HomeMy WebLinkAbout23820-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24989 Date APRIL 18, 1997
THIS CERTIFIES that the building ADDITION
Location of Property 725 MARRATOOKA LANE MATTITUCK,N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 115 Block 4 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 1, 1996 pursuant to which
Building Permit No. 23820-Z dated NOVEMBER 23, 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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to EUGENE H. MISKA
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-415012 - MARCH 25, 1997
PLUMBERS CERTIFICATION DATED APRIL 1, 1997-MATTITUCK PLUMBING & HEATING
� u
lding epector
Rev. 1/81
roast NO. a
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)
M23820 Z Date ...................................... i9f!��
Permission is hereby granted to: /� >
...... . .... .....................................
[/ 7/
G ^rA, <..... ......�SZ—...... I
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to G�l �.... . . ... . .... ......^.. �... pf" :•{••�" ...............
... ... .: .....lt. ........... ........ ... .. ..................... .
C/ ..
of premises located at ...do .
.................................................. ......... ... ................................................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section ..... ...................................I........ Block ........,�........ Lot No. .Pp.................
pursuant to application dated ....../../. ../ 19.10 and approved by the
Building Inspector.
Fee 5....7;
uilding Inspector
Rev. 6/30/80
ju
PoµMis F
Form No. 6 M tf•
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
1. 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.
M
Fees
1. Certificate of Occupancy - New dwelling' $25.00,)Additions to dwellind'$25.000
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 Buildine - $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 . . . . 14PL. V1. . 'p3'?. . . . . . . . .
.. . . . . . . . .
ew Construction. . . . .
r. . . . . Old Or Pre-existing Building. . : : : : : : : : :
, . rn . . . . . . .ocation of Property. . . . . . . . . . . .. . .. . . .101 � � �
House No. Street /. Hamlet
nwer or Owners of Property. . . . . . . . . . �V.ltA``�� r. .A. . L�,AIA. . . . . . . . . . . . .. . . . . . . . . . . . . . . .
ounty Tax Map No 1000, Section. . . . .)/.�. . . . . .Block. . . . . . :X . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . .
ubdivision. . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . .. ..Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
ermit No. . .�J.&kQ. . . . . .Date Of Permit. .��/i ( .46. . . . .Applicant. . hv-uev4V1.. // 4441,/ . . . . . .
ealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . `! . . . . . . . . . . . . . . . .
tanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
equest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . :Y. . . . . . .
ee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . MM
(3)-ua7k� . . . . . ���. .t!�. . . . . . . . . . . . . . . . . . . . .
. _CO � !Pf APPLICANT
i
JI
Town Hall, 53095 Main noad i 1 } rax (510) 765.1829
"a I, P. U. Box 1179 , . ,,-a ';;.:, 'rJ Telsphone(516)765.1802
Soulhold,New York 11971
OFFICF OF THE BUILDING INSPECTOR
' TOWN OF SOUTHOLD
C E R T I F IChTI0Yr
!
DATE#_ �
Duilding Permit No.
Owner: Otr�r<
(,please print)
' )?lumber: o. �f uc-K 1� ,h<• �- zo.�;.,4 �s
(please print)
�I
I certify that the solder used in the water supply system
contains less than 2/10 of fl; lead.
ij
s
j (Plumbers i
Sworn to before me this
�I
day of 19
Notary Public, � _ County
>
Term EU�usallNdM>3�dtGlcS,ouMy
FIEZD—INSPECTION REPORT DATE COMMENTS
II II .T.
II 1'
FOUNDATION ( IST)
,I II
n 1
n II
-OD'NDATION (2ND)
II �
R .._...�
--� Z
If--11 �
ROUGH FRAME h
PLIIMBING
n n
it
Ole--
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TNSIILATION PER N. Y. u u C
STATE ENERGY All
CODEitp
n ¢ f
u It
II n
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AI
II II
If
FINAL
it I
1I��I1 I
II II
—_-- _— --_ —' ADDITIONAL COMM ENT S:
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I
M-1802
BUILDING DEPT.
f NSPEC
[ ] FOUNDATION ISTH PLBG.
