HomeMy WebLinkAbout22455-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23818 Date AUGUST 15, 1995
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 380 MIDWAY ROAD SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 90 Block 2 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 1, 1994 pursuant to which
Building Permit No. 22455-Z dated NOVEMBER 4, 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 ALTERATION & TWO STORY ADDITION TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to ALFRED AMEND
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-359550 - AUGUST 1, 1995
PLUMBERS CERTIFICATION DATED JULY 7, 1995- MICHAEL DAWSON
Building Inspecto
Rev. 1/81
I
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 / 19. 9 ~
N° 22455 Z
Permission Is hereby granted to:
......,E.®sj' ......../r 4 /~91~fC.
to / 1- 1~............ .......`T .
7 ......f ~
r ~ .
....s
1 5
at premises located at 30669 ~
Tf?
County Tax Map No. 1000 Section .....9d............ Block Lot No. .....®T
pursuant to application dated ~ 19... T~°..... and approved by the
Building Inspector.
Fee $./'r; .
t
: B ildi ~.1 .......r
~ ng Inspecto
I
Rev. 6/30/80
wP^~ ~~~yy Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL di )r 2 ~g95
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY' Nn
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new bui.ldirng 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-disposel(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 17 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
1. Certificate of Occupancy - New dwelling $25.00, Addition 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 . . ...7Il~ ?S
New Construction......... Old Or Pre-existing Building
Location of Property....... I's ! iAa !v ...RA........... sqv. o).A..........
House No. Q A 'Street Hamlet
Onwer or Owners of Property....!"...
County Tax Map No 1000, Sectioo..Ol Z,.QQ....Block.. OO..QQQ......Lot. A21, OQ{............
Subdivision F!I ed Map... 6? Lot. .N t...1./~
Permit No..a,a.A- 5Z....Date Of Permit. 1!!.9/9.1...... Applicant )'R.A?tu . .-Tk~p04.;r;1v,
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate........
Fee Submitted: $......~a5p° J. R.HnMr..INIP.OVEM74TS
30 SVJi?? s7. P.O. BOX 314
"l vl S~ GREC1PdPOR r, NY 11344
~t(/......................
6 ~7Ij ( APPLICANT
o~OgOFFOL4,eaGyJ2
o~
NJ Z
Town Hall, 53095 Main Road p Fax (516) 765-1823
y'11p~ ~.a0~ Telephone (516) 765-1802
P. 0. Box ewvork 9 11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
July 24, 1995
J.R. Home Improvements
36 South Street
Greenport, NY 11944
Re: Alfred Amend - SCTM#1000-90-2-4
Prem: 380 Midway Road, Southol
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
xx 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 # 22455-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1DATIOy Tf 1st) I -~i
IDATI01!
f2nd)
zzl~
.H FRAME I //v JjO O
LATION PER N, Y. 2 r; y
STATE ENERGY ~Z s _
CODE
l 1~1
FINAL C _
• ADDITIONAL CO?4-%EIITS:
-
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9
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TEL. 765-1802
oS~FFOL/rTOWN OF SOUTHOLD
G
Z y~ OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
up' TOWN HALL
SOUTHOLD, N.Y. 11971
''~yff 1
C E R T I F I C A T I O N
Date 7f://- L/ ) /Jg
Building Permit No.
Owner lfG~/~~~Jj 1~ 1'7lz-~- ^%p
(please print)
Plumber %~&&- Et,~ N-50
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
zz
(plumber's signature)
Sworn to before me this 44
Job-day of
19 9S Notary Public
Notary Public, ~FGUc h County
L %v- K. (Frk4"f:'r
Nolvy P,hi'44. 5,Nvs of Now York ('o
g~?FFO,(k
JoAlbert J. Krupski, hn Holzapfel, Vice'Pres dent
-4 CaGy Town Hall
53095 Main Road
William G. Albertson P.O. Box 1179
Martin H. Garrell p Southold, New York 11971
Peter Wenczel Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUT 4OLD
October 28, 1994
J.R. Home Improvements
36 South Street
P.O. Box 314
Greenport, Ny 11944
Re: Alfred Amend
SCTM #90-2-4
Dear Sir,
The following action was taken by the Board of Trustees at their
regular meeting of October 27, 1994:
RESOLVED that the Southold Town Board of Trustees grant a waiver
to remove existing garage (21' X 19'), and build a new two story
extension (25' X 191). Located 380 Midway Road, Southold.
i
If you have any questions, please call our office.
ery truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. CAC
`s:~}Y .uNO~ ` `g9A
J
1
765-1802
BUILDING DEPT.
INSPECTION
BG.
[ ] FOUNDATION 1ST [ ] RO=ATION
[ ] FOUND TION 2ND [ ] IN [ ] F ING FINAL
FIREPLACE A CHIMNEY
REMARKS: ax<
_
r
DATE 1,;? / " INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
REMARKS: x/o If
DATE rJ INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] RO H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
4
t
REMARKS: a3e ~r CAC
~,CsK(~~~DATE /7 INSPECTOR
-7 7
M-1802
BUILDING DEPT.
1 N S PE CTI ON
[ ] FOUNDATION 1ST [ ] R GH PLBG.
