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Home My WebLink About22375-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No z-24620 Date SEPTEMBER 11, 1996 THIS CERTIFIES that the buildin~ REPLACEMENT Location of Property 1870 OLE JULE LANE House No. Street County Tax Map NO. 1000 Section 122 Block 4 Subdivision Piled Map No. MATTITUCK, N.Y. Hamlet Lot 6 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 8, 1994 ~ursuant to which Building Permit No. 22375-Z dated OCTOBER 13, 1994 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 INSTALLATION OF NEW BOILER & HOT WATER HEATER AS APPLIED FOR The certificate is issued to JOHN HAAS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 12791 - JULY 23, 1996 PLUMBERS CERTIFICATION DATED JULY 18, 1996 - LAWRENCE C. TRAPASSO Rev. 1/81 FOBM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N£ 22375 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ddte ....~. ~...~.../....'~. ........................................ Z CounlyTax Map No. 1000 Section ....... ;..~.....~T...~ Block ............ , .~,,.. ...... Lot NO ..... .~. ................... pursuant 1'o application dated...:...~.., ../.,..,~., ..................................... 19~.,~,,, ..... and approved by the Building Inspector. Fee ~,,, Rev. 6/30/80 / z~lllding Inspectdr Irurm Flu. 6 ' ~ AJa ~a1996 APPLICATION FOR CERT[I;ICATI~ OF OCCUPANCY ~LDG. ~ own OF $OUT~OU) A. Thig applicatiou must be filled In by ~ype.riter OR ink and inspector with ~]lC follot~ing: for ne~ building or ne~ use: 1. Fiuai survey of property with accurate Jocation of ali bnildings, property lines, streets, and unusual uatoral or topographic featnres. 2.Fiual Approval from lleh.ltb Dept. of writer supply aud sewerage-disposal(S-9 form). 3.Approval of eiectrici~l, installation from Board of Fire Underwriters. 4. Sworo staternent from'plumber certifyiug tbat the solder used in system contairs less than 2/10 of 1% lend. 5. Co,un~rcial building, industrial building, multiple residence and mnstallatio.s,I.a certificate ~r ~,-, - ~. a.and oimilar buildings responsible for the building. P rom architect or engineer ~ 6. Submit Platming Bonrd Approval of completed site plan requirements. 'B. For existing buildings (prior to April 9, 1957) uon-conforming uses, or buildings and ~ ' ~re-existing" land uses: 1. Accurate survey of property showing ali property lines, streets, building and uuusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a CercificaCe of Occupancy is denied, the Building Inspector shall state the reasous therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,-- Alteratioes to dwelling $25.00, S~imming pool $25.00, Accessory building $25.00, Additio,s to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildie~ - $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,, Co~ercial $15.OO' Date JULY 10~ 1996 New Construction ..... Old Or Pre-existing Building.~p ............. Location of Property .... ~70 ............ alp JU~E LANE ..... llouse No. Street Hamlet Onwer or O~mers of Property...40~.~ .... m, ,o 000, ...... ...... ....... . . ~ bdi i~z au v on .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ ApplicantRELIAMCE.FU~L.OIL.aSSOCi~S. .............. Underwriters Approval... Planeing Board Approval ........................ ]equest for: Temporary ert~f~cate ........... Fiual Certicate ........... :'ce Sub,,i! ted: $ ...... i75.aQ ................. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 'Telephone {516) 765-1~02 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION DATE: Building Permit No. Owner: ~O~ (please print) Plumber: (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead.. - (Plumbers~ign~ture) Sworn to before me this J ~ day of 3 ~L 19 ~ Notary Public, ~ ~ ~ County Q~I~ In ~ff~ C~ ~ ~ ~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & :PLUMBING~ INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: OIL BURNER Certificate of Inspection Name John Haas APPel2791 Loc~tion: 1870 Old Jule Lane, Mattituck, NY Applicant: Reliance Associates Address: P. O. BOX 868 Patchoque, NY 11772 Tel. No. 475=4754 U~ N(~ 2901-RE Expires: ELECTRICAL INSPECTION SERVICE, INC. 375 I)UNTON AVENUE EAST PAT{~tlO{}U£, NEW YORK 11772 TEL: (516) 286~5.63~ ....~:.,...,..~ ......................... , ..... ~..~.~.~.' ............ 765-],80Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ] INSU~.ATION [ ] FRAMING [,.']"FINAL [ ] FIREPLACE & CHIMNEY // INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exanlined Disapproved, a/c ............ .