HomeMy WebLinkAbout21930-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24140 Date JANUARY 26, 1996
THIS CERTIFIES that the building NEW DWELLING
Location of Property 265 OLDFIELD COURT MATTITUCR, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 120 Block 3 Lot 8.20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 28, 1994 pursuant to which
Building Permit No. 21930-Z dated MARCH 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & COVERED PORCH
AS APPLIED FOR.
The certificate is issued to NORTH RAY CORP. '
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-94-0015-JAN. 25, 1996
ELECTRICAL INSPECTION CERT. #4941 - SEPT. 15, 1994
PLUMBERS CERTIFICATION DATED JAN. 25, 1996 - JOHN DEACY
Building Inspector
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)
Date ............3/ 19... /z
N° 21930 Z C~[[
Permission Is hereby granted to;
I t ~FvrizGt. ..u!C?......J? ........G.......:...........
........fire
,.~~L~
k
at premises located at z~o.sa G/ ~ ~G~......4:f.~..t%J/4'r'.:...
4. . .irr~
County Tax Map No. 1000 Section Block.. Lot No. J. k.2 .
C/
pursuant to application dated ..........1.. . 19... yl and approved by the
! Building Inspector.
Ip~
i Fee $
...~.F.~:...,,<.~lf/.
../Sui inspector
i
Rev. 6/30/80
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Town Hall, 53095 Main Road p • Fax (516) 765-1823
Telephone (516) 765-1802
P. 0. Box New York 9 11971
Southold, N
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 24, 1996
North Ray Corp.
P.O. Box 655
Shirley, NY 11967
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
xx Application's for Certificate of occupancies are
not on file. (Enclosed)
xx No Underwriters Certificate's on file.
xx The check's are not on file. $25.00 each.
xx No Health Department Approval's on file.
No final inspection has been made.
xx No Plumber Solder Certificate's on file
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 2193071" F46V-
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
a 9 p- 13~j Form No. 6 I EE
TOWN OF SOUTHOLD f P F
BUILDING DEPARTMENT
TOWN HALL i:~ ~ •
JAN 2 619i_
765-1802 1,
BLDG. DEPT,
APPLICATION FOR CERTIFICATE OF OCCUPAN3 TOWN OOFSOUTHOLO
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 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 Buildinz - $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
--7.~,
/ Date .....l. l/"
New Construction.... v....//O,,ld Or Pre-existing Building
Location of Property.... Ao[~5.....:....o
House No. Street Hamlet
Onwer or Owners of Property..~... • • • •
County Tax Map No 10000, Section '..I.../. u..Block 3....... Lot. ® •
Subdivision...... " .V. .v ............Filed Map..? ?R? Lot....
/.V. ~
Permit No......~1`13D.Date Of Permit.. ...Applicant
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.....
Fee Submitted: $
z...........
APPLICANT
co ca-iv) YO
Town Hall, 53095 Main Road Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE: / I
Building Permit No. Owner: OR7 / ~EJ ~
(please print)
Plumber: 1(I n , 'h l
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
lumbers Signature) r
Sworn to before m his
~I day of S ° , 19~
DEBRA ANNE
U
Notary Public,
County NOTARYPUBLIC, SYteDfNow YotR
No. 4818621, Suffolk County
Commission Expires March 30, 10
00000000000000000000000000000000000000000000000000000®
0 (516) 286-6642 ELECTRICAL INSPECTION SERVICE, INC.
0 375 BUNTON AVENUE
° EAST PATCHOGUE, NEW YORK 11772 °
0 4941 _
° Dale 9-15-94 APPLICATION No. ON FILE p
0
O °
0 ADDRESS: Jot #18 Oldfield et. VILLAGE: Ma'ttltuck TOWN: Southold
O °
O ISSUED TO: MT't'h Ray Ong-p..
