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HomeMy WebLinkAbout23705-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24994 Date APRIL 18, 1997 THIS CERTIFIES that the building ADDITIONS Location of Property 100 OAK STREET MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 141 Block 1 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 9, 1996 pursuant to which Building Permit No. 23705-Z dated SEPTEMBER 30, 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 ADDITION & SCREENED PORCH ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN R. & DOROTHY VICTORIA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - APRIL 7, 1997 PLUMBERS CERTIFICATION DATED MARCH 5, 1997-LAWRENCE TRAPASSO Bui ding In ector Rev. 1/81 FORD[ NO. I 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° 23705 Z Date ...1. :....�..�.......................................... 11 Permission is hereby gra ted to• .?�... ... . .....��.. . ........................ .01.o.v..... ..... .:............................... .... :....... ...a..�,�.- ............... to ..... ..... ... .. ...... .. .. . . ., .. . ...... . .. .�, ....... ... ... .... PA.9 .. . .. ..... . . . . '..f / ..�.�. . atpremises located at .147.1D...... ........ .. t... w.................. ............................................................ ..................................................... .... .� .............................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ...... ?/...... Block .......f........... Lot No. ...�/............... pursuant to application dated '.... 1 ., and approved by the Building Inspector. Fee 5...1 .. .. . dIng Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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 sewer age-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 existing buildings (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 Buildinz - $100.00 3. Copy of Certificate of Occupancy - .25e,. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . .. . . . . Old Or Pre-ex /isting Building. . . J .. . . . . . . . . . . Location of Property. .. . .U.... . . . ...C.) . .. .��.�. : . . . . . . . . . . . . . . �� �. ✓7.0 G. . ... . . . House No.� Street Hamlet Onwer or Owners of Property.. .. ..`. . . . .!�:.. . .`DDr�!.. ./. . . ../L rG. ... . . . . . . . . . .. . . . . County Tax Map No 1000, Section. .!'/./. . .. . . . .Block. . . ./ . . . . . . . . . . .Lot. . . . . . . . . . . . . . .. . . . Subdivision. . . . . . . . . . . . . ... . . . .. . .. .. . . . . . . .. .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . .. . . . . Permit N0.2) J (� . . .Date Of Permit. . . . . . .Applicant.`!'L;/� /V. .t :�.�'�`�� •`•'•'•C v� � Health Dept. Approval. . . .. . .. . . . . . . .. . . . . . .. . .Underwriters Approval .':S . . �;; I y q• .V.7 J Planning Board Approval. . . .. .. . . .. . . . . . . . . . . . . . Request for: Temporary Certificate. .. . . . . . . . . Final Certicate. .` . . . . . . . �, `L Fee Submitted: $. . . . .. . . . . . . . . . . . . . . . . . . / S APPLICANT r Town Hall, 53095 Main Road '; Fax (516)765-1823 516 hone Tele 765-1802 P.O. Box 1179 P ( ) Southold,New York 11971 1 '> '^l OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: Buildi Permit No. Owner: ,e .41 (pleas print) Plumber: �i4uJ�L.f1C -Cl-so (please print) I certify that the solder used in the water supply system contains 'Less than 2;1C of 1% lead.. '(Plumbers-sig ature) Sworn to before me this day of/f L 19f,7 Notary Public, Pf �County KENNETH A.MIONE NOTARY PUBLIC,State of Now York No.01110115040174,Suffolk aT Tenn Expires March 6, 1 7ss.isos BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: 00 DATE 3113A 7 INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] �ROH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ j FINAL [ J FIREPLACE & CHIMNEY REMARKS: r ��:���-�-.✓+? �n T.J'irf n DATE INSPECTOR a3 �os� suauINa DEPT. INSPECTION [ ] FOUNDATION 18T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: DATE INSPECTOR �� T65.1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARI 612?