[ ]FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
o -
DATE INSPECTOR
i
42
M-1802
BUILDING DEPT.
1 NSPECTIO
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ I INSULATION
[ ] FRAMING [ I FINAL
R ARKS:
~
DATE 411 INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F DATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
R ARKS:
~f
DATE / INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUN ION 1ST [ J ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE 0~4;,INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1
1000121 BUREAU OF ELECTRICITY
1 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date AUGUST 01,1995 Application No. on file 07453195/95 N 359550
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
ALFRED AMEND, WESTCEDER PT. ryDy~R~IVE, SOUTHOLD, N.Y,
in thefollowinglocation; ? Basement L`J lst FL ® 2nd Fl. OUT ' Section Block Lot
unsexaminedon JULY 26 ,1995 andfound to be in compliance with the National Electrical Code.
FIXTURE fCEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHEn AMT. K W. AMT X. W. MIT K.W. AMi K.W. AMT. H. P.
8 18 11 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. NO. A. W. G AML. AMP. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS AMT. WATLS
NO. OF FEET
SERVICE DISCONNECT NO. OF S E R V I C E
AMC AMP. TypE METER I.a tW 1 B 3W 3.e' RW 3,e' tW NO.OF CC. COND. A. W. G. NO Of HbWG A' W' G [NO. 01 NEUTRALS A. W. G.
EQUIP. PER a OF CC. C ND OF HI-LEG OF NEUTRAL
4I
I
OTHER APPARATUS:
.
t G.F.C.I:-1
i
i ,
PAUL R. BURNS LIC.#3397-E
P.O.BOX 1061
SOUTHOLD, NY, 11971-0932 GENERAL MANAGER
11 r
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.
i
COPY FOR BUILDING DEPARTMENT. THIS DOPY OF CERTIFICATE MUYST NOT BE ALTERED IN ANY MANNER.
Wg gj~ em RIP Imp oz, av
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
10M121 BUREAU OF ELECTRICITY
F 85 JOHN STREET. NEW YORK. NEW YORK 10038
Date OCTOBER 11,1995 Application No. on file 88362395/95 N 366135
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the oboes application number in the premises of
f1'1i~~1 F''D
ALFRED AMEND, 4TH HOUSE/WEST CEDAR PT. DR, SOUTHOLD, N.X.
in lhefollowing location; ? Basement ?X /At FL ® 2nd Fl. OUT Section Blue* Lot
was exE71"ed on OCTOBER 04,1995 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACIES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K W. AMT. K.W. pMI K W AMT. H P.
7 15 11 7 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRECT7 TIMECLOCKS gEll UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. NO. A. W. G AMT. AMP. AMT. AMPS. TRANS. AMT H. P SYSTEMS NO. OF FEET AMT. WATTS
2
SERVICE DISCONNECT NO. OF S E R V 1 C E
AMT AMP TYPE METER 1,9 2W 1.9 3W 3$3W 304W NO. OFCGBCOND A.W.G. NO. OF HIAEG A.WEG NO. OF NEUTRALS A. W.G
EQUIP. PER OF CC. COND OF HIAG OF NEUTRAL
OTHER APPARATUS:
G.F.C.1:-1
SHORE DETECTOR:-1
PAUL R. BURNS L1C.#3897-E
P.O.BOX 1061
SOUTHOLD, NY, 11971-0932 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.
iv
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT I3E ALTERED IN ANY MANNER.
BOARD OF HEALTH
FORM N0.1 3 SETS OF PLANS
i,
1 I„_ TOWN OF SOUTHOLD SURVEY ? .
BUILDING DEPARTMENT CHECK
NOV 1 1991 TOWN HALL SEPTIC FORM _
SOUTHOLD, N.Y. 11971 _T /k TEL.: 765-1802 ttOT I FY ,
3 (~,~y /1..~II'-~9UQ
CALL Jv..r.1k Pt A .r
ExAm6d'......1....~...119 MAIL TO
Approved /I/f~.., 19(~Permit No.....Z. 9 Z I 1,rj J=+. G : een~,-,.!
Disapproved a/c N,.Y I j'~ f( .
(Bui Inspector)
APPLICATION FOR BUILDING PERMIT q
Date 19 YJ
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation. I
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 Certificate 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
Buildigg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinces or
Regul tions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein de crlbed.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessa rnsp ctions.
(Signature of applicant, or name, if a corporation)
9a1 ,r4 J-4"y
(Mailing address of applicant)
Statee~ whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
IJL/\ QMs.I l.rOli ~l'rc'.G~Y
Name of owner of premises M C... R! A meAA
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name anti title of corporate officer)
Builder's License No. ..!.Zop3.':
Plumber's License No .
Electrician's License No. ! twl...~Yrn r'• . ; P7
Other Trade's License No .
1. Location of land on which proposed work will be done .
.5 .......................Mi41.w~~~'
I-louse Number qq Stet Hamlet
County Tax Map No. 1000 Section ...U !.Q : P.z:..... Block .....U Lot S?QA,A?P........
