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Home My WebLink About21240-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22161 Date FEBRUARY 25, 1993 THIS CERTIFIES that the building ALTERATION Location of Property~1140 PARK AVENUE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 8 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 24 1993 pursuant to which Building Permit No. 21240-Z dated FEBRUARY 25, 1993 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 ALTERATIONS TO EXISTING ACCESSORY GARAGE AS APPLIED FOR. The certificate is issued to ESTATE OF GILDA DODGE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - FEBRUARY 24, 1993 PLUMBERS CERTIFICATION DATED N/A ~v ui Iding Inspector Rev. 1/81 "an NO. a 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°_N? 2124O Z Date 192 P43 si is h r by granted to: to 4ee• w.... at premises located at .......r~~Q 1~~ County Tax Map No. 1000 Section Block ........4 Lot No... ` pursuant to application dated 19-9 and approved by the Building Inspector. Fee Bu' ng Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 i'Gu APPLICATION FOR CERTIFICATE OF OCCUPANCY A. -Tfiis'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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, C/Pmmercial $15.00 / - Date ......~.~.Z ~ New Construction. ..X Old Or Pre xisting Building. Location of Property. S fL' ...~~?F zs c ock c 7 . C House No. Streett Hamlet Onwer or Owners of Property. ...4°~ f~...........~.\.~~ County Tax Map No 1000, Section ....l~ ......Block..... K....... Lot......) Subdivision....... .............................Filled Map............ Loft........................ Permit No. 2~~0......Date Of Permit.../ ~s/.~ft ...Applicants.. J Health Dept. Approval ..........................Underwriters Approval...................... Planning Board Approval Request for: Temporary CCee`rtificate........... Final Certicate........... Fee Submitted: ~a.:............. 7s y APPLICANT Co~.~alfol THE NEW YORK BOARD OF FIRE UNDERWRITERS , DO NOT WRITE HERE -FOR OFFICE USE BUILDING RERMITNO h J rt ' OIi O ILIAC ZIP GOyOEt ~ ' C s.~~ 1 \ ~ I l ``~i 1 I~OWt46PH`IP...r~ ~ i ('i cGUNTxy ~ $~mt t-~ ( . 4`\~. at"4S i STREET O NO OR ROAD }°N \ POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED'+ SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER' NAME A DA?DRESS }T"t HO TEL11,7OOyN'E`/NUM'B`EER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER - BUILDING IS NEW CL WGRNJ ~AE ADDITIONAL I DEFECTS REMOVED? LIST BELOW ALL f QWWMT`EhkMWWN WtCH YOU IN TALLED Inca- NUMBER OF UTLETS BRANCH ptTFi U E., MOTORS HEATE . . - tlon '`..""".~"~n?a°.' .µaPceBtacles .CIRCUITS Stle achT F` AWG r HT^t`?1+.'v fi Ce,hng Wall BE ep is SWUch Pentland Bracket No Type Each «NA E h,^-N°... Gauge OUT- SIDE SUB BASE THE NEW YORK BOARD OFFIRE UNDERWRITERS BASE- _ - `TM" 00 '1% ~01 MENT WE ARE IN THE PROCESS OF ISSUING A tst CERTIFICATE OF COMPLIANCE FOR THE FL. ELECTRICAL INSTALLATION AS COVERED 141 _ IN AN APPLICATION NOTED BELOW. FL i .