FOUNDATION 2ND [ 77R
INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATEINSPFCTO
'65.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] F�ATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE HIMNEY
REMARK
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SOLATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: OZ
DATE INSPECTOR
I
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
r1001.071 .. , BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NY 10038
Date MARCH 25,1997 Application No.on file 131.19197/97 N 415012
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
GENE, MISKAS, 725 14ARATO01M LANE, MATTITUCY, N.Y.
in thefollowing location; ❑ Basement ❑ Ist FL ® 2nd Fl. Section Block Lot
nets examined on HARCH 18,1997 and found to be in compliance with the National Electrical Code.
FIXSURE FIXTURES I RANGES ICOOKING DECKS I OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENTI FLUORESCENT OTHER MMT. K W. T. K.W AMT. K.W AMT K.W AMT. H P.
() I 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS JSPECIAL REC'PTj TIME CLOCKS I EELL UNITHEATERS I MULTI.OUTLET DIMMERS
Olt H.P. GAS H.P AMT. NO. A.W.G AMT. AMP AMT, AMPS. TRANS. AMT H.P. HIS: F FEET AMT. I WATTS
9. 600
SERVICE DISCONNECT NO.OF S E R V I C E
MMT. AMP. yvg METER iX tW 115 SW 893W 9,e IW NO.OF CC GOND. A.W.6. NO.OF HIAEG A'W'G NO.OF NWTRAIS A. N G'
EQUIP. PER. OF CC.GOND OF NIAEG OF NEUTRAL
OTHER APPARATUS:
PADDLE FAN'-1
MOTOR`.i:1-F H.P.
G.F.C.I:-1
SMOU DETECTOR: -1
G & S CONTRACTOR LIC.#578 FA % LL
BOX 215 ANN
SOUTHOLD, NY, 1:1.971 GENERAL MANAGER
11
9S Per—
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may beidentif�heir credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
BOARD OF HEAL'TH. . . . . . . . . .
'.•r FORM NO. 1 3 SETS OF PLANS
. . . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY
a� —' � �,•• ,, BUILDING DEPARTMENT CIIECR . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN KALI. SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.X. 11971
TES.: 765—I802 J NOTIFY: ,
4.----
Eucmined.f/ .. 3........, 19..!!� MAIL 'TO: . . . . . . :. . . . . . . . . . . . .
Appmvedl..�l�y ....., 19. 1 Pernnit No. � J. ..... .................',...:..............
Disapproved a/c .................................. ....................................
(Ihuildi , Ins .or)
APPLICATION FOR BUILDING PERMIT /(�
' Date. . . N�V„ . .� . t. . , 19A
INSTRUCTIONS
a• This application mast be completely filled in by typewriter or in ink and-submitted to the Wilding Inspector with
3 sets of plans, accurate plot plan to scale. Fee according to sc}uedtle. F
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 mist be drawn on the diagram wbich is part of
;this application.
c. Ilue work covered�by this application � not be cormenced before issuance
'of Building Permit.
d. Upon approval of this application, the Building Inspector mill issue a Building Permit to the applicant. Such
permit shall be kept on Lbe Premises available for inspection throdghout the work.
e. No building shall be occupied or used in wluole or in part for any purpose whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATION IS HEI M, MAA' to the Building Department for the issuance of a Building Permit piursivan0to the
Building 7.one Ordinance of the Town of Southold, Suffolk County, Neu York, and other applicable Iaws, Ordinances or
Regulations, for the construction of Ixuildings, additions or alterations, or for roroval 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 promises and in buildifor necessa in tion
(Signature o applicant,'or none, if a corporation)
MPATAT.VY ,.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Wilder.
.3
Name of owner of premises ............E f�IF-.►J E....l'k .............................................. .:
(as on Ow tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. "
.........................................................
(Nave and title of corporate officer)
Builders License No. .........................
Pludbers License No. ......................... .
Electricians License No. ..................... -
Other Trade's License No.
1. Location of land on which proposed work will be done...............................................................
.................. ........I.........!MAi.Tvv-\)-Q�.....................
house Number Street llaU/nlet
Tax x Map No. 1000 Section ......JJs...... Block .......q........ Lot .......1Q........
