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Home My WebLink About22166-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23253 Date SEPTEMBER 29, 1994 THIS CERTIFIES that the building Location of Property 200 CONKLINROAD House No. County Tax Map No. 1000 Section 139 Subdivision ALTERATION MATTITUCK, NY Block 4 Filed Map No. Lot No. Street Hamlet Lot 12.2 conforms substantially to the Application for Building Permit heretofore filed in this office dated J~NE 21, 1994 pursuant to which Building Permit No. 22166-Z dated JULY 5, 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 TO CONSTRUCT AN ALTERATION TO AN EXISTING OWE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. EDWARD &ALTHEA SIDOR (owner's) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING SEPTEMBER 26, 1994 PLUMBERS CERTIFICATION DATED MATTITUCK PLUMB. & ~AT. SEPT. 26, 1994 Rev. 1/81 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN ~LL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ...... ........ .~,,,..~.. ........................... 19, ,~.. ,~,,,, N£ 22166 Z Permission is hereby granted to: ...~.~ ....... ~../~../..,.~ ......... ~..., .. ................ ~..~.~..~.~ ........ ~.~ to,,,~..o...~....~....~....,~ ~.~ ~../..~.~../..~ ....... .~.....~ ................ ~ ~ ~..?? L~.~,~ ..~.o r~..., ..................................................... ......................................... ~..~.~...~¢~/~....~....../...V.;...~ ..................................... Coun~yTox Map No. 1000 Sectlon.....~..,~,,,~.. ....... Block ...... ~ ............. LotNo...~..,,~,,/......~.,, ......... pursuont to application doted .................. ~....~....../~.,..~...., ..~.../, ....... 19...~...~....., ond approved bythe Building Inspector. Fee $ ....... /....~......~.~.,., Rev, 6/30/80 ' ' glnp ~r~ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to "pre-existing" land uses: 1. ,2. April 9, 1957) non-conforming uses, or buildings and Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 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. 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 Buildin~ - $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 ocationeW Construction.;;;::].~.,~of Old Or Pre-existing Building''"''~''/~ .......... Prope ......... .¢~.. ,~... ~..~/: ~..<~. .... ~. ........ N~. :~.~..~.~. ~ House No. SFreet Hamlet .~r or Ow=er~ o~ ~o-ert,, ~O/~i'rl/~ o~y ~ax ~a~ ~o ~000, s~o,.../JZ ...... ~o~ ...... Z ........ ~ot..TP.~.~. ............ abaivision.. ~~ ....... Filed Map .....Lot. No~/f~~ ....... .... ermit .... Applican ~alth Dept. Approval ..... ~ ...... Underwriters Approval ......... lanning Board Approval ...... equest for: Temporary Certificate ........ Final Certicate..f~ ......... ee SubmS~ted: $ ..... ~ .............. ~ q ~sltt ..................... :i=LD ~, .... ~.-u,; · ' 'IlDATE II '"' COH~£NTS FOUIIDATION (1st) '~OU~ DA TI 01.! ( 2nd ) :OUGH FR AI-IE .' CODE FI;;AL ADDITION~'L CON~E~;TS: INSPECTORS Thomas Fisher Building Inspector Gary Fish Building Inspector Robert Fisher Assistant Fke Inspector Telephone ( 516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L HARRIS, Supervisor, Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 F~x (516) 7654823 Tdephone (516) 765o1800 CERTIFICATION "'(please pt Zut) , , conealns less than 2/10 of Ig lead- Sworn to before me this 765-S802 BUILDING DEPT. INSPECTION FOUNDATION SST FOUNDATION FRAMING ROUGH PLBG. INSULATION ~FINAL DATE ~/~'//~ INSPECTOR 765-18~2 BUILDING DEPT. INSPECTION ~ FOUNDATION 1ST ~ ] R/~'~H PLBG. FOUNDATION ZND ~/INSULATION [ ] FRAMING [ ] FINAL DATE '~~~'~ INSPECTO~ ]65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~~ouGH PLBG. FOUNDATION ;ZND [ ] INSULATION [~F~MING [ ] FINAL Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 26, 1994 Edward Sidor R.D. 1 Box 166A, Conklin Rd. Mattituck, N.Y. 