~y S'v R V L ,21 - APPLICATION NO wad i iyJA k%,Z LacnnoN Co ~ . , ~ REMARKS: LIST OTHER ELECTRICALq ICES NOT SET FORTH ABOVE. INSPECTOR DATE IBD(REV9190) .Y r f t' ~'a i r"le ra - - ' THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDN 4t.,EY TH,g APPLICANT. SZEOFMAINS FEEDERS ELECTRIGSIGNSILAMPS TOTAL WATTS CHARACTER OF WORK GAS TUBESIGNRRANSFORMERSOF VA ? EXPoSED ~ , - _ .a;.:`a=,r ;.1z, A.; -..F = •DATE WCR TORE 6TARTED OA ECOMPLETED' SQEOPSION(NUMBE CAPAC tt-v SER IJCE ENTERS BUILDING MANUFACTURER OF SIGN ? OVERHEAD ? UNDERGROUND DATE INSPECTION REQUESTED ON IOR AS NEARAS PoSSI LEI AV ID DELAYS BY GIVING FULL AND ACCURATE INFORMATION,'dLL SRABES U T BG:FIL1: IN i P T1 Y jW1R&4 NED _ PRINT NAME AND ADDRESS - FAPPLICANiQ, ` q DATED APPL TION > +i~p'.?d ,^.{5's' ' T .,....T • t ETADDRESS- r TELEPHONE NO -A L CIjY OR POST OFFICE _ FT ~~'r t• t! 2c1P;. ODE LICENSE NO WHEN APPLICABLE 85 John Street 41 State Street Q 570 Delaware Avenue E] 217 Lake Avenue 202 Arterial'Road NEW YORK, NY 10038 ALBANY, NY 12207 I BUFFALO, NY 14202 ROCHESTER, NY 14608 SYRACUSE, NY 13206 _ (212) 227-3700 (518) 463-2122 (716) 884-1155 (716) 254-0141 (315) 463-8552 _=THE,_NEW- YORK, HQARD OFIRE UNDERWRITERS THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTIFICATE NO. DO NOT WRITE HERE - FOR OFFICE USE ONLY BUILDING PERMIT NO i TEMP N DATE 4 CITYO ILLAG` ( ZIP pDE jpWNSHI GOUNIY x- pf, STREETgNo NO. OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME ` BU ILDINGOCCUPANCY { G L - OWNER'S NAME AND A9DRESS 41 TELEPHONE NUMBER 1i 7 7 CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPH-OrN-El NUMBER BUILDING IS - '3r NEW ? JR OL } WORK IS ] I.Aev% Ll - . ADDITIONAL DEFECTS REMOVED ? LIST BELOW AL H YOU IN TALLED NUMBER OFOUTLETS BRANCH OFFICE USE Loca- MOTORS HEATE L p„Beceptacles CIRCUJTS - -ONLY--, tion Ceiling Side Reps Switch Pendant Bracket No. Type Each No. E I No- Gaug INSPECTION OUT- SIDE SUB- BASE THE NEW YORK BOARD OF FIRE UNDERWRITERS ( BASE- MENT } WE ARE IN THE PROCESS OF ISSUING A e. ut CERTIFICATE OF COMPLIANCE FOR THE F. FL. r ? ELECTRICAL INSTALLATION AS COVERED 2nd j } IN AN APPLICATION NOTED BELOW. FL zl ; 1 S'~JY-vC FL i• APPLICATION NO LOCATION S C C'C z . ~~4/u Z I - INSPECTOR DATE REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. IBD (REV 9190) THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED, BY THt APPLICANT. SIZE OF MAINS FEEDERS ELECTRIC SIGNS/LAMPS TOTAL WATTS CHARACTER OF WORK ? EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA DATE WOR TO BE STARTED ' DATE COMPLETED SIZE OF SIGN (NUMBER) CAPACITY t SERVICE ENTERS BUILDING MANUFACTURER OF SIGN ? OVERHEAD y+^ ? UNDERGROUND DATE INSPECTION REQUESTED ON (OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS _ IDENTIFICATION NUMBER AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS - F APPLICANT GATE O APPL TIQjJ t I p { S A TURE OF A "CANT ST T ADDRESS TELEPHONE NO CITY OR POST OFFICE ZIP CODE LICENSE NO. WHEN APPLICABLE 85 John Street 41 State Street 570 Delaware Avenue 217 Lake Avenue 202 Arterial Road NEW YORK, NY 10038 I~ ALBANY, NY 12207 BUFFALO, NY 14202 ROCHESTER, NY 14608 ? SYRACUSE, NY 13206 (212) 227-3700 (518) 463-2122 (716) 884-1 155 (716) 254-0141 (315) 463-8552 THE NEW YORK BOARD OF FIRE UNDERWRITERS BOARD OF HEALTH i 'IS FORM NO. 1 3 SETS OF PLA. TOWN OF SOUTHOLD SURVEY FEB 2 4 W BUILDING DEPARTMENT CHECK i TOWN HALL SEPTIC FORM 4L-1 1 i r~ :t, ~r SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NOTIFY ~ CALL 0 IO:4 Examined A 19 MAIL TO: Approved ..j! , 19 Permit No. Disapproved a/c (~uild~ e Inspectar) , APPLICATION FOR BUILDING PERMIT y Date ? z 19C.