HomeMy WebLinkAbout23851-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25534 Date: 02/09/98
THIS CERTIFIES that the building ADDITION
Location of Property: 4835 OREGON RD MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 95 Block 1 Lot 1.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 25, 1996 pursuant to which
Building Permit No. 23851-Z dated DECEMBER 10, 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 ONE STORY ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MORRIS ISAAC & ELLEN COSTER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N434707 10/14/97
PLUMBERS CERTIFICATION DATED N/A
u' ding Inspector
Rev. 1/81
I
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? 23851 Z Date ....... /a................................. t9
Permission is hereby granted to: /
...................................l..... .................................
, . ...4X..1 . ....................................
to ...... . . fT..........�....:.c �✓.,�......�� . ......... �ir7p�...../�.......�...........
...... .... .. ......
at premises located at ... .... ...J. ....11 ..............................................
.................................. .............
......... ............ .. ...............................................................
County Tax Map No. 1000 Section .......
/ /
...�........... Block �.l ....... Lot No. ....1..:.
...... ....... .. .. .........
pursuant to application dated ........,(".N..��'?�!!�f`f�....f.. ✓......., 19.90and approved by the
Building Inssp�pe''ctor.
Fee $..../ie...`...........
...... .... .�...`�.. .........1...... f
I
„ .or............................
/ Buildln
Rev. 6/30/80
Form No. 6
f
TOWN OF SOUTHOLD
BUILDING DEPAR=I NT
TOWN HALL F iU6 Z 9 lo
765-1802 gT
i 4
APPLICATION FOR CERTIFICATE OF OCCUPANCY f 41't ()F
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.
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
10. 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 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 . . . . . � ��.� . . . . . . . . . . . . . . . . . . .. . . . . .
New Construction. . . . l/ . . . .E_ A
Old
/ Or Pre-existing Building. . . . . . . . . . .�.q� I + 1
1,ocation of Property. . . . . . .:I2,` .. . . . .'. . . .Q .�flAJ. . . 91A . . . . . . VyL6 tal•1 c_� - . . . . .
House No. Street Hamlet
Jnwer or Owners of Property. �. . st .l .�fj�'/Yll . . . ,. .
. . . . . . . . . . .. . . . . . . . .
Jounty Tax Map No 1000, Section. . . .�J . . . . .Block. . . . . .I . . . . . . . . .Lot. . . . . . ! : . :-. . . . . . . . . . .
>ubdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
?ermit No. . .� )r� . .Datne Of Permit. . . 1 I Jtl J q� . .Applicant. .I.Qun u -�- c • • • • • .
Health Dept. Approval. . .YL . . . . . . . . . . . . . . . . . .Underwriters Approval. . i-.'' . . . . . . . . . . . . . . . . . . .
?lanning Board Approval. . .. . . . . . . . . . . . . . . . . . J[\/
request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . .. . . . . . .
7ee Submitted: $ . . . . . . . . . . . . . . . . .� _ 1. . . . .Y.C!1 . . . . . . . . . . . . . . . . . . . . .
APPLICANT
o��gUFFO(/rCO
Gym
Town Hall, 53095 Main Road y Fax (516)765-1823
P. 0. Box 1179 .y Telephone (516)765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 5, 1998
Fred Milner
870 Bray Ave.
Laurel, New York 11948
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX The check is (outdated & returned) $25 .00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT #23851-Z Isaac Morris
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
o�os�FFot�-�oG
o� s�
C* x
Town Hall, 53095 Main Road p • Fax (516)765-1823
P. O. Box 1179 �� �� Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
May 29 , 1997
Isaac Morris
P.O. Box 1687
Mattituck,N.Y. 11931
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
X-2cx__ An application for Certificate of Occupancy is
not on file. (Enclosed)
XX 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.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 23851-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
ISM 1.6(; 1011�Ill;1,0 It I OA*I V CUHt11iN 1':i
I'OIJIIOA'I ION
FOUNDA I (ON RID)
I
--------------
INNIII.AI'lon virit N. Y .
Ilk
COUP.
----------- ------------- -------------------
4z 4�"
FI OAI.
----------------
---------- --------- --
ADDITIONAl. COt%Ij,-tjI-!;t - -------
-----------
---------------- ------ ------
M-1802
UILDING DEPT.
INSPECTION
FF NDATION IST [ ] ROUGH PLOG.
[" FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: "
DATE c- L 1 INSPECTOR
765-1802
� '' BUILDING DEPT.
INSPECTION
[ ) FOUNDATION IST [ ) ROUGH PLBG.
[ ] F NDATION 2ND [ ] INSULATION
[ ' FRAMING [ ] FINAL
[ ] FIREPLACE S CHIMNEY
�r
REMARKS: /DY ✓� .
DATE 3 ;x 1' , INSPECTOR of
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: D/L
DATE ItI4 �7 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN L-ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE l INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1135107 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NY 10038
Date OCTOBER 14,1.997 Application No.on file 13628497/97 N 434707
THIS CERTIFIES THAT ,
only the electrical equipment as described below and introduced by the applicant rwmed on the above application number in the premises of
MORRIS ISSAC, 4835 OREGON ROAD., I�IATTITUCK, NY
in thefoliowing location; ❑ Basement ® Ist Fl. ❑ 2nd FL OUT .Section Block Lot 151
was examined on OCTOBER 07,1997 andfound to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS XHAUST FANS
OUTLETS ECE►TACLES SWITCHES INCANDESCENT FwORESCENT OTHER NAT K W. AMT K W. AMT. K.W. AMT. K.W AMT. H.P
7 6 - 2 7
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIALREC'PTI TIME CLOCKS I BELL UNIT HEATERS MULTI.OUTLET DIMMERS
"
AME. K.W. Olt H.P GAS H.P. MIT. NO. A.w G. AME. AMP. NAL AMPS TRANS. RMT. H.v. NOSYSTEMS.OF FEET AMT WAITS
SERVICE DISCONNECT NO.OF S E R V I C E
MIEAMI. AMP. TYPE EQQUIIPR 1A 3W 10 3W 3$3W 3,F IW NO,OFPER C ACOND OF CC.COPD. NO.OF HI-LEG pP M L G A. NO OF NEUTRALS Of NEUTRAL
OTHER APPARATUS%
PADDLE FAN-1 p R
MOTORSsl-F.M.P.
G.F.C.Ii-2
OCT 17 1997
TOWN OF SO(j rhOLD
JAMES MURRAY LTC43ti33—E111C�L
.O.BOX 305
LAUREL, NY, 11948 GENERAL MANAGER
11
Per.
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.
+ BOARD OF IIKAIA11 . . . . . . . . . . • - ' - -
FORM N0. 1 —7 ;iETS OF PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMEN'r CURCR . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN MALi. UP'1.1C FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.X. 11971
+, 'rm.: 765- 1802 N0TIFY: _
CALI.
P.x:niiuivl../<� /Q 191-.� ryJ/1 / MAIL TO: . . - -
Approverl...��,r.0......, 19� Peu ..nit No. OAcS�. .
................................ ....
Disapproveulale .................................. ................................ ... .
(IluiIno ,ecLor)
APPLICATION FOR BUILDING PERMIT
Date. . V1 vv. . . . . . . , 191(a.
INSTRUCTIONS
r a. 'Illi, appl icatiai nusf be corgrletely fillet] in by typeiyriter or in ink aril sullaitted to the Building Inspector wit
9 sets of plans, accurate plot plan Lo scale. Pee according to schedule.
b. PIoL plan slxxaing IOCatiar of lot and of IxAIdings on preinises, relationship to adjoining premises or public
' streets or areas, aril givirp; a detailed description of layout of property rust be drawn on the diagran which is hart of
Oii s ap pi icalion.
c. 'Ibe work covered by this application Pray not be conroenced before issuance of Iknilding Permit.
d. Upon approval of this application, the Ruuilding inspector will issue a Mildiag Pennit to the applicant:. Such
pxvmit. steal] be. kept: on the premises available for inspection thro uglxxat the work.
e. No lnilding sItal.l lie occupied or used in whole or in ]kart for any lnrrpose Miatever until a Certificate of
Occup nc-y sVuali have been granteol by tloe Ikrilding Inspector.
APPEIGI'1'ION IS 1003Y MAIM to the Ituildiog Departrmnt for the issuance of a lkuilding PenniL pursuant to the
IAuildiog 7cne Ordinance of (lie 'Paan of SouLlrold, Suffolk QxroLy, New York, and other applicable Taws, Ordinrrrrces or
NIgulaLioxus, for Lire crnrstruction of luildirl s, acklitions or alterations, or for rcrnoval or dennlition, as herein
clescrilled. 'Ili: applicant agrees to cargAy with all aptAicable laws, ordinances, lxrilding code, housing code, aal
relndatiars, aux] to a8nit auUurizeol inspectors oxr premises aal in luildin, for necessaryinspections.