~ . ~ . (Bu}~mng APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PL2~NS ......... CllECK ....... .. ~;OTI PY; CALL HAlL TO: INSTRUCTIONS Date a. This application must be completely filled in by Wpewriter or in ink and submitted to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or publ/c sti'eets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this appli- ' 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 issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificatd of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for.the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New'~York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, btclding cod~, housing coqle, gl~d-regulations,~md to admit authorized inspectors on premises and in building for necess~ ig~l~ecti°n"s'~JJ . A.'- .~.~,,~-.~:. · .~:~...:: 2 .~.- .~ ~:: ...... -- · . (~gnature of applicant, or name,./if~ corporation) (Mailing address of applicant)/ State w~ether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. , -- , --- - .................... . ......................................... N~me of owne: of premises,..~...~r~..,... ~:~ ........................... : ..................... . ~/ (as on the tax roll or latest deed) If. appli~nt is a cor~po~nature of 0..uly authorized officer. . (Name and title of dbrporate officer) Builder's License No. Plumber's License No....~.l.~..]]..~ .~... ......... E,ec,r, cian's icense 7:.Fi.£ .... Other Trade's License No ...................... , UNDERWRITERS CERTiFiCATE REQUIRED Location of land on which proposed work will be 'done ...... , ........................... ~ ............... .... ...... , ........ .......... Itguse Number /Street Hamlet , // cotmty Tax Map No. 1000 Section ...:~..~.~. ....... Block ...... .~. ..... J... Lot ..... ~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) , Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ' .......... ' .................... i .................................. -. b Intended use and occupancy ' . Nature of work (check which applicable): New Building .......... Addition . .'... .3. . .... Alteration..' . .... Repair .............. Rgmova1 .............. Demolition .... : ......... Other Work ' ~ '"" ' (Description) 4. Estimated Cost ' · ............ Fee .'/-3.. A.'f~'.gf,~'. ~7.V .... ' (to b paid on fill gthi appli tion) 5. If dwelling, number of dwelling units ..... i ........ Number of dwelling units on each floor ....... If garage, num bet of cars ! ............ ' .... · ....... 6 If business commercial or mi,(ed occupancy specify nature and extent of · ' , ,each type of use 7. Dimensions of existing structfires if any Front R ............... ' .... Height Numb ~o ' ' "~ ........ ear Depth Dimensions of shine structure~itt~ .................................................. Depth ' alterations or additions: Front ................. Rear ................. ........................ Height .................... . · · Number of Stories 8. Dimensions of entire new conlstruction: Front .......... Rear ..................... .... : · ............. Depth Height ............... N0mber of Stories ...................... 9. Size of lot Front . . i Ra~- "~ ............................... ....... i~ ................ m ...................... Depth. 10. Date of Purchase . · .................... .............. Name of Former Owner . . 11 ti p it d '~ ......................... · Zone or use distric n which remises are s uate ......... · .xz. Does proposed construction v olate any zonin aw, ordina ce or regulation: ................... 13 Will I t b · · ............ · o e regraded ....... i ..................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .: .......... , ........ Address ................... Phone No ............... Nam f A hit · e o rc ect ........ ~ ................... Address ................... Phone No ................. Name of Contractor ....... ~ · · · .. Address .... . Phone No. ' 15. Is this property withi~ 300 feet of a tidal wetland? *Yes ........ No ......... · *If yes,~Southoldi Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. .i FOLLOW~MG ~NSPECTIOt~G: % FOHNDATtON . T~A/O REOU~RED 3~ ~SU[ ATION 8E COMPLETE FOR 'ALL CONSTRUCTION SHAI, L MEET THE REQUIREMENTS OF THE N.~ STATE CONSTRUCTION ~ ENERGy CODES. NOT RESPONSIBLE FOR DESIG~ 0 ' " R CON81 RUCTION ERRORS STATE OF NEW YO.RI~,~_ ~/ o o ' · .~..~..I../~0~.. ~~ being duly sworn ~e ones ~ds ' , p ays that he ~s the apphcant (Name of individual......... ' above named. .~ ~ (Contractor, agent, cofporate officer, etc.) .... . of said owner or owners, ~d is duly~ authorized to perfom or have perfomed the said work and to m~e and file this application; that all statements contained M this'application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the manner :set forth in the application filed therewith. Sworn to before me this . ....................... ..... ..... '...... __ Nota~ Public ........ .~. ~t.[%1.~ ....... . ..... ' No ~2-4~0~ ~ ~ / . -- I 11' (Signature ofapplic~t) . Qua fe~ nStfffolk~ounW ~" It.I ~ ' IJ / il **