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Home My WebLink About22671-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. No Z-23724 CERTIFICATE OF OCCUPANCY Date JUNE 21, 1995 THIS CERTIFIES that the buildin~ Location of Propert~ 250 BALTAIRE House No. County Tax Map No. 1000 Section 100 Subdivision ADDITION MATTITUCK, N.Y. Street Hamlet Block 1 Lot 39 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 21, 1995 pursuant to which Building Permit No. 22671-Z dated APRIL 13, 1995 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. WILLIAM SANOK SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-354842 - JUNE 13, 1995 PLUMBERS CERTIFICATION DATED N/A /B/1 dl/ng Inspector Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING D£PARTMENf TOWN HAl1 SOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....................................... 22671 Z ~ Permission Is hereby granted t~ ................. ,/~,~ / ~ ~ ./.. .: .~~..m.~ .............. :,.. ........ ~ ................ ~o .... ~~.....~.....~.....~..~.......:...~.....,~~ .............. ~ ~.. ~ ~.....~.~......~..,.. ~ ~.~?....~,..~.:./...~ ..... ~.. ....... ...... - ......................................................... ~:~ ................. ~ ..................................................... CountyTax Map No. 1000 Section ...... /..~.,.,.~.,,,, Block .......... ../.. ........... LotNo..,,~.....~.. .............. pursuant to application dated ............... ~~..~.~.~ 1 9.~ and approved bythe Building Inspector, Fee*...~..,~.....~.. Rev. 6/30/80 Fo rrTi bio, ~[OI,h'q OF $00Ti[OLD BIJ Il,I) l NO I)EPAIITHEblT TOWN IIALL 765-1802 APPLI. CATION FOR CEI~'I'IFICATE OF OCCUI'ANCY A. This application .lust be filled in by typewriter OR ink and subrnitted to the building iaspector with the folloej, ng: for tlC~ building or tlet~ rise: ' 1. Final survey of property with accurate location of a.ll buildings, property lines, streets, and uausual natural or topographic features. 2. Final Approval frof~l Ilehlth Dept, of water supply and scwerage-disposal(S-9 form). 3. Apprnval of electrical, installation from Board of Fire Underwriters. 4. Sworn statement fromfpinmber certifying that the solder used in system contairs less than 2/10 of I% lead. 5. Commercial building, industrial building, multiple residencea aed similar buildings nnd installations,kg certificate of Code Compliance from architect or engiacer responsible for t[ld building. 6. Submit Planuing 8oard Approval of completed site plan requirements. F~r existing buildings (prior to April 9, 1957) non-conforming uses, or luzldzngs and 'pre-existing land uses: 1. Accurate survey of property showing ail property lines, streets, building a,d unusual aatural or topographic features. 2. A properly completed application and a cousent to i,spect, signed by the applicant. If a Certificate of Occupancy is denied, the Boildi,g 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, Additioes to accessory building $25,O0. Busi,esses $50.00. 2. Certificate of Occupancy ou Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary ertiflcate of Occupancy - Residential $15.00., Cmm, ercial $15.OO flew Construction ..... Old Or House No~ Stre~ Ilamlet Couuty Tax Hap No lO00, Sectloa...~ .Block.. / .Lot.. ~.., Subdivision .................................... Fi; ed Health Dept Approval ' ' ............. ~ ........... Under~riters Approval ......................... "lanning Board Approval ........................ ~equest for: Temporary Certificate ........... Final Certicota...~.. THE NEW YORK BOARD OF FIRE UNDERWRITERS J.(~)~.21 BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 .... 0~[~,' JUN~ 13,1995 ~pplicationNo. onfile 07275695/95 N 354842 THIS CERTIFIES THAT only t~ electrical equipment ~ ~scribed below a~ intr~uc~ by t~ ap~icant ~med on the a~ve ap~ication nu tuber in the prem~es of WI~I~ S~OK, 250 S~TAI~ WAY, ~TTITUCK~ in the following location; [] Basement JUNE 06,1995 [] let FI. FIXTURE FIXTURES OUTLETS FtUO~E$¢ENT 2 [] 2nd FL G~/OUT Section Block Lot and found to be in compliance with the National Electrical Code. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: G.F.C.I:-i E R V I C NO Oi~E RCC~CON D- A- W, G. NO' OF HI-LEG A. W G NO OF NEUTRALS A. W, G, OF CC. COND OF H[,LE(~ OF I'~EUTRAL PAUL R. BURNS P.O. BOX 1061 SOUTHOLD, NY, 11971-0932 LIC. #3897R 11 Per This cert;ficate 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, ADDITIONAL COI~IEWr S: CODE JJ II FIN~ mm HAR '-. IDg,~ BLDG, TOWN OF $OUTHOLD fltOVIBt ~ HIL BATEO SEPARATION TO I~ltT,~)7.3 (~) (J) OF I..Y. 6'IIIIE BUiLDIN6 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING ROUGH PLBG. /] INFLATION FINAL [ ] FIREPLACE & CHIMNEY REMARKS: /~//~' ~r ~ 7/ 2 -- 76S-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ,] F~JNDATION/2ND [ ] INSULATION [ ~]' FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY .EMA?KS.~~-~' '~ ~/~,/~,~ ./t.~..~E~ ~:-/~ ~ ~ 7/7, ~4~(~¢ DATE INSPECTOR 76S-1802 BUILDING DEPT. · .,~SPECTION [,~J/FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL ~AR z 1~995 BLCG. D[lPlr. Examined .... Approved . Disapproved a/c ..... ' ¥ FORM NO. 1 TOWN OF SOUTHOLD BUt. LDINO DEPARTMENT~ TOWN HALL 8OUTHOLD, N.Y. 1197] ~..,~,. TEL.: 765-1~02 .... , if. No. (Buildin~ Inspector) / LICATION FOR BUILDING'PERMIT INSTRUCTIONS B'OARD OF HEALTH ........ ,3 gETg OF PLANS CIIECK ......... . SEPTIC FORH ............ CALL .7. ;.. . . HAIL TO: Date , a. Tl~s application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationshii~ to adjoining premises or public sti'eet or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appl: cation. c. ' The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will fssued a BuildLng Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work.' , ..e; No. buil~f~j:~ ~,~help.~all~lljor used in whole or in part for any purpose whatever until a Certificate' of Occupanc' snaa nave ~een grantedll~.~(~l~ilBuilding Inspector . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th. Building Zone Ordinalaie'. o}f. thefT, own of South61d, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the .9onstruction of buildings additions'or alterations, or for removal or demolition, as herein described The appliCa'nt aff~'s ~to ~om/5ty ~ith'aI1 applicable laws, ordinances, building code, housing code, and regulations, and t( admit authorized inspectdrs on premises and in building for necessary, inspections. .. . · . . .. · . . (Si,,natur9 of applicant, o.~mme, if a corporation) / ........ .... (Mailing address of applicant)0 State whether applicant is owner, lessee, ~agent, architect, engineer, generai contractor, electrician, plumber or builder. N~meof;w'ne;;flbrem;~s .~..~.~....~. ~..//~: ;~:";~ ....... } .... ' ........................... ,,;:,. ;,, ~ ~ .: ... , . (as on'the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. : (Name and title of corporate officer) 'u' B rider s L~cense No ............ Humber's License No ' Electrician" s License No Other Trade's License No... .................... 1. Location of land on which proposed work will be done .................... N St ...................... House umber reet-- Hamlet Con~ltY Tax Map No. 1000 Section .... ../..c.e ...... Elock ...... I .... . ..... St bdw~smn ............. Filed Map No. (Name) .............. Lot .............. 2: Stat~ existing Use and occupancy of premises and intended use and occupancy of proposed constructioni a.Existing use and occupancy · . .~¥ · '. . . "' .............. , , .... ~ :¥~.r¢1~ ...... ........ Height ............... Number of Stories [ . . ',. ' .............. Dane. risings o.f same stracture W~th alterations or additions: Front ~.~ .............. Rear~./ ....... 9. 10. Date of Purchase .... ...... [ .......... · ........ . Name of Former Owner ....................... 11. Zone or use district in which p~emises are situated .... . .......... ' .............................. 2 ~ .12. Does proposed cgn~lruction violate any zoning law, ordmar~ce or regulation: ~ ,'....... ....... ~ ........ 13. Will lot be regraded ~ .'7~-~ ....: ~, .................... Will excess fill be removed from premises: Yes 14. ( ppli ) Bhilding Additi. .~f~. · ·. ' .3. Nature of work check which ~ cable: New . '. ........ on ......... Alteration .... ; ..... Repair .............. Ret loyal .... , ........ Demolition ..... ; Other Work - ~'~ ~'~t fro i .... (Description) 4. Estimated Cost .~'/e~a.~ .... i Fee : (to be paid on .... filing this apphcatmn) 5. If dwelling; number of dwellin umts ........ .. Numbero/;dwelli'n units h fl ..... . g on eec ocr... ........ If garage number of cars ~ 6. If business commercial or mixed o if.. .... ' .... · , ccupancy, spec y nature and extent of,each type of use .................... 7. Dimensions of existing structures, if any: Front..~./..; ....... Rear .~ ..x./ ....... Depth .{tr~../. ....... . Name. of Owner. of premises .. ,~ ......... ;... ,. ....Address ..; ....... . .......... Phone No ............ ;,. Name of Architect ........ : ................. Address ........... . ........ Phone No ............ , .... Name of Contractor ~r.~...~..,.,.,.,~ .~. ...... ~Address,.~O.~ : . . Phone No. 15.' I.s this property within !300 feet of a tida.[ 'wetland? ~Yes ........ No ......... ~If yes,' Southold ~owr3 Trustees Permit mag.be required. ' PLOT DIAGRAM Locate clearly and distinctly alli buildings, Whether existing or proposed, and. indlcate all set-back dimensions from' property lines. Give street and blockinumber or descriptior~ according to deed, and show street names and indicate Whether interior or corner lot, UNDERWRITERS APPJIOV i) AS NOTED NOTIFY BUImlNG DEPOT 765-1802 g AM ~ 4~M FOR THE FOLLOWING INGPE~ONG: 1: FOUNDATION - ~0 REQUIRED FOR POURED CONCR~E 2, ROUGH - F~MING & PLUMBING ' 3. IhSU~ON 4.' FINAL - CON~RU~ON MUST . SE COMP~E~R C.O. ALL CON~RU~ON 8HALL ME~, THE REQUlREME~ OF STATE CONS~U~ION & ENERGY CODES. N~ RESPONSlB~ FOR DESIGN OR CONS~M~ION ~ROR8 STATE OF SS ..... .... oetng~iy ~:~[g~;~?~:~'s that he is the applicant (Name of individual signir ~bove named. ................ .... ........ . ........... .... ............ ' ' ' [ f~tract~gent, corporate officer, etc.) ' said owner or owners, md is duly ~ut~ofized to perfom or have perfo~ed the said work and to m~e and file this tpplication; that all statements contained ~his'application are flue to the best ofh s knowledge and belief, and that the ~ork will' be perfomed in the m~ner spt f~tt~.tlm application filed therewith. ' ' ' ;worn to before me this t ota~ Pubhc, ounty ARY PUBLIC, State of . No.. q??p. ~.,~t. ~/ . · ............. /. 5 ................ . ~m~sie~ Expires December 8, t~ . . , ' ~gnature of applic~t)