Subdivision Filed Map No. Lot . 4°~,+....~L s... .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy l! C.t ,i~ ey~t..l .
rl Jai ll~h~i 1
b. Intended use and occupancy .....Pr......... s , .
3. Re air Nature . of work (check which applicable): New Building ddition . Alteration
P Rerhoval . emolitior. Other Wor .
(Description)
4. Estimated Cost . ~7OO [70L? . 01)....................... Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....!L.......... Number of dwelling units on each floor. . .7
p
If garage, number of cars . .
6. If business, commercial or mixed • . • . . .
. , , • occupancy, specify nature and extent of each type of use . Depth . .
if any: Front .~2 Rear ~A......... Depth r'~~A . ; , , , , , , , .
Height Dimensions of existing
Hight of..ng structures, ,mber of Stories ...'&2i .
Dimensions of with alterations orodditions: Front ...7, , ; , , , Rear ,7 R.. , , , , , , , , , .
Depth . .
.
8. Dimensions of entire . .new.. . . cons' Height Number of Stories .
truction: Front ....1 Rear I Y.......... Depth A........... .
Height a. V Number of Stories
9. Size of lot: Front 7 5 : Rear y. ~ D th. 1
10. Date of Purchase . . . Sep Name of Former Owner ..'l iG.1v.+7?.... iI~ f
1]12.. Does Zone or r use district in which
construction violate premises are situated - .
13. Will proposed 'Mate any zoning law, ordinance or regulation: NU :.....................18"
S . Will excess fill be removed froQm premises: Yes
14. Name Name o of Co tractof Owner of fprem~ Address ..1.7 .ri.~.duPhone No..Z47.'.
Name of Contractor n ' . ' • . • • • • Address /Phone No............... .
yTl't within,i,r, Address .9 ~..1r~..a: rn :1. Phone No..9I.Z.'. S'4`I...
15. Is this If roert Southold300 feet of a tidal wetland? *Yes..71... No.........
* yes, 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.
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STATE OF NEW YQR S.S
COUNTp _
O.. . ? . • • , • , • . _ , being duly sworn, deposes and says that he is the applicant
(Name of mdrvtdtial sigq~ ing contract)
above named.
He is the .....4u1~ .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
2~`( A of. . .19
Notary Public, unty
ROBERT I. SCOTT, JR. xe~. ! .
NOTARY PUBLIC,StatanY (Signature of applicant)
Teerm Ex M9MaY 0 1 19
N'c4L-: Fir-s+ f rxN- 44esv. le.9 ~CC5!!!-
above mean seer ! r(,~er NGVD.
Gear. l7, r90-1
to Ihis carvsy -Iw'WII
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OCCUPANCY OR
!~•I'=~." USE IS UNLAWFUL
WITHOUT CERTIFICATE
FROM OMMUFOR OF OCCUPANCY 1. ALL Y /IYL6 OOIDLY Y NYROIT MW YOU NMU NIILOIYO S aO~Y~ OlilONl 7iY . AND Loa" xmm"92 lf.
ENEROENCY ESCA M
siamim eve ours xu ea 3. YSVLY CMMEIAM / 71Aw Am Euvr ..w.~..
!SW NOOK. ~ war. +raw~~aew~ I
PLUMBING iL STATE 8UN8iNC BDDF APPROVED AS NOTED ALL PLUMBING WASTE D 6/ B.P.N
12 J-S & WATER LINES NEED - AE: - , 3. DO NOT NONLN DYNINON. NRITTNN DINxNNIONlt ANN TO ON
TESTING SEPORE COVERING FEE. ? By PNIiiI1N1A
NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE ALL NNTJNIION NNLLN SMALL NN I•x$m 00MMOCTION , JILL
FOLLOWING INSPECTIONS: z PPRNITiou sD a 2X40 oONJrPiwcrtou ONLIU F
PLUMBER CERTIF/CAT/ON 1. FOUNDATION . TWO REQUIRED ; V IYZa,l11~
FOR POURED CONCRE ONLEAD CONTENT BEFORE 2. ROUGH - FRAMING & PLUMBING 5. ALL mimmas AT muzoK NALLN an" u (3) I•xa¦ amm" ~~s Ay No1~v
N copper tubing Is used for water CERTIFICATE OF OCCUPANCY 3. INSULATION distributing 4. FINAL - CONSTRUCTION MUST f. ALL N1pOR JOIJNH TO NO DDDNLND N=LON PANAi,i.NL PARTITIONS, Y ~l
system; piping shell be SOLDER USED IN WATER BE COMPLETE FOR C.O. z AM RAM OINMINM.
Of types K or L only SUPPLYSYSTEM CANNOT THALL E REQUI EIMENTS OFATHEMN.Y.
UNDERWRITERS CERTIFICATE EXCEED 2110 of 1 % LEAD. STATE CONSTRUCTION & ENERGY 7. PWVM MUCUM AT KID POINT OF FLOOR JOIN wr DR I~
REQUIRED CODES. NOT RESPONSIBLE FOR O'-" •.0. lax. IN AU ROOK NYSTM.
DESIGN OR CONSTRUCTION ERRORS N. ALL L136M " u WGRW NAMWACSwu {N L M R~
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