O
0 INTRODUCED BY F. C. N. ElectriC 7110. LIC. No. 3615-E
0
0 was examined on 9-14-94 and found to be in compliance with the National Electrical Code. Q
0 LOCATION XX BASE. XX 1st. XX 2nd 3rd XX Attic Pool
O _ DET. GARAGE HOT TUB O
0 ===OUTS DE_=R
O FIXTURE RECEPTACLES SWITCHES G. F. C. I. DIMMERS FANS AIR. COND.
p
O
0 25 50 34 5 2
0 0
0 DISHWASHER DRYER CLOTHES WASH. GAR. DISP. RANGE OVEN SMK. DET.
O O
0 2#12 3 20aml 1 2
FURNACE OIL GAS Cl R. MOTORS BELL TRAN. SERVICE DISCONNECT v
p e ers m s ase
0 2#14 1 1 200 U.G. o
o °
0 1-EXHADST FAN Dp
° MATER POMP O
Q President °
0
0 a °
O ~ V O
0 0p~
0 This certificate must not be altered in any manner. p
0 Inspectors may be identified by their credentials.
°
O
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE L~INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE /L INSPECTOR ~`~`J
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE j INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] UNDATION 2ND [ ] INSULATION
-'r
FRAMING [ ] FINAL
REMARKS: I~Xe?- d
DATE INSPECTOR
f
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] UNDATION 2ND [ ] INSULATION
[ FRAMING ( ] FINAL
REMARKS:
19
DATE INSPECTOR
I
7' AW2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ OUCH PLBG.
[ ] FOUNDATION 2ND INSULATION
V.4 FRAMING [ ] FINAL
REMARKS:
sr~z1~~
s ~
DATE Jd/ 491W INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ) ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
/y/ Z t6
A /7
DATE / INSPECTO
T" ~ is L'Ti i ~:.r.:~ 1 u:7 ' If D (s i G ~ exa:,.r.-nCmt - ~.-e^. «..;c•.a.,e.,n.,; ' -
- ~ COM LNTS
~J
FOUNDATION (1st) - y ~NN''
FOU14DATIOIJ
(2nd) _ 0
2. 7 /•U O ~l~i~ 22/~~rxrea ca m C~
ROUGH FRAME & 141AIJ
PLUMBING- .fill ~X y~j `
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ff s
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H
INSULATION PER N. Y. 71 =Zt7
STATE ENERGY
CODE p
m
~ r
FINAL d
ADDITIONAL COMMENTS: x
x
H \
9
9
H
H
O
m
o ~
~ QQ
• H h
3. Nature of work (check which applicable): New Building r~
Repair Addition Alteration
• • • • • • • • • • Removal Demolition Other Work
4. Estiinated Cost / (Description)
/ Fee......................................
5. If dwellino (to be paid on filing this application)
If garage, d, number number of of dwelling
cars . we .lling~ units Number of dwelling units on each floor
,
6. If business, commercial or mixed occupancy, specify nat.y r ~.rtd extent . each p F of use . .
7. Dimensions of a 'sting structures, if any: Front ' ' ' ' ' ' r• •
Height ` "...5 , , , , • . Number of Stories Rear Depth
Dimensions of same structure with alterations or a.dditions: Front . • • • • • • .
Depth Rear
Height Number of Stories .
8. Dimensions of entire new construction: Front Rear
Height NN mber of Stories Depth .
.
9. Size of lot: Front ' • • • •
~
10. Date of Purchase . Rear • , , , • . • •
• . • • • . • • Name of Former Owner
IL Zone or use district in which premises are situated . . .
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded
Will exc ss fill be r7404. from premises: Yes o
14. Name of Owner of premises . . .
ltLl
. , , AddressA4 J ,
Name of Architect , . 111 • Phone No.~ ' j,
Name of Contractor . Address ...................Phone No.............. .
15. Is this property within 300 feet of a tidaldwetland? * na No .
*If yes, Southold Town Trustees Permit may be required. No.........
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.
t
STATE OF NEW YORK,
COU F S.S
' OwD C• ~ . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the.
.
