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HomeMy WebLinkAbout22468-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23571 Date MARCH 29, 1995 THIS CERTIFIES that the building ALTERATION Location of Property 855 OLD SALT ROAD MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 144 Block 5 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 3, 1994 pursuant to which Building Permit No. 22468-Z dated NOVEMBER 15, 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 TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD A. REYNOLDS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N342726 FEBRUARY 14, 1995 PLUMBERS CERTIFICATION DATED FEBRUARY 14, 1995 STEVEN BURNS Buildin Inspect/ Rev. 1/81 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) N® 22468 Z Date 19../... Permission Is hereby granted to: l/~s ...............c....s to ....................X? lTz!r. ~1-............' ~yE........."~'... c/ at premises located at .CfJ........ . ~Skl /5, },/7,1-Ze c~ . County Tax Map No. 1000 Section y.............. Block ........~......../Lot No....zw/ pursuant to application dated ..............r 19../... T and approved by the Building Inspector. Y Fee uilding Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 1. Certificate of Occu a N w dwelling $25.00, Additions to dwellin , terations to dwelling g g $25,00 Swimming pool $x.00, Accessory building ng $25.00, ions to accessory ui ing $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $ 5.00, Commer .1 $15.00 Date 'S,/..... New Construction........ Old Or Pre-existing Buiding..... . Location of Property.... /M . House No. licH ,E Street Hamlet lnwer or Owners of Property ...~ii....ozG° p~~ ,ounty Tax Map No 1000, Section.. Block .....t........... Lot.. _ subdivision.. ..Filed Map............ Lot.. 'ermit No,2~,f•Ay - J/JJ~•-~•- .Date Of Permit. /l ,n l~j,[,~y Applicant [ealth Dept. Approval .......rV . ..........Underwriters Approval............ Tanning Board Approval equest for: Temporary Certificate........... Final Certicate........... ee Submitted: $ a35 1 - APPT TRAA1m TEL. 765-1802 00 D~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR 0 ~ P.O. BOX 728 TOWN HALL p~ SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date / y1 9r Building Permit No. Owner_ C-6 1~P Y,,vo Jd g (please print) _ Plumber S re ?P~ IKIi?ivS (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this _I t day of Fe-L rvcLY- 199~. Notary Publi. 1lotary Public, SUf~O\k County Joannel-agan Notary Public, Suffolk County, NY X01 FA4991777 Commission Exp. 2-10-9(o i:OHML•NTS =r 11ID,1TI0V ~•_(lst) I o~ 11DATT01f (2nd _-I y LAI GH FRAME & • - II ' •PLUHBING r, m JLATION PER N. Y. II STATE E21ERGy II I y CODE II m FINAL - LIZ ADDITION COMMMITS THE NEW YORK BOARD OF FIRE UNDERWRITERS WE ARE IN THE PROCESS OF ISSUING A CERT F CATE OF COMPLIANCE FOR THE ICA[ALLATION AS PLI C COVERED IN AN APpLICgTION NOTED BELOW APPLICATION NO. ,.y Z 41 LOCATION27 b ID(REVOfl O ~ Z / j ID (REV B/9p)--DATE p b • + . . al. VI M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST F ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING [ ] FINAL REMARKS: Z/"4 A~q X07 S/~ DATE b INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ 7 FRAMING [,,]-fPNAL REMARKS: q DATE / ~ INSPECTOR t - ® I~ I M-1802 BUILDING DEPT. 1 NSPECTIO [ ]FOUNDATION 1ST ( RO H PLBG. FOUNDATION 2ND [ NSULATION FRAMING [ FIN AL REM S: E DATE INSPECTOR ' ¦ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000415 BUREAU OF ELECTRICITY I 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date FEBRUARY 1.4,1995 Application No. on file 86652594/94 N 342726 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant homed on the