lleplh .. .. ...... ..... ..... Ik-iljtt ... ... ... ...... .. ... Rolle'r of Stories .. . ....... .....
it. NimCaBioe] of entire oero; axistr(x:l-iot: I''rtxtt . ... .. ... ....... Rear ... ... . .. ...... Depth ... ... ........
Ileiahl. .. ....................... UMI er of Stories .. ..... .... ..........
9. Size of lot-: Float ... ....... .. ........ Itear ..... ............. .. Depth .. ... .... ... ... .....
10kite of tiarcha:;e ... ... ... ............ 11.xte of Poutx:r Otter .. . .. . .. . . . .............................
Ii. Zxxie or ose district: in tildcin premises are sittwteil .. ......... .......... ... ............................... .. .. ...
12. lkses prolxauxt coiMlot:tion violate any "dna tau, ordituax:e lir regulattoll; . . . M?....... ..........
11. Will lot. Ice regrxled .....hQ.. .........
_Wi�lJl extcess fill lie reu7ved fr(An pte.aises: YES
M. Naves ()I` (kmter of premises ..1':4v.1:l(a-,, F'!'a........ /nklress . .. . .......................... liux x: Fki. 73y-•S`�y
More of Ar iilect Mireas ........ ...................... litooe li). 76�5-�ap
Naar: ol` Olotractor .ft'.?!::`f!':...!:+4: `%�........., Aaklress li tome lk>. 765-6/r
h. is this prolxerty within "i(><) feet of a tidal t,xalatxll A YM ...... .... 91 ..........
All.. Y1i3, SYII 1m) 7(A•M 'IRlisim; mimic k1AY lac Ia1Xll IUJ).
L'l.(t'r IIIAGUAM
Iticate clearly aril distinctly all Ixniltliogs, whether existing or proliosed, will inlicaLe all set-Iwck dimensions
1'14.a prulxaly linxs. Give street and block raudwr lir (kescripl ion according to clod,-anl fdvw street ones and irxlicate
idtellier interior or corner lot.
S KIP" (H? N31 Y(N[K�+.
SS
11111NIY (M .. .C.l�.1...V.-....../..
..... ............... ... ..1xAilg duly rwonn, delx)sces atxi says Ihat he is the applic•aul
(Non: of inlividual signing ronlracl)
alxrve auaed,
Ikei:; (lie ............. ................ ...................................... .............. ..
((Dntrartor, agent, corlic ate officer, etc.)
of said (limier or cuo:rs, mitt -is duly aulhnriZe(I to lxerfmw or have lx:rfoiiwd the said wick mit to uedce aril fill. This
app! kation; Ilial. all slalerents conlaiiied in dais algal kation are title Lu the liest. of llie; luxuleilge. aid Ixel ief; mil
that Ole ' )Il< will Ice lx:rfontxxl in the acuaxir tun forllt in the appl icalAon filets li(erewitln.
:kx)m to lxerore ae this
_ ppi
....2041........Clay of:
ikd ury Ihihli`:.Y.r......... .. �5 .. /�
yy ..!.......
1 ROSERT1.SC JR. (Siaualure of Applicant.)
Notary F &r.Stan Naw Yorll
Qualified to 3uff County
No.01SC472
Term Expires May 31 _,,.Q L
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H+• UNAUTHORIElO ALTERATION OR ADDIS
10THIS 5URVEY,IS A WOLATION OF
1 SECTION 7209 OF THE.NEW YORK STI
v RDUCATION LAW.
K
COPIES OF THIS SURVEY MAP NOT
THE LAND SURVEYOR'S INKfD SEAL 04 OR
EMBOSSED SEAL SHALL NOT 9 CONSIt
TO BE A VAUD TRUE COPY.
/.\�t�ii. • .��.'a'i,1AA.L5A {G.G tlLti Vh`[!(711 a;. I? .,tJ nt�.t•.N'(L'—L•fJ T071-tt. AMEt' CAM GUARANTEES INDICATED HEREON SHAL
N T I't L E LI`35. G'..,�/,�, �v�•}.ry /1.1•'{f�1 7C> 7L'I{.' � ONLY TO THE PERSON ED0.WHOM iH
9EJL7 i 1':+J trizry' C 0 K N 2;R oft pmLAGt14jc- -J:�� - - ' � 15 PREPARED, AND ON HIS BEHALF TO I . 1 ''•"r •1Y/t 'T' N K. TITLE COMPANY, GOVERNMENTAL AGE
Y; <, T v :L.I iT•4 L:•, r'{. " f' tti 67Lf/1 Q:A1r 1 { ,A ��rJ. LENDING INSTITUTION LISTED HEREON,
TO THE ASSIGNEES OF THE LENDING I•
.1 . . 'v. j l S ., �.��t , ( . l.+• TO ADD GUARANTEES ARE NOT
OWNERp1110NA1 INSTITUTIONS O0.R SU
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PLUMBER CERT/F/CATION h, ' fr
-_ --- _ ON LEAD CONTENT BEFORE OCCUPANCY 0R „ " I, Lit,r it
- - - CERTIFICATE SOLDER USED IN WATER OCCUPANCY
I Sl Y
USE IS UNLAWFUL
— - SUPPLY SYSTEM CANNOT WITHOUT CERTIFICATE
-
EXCEED zi1ooF1%LEAD. OF OCCUPANCY 7" l'
E [
If oopper tubing Is used /," V "' P""lP'It
for water distributing E. 419 /7 , -k J3 z/rz� Aw ► ,dDCN1wM !� �r, e, [ �I
system:piping shall be
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