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. ~ The check is (outdated/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 # 22166-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. L ..................... ,.: .__ ,__ ............. · '~ z,o'~ -' 14 02- ;.~'0 ~ /~0.09 BOARD OF' HI:'ALTH 3 SETS OF PL.'~NS SURVgY SEPTIC FOR~I FORM NO, 1 .... TOWN OF SOUTHOLD .... ~-~ BUILDING DEPARTMENT .... - - - '~ TOWN HALL SOUTHOLD, N.Y. 11971 xamJned ..... , 1 approved ..... ......... a/'c / Disapprovcd ..................... .............. .............................. Date INSTRUCTIONS a. Tlds 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. 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 Pgrmit 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 Bmldmg Department for the zssuance of a Buildiflg4~e~.i'~;p~qr~¥.~nt to the ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other'nnhli'dal~l~t*~)Jci.~nances nr R o .... ' · · · ~='~ ..... e=ulatlons, for the construction of buildings, addztmns or aiterahons, or for removal or The apphcant agreeslto ;c,p,m. ply~wittt ali applicable laws ordinances building code admit authonzed,mspeci:ors 6n premises and.m bmldmg for necessary ~nspec, tj, gns. ,, ~'~ ..... '~ ~ · .(.1 ,~ ~,~c~/ ./ ........... . ........ T- , , , ' ,, (Signature of apphcan}[~o[name;}[ a corporatl0I}); ~}}"th*~:~',~ ¢7[;ff,~fit/¢l!ti,i~i~} (~ili~g address of applicant) ~ ~ a,~.~:!4 . . State whether applicant is owner, lessee, agent, architect, engineer, general contr~¢~0r, electrician, plumber.,?[ bQild'~¥ Name of owner of premises ............... ................................ ~.~.~ -~ .%. ~t- (as on the tax roll or latest deed) ~>',:'~ ~ '.,, ~' ~ · · If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · Builder's Lice,se .... .... Plumber's License No .... . .oQff....~..~../? .......... Electrician's License No. ~Q(-q'...tkO.. ............. Other Trade's License No ..... ~ ........... I. Location of land on which proposed work will be done. ~ Co .. ~ House Number Street Hamlet County Tax Map No. 1000 Section ::. ~.~.~.: ........ Block .... ~ ............ Lot.. Z~i.4 ......... Subdivision..~&~...~4~/Z~.., ..... Filed Map No. ~.?~ ........ Lot ].Z:. :~'C.Q.~. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisling use and occupancy .. ~$.~....~ ~/.~4~ 4~& ................. SV ;'~& ~4.~%~,~ ....... b. Intended use and occupancy ~]~/~ ~ v ,,a ~ .......................................... ~r ~ ~:~:g..~. ,~ th.,~.~ (~ ~.¢.:i,. ~? .... 3. Nature ofwo~,k (check which ~p"licabl ........ ' ' - .....' Alteration ~ , ~' ~j: cqew sauaemg .......... Addition .. . Repair ........ : ..... Removal . . ' ... R/r'mao~q- ~tr'aw/4rtff ~,~O )-8o-Xz~ 'j~.~' .... Demolition ............. Other Work . · I (to be paid on filing this application) 5. If dwelling, number of dwellin~ units -- . ........... Number of dwelling units on each floor · If garage, number of cars .":'.. , . ' ............... 