.67 (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
.......4-~ C-~ ........day of . . , 19 Sc
Votary Publi
e F. ..~.........h~ ear.. County
b LINDA J: COOPER .
Notary public Statoof NebvY (Signature of applicant)
Cour
Tartu E Pyres De embber.
19 a,.
FORM NO, 1 BOARD OF R EALTH
3 SETS of PLANS
.15
(FEB 2~g I99 TOWN OF SOUTHOLD SURVEY
Yy3
BUILDING DEPARTMENT CIICCF
TOWN HALL SEPTIC FORM
®t~rns ts'rWcisit,t:.e): SOUTHOLD, N.Y. 11971 /&I-J F~6ufiV~
? TEL.: 765-1802 NOTI FY ; 0-" q -3gd-.-
Examined 19 CALL . .
77 MAIL T0:
Approved J 19 I. Permit Noc~! of ' . ' . ' ' ' ' .
Disapproved a/c
/
(Bui in" g Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter Orin 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
nr areas, and giving a detailed description of layout of property must be drawn 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. 1
. 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 M DE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the TOTn 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, building code, housing code, and regulations, and to
admit - authorized inspectors on remses and in building for necessary inSna ns
P . P
Si of aPlicant, o name, if a corporation)
f
(Mailing address of ap icant)
State whether applicant is owner, Lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises (/1 c" . .
(as on the tax roll or latest deed)
If applica is corp ration, signature o, duly authorized officer.
(Na and title of corporate officer)
I
Builder's License No . . .
Plumber's'License No. ~ W-P
Electrician's License No.. ~I.J, , , , , , , , , , ,
Other Trade's License No. , ...I . . . . . : . . .
1. Location of la'ndon which ropo ed wor will
a done. . .
.~5... .
House Number Street Hamlet . . . . .
Y Tax MP
a No. 1000 Sectio
Count Block Lot . . b
~~/(~Y(.(~~~(yL
Subdivision (Name.....)................ Filed Map No. Lot .4
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy I , V/ ~et!~d/
b. Intended use and occupancy ! .
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§
UNDERWRITERS ED TIFICATE I_ - i
Zvi
If copper tubing is used r
for water distributing
system; piping shall be a I
of types K or L only I D
PLUMBING I ti 001A1
1i K, l-t" ALL PLUMBING WASTE
& WATER LINES NEED I r i .I j II I ~ II
TESTING BEFOHE COVERING ~l Cj r i I
N n - a~
PLUMBER CERTIFICATION i
ON LEAD CONTENT BEFORE 1
CERTIFICATE OF OCCUPANCY
SOLDER USED IN WATER r- I I 1
SUPPLY SYSTEM CANNOT
DO NOT PROOFED EXCEED 2110 Of 1 % LEAD. PI
UNTIL 2nd SURVEY OF
FOUNDATION LOCATION I r!" G C `N r
HAS BEEN AppROVED a
P 6 o v rr, irz
APPROYED AS NQTE 3 U l7 z p I I
DATE: 02 9 9 ~ ao &P.#
FEE: (aW' ~
NOTIFY AM TO 4 PM FOR DEPARTMENT THE AT OCCUPRNff OR
FOLLOWING INSPECTIONS; 1. \Q ~ ~ ~ 1 8x/~~_f'G
t. FOUNDATION ON - TWO FOUNDATION ~ CRETE REQUIRED _ USE IS UNLAVVFUL
FOR POURED CONCRETE I' 'I `fit I -yE I''
2. ROUGH -FRAMING & PLUMBING _ If INSULATION WITHOUT CERTIFICATE
4 FINAL - CONSTRUCTION MUST
SE COM'LETE FOR C.Q. OF OCCUPANCY
ALL CONSi RUCTION SHALL MEET
THE THE REQUIREMENTS OF THE N.Y. h)--_ - - - I I, I
STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR (u g'klm rrF'G~"
- DESIGN OR CONSTRUCTION ERRORS ( }5p a!.oc/EP>J ~~~~GN
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DRAWING NUMBER
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