above application number in the premises of FAYE & EDWARD REYNOLDS, SALT~LAKE LANE, POLE- 5-I, MATITUCK, N.Y. in thefollowinA locations ? Dosement L'J' 1st FT. El 2nd FT. GAR/OUT Section Block Lot was examined on E E BRUARY 09 ,1995 andfound to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS 11 DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. K W T. K.W AMT K W AMi. H. P. 6 15 11 6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. OIL H. P. GAS H. P. MIT. NO. A. W. G. AMT. AMP. WT. AMPS. TRANS. AMT. H P NO. OF FEET AMi. WATiS 1 1 600 SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC COND. A. W G. A. W. G A. W: G. AMT. AMP. TYPE EQUIP 1.0 tW 103W 3.e 3W 3,e dW PER% OF CC.COND. NO. OF HIAEG OF A. NO.OFNEUTRALS OF NEUTRAL t I OTHER APPARATUS: , MOTORSt1-F H.P. G.F.C.II-1 SMOKE DETECTOR[-1 i t'O'l { ALEXANDER G. HtBBARD LI.C.#304-E t BOX 222 AQUEBOGUE L.I., NY, 11931 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 byT their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY 0 F CERTIFICATE, MUST NOT BE ALTERED IN ANY MANNER. FORMN0.1 BOARD OF HEALTH _ 3 SETS OF PLANS TOWN OFSOUTHOLD SURVEY . . . BUILDING DEPARTMENT CHECK ni`I 3 1994 TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 LDG.DEPf.rn TEL.: 765-1802 t;t)TIFY TOWN OF SOU(H i_D Gj CALL Examined..... .,19c~!,/~ rfnzL To 'approved . 19/. Y': Permit Nw . . Disapproved a/c _ . (Build g Inspector) APPLICATION FOR BUILDING PERMIT }}~~ff Date /',(Q3! 3 199f. y INSTRUCTIONS 11 a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 r, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 call 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 tall 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agiees to comply with all applicable laws, ordinances, building code, housing ode, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspectio (Signature of appli a t, or n e, if a corporation) (Mailing a dress of applicant) state whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. lame of owner of premises • , , , • , as on the tax roll or latest deed) `applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) / Builder's License NosA..1 M.. 2,03 1-H-T Plumber's License No. t'..7, • • , , , • Electrician's License No. ,a ©,T• e• • • . • Other Trade's License No . Loca work / will be done. eDon of land . on which h p.. se k 7 4,- 11 n[/~/ Houst Number '1 Street Hamlet WOOL 'A~ County Tax Map No. 1000 Section . b Block Lot Subdivision . V..V, 1 `/aL 'e. Filed Map No. .l. ~ 1:0...... Lot ~.JC (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy SG .Y.C 4~ b. Intended use and occupancy " ! ~ %1INr~~ I+~Jy1 j,~ 3. Nature of work (check which applicable); New ~.uilding/ Addition F Alteration Ali A Repair ...s-t7rtor emoval . GQi~v~.Wt.< W0,111bernolition Other Work as /~~y wln~a^ (Description) 4. Estimated Cost ~(t0 L? Fee . . . • . • . (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of exi t'ng structures, if any; Front j. . , , . , Rear • , , , , , , , , Depth . ,r • , Height Number of Stories . " " Dimensions of same structure with alterations or additions: Front . Rear Depth ...................'I. Height Number of Stories . $ Dimensions of entire new construction: Front . . Rear • , , . , , , , , , , , , Depth Height Number of Stories , " " " " ' 9. Size of lot: Front f'73 Rear .......14. Q........... Depth ..//.w . 10. Date of Purchase 11. Zone or use district in which • • • • • • • • • • • • ....Name of Former Owner premises proposed construction aresituated ........................12. Does . violate any zoning law, ordinance or regulation: . , ;71o.. • , , , , • • , , , , • , • • 13. Will lot be regraded ~ vio', Will ess fill be r move f om premises: Yes, ®o 14. Name of Owner of premises 4C . ~P ! hp... • , Addra . Phone No. '.Z,? yCy15 . . Name of Architect ' . f, .a ,'°1? ? tidal Address wetland? 