HomeMy WebLinkAbout22106-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23403 Date DECEFD3ER 12, 1994
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 1350 COB NECK ROAD MATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 113 Block 14 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 18, 1994 pursuant to which
Building Permit No. 22106-Z dated JUNE 6, 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 AN ADDITION & ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to JACQUELINE ADAMS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H042798 SEPTEMBER 27, 1994
PLUMBERS CERTIFICATION DATED 12/7/94 CUTCHOGUE EAST PLUMB. & HEATING
$ ilding 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 ~O 19T...
N°_ 22106 Z
Permission Is hereby granted to:
riKFi......
. ....,..."V......7...........................
to . ....ae~~ -401)...... ;
X 41k, 0~y ...g 1~F .....4241
.
at premises located at.....~ .~r~.....~ L ..!s~
..il....4:e ~.Y
County Tax Map No. 1000 Section Block ..........f Lot No. 14-11
pursuant to application dated Jrl/ 19.9.7 and approved by the
Building Inspector.
~d
Fee
.
Building Inspector
Rev. 6/30/80
I
Form No. 6
• TOWN OF SOUTHOLD L
BUILDING DEPARTMENT ,
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OF, 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 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 ..c?.G+
New Construction............ Old Or Pre-existing Building. Iy'....~~......
.
Location of Property..1.3.50
House No. Street Hamlet
I v ~c~ r~~ S
Onwer or Owners of Property... n,~2
......:V
County Tax Map No 1000, Section .....Block...j ..........Lot....1
Subdivision ....................................Filed Map............ Lot......................
Permit No zZ:.~~.~..Date Of Permit ................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
S
Fee Submitted: $...~e :~a......... i
R2_ ~ 4,~9 o o -
.
CJ]-~a 7j L{~ APPLICANT
TEL. 765-1802
TOWN Or SOUTHOLD
f ~c OFFICE OF BUILDING INSPECTOR
o P.O. BOX 1179
TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
I Pate C
Building Permit Nor--')a O(d
Owner-, ~ I I~
( lease print)
~ , Plumber
(please print)
C'U iC'l1cc~' 6AS7 PLUO1BrfuC N 1tNG
I certify that the solder used in the water supply system
contains less than 2/10 of l% lead.
1
(plumber's signature)
Sworn to before me this
day of
I. 19 g7• tary Public
Notary Public, J u f'O County
Cn.
. - - - 5
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1.
'x115( 09~ BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
06453894/94 H 042798
Date 5EFTFIMffiER 27,1994 Application No. onfile
THIS CERTIFIES THAT
only the electrical equipment m described below and introduced by the applicant named on the above application number in theprembee of
JACQUELINE ADAMS, 1350 COX NECK ROAD, MATTIT1=, N.Y.
in thefollowinp location; F1 Basement ® Ise Fl. ? Ynd Fl. GAR/ATTIC/OUT Sertion Black Lot
Lvas examined on SEPTEMBER 22,1994 and found to be in compliance with the National Electrical Code.
FIXTURE RXTURES RANGES COOKING DICKS OVEMS MSII WASMNS EXHAUST FANS
OUTLETS ECEPTAClES SWITCHES INCANoESCEM FLUORESCENT OTHER MIT. K. W. AMT. K. W. MIT. K.W. MIT. K. W. Mfr. N.I.
;F
8 10 9 17 1
DRYERS FURNACE MOTORS Fuium AMUANa mweas StecIALRECTT TIeARCLOCKS "a UNITHEATERS AWlT14UTIET DIMMERS
i' AML. K. W. OIL H. P. GAS H. P. AMT. NO. A W. G. AMT. Mr. AMT. AMPS. TRANS. AMT N. P. NO. O.OF FEET AMT. WATTS
1 20 1 600
SERVICE DISCONN[CT NO.OF S E R V 1 C E
AMT MP. rmt 1 / tW 1 / M ] / tW t,e tW No. o`MCC*COND. or ACC! NO. OF Nb1eo OF'H 160G NO. OF Wt;;* LS Of I'IWENNAL
1 200 CB 1 X 1 210 1 2!0
` OTHER AMARATUS-.
MOFiFORSt1-F H.P.
G.F.C.It-3
r~
JACQUELINE ADAMS
1350 COX NECK ROAD
NATrrr", NY, 11952 004WAL MANAOM
11
Pn
This corfificate must not be ahered in any monner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
h~o~~gpFFO(/(~oGy
o ~
Town Hall, 53095 Main Road co am Fax (516) 765-1823
P. O. Box 1179 ~ • Telephone (516) 765-1802
Southold, New York 11971 y
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 8, 1994
Ms. Jacqueline Adams
1350 Cox Neck Road
Mattituck, NY 11952
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)
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 # 22106-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ION
[ ] FRAMING FINAL
REMARKS: C-Q
DATE ' L 1 ! INSPECTOR
0 ~72~--
M-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [GH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: -6 c..•,,yc~
DATE / G INSPECTOR Z4"5f.~4~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
ely
[ ] FRAMING [ ] FINAL
REMARKS: J.lalrllgL be~u~rr~,U
a-
DATE v INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ I FOUNDATION 1ST [ lo-ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
rfil!AMING [ I FINAL
REMARKS:
DATE f INSPECTOR - 9
M-1802
BUILDING DEPT.
1INSPECTION
[ } FOUNDATION 1ST [ } ROUGH PLBG.
o x [ ] F NDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
17
REMARKS: jx~
6-Q- .eel
~-c ds iN 4 ~-.po -
mac. ree-4~
DATE / INSPECTO
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
c..
DATE a~_INSPECTOR
M-1902
BUILDING DEPT.