Subdivision ....................................... Filed Map No. ..:.........1.. Lot ............... ...
(Name)
2. State existing use and occupancy of premises aril intended use Aand occupancy of pr'op6sed tcgo'nslnuction:
a. Existing use and Occupancy .................. ��.�1�......�R��f1A�.�I.....:�1 .`q/ .............
b. Intended use and occupancy .........................I........o1.Rin%s..................................
J. I.' ore of wik (cleek wllicdl 1110icsbie): ikw Iluildinll tuklitioo .. .... Alteration .. ........
{ Itrgair ............ Itenmal ............. Wool itIoil ............ Other Wolk .. ................................
(Description)
4. E:ainuu'c�d Cost ...Iltti Q. fee ............................ .... .
(to be liaid rill filloll this application)
5, If rkoellinj , m4wr of d4ellinl India ..........., lknier of: Amiling units ca each flour ........ ........
if l;urage, lxnler of Cars .....
G, if lasbless, cxnslercial or nil xri.l oemarcy, specify nature mill extent of each type of use.......... ............
Y. Dimensions of existing str uallfen, if any: Front ..... .... ... .... hear .. .. ........... Depth ............ .....
IlniglLL: ;. Mnier of Stories . ........ ......... .. l i
........ ... ..
10
Ilimenslons of sar+e stnu.lure wlth alteraciras or Fxklicfons: L'rouC ..... ... hear .. .... ........
.l OIC ................ .... Mrdler of Star fes ,... ........
'
q f
Depth nt-ire .,... ileftoct.ial: FICAIL .....af,�.... .... hear . ... . ....... Ik lith ...�l ..,.. ..
If. Illur.nbllx la of enure r,ew t.arlaC�,
�. 3izeloC` lot: Fant �Q9.' .•.,'.•sof: SCories ........�. ...........
311 .......... IJ.nber .. ��qq
' . Ilesr .....10�............ Depth .....ISO..........
IO. M-111L of Purchase .............:L....... Mww of Forlser lister .,.... ...... ... ..... .....................
-It. &x le or use district in %Allen Prenises are aituatect ....................................................... .......
12. Iklea propx/scxl coonLrucGoiC violare any uxlina lim, ordinance or regula(.ica: ....... .................
Ia, Will lot be regrrlrled .....M- .........., W,i`II exc'es's' fall Is. relr^med frons prat lyi sea: VES
14. Wises of Owner of prenfses VVG.nI ..�1r. .W4Y�kklresa �,V.�Q�l1 .rtrt��i�Q14� ,.. Illae
Nfnle of ArchlLecl` ...........:........ ............... Arklreas ......... ..................... [l arse lTa. .............
PPknle of Cclnl:ractor ...........I Arklreas ...............................I'llole Na. ....... .....:
+, L1. Is title property
ml ry
wtiffeet: of a tidal ' YES ..-........ ) ...
*Il S, lil7CJN • Y...... '
ISnu?s navi '1' MAY w mypifal. -
I'LO'I' DIAGRAM
T[x:al'e clearly std distinctly all buildings, whether exist ing,�or.Proposed, atilt i(IrlicaLe all set-back dimensions '
Plan proletty tiles. Give street aril block Ixniar or description agcording to ifeed,,arxl allow atreet mines alxl irxllente
IAhether interior or corner lot.
IS^ li !r
�Flri li � 1' d ?til' n T lrr�:it!l!G(i.'.'
,� tinyA, i. MARRA'f00KA LANE
e x ' �
mo.aD'
O
I .
MOD",
'Y s i � I I t r � � 't�fl ,lr elt �'i'•rl i�I I{
now or marl r a !3 1
3i l'A'l l'. U? N W ¢ + " l Jonn J M rtr rr�` ? r 1 �+ a "
D a
UAINI
``C ........... ..lain. dol awilnl, de aces will Clays that he is the split i
.....�.V.�Y..Y�...14>f'�+...�:....�45��.. .. b Y 1 Y II csul.
(Nare of flxlividual, signing contrac'L)
f/lxrve IMnnd, Q
Ile f:: file .