1A, I ?Phone No..~Z. Name of Contractor ...lTlaYtlS. ~t~°rYa Address z.98 .r4-C,(t ,No ...Phone 15. Is this * property ...No.... outhowithild R10 fn eetc *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 blocklnumber or description according to deed, and show street names and indicate whether interior or comer lot. I ~I !I STATE OF NEW YORK, 'OUNTY OF S (Namwrdual si i • • . • . • • • • ' • • • • • • • being duly sworn, deposes and says that he is the applicant gnng contract) ibove named. le is the . .[.y L4u~ (Conte tractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the vork will be performed in the manner set forth in the application filed therewith. -wom to before me this ...day of .I!!L 19 ,otary Public, :County oYCE M. Notary 2248 state of N York u (Signature Term ExpireBJune 12, 9. of applicant) I mmlONe By d VIC ro S~l 11 ~I ~IOIIII IY-IM pp Jo* 70~~ 6.N/ I G N I- H Z Z~I*IZMIfl~2. s. ALL srDMS r.-.W rfL4 r CODrs, un"m CD nary uz~ w ft", wrww / fMIALeMrM11 a. Way i ~r~~uareelew rwem v~wtrwr mot, etrrwrrw mal soieMMSra~aDSrDwoes. a. Dom saw mWawss. MMMwC' Mlle.. 01"m Irww ewe ft w postam. ~XI~TII ~q Ho WM*- Cxlhf~JeU1~ J.I•~• To 9 a. ALL ISTO M OWN ARM & $I x 1"M ae IN on 2ailX4"-lllM xr *Vid ~ ThI(,) AgrA, ff KWOV~P. soaoss TO an 2+1 N wwrrlhl S t wtwe 1 /IIYtlY1, 0 t2T Ban ~xwl(IrV~ wl(IrV~ N f. M sro GOUrsMnr. ~a?am i. ALL PL80A measfr " sr rrsDD to all mom imam ftomm oft"who, AT Ma e-40rli ma raas am=". DEIUI~q -lmomi° t M~jDI 7. MVZDS rMt MOM At MD wrw ~ n To H~ rW so-o» O.C. MAX. aw AM MMAfMM ftm U.~ f. 11afTr, wMIMMDm .V rs Amnow 0 aiwloDMaMs. S 2. 13/~~Ix III/All MlWLAMO plUhrl f. AM OWN ssicMrre TO BE Ar V ro ee xr e~-a DwT~N wpb e+1~NIRYM7Ctt. I mmov~ ~xw 11 \\14U. To N ll+ o GI4TE 'NF\JIOH FxM, Nj i-- I ~ I, L exit 1 t2c~J J ;%xlmH vAy ,,PWHq To M WNW, INyfeU ~I HE~d I/z p W?H~I oUT \ ~ IZEM I.NINq o niNl Nq fzooM~~ IIMERWRITERS GERTWICAIk REQUIRED li x ~ v N N / OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY 2-Is/Kilxll7~° MI~Roldh'Y> -i~~~'~b. APPROVED AS NOTED DATE: ! I S 9 D.PM 1 6 f M ~X hriHU ova w TO r NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE ~A7N ~T~ N ATE 'N~d' auuN. op~NiN=~ ~ FOLLOWING INSPECTIONS: 7. FOUNDATION - TWO REQUIRED V \ FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING 3. INSULATION (2~h'lo~/~ ~XI~TING I q, FINAL - CONSTRUCTION MUST I ? 131.o~k o;~l-IINq ~ vlt-111~ ~ ~ BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. N ~ N STATE CONSTRUCTION & ENERGY \~`'lI u o I H CODES. NOT RESPONSIBLE FOR • + DESIGN OR CONSTRUCTION ERRORS ~7Ted,l, / - \ 12 ~h'1o~~ ~XI~1t~~ ~fzJDIZ Xi 7rf6l (IoH, T%&TIoH. 17 OR ± ~I NN Z~~~q~~ ~fUl~ vCisl I.~IrdioG• `1 15~" 5N ~ ~I ~\iALI_ to n I~ Mov~v- N~~V ~VbJ,I. Gof~~I,I~TIo~}. Ilj AZ z a ~ 2. DATE 10,2~' I~ eo LeAyy Notes IMAV N~^I FLOOR FLAH ~ ALT1ATIoHe? 5 _ Joe eHCET r e 4 by \~/O, SHEETS s 0 STOLXGR~FTIHG FOPM XG, IOI+JI I N~Whb10Nb !iY u~ run.; . ~/J ~s~~~~iu hY/CAS ~V".~ :f J ry ((I+ { '-.:nY ~iL' b a /k A,e,)qJALT KoorIN~ e+IINGLE,~2, t5~Lr, - ~.~a h \ 05 f,10. Tl+I q Ae7 ~o~ I-IbAY i o~ 112-11,~,x pLYwr ~I I TNI N~ o,~ a~, ~~~o IN~UL.A71o1~. too Fula ~p To LOOK JoI~T M4YG~ ~XI~NG1-~ Llxd G it Mv•PoII~T LooIZ col% vl~IvgIN~1 4'ix~a PT roof oil 2q',, Xlz~ Q ~ i, otl VI ~ ~o ~ILIN~ Jol~r~ C, Ala 0•U. SIT PEA{' FoGw 0HXf-TI r ~ T7~loa~l. Fob N ~ 1 f 161, c,Y~~LIM C, AJ vVeJar~ 1- t O(IN~e~, To W MLRO of N5\V wow- j ~ s VINY~ ~InIN~ ° 1YV~k" o. ~ ~H N~ oN z I UI~IoI~ e'rUV2 I~ 0•G, r? 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