INSPECTION
[c,,~FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: - -i O!E
DATE 4,0') INSPECTOR
d,A E
I H ~
FOUNDATION _ (1st)
44"
7OUNDATI011 (2nd) _
. 7 601 2 N
d Z
o
ROUGH FRAME & iCedi~
PLUMBING
m
INSULATION PER N. Y.R
STATE ENERGY l7he -
ld33
CODE
A?/'.~
/
4.
L
FINAL
ADDITIO L COM4IENTS: ~
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THE NEW YORK BOARD OF FIRE UNDERWRITERS FACF 1
8050140 BUREAU OF ELECTRICITY
F 83 JOHN STREET. NEW YORK. NEW YORK 10038
Date DECEMBER 13,1994 Application No. on file 85830794/94 H 043681
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant noosed on the above application number in the premises of
JACQUELINE ADAMS, 1350 COX NECK-ROAD,HATTITUCK, N.Y.
in thefoltowinp location- ? ment ? let F1. d Ynd Fl. Sertion Block Lot
D ERR6,1994
was examined on and found to be in compliance with the National Electrical Code.
RXTURI RXTURlS RANGES COOKING DICKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ACLES S1111TCIK 1WUM ESCEMT FIUONESCENT DTNER MAT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P.
1 9 1
DRYERS FURNACE MOTORS RUTURI ARMIANCE RMIRS SNOAL REC'PT TIME CLACKS IML DIOT HEATIRS MIATI.OUTLIT DIMMERS
AMT. K. W. aL N. P. GAS N. P. AMT. W. A. W. G. AMT. AML. AMT. Mrs. TRANS. AMT N. P. NO. O. OF NET AMT. WATTS
1 201 1 1 600
SERVICE DISCONNECT NO.OP S E R V 1 C E
MAT. AMP. 1TPE I / tW I / xW 7I SW t / nR NO.OfCC,jCOND. Of CC. COND. W. OF N4aG OP H J A. W. NO.Oi NEUTRALS OF NEURAL
OTHER APPARATUS:
H[TMo1-F H.P.
12
JACVJZMM ADAMS
1350 COX NECK ROAD
HATTITUCK, NY, 11952 GLOOM MANAGER
11
Per
This certificate must not be altered in any momwr; return to the office of the Board if incorred. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
ty TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK 1W 18 as TOWN HALL SEPTIC Fom _
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:UT IFY
: a~ _ 38_~
t.D CALL f 3
E. 19 MAIL TO:
Approved lll~..... , 1916)1(. Permit No.
Disapproved a/c
(Buil ng I ector)
APPLICATION FOR BUILDING PERMIT
Date g........., 194.
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-
cdtion.
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
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, o nance bu- g code, housing code, an reg tions, and to
admit authorized inspectors on premises and in building f necessary ections.
(Signna re of applicn , or name, a/corporation)
~VjJV ..~Mkn ! .
g add 7l7 I / \ of pp trat'
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
J c-.-D rl e/1~
..........................11............`...........................................................
Name of owner of premises 01.5 .
(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 License No. -7 .-,=v
Plumber's License No .
Electrician's License No. .....M!
Other Trade's License No. 4
1. Location of land on which proposed work will be done .
3so... Q......cr<
House Number Street Hamlet
County Tax Map No. 1000 Section 3......... Block y........... Lot... -J
Subdivision Filed Map No. Lot...............
(Name)
State existing use and occupancy of p're'mises and intended use and occupancy of proposed construction:
a. Existing use and occupancy J S '
b. Intended use and occupancy ......~lrt~.. `Q.. .6p ~jbpOY~
3. Nature of work (check which applicable): New Building Y.. Addition f/ • ? *QQCriD
Repair
Removal Demolition Other 4. Estimated Cost 3 9f . V v. P Fee " .
(to be paid on ' do )
5. If dwelling, number of dwelling units Number of dwelling units on each J~
rT
If garage, number of cars .....t
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number ofStories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number ofStories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
11. 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 excess fill be removed from premises: Yes No
14. Name of Owner of premises Address Phone No............... .
Name of Architect Address Phone No............... .
Name of Contractor Address Phone No............... .
15. Is this property within 300 feet of a tidal wetland? *Yes........ No.........
*If yes, Southold 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 comer lot.
STATE OF NO f~ S.S
COUNTY OF
rCg G(.P Y.... l • . - • • . • •~1 • . • • . • being duly sworn, deposes and says that he is the applicant
J (Mme of individual signing contract)
above named.
He is the
0?......................
(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
G~
....day o
~
Notary Pu lic, ~ ounty
CLAIRE 4 CLEW
Noury Pow, State of Newyork .t QlrFr4l~ .
No. 46796% (Signature f appli t)
Qualified in Suffolk County
Commission Expires December 6, 78
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ec: aLJr VH REQUIRED
PLUMBER CERTIFICATION i
ON LEAD CONTENT BEFORE PLUMS
CERTI~FnICATE OF OCCUPANCY NMI OCCUPANCY OR %OD AS NOTED
Tta USE IS 0.1NI!IWFUI
SUPPLY SYSTEM CANNOT En d BE O WITHOUT CERTIFICATE DATE: AVAP t~.Ra ~21~
EXCEED 2/10 OF 1% LEAD. BY. OF OCCUPANCY pgjjlFY SUS~~ F PARTf TAT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWWr INSPECTIONS: -
Y. FOUNDATION - 'RNO REQUIRED FOR POURED CONCRETE
H ooppw tubing U used 2 ROUGH - FRAMING, & PLUMBING
10r wow distributing ism; piping shall ba 3, INSULATION
4. FINAL - CONSTRUCTION MUST
01 types K or L on RE COMPLETE FOR C.Q. '
ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS' OF THE N.Y,
G.N?I,Md'Y STATE CONSTRUCTION & ENERGY
owl CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS'
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