HomeMy WebLinkAbout23308-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26295 Date: 02/23/99
THIS CERTIFIES that the building ADDITION
Location of Property: 1305 LIGHT HOUSE RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 50 Block 6 Lot 5.9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 13, 1996 pursuant to which
Building Permit No. 23308-Z dated MARCH 15, 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 RAISED PATIO/PORCH ADDITION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to JOSEPH T. 0 SUZANNE ANDREJACK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-457993 07/06/98
PLUMBERS CERTIFICATION DATED N/A
Build g Inspe r
Rev. 1/81
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.....................
N-0 23308 Z
Permission Is hereby grante to;
' ....>.�. -- .......................................
. ...3✓
a. �..t.... .... v �y................
..................................................................................................................................
- ! ..
.....................I.-.....................................................................................................................................
at premises located at......-1...✓,.d iJT....411 . .......2Q...............
I--................ ...................dose �...t49n....................................I
County Tax Map No. 1000 Section.......n Q....... Block.......(R.............. Lot No. SY................
pursuant to application dated ......................�'..r.aaA.1.3.:.... 19.9.6....... and approved by the
Building Inspector.
Fee$..,7dc. r'..,....
.. .............. ..........................
Building Insp for
Rev. 6/30/80
BUILDING DEPARTMENT
TOWN HALL fCti'i
765-1802 �b
APPLICATION FOR CERTIFICATE OF OCCUPANCY �w �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.
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.
Fees
1. Certificate of Occupancy - New dwe
Alterations to dwelling $25.00, Swimming Plling $25.00,$ 52d00,iAccessory buildingons to dwelling $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ..�:� .. ... . . . . . . . .. . .. . . . . .. . . . . . . . .
v Construction....`..••• Old Or Pre-existing Building.... .. .. . . ... .
1305 t Yy�;Y.ta�dSQ ►� . . . .. . ...�� ���.. . . . . . . . . .. .. .
•cation of Propertq.....se No. ••••••trees""
House No.
Street Hamlet
:ver or Owners of Property.
0 ....Block. .. . .JC.-�. . . . . . . . . . . . . . . .
. . . ... . ......Lot.
,unty Tax Map No 1000, Section. . . ..
•1 &bdivision.. . . .. . . . . . . ... . . . .. . . . . . . . . . .
Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
&rmit No. • • •
a33�?. .Date Of Permit. :�. .15.�� . . . . . .Applicant-AUnu. . . . . . .
&alth Dept. Approval. . .. . . . ... .. . . . . . .. . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .
.anning Board Approval. . . . . . .. . . . . . . . . . .. . . . . .
&quest for: Temporary Certificate. . . . . . .. . . . Final Certicate. . . . . . . . . . .
to Submitted: $. . . . . . . . . . . . . . .. . . . .. . .. .. . . .
��(dcun!n c4p. . .. . . . . . . . . . . . . . . . .
APPLIw
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
�'�l '95205 BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10036
Date JULY 06,1998 Application No. on file 15094097197 N 457993
.•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
JOE ANDREJACK, 1305 LIGHTHOUSE ROAD, SOUTHOLD, NY
in the following location; ® Basement ❑ 1st Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on JUNE 19,1998 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 I OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
3 1 1 3
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT.1 TIME CLOCKS BELL UNIT HEATERS MULTI-OSYSTUTLET
ET DIMMERS
AMT. K.W. OIL H.P. GAS N.P. AMT. NO. A.W.G. AMT, AMP AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C - E
METER NO.OF CC COND A.W G. A.W.G F EW.U G.
AMT. AMP. TYPE EQUIP. 1 0 PW 1 0 3W 3 0 9W 3 Ol GW PER 0 Of CC.COND. NO.OF HI LEG OF HIAEG NO OF NEULRALS OF NEUTRAL
OTHER APPARATUS:
SOUTH FORK ELECTRIC LIC.#40801,,, i
562 PLEASURE DRIVE
FLANDERS, NY, 1191 GENERAL MANAGER
EPer
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.
Plii l.11 Itlti.4..LU11 HLI -11,' DA'I'lia (;OIn11_I_L_I I IS
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 SOLATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: 7
DATE INSPECTOR
BOARD OF 11FAI:fN . . / . . . . . . . .
FORM NO. 1 3 SK'I'S OF PIANS . . . . . . . . . . . . . . .
TOWN OF SOUT1101.D SIIRVRY . . . . . . . . . . . . . . . . . . . . . . . .
RNII.DINC DRPAR'1'MRN'f CIIRCR . . . . . . . �A. . . . . . . . . . . . . . .