..... .. .......... ...................
(Sigux'nhrre of applicant, or nolle, if a c(rlurat ion)
(Mailing aoklress of applicant)
Stale wlue Llrer applicant- is owner, lessee, agent, architect, engineer, general contractor, electrician, phniber or Ixuilder
�} CA!Yi....iS ..�ld'Mt..O3n�. �G.1�... I....-./...n.......(...........................................
NaMne of Owner of prcrnises ...//(v�J`.�5...�.�.�'.AA'G..�!�1��!Y..!•.'P�:r45K.................................... ... .
(as our the tax roll or latest: deed)
If applicant is a corporation, signature of duly audiuri7:eA off icier.
.........................................................
(Nene nxl title of corporate officer)
IAnildevs License No. .........................
I'ludners License No. .........................
Electricians License No. .....................
Other Trade's LiceowNo. ....................
I. IncaLion of laal on which proposed work will be donee..............................................................
4 ..............0„NN! ..ter..................... ?A ! 7��- .
.. . ................... .................
liuse RMdor SI reeC Ilrrnlet
0 xint.y Tax Map No. 1000 SecLioo ....1.15�....... ]]lack . ....!. �' 1/
......... Int ................
Sulxlivisiru .................. .................... Filed Kill No. ............... I.oL ...............
(Nome)
2. State existing, use and occ:upaaly of premi9es, oll inter�xtled� use aux] Occupancy of proposed construction:
a. Existing use alxl Occupancy .'...��17�Y�.. S.l�DMf'.r.V. G. ........................ ....................
b. Intouxkvl use aril oecupaoc.y ................ ................................ ...
jTL YTO-1 .17,03 Oq
.VA4 to fiURU9 YWCA
vsrauep9 Av"ktc,f3t?021vJb xA
w:,e t ,t wfim aystrzxa mlir
I. t.tltue ul' lank (check whicht di
:l4 ILable)I Non Ikaild Jng ... ..... . . Aklition �. .. . . Alteration . .. .. .. . . .
IWIW!r . .. . .... .... firairwal .....II.... ... WINI)1i1.ion .. .. . . ... ... fiber Iknk ...... ... ...... .... . ... . ... . . ... . .
(IAeacripLire)
h , iistinvited (Lal .. . . . ,.. ... . fee ... . ... ..... . . .. . . .. . . .. .... .... . . ...... ... .. .
(to le Ixaid on 111 int, 11119 11)1)1 i(:al ion)
'i. If duelling, axaler of lh,�ell Jng ill L1 . . ... ....... lender of duel IIng units as each flare ... .. ... . . .. . ...
If garage, twnier of earl ..... .. .. ... ... ... . .. . ... ... . ..... . . . .
fiifbtlsitear, cxnlseic.Jal or luixed jx:culericy, aleeify nattre 1110 extent of each Lyle of u1e....... . . . ...... . ... . .
1. Dinmmsicros of existing al netulesl, if 1ny: kion! .. . . . .. .. . .. . . . . Rear . . ... . ... ... ... Ikeplh . .. . . . . .. . . . . ... .
101011 . ... .. . ..... .... .... ..... �'�, Maier of Stories .. .. . .. ... .... . . .. . . . .
Dimensions of wants stcncture will,! Filleraticxaa or additions: Front .. . . . . . ... . .. .. •l>t:ar .. . ........ . ...
Ilepth leil)il.l . . . .. .. .. ... ... .. .. . Wier of Stories .. . ..... .. .....
if. Dinrnaicna of ent-ile 1"4 cats!ort ini: krait . ... . ... . .. . .... liear . .. . ... ... ..... N21)1 It ... . .. . ..... . .
Neilllal ......1111— .. . . ... ......... hider of fitorien . . ...... .. . .. . .. .. . . .
9. Size of lot : Ihcnl .,d......Q. .... .. .I�. .. .. .. Pear . . .. . ... . . . .. .. . . .�t.. Dep�th'f... . ... . ... . . . . .. .. .
Win 10. Wof NtrchaNannie of...�.1.y,J, ,, ,,,,'I,...., Nanof Funm (anteA/,/.
r
r ��W.y.+`.).15... .... ....... . ..... .. .