6. If business, commercial or m;-~L~ .... : ........ .2 .................... ; ............................. · ..,,ca o&~Upancy, specuy na~ture and extent of eact~type of use ..7 ............... ' 7. Dimensions of existing struc~tbf any. Front .737. ....... ' Hem it ~ ? ' ~llW,' 5,~- r., , .,, .... Rear .7..,? ......... Depth ...5'/.. . ,,. ~ . '~o~ Stones . t~./ .O.t~..qC.~. .~/.J ~.~./~...~/t~.:O. .. .. ~/~q~[~l[l~th alterations or addihons: Front 7~Y... ~ . ~,, 7.3'" ' ' ~Jeprn .j~. ~i--. · .~,ll~.. .....:.¢..H~ -- .~ * ' ............................... HD~lg~~' ' ~'~t ~F~:?e'gnt · .etd ..... ~ ......... Number of Stories...;~ ................. .... ' ........ '2: ~'qum~b)~f ~toi'ies ...,~o'/~. ¢ ............... ' ..... 9. ~ze o~ ~ot: Front /.,J~'.~ e~. j~. ~ .,,:" .,~ /e-,~ .............. '.' -' ................. I0. Date of Purchase ~ &~.~ ....... ~x~ar ..~,,~ .~.. :._, ........... .Depth .Z~;~,5~....,~ ........ ..... ' · '"' ",'C q~,~J~.' ............... marne ot~ormerOwner ~O~. L~.(9 .F~../~. 9'$c~O~ ' 1 1. z. one or use mstr~ct m wl~h-~iStemises are situated .:~ ' '~ ~' ~'/ ........ ,D, , .o, ,e s, proposed consi.ruct'ion violate any zoning law ordinance or regulation, t&O ........ I3. wii, lot be reoraded ~ I .... ' ............... x, ,- .-- . . --LL'~:~'; '.-' ~' f %' ' 'l ' ' '~.' · Will excess rill be removed from premises: Yes 14. ~ame ot uwner o~ premises ~..~/.O.~.~. ,~d'...$.~..oq~. Address C¢~.~.~...~q..~./.~,..~. tPhone No Name of Architect ~ ~ ..... ~ ............ uuress ...... Name of Contractor 4r~.(a. qrt. o~$~"'~_..,O &:'_~f.~ _~,. t, L/'..J~.gJ_:.; ....... Phone No ............. - -- . · '_Lc' ' ~..~'~-~i3t~c~taaress .t.tc.~.¢~.o.~.~&... 15. ~s tnz~s~p~roperty wzthin [300 feet ~-f--a tidai wetland? *~es. · .... Phone No...~2. ........ · ,~ . · ...... No.~ ..... ~ yes, Sou~hold iTown Trustees Permit may be requ±red. PLOT DIAGRAM Locate clearly and distinctly al~ buildings, whether existing or proposed, and, indicate a/1 set-back dimensions from property lines. Give street and block!number or description according to deed, and show street names and indicate whether interior or corner lot. PLUMBING -- . u~:~ NEED IE$TING BEFOre CO~RINQ UNLOAD COmEm CERTIFICATE OF OCCUPANCY SOLDER USED m wATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1~ LEAD. If copper tubing I$ Use~l for water distributing system; piping shall be 'APPROYED AS NOTED .FEE: -~7.~ ~,~ By:~_,~. NOTIFY BUILDINO DEP~ 76~-180~ g AM ~ 4 ~ FOa THE FOLL~WIN~ INSPECTIONS: t. FOUNOATION ~O FOR POURED CONCRETE 2, ROUGH ~ FRAMING ~ PLUMmNG 4. FINAL CO~ST~cT~oN MUST 8E COMPLETE FOR C,O, ALL CONSTRUCTION SHALL MEE~ THF REOUff~EMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES ~'~O~ R~SPONSIBLE FOR OFS~GN OR CONSTR~TION ERRORS ........ ~"f'd' '°/' '~' '~'O' ~" '/~' ~ '~"' being duly swoin, deposes and says that hdis the applicant (Name of individual mgnlng contract) above named. He is the ' I I (Contractor ............................................ .' · , agent corporate officer cfc ) ~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 appl cation are true m the best of his know/edge and belief; and that the .york will be performed in the manner ~et forth in'·the appl,catlon filed therewith. ,worn to befor~i~ this [ . ...... ..~..b ........... day°f'i''cr"~.. ............. , 19.?.q Pub,c .... i --" ....... . County , , {luallfl~l In Suffolk Ceunt~/. ~'"'- (Signature of applicant)