....... ........ . . tt;ke�nl.Fe ....,........... .
! , corixlraw officer, etc.)
of: said owner or tmicra, mill in dully oulhor!7cNl to perform or have lerforuled (he said work alxi to w1w arxl file this
applicatiaal that: all sLatanento contained in Ibin applicaHoo fere tree Lo the beat of his klxMledge null NA,ic!", nix]
that. Live Werk Will Ix' lierfolllyd ill the IIr111nor eel forth ill file split lCntioll filed IIIelE itll.
Nwonl to before nra this /n\ \nlln� r r
l l.(Y.v . 9
�J�.. lay of Iv..`
Nolary I'uhI c .. �:: �-!....,.....:•
CLAIRE L.G 'EW (SiguaLure of Applicaul.)
Notary public,StION NOW York
No.4879505
Quatffled in Snlfok County
Commission'Expires Dee,ember 8,15
ot
MAIN ROAD Young & Young, Land Surveyors
( N.Y S. RTE. 25) 400 Ostrander Avenue, Riverhead, New York 11901
IIuit>q 516-727-2303
• 843
II1TITJ c Alden W. Young, Profeasional Bugineer & Land Surveyor
- d Howard IF Young Land Surveyor
m
Thoas C. Wolpert, Professional Bngineer O
gym Kenneth F. Atrruzzo, Land Surveyor lit
s 3 now or formerly SUFFOLK COUNTY DEPARTI&ENT OF HEALTH SMILES
` cc 0 James R. a Mary M.
SINGLE FAMfLY Gds tL1?e', 'O' LY � s
P
N — —
Tyler DAT- 2 KS. R-,.
y a
° The sewage disposal and eater supply facilil for this a
1 location have been inspected by this Department and/or
other and'"fo •�d to be sstisf=,tory.
7'40E. � k50.00
"! r PRlver HED
Chief bf Rurnu of Wastewater Management
PRIVET HEDGE 1
— LLIz ANCHOR i s Area = 15000 s.f.
W. I SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATION
��---- s,s' ------ •`I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE
O 1�
Q
2a.e• \\\ O SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND WILL ABIDE BY THE C%QTICNS g
O TY SET FORTH THEREIN AND ON THE PERMIT TO CONSTRUCT.' 'F
L
N .N APPLICANTS SIGNATURE: 9
:;.t!r. „c.o• »f
\
----_-47 ?� )
APPLICANT:
C
QL 2.0' STREET ADDRESS
/t7r 7 gypQW 4Pan: STATE: ZIP CODE
M.2 __
N1 — 3 O TELEPHONE NUMBER: 4m
AJ 3
C3
/y N ,—� O C t0
N N EARTH DRIVEWAY I„ l
PRIVET H GE Ili
7 e
LL ° ; 1 -C%j SURVEY FOR:
Q z 0 EUGENE H. MISKA
tir
W
IFHNCELINK
Y
h If
At: MATTITUCK Town of: SOUTHOLD °
N.88037'40" W. a150
,00 d Suffolk County, New York
° N
Z CONCRETE BLOCK WALKWAY
now or formerlySuff. Co. Tax Map: 1000 115 4 6
° John J. Miska, Jr. a Barbara Ann DiatNOt Sectloo Block Lot
M isko CERTI E-g
E I •
' TITLE INSURANCE
F}"P. LVANIA (TITLE NO. 163 - 4469) o
NOTE:
!. 0 - PIPE FOUND i JUL. 16,1993
- MAY18,1993
DATE :APR.20,1993
SCALE :1"= 30'
Q S JOB NO. :93-'0232
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' L J SHEET 1NO. :1 OF .1
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OpC OVNbC2 DUMBING
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i _ k irk, u B VIATEB LINES NEED y
TESTING BEFORE COVERING_
wr �
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y oP-r boaR � � ` � PLUMBER CERTIFICATION
_ 4 ON LEAD CONTENT BEFORE 1`d
CERTIFICATE OF OCCUPANCY'
SOLDER USED IN WATERON
x
SII' SUPPLY SYSTEM CANNOT yI `
EXCEED 2/10 OF 1% LEAD
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RWRITERS CERTIFICATE
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