TOWN IIAIA. SEPTIC FORM . 11tIQ. . . . . . . . . . . . .
SOII'rOol.D, N.X. 11971
'1'GI.: 765-I802 NOTIFY:
(:AI► Sue Andre j atk
/3� 9� 765='3281"Or' 727-7114
I;x.ni,xxl ..:.. 19.7 MAIL. T0: M/.M. Andra]ack. . . .
/ L)
CFU.64
Post Office Box 1682
Approved../�6 l�1..., I p. Permit lx,. ....................................
Southold, NY 11971
Disapproved a/c .................................. ....................................
..
.... .................. ....
Wilding Inspector)
A I' .KATION FOR DIVIDING PERM IT
Dace March 12th pg96
s
INSTRUCTTONS
a. 'Itis appd ication trust Ire comlileteby filled in by type riLer or in ink and mdrniLted to the Building Inspector will,
3 sets of plans, accurate plot plan to scale. Fee according to sdiedule.
h. Plot plan slowing location of lot and of Iuildings on premises, relationship to adjoining premises or pxtblic
streets or areas, and giving a detailed description of layout of property trust be drawn on lite diagram wltidu is part of
this application.
c. The work covered Try This application may ix)t lie commenced before issuance of Ikuilding Permit.
d. Ippon approval of this application, the D uilcding Inspector will issue a Wilding Permit to the applicant. Such
permit shall be kept on lie premisea available for inspection throttEliout Lite work.
e. No building tilnall Ire mc,pied or used in uFliole or in part for airy purpose wiatever until a Certificate of
Occupancy sliall have been granted by lie guilding Inspector.
APPIdC8fIf1N TS ItERE1TY PWE to the Duilding IleprrtmenC for the issuance of a Ik,ildine Permit pursuant to the
Building- Zane Ordinance of the Town of Soutlwld, Suffolk Canty, New York, and osier applicable laws, Ordinances or
Regulations, for the construction of Iuildings, additions or alterations, or for retoval or detnlition, as herein
descrilued. 'lie applicant agrees to amply with all applicable laws, ordinances, Wilding code, housing code, and
regulations, six) to adnit m,Uwrized inspectors o, premises nix] in building for necessary inspections.
.....................................................
(Signature of applicant, or name, if a corporation)
P. O.Box 1682, Southold, NY 11971
......................................I............
(Mailing address of. applicaut)
State wlnelber applicant is owner, lessee, agent, ardtilect, engineer, general contractor, electrician, pluriber or Iuilder.
....................................owner ...........................................................
Name of o-nter of premises Jose h T. and Suzanne .Andrelc ja_c
(as on the tax roll or latest deed)
If applicant is a corporation, signature of (holy Fnllnrized officer.
......................................................... y _
(Raine Fax] title of corporate officer) �s' ] �� -x-"• 9
guilders License No.
MAR 1 3199's t
i
Pdmbers license No.
Electricians License No. ..................... �>-_._1"
Outer Trade's license No. ....................
Lot 3 , Subdivision Map of Too Bee Realty
I. location of land on titidn proposed work will due clone..........................................
1305 Lighthouse Road, Southold, New York 11971
.....................................................................................................................
Noise Ntnber Street hamlet
County 'Tax Map W. 1000 Section .....SQ........ glox_k .......6....... Int ......5.:9......
Too Bee Realty at Southoldr. 9396 /o Lot 5
&tlxlivisicxt ...................................... rlecl Dk�p fkn. ............... 1nC .........
(Name)
2. State existing use and occupancy of premises acid intei ded use and occupancy of Proposed construction:
a. Existing use and occupancy ......one-family
,_dwelli0g..........................................
b. Intended use an occupancy ......one-family dwelling - patio/porch addition
................................................:...................
I. Ktlute of: %mik (c:lwck w(ticl, sllilicuble): WM Ilididing ......... . Mlilion .x........AIternOon ..... .....
Ikllxtir ............ Itemwal .. ....... ... DeaulII:left ............ Other Unk ..................................
00escr 1p('ion)
4. linikiv,le(I (krst ..$3,.QQ.Q.... ......... fee ............. ..... ............... ... ..........
I, (((I Iie paid on filing Ilds alrplicatim)
i. If tkx!Iling, txoher of (Iwelihy tills , ,,one ,.. Itnher of okaellhgl units on each Floor ... .............
Ifgarage, txnher of cnre ....:......... F..Q....................
6. If Ix,nim-un, umrercial or adx4d oc:rayxrncy, specify nature atxl extent: of each type of title.......... ............
7. Winennl(cn of exleCing ntncLures if nn Pncl... ...8.0.t.8.11.... Bear , 80 ' 8" 44 ' 4"
y: .... . I)epth . .... ...... ......