I1. y.ae or use district in which ralQuisea are 01"al.ed .. ...... . .......... . . .. . ... . .. .... ... ..
...... ... . .. • . . . .. .. . ., i
12. Ikea pro]wsed construct i(n violable fitly zaaing If", ordinance or regubalJoe: . ,(N.Q. .... ........ . ....
11. 14111 lo( le. regraded I........ Will exresa fill Ix: rolitwed frown plollisen: YES Ill t
14. Hanes of Water of prollisen .....,'.... ... ............ ... Aklraas Iltotxt No. .... . . . .. . .. ..
Nam of Archilect ..... . ....... 1.. .... ....... ... ... .. Address ... . .. .. . . ... .. . .. ... ... ...... Ilaone No. ..... .. . . .. ...
N:ne of (intrar.lor ........ ... . .1111.. . ....... . ... .... ... Ak )ass ... ..11lote No.
Pi. Is this prnlerLy Within :1(10 feet.�l,of if I.Jdal rueLlalxll * YKS .. ... .. ... M) ..V/. ...
AIF YGS, fitllf11m) 'ICAJNIlilfi• rr k1AY Iv Inpli(Im.
PLOT DIAGRAM
locate clearly girl distinctly all linildhgs, rAiether existing or proposed, trod indicace all setback ditmoaiona
flint prodecly lines. Give alrreL and i0ock aridaer or description according to oeed,,anml rdxaa street nares and indicale
inlaether inlet Jor or collar lot:.
GIRII'. fNa M•lJ Y(Ntl(, (�'� 111'
UA11J1Y (A' ... . . . v`°lo� . . . ... . c,(,
Q� tK . {.. ... . .i leing duly awn, dellowa;, film[ arya fluff he is the app! irasll
(Mnwe of individual signing cont -act
alxcve tulael,
I
ik, in the .... ... .. . . . . . ...... . 1410(7. . .. . .".. .. . . .. ... ....... . .. .. . ,. .. . .. . .. ...... .... ,A ... . ....... . ...
((bnlroclor, agent , (j,urlxtrale officer, etc.)
of raid (Honer or owters, film] is duly ;411110 ized Lo lerfonn or have lerfonied the laid work and to urike and file Thin
n1w1)licalion; that. all affilcvtents contained in Ihla application are I.IIe to the beat of his knowledge and belief; film)
Ih1l the Milk will be lerfnrnred in antler net. Barth in The 1pplicaLioa filed therewith.
fkatnt to Wrote ur !ilio
. . . . .. . .2. .I. ...
Notary LLblic .. ..... -
ERT I.SCOTT,JR. (9igna u e of Applicant)
NOTARY PUBLIC.State of IN
No.4726088.Suffolk Cou
Term Expires May i1.tfli�$
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e_accenrn tn�. The rile Gurnreeai�thee CoeN�aafty� L'. S. L_rf�. -i''i'-1-;c !^(<rJ;^.'Yrrce Lam'].
�. \ crnfne nt mm eurcq mm rnot haexfnq as SUrverjpc!' Atiri78, 19La¢; .]'s :_c.lrv��d �fMi! ct+ /9r3U.
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np fo tno paeon Ser vAom the purvey �L
� ,� is ve,wrea.ena on his�nenmrn. —
titlo 1.11111Z.1.M^'mrmantal ooency nna L(CCMSECt L_OtIOC! $UYV4y0!"3 !
Suffolk Courchj TaK Map Oesicjm& bn: LA.
' Dish:IOOOx Sec{-095, Bfock 1, Farce! !. ��L O�ANs- Z� I.-Al.,� cl�n &�p�O(.-p Na.W York
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1
i OCCUPANCY OR I
-- -- - - - - - -' - - I - - - -USE IS-UNLAWFUL
- - WITHOUT CERTIFICATE
OF OCCUPANCY
` N '
APPROVED AS NOTED
DATE: U B.P.p "�$7e
FEEp BY.
NOTIFY BUILDING DEPARTMENT AT
UNDERWRITERS CERTIFICATE 765-1602 9 AM TO 4 PM FOR THE h
REQUIRED FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION S.�F,TE 0 ,y -
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE, REQUIREMENTS OF THE N.Y. •'�-' (i1f�
S7"ATE CONSTRUCTION & ENERGY „
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