� DATE � INSPECTOR �""" 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ �NAL ��`L2.liw�) [ ] FIREPLACE & CHIMNEY / REMARKS: DATE `T �� g INSPECTOR NIEh.D' lWSPECTION REPORT DATE COMMENTS --------- ------ -------- ---- H�` FOUNDATION —( I ST) II il-----_— -- — --- -------- , ii m— ii Im----- ii FOUNDATION (2ND) ---------- FOUNDATION OND) ________I --------_— -------- ------- ROUGH -- ROUGH FRAME & PLUMBING II _JI -- -It 4 INSULATION PER N. Y. -- jj -- STATE ENERGY li I CODE It u--------ii —It — — u II ii II a &,yz u II FINAL. a II ---ADDITIONAL COMMENTS: C=7 -- H BOARD OF HEALTH ' . . . . . . . . FORM NO. 1 3 SETS OF ANS . . . . . . . . . . ' TOWN OF SOUTHOLD sulmY 1 . 9 BIJI1.DING DEPARTMIiN3' CIIECR * 20 . . . . . . . . . . . . . . . TOWN IIAT.L SEPTIC FORM . . . . . . . . . . . . . . . . . . . . BLDG.D"j. SOUTHOLD, N.Y. 1 19 7 1 TOWN!0'_SOUTHOLD TEL: 765-- 1802 NO'1'I FY:a gg'L1'f 19 �� ....,.n.m�...�ti. ,.r GJr CAI.i., 1?x;xniixxl. 19.! er MAIL 'ro: . . . . . . . . . . . . . . . . . . . . Approved— _f.. ....., 19.71!7 Permit No. ................ ..... ............................ Disapproved/a/c .................................. .................................... ...................................................... (Ik,ildinb Ins .ctor) 1 APPLICATION FOR BUILDiNG PFUMIT pp// Date. . . . . . . . . . . . . . . . . 19. .7. 50 I Ns'rROC'riONs a. 'This application mist be coil letely Filled in liy typewriter or in ink aril sulxniLted to the lkiilding Inspector with 3 sets of plans, accurate plat plan to scale. liee according to schechde. c b. Plot: plan showing location of lot aril of lxrildings of premises, relationship to adjoining preinises or lxihlic streets or areas, atxl giving, a detailed description of laycxiL of property rust lie dr.nni on the diagram which is part of this application. c. 1lie work covered by this applicatiorn very noL be comirnced before issctance of iltrilding I'ernit. d. lllxxi approval of this application, the iliiilding inspector will issue a iltiilding, Permit to the alifoicarit. Such ix-nnnit shall lie kept cxr the irrclnises available for inspection thrcxiglxxit the rarirk. e. Nci Wilding slialI lie occupied or used in whole or in part: for airy ptirpose whatever tintil a Certificate of Occiiii.mx-y slial l have been granted Iry Ilse lltti(ding Inspector. APP(UX11(11 Is IEM,15Y MAIC to the ihiilding ileparLnxnt for the isstrarWe of a Wilding Permit ptirsivnnt to the 1kii1dinig 7Axie O"Iinatx.e of: the Tcxnn of Stxrt.lxild, Scrf.folk Uxmly, New York, and other alypticable isms, Orrlitinnees or Regnlatiots, for the constriction of Ixtildings, atklitions or alterations, or for removal or demlition, as herein described. 'Ilie applicant agrees to couply with all. applicable laws, ordinances, building code, lnoising cote, atxl regcilaLiorns, aril to admit mitltorized inspectors mi premises aixl in lxi' lira; for ne.cess.ry inspeclitxns. .................. (Signature o . alipl icant, or Wane, if a corporation) Wailing mklress of applicant) Stale wlietlier applicant is owner, lessee, agent:, architect, engineer, general contractor, electrician, phinber or Wilder. 1.1V'G�j ............................................... .....,................................................. Nance of owner of premises �! .�.Ii..�............OT.j .........T��'�.......................... .................. (as on the tax mll or latest deed) If applicant is a corporation, sigriature of duly aul_horired officer. ......................................................... (Manse aix] title of corporate officer) lhiilders License Ab. T ................. Phiribers License No. ......................... Blectricians license No. ..................... Other Tuxle's i.icense No. .................... s .. d �o rTo7✓ �l✓�. I. i,cxaticwl xt of larxl on ►icln proposed work will lie cbite.. .... .... ..X.............. ............................. .... J00 ...................�>.1.i.K.....s T :..,.....................r�?�.TTj' 7-4" . :..>.�. (louse Nuttier. St/r//J ee LIlanleL Crxinty Tax Map No. I(XX) S1 ection 700...... III o k .��� ...... Iril' ......... Stilxlivisiot ...................................... Filcxl Kip NO. ............... l.ciL ............... (N.-rtrie) 2. SLate existing use aix] ocr-rgiaix-y of premises aixl intemled use a1x1 occ-Upancy of Propose(] construction: a. i�xisting use arxl ocent-kincy ...gulivet-...0(7c a hC y /1 f'S/c��fU7;4 -,.l................ h. Inteixled rise aix] occupaixy .0lve.... GC G/�q�r G e/t T� , L . 