I ineisioxrs of: sate stnr.....t-vire wl Mnher of SLorien one and .. half
24 ' -25 '
... ..... ............. .
1th alteraLi ns or txlditionn: Prrnot ..88.'.8�� lienr .881.8
In.......
kpth ....44.'4:'......... llei(�tO ..24:-250 t ....
Mrtlx:r of itorien ..1.R.. ........
0. Dlnenshcs of entire new <xcnL tx .tat: Fran ..... Itear ...34 ... . .... 1)nplh 18 !4':.
................... Mnlcr of 9loriea ...0...... .... ...... .
9. Sive of lot: tlrxtt ......... Iwar ....1:$Q.:Q....... .. I)epth .45.1,9$..-..9.53.. 52
I(). IL,te of n,rrlan!e .g.: 7-93..;........ Nate of Forcer (xmer .` q(?..$e7..PAaUty...Cr9rp.•.......... '
11. Z(ce or use district in which prenises are s$tuaLed ................................ .... ............ .......1.......
12, floes prolx,ned constncl.looviolate any zoxrhtg law„ordinn!x:e or regulstlon: ....nQRQ..knQ.W11.....
I:). Will lot- Iiia rellr!xlecl ......n0;. .......... Will excens fill, lie re,rared frau prenises: YES M)
14. Plies of (Owner of prenises ,,,,xndrejackAklrens P. O. Box 1682 , .Southok&* No. 765-3281.,.
Mile of Architect: .GeCIrg.e- ishex............... txktrens ... ...,Southo.id............ Moon 110.7.65-3654...
Mie of Conl.ractor .........Qvner................... Acklress ................ ...............Ilton tb. ..............
I:r. Is title pmperty wilbin 700 feet of It tidni vetlnrxlY * YIPR ........ .. M) ..........
*11? y1m, B(Atllkxl) lam '11D.1SIlw.9 Ll'sul'i' IJAY 1% ITIpl Taw.
PLOT I)TAGIIAM
loctil.e clearly aril dintinctly all ImIldingn, %Atelber existing or prolnsed, ntxi hxllente fill set:-back dimanalons
fitxn prolxerry lines. Give street aril block onl,er or descripLitc according to deed, and shag street nines nrxl hxlicnte
%kether interior or corner lot.
Section: 50 Block: 6 Lpt: p/o 5
1305 Lighthouse Road, Southold, New Yo>ak 11971
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(zauJlY (IF ....Suffolk,. ,,..,,, (,(,
.. ..... .. ....... ..Icing duly owcn-n, delxmoa a!xl unys (lint be hr the npplicanl:
(M;ne of itxlivi(Ita,l sinning conti'MA,,)
olwve nim!d,
Ileit; the .. . .... .......owner. ...,.......... ............. ................... ... ...............
.............
((bili:rile Lor, nitent,!, corlcr'nle ofl'Iaer, etc.)
or onid (xacr or owix!rn, aixl in dilly; nulhorived to lcrlmin or bnvo Ix!rfunied Ihu naid work incl to owke atxl lila Ihis
spplieation; 1.bfil: fill ntatetents conlaircd in Lhiu oppi lest im are Ltoo to life Ixm1: of bin knowle(Ige otxl IclleN, fiixl
I int the wail( will be perfomed ht bio+user net: forth iu the sly ic:nclotI filed the rewi lit.
!Mm% u, Icfore fir: Oils
13 ............day of: ......NAV b. ...1996.....
M!lcry niblis ...�<9.-�?�:. ...... l
gn,d.ure of Appl knot)
LINDA J.COOPER
Notary Public,State of New York
No.4822563,Suffolk County 96
Term Expires December 31,141
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HE
705-1ROJ 9 AM TO M
FOLLOWING INSPECTIONS' 7 Iu -� —
i if 1n,J!:.i P'.6L alLb �i✓;E.a -___ .l f'T�1 NQt Nsa1 _�
1. FOUNDATION - TWO -REQUIRED rr,4 b' '3,�y� -FOR POURED CONCRETE ! @ ." _ _._— _ .— --- -' _._ _ .
2. ROUGH - RANTING lk PLUMB
ING I I , 1 �, — "� i '�
3. INSULATION
4.' FINAL - CONSTRUCTION MUST L ""
BE COMPLETE FOR C.O, , r�
ALL CONSTRUCTION SHALL MEETI`QI A
THE E-CO
REQUIREMENTS OF TEE N.Y. -
S-FATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR *max
DESIGN OR CONSTRUCTION ERRORS
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