1. R-li )e of wurk Glieck widd► al,!)licfdrle); Nca4 Ik►ildIni; ..... ... .. ArkliIiofi Al Itca>i►Ir Itarryval Iki)oIi11ion ............ Other Wo►k ... . .. ..I ...... . ....r. . 100 (Desc:rlpticx)) `1 Ui............... 4Est. luk►led (bsl: ... . fee ....... ........... .. . ............. ...... ...... ,/ (lo be paid oil fi I ing this appl icaticx)) i. 1f (kxaling, rxnf.l)er o (Irx:ilil% units 1,7 4.1.. Ilnl)er of d\+el16% unlrs ox) each fl(x)r ........... .. ... If garai;e, ►xnlx:r of care 6. If Ix►ah)ess, rxnn)ercial or arix)e(I (x:r_ul)arxy, specify nal.ure mxl extent: of each lylx: of use........ .. . ...... ... .. 7. Ilimx:nairxu; of exisring strlxaures, if any: Flow:. . ... .... . ... ... (LearIkptlr .... . ......... . . ........... . .... 11eil)il: . ......... ............... Radler of Stories ..... . ....... ... . ... Uinlensi0os of s(rre st.rex:ture will) alleratlrx)s or (wklitions: Front . . .. .. Rear Ik:plh .................... Ik.1i;l1t ... ... .. ... .. .... . .. UA)er of Storks .. ... .. .. ................... .. 0. Diur.nsi(xry of enl:.ire rx.w'cmatnxa lcxi: Fr(x►t . . ....... ... .... Itear Ikpll► .... .. ........ lk:igl►l: ......................... Mn )er of Stories .. ......... . ..... ... . 9_ SiW.e of lot: Floxd: ... ........... ...... Rear De-Ill lr .. ......... ......... M. IWe of NuchasL. ..................... N%nr: of Former (A.nrer ..... .. .... ..... .. . . .......... .......... I. Mike or use district in wt)i4j, preluises are a•ttrwted ....... ... ........ . .. ...... .................. . .... . .. 12. Ikx:s prolit)ued ccx►al:rlx:l:iex) violate any zcx►ing Irxr, ordilralx:e or rel;ulal.i(x): . .. .... ................. H. Will lot: he regraded .................... Will excess fill lie 1,110ve(lJra�in premiseyys�; /YES{{ ND r Ifs- Rai" of Woer of pranises V.Q�i �"+?rdTfj y �jGr/� cklress kA.(//'A ..,2-- Q-C IY." 1( x� Nolk-417�<,,-... Kim- of' Architect • ,•a . STp�fhJ4/✓ � 2 / . ... Nkiress a�5. ✓. I N a...... t1x�(� No• 73 N:rne of Contractor ................... ............. .... Alrklress ......... ..... .. ............ ...Pixnte No .. .. .. . .. .. . Is this prolx:rly within W) feel. of it tidal )aetlarxl? * YES ........ .. Y` *IF YES, 8(11I111(An 'ICINN 'I1t1IS119ss LTIif11'1' !NY Igr Illl J). PLOT DIAGRAM Locale clearly six] distinctly all larildi)►its, wl►ether existing or prolx)sed, aril i)xlicate all set-hack dia►eosions frcn► property limes. Give atreet and block maker or (lescription accotrling Co fleet] aril silm street ruraes arxl irxlicate edrelher interior or corner lot. I .r� "V Y(MtK, SS lxalrnY W �..... e✓ . .�.... .. . . v �• •-• ••�•�• ` .Ix:ing duly m-Ami, (lelx)ses 111141 a(ryc) lh11C he is the applicant (Niruc: of irxlivi(kwl sil;nirrg contract:) alx)ve rurlied, in (he . . . .. ........ ... { ...... ... ..,.. ....... . ............. .... ..... . .................... / (Unrt:ractor, ngenl:, corlx)rate offi(:er, etc.) of (:aid owner or (wrx:►s, 111x1 1s duly authorized to lxtrfor►n ur have Ix:rforurd the aaid 4x)11( a►xl to nolle (axl file Ibis 11ppl ic:ation; Thal: fill staleirrents ccx)tahked in I.his 11ppl ical-ion are (:fix, to the betil: of his k►x)4)ledg-e a(wl Ix!l ief; alwl Ilial. life work will lie performed in the mranner set forth in like applical:ion filed thereNilh. !)mmk too kx-fore file this ...... ..4 "-\. . .. .dry of: Notary N)blic ... ..... U ELIZABETH ANN WEVI E f Appl ic.)nl) Mbtary Public State of t_'w York 5? p�'..��`G.Suffolk COUAIpr i SURVEYED,FOR:- AeNz"99.- llolr?Z%5� /.!/C. t a LOCATED.AT IV;9T7/T'L/G.� A SUFFOLK CO., N. Y. "LOT SCALE I" �h 5 10 n � � 5�_70 y o , sTy ��.35 o �,�. OwG • � � o o N 0 20. 90 " 53. 77 �< a ^ ; L Eer��iE� To TE / ' f��A[ 1 oc. ✓JAy SfGU2iT �t/O 7 iO.vA C �� 4iv t� _-oavaq rlo.(: Zoe- - FEB• �5. i 9�o o214 41, SURVEYED ✓fi'.Ci: /y 19,;, BY c_" �. ��q Two i ir�E Oivisia.v C'� WILLIAM R. SIMMONS, JR. Tr�E .;v'SU2 4i✓CE - : 210 EAST MAIN STREET EAST ISLIP, L. I., N. Y. PAGEGRID DRAWN BY f-iLE NO. 25to T F � u 16 -oll 4r-10° . Hl- 1011 4'-10' 3 LINE OF- 4-NG FHANG Aaov 0.n CFJO1Nz F_CpREEN r'K1N�(TYP - 6NbT�E�j: ^PRr�,�r/ D•']��/+� Vit. s' INcep�e " FI I DEC < x� MAH pPe GC_F_e�N ,�� 5PO RSH ECS DN _ ` 0 _0\\ get% Z ani _ -- _ _ 2xlo RST CPSE•D - - - - ,V„ LC 10 0 W Z A'foL4YATCDN�6� .. - G R1-2NL '�. c� 4R.Ft�ST I p �TDPC C:roT i ,l y. 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