(.. 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. 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 Buih',jng 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins ections. - C--nt'< yI .~I Cyr ~.1 . (Mailing address of applicant) State whether applicant is owner, less e, agent, architect, engineer, general contractor, electrician, plumber or builder. . F cs~-c .7 c ~ toJ Name of owner of premises . . (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 . Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of laid on w ich proposed work will be done. II .....r...... ~e ~A_;i_ House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy proposed construction: a. Existing use and occupancy . . b. Intended use and occupancy ~.4°.-.~-':.... 1 ~:,c,....: , . cS_ sr. -1 3. Nature of work (check which applicable): New Building Addition Alteration C>.<~ . Repair Removal . Demolition Other Work 4. Estimated Cost ? ts4(Description) 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 existing structures, if any: Front Rear Depth Height Number of Stories . Dimensions of same structure with alterations or additions: Front Rear . Depth s . Height Number of Stories . 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories . 9. Size of lot: Front ~ , Rear . Depth . . 10. Date of Zone or Purchase use ...in. . . . .which. f , , . ' ' ' ' ' ' • • • Name of Former Owner premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation : 13. Will lot be regraded 1 Will excess fill be removed from premises: Yes No 14. Name of Owner of premises mises Name of Architect . Address Phone No............... . Address Phone No................ Name of of Contractor . . . . . . . . 15. Is this property within 3 •••Address ...................Phone No................ 00 feet of a tidal wetland? *Yes........ No . If yes, Southold Town Trustees Permit may be required. „ PLOT DIAGRAM Locate clearly and distinctly all ~uildings, 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. Dn ri_~ 1 I 1 N AP RU D ASPIOTED P_..~ DATE: b` B.P. N / 5/0 ~~cS FEE: By: IWP NC)TIFY St ILDING OEPART T 0) 165-1802 9 AM TO 4 PM FOR THE o4C FOLLOWINGIN'.PECIIC}NS. ^•7C'~-"~~ 1, fC)117V Ida iv, I'k'C?d J1~P't3 FOR P MRLD C7;YR!(;SPI ' 2. (vi).1CH - FRh\E1?iN6a 3. INSULATION J q, FINAL - COP45TRUCTiON MUST BE COMPLETE FOR C.O. ALL 'CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY. CODES. NOT RESPONSIBLE FOR STATE OF Nk W YOB{, ` DESIGN OR CONSTRUCTION ERRORS 1C Y OF . . .`.S.S (Name •of individual ~signing . . ' • ' ' ' ' ' • . • being duly sworn, deposes and says that he is the applicant contract) above named. He is the.......... I..................................................... (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 ,vork will be performed in the manners t forth in the application filed therewith. Sworn to before me this Z~l .day of.. Votary Pub Coun CLAIRE L BLEW . ` C: ~l" :.4 . Notary Public, State of NOW York (Signature of applicant) No.4879808 OuaiHled In Suffolk County Commission Expires December;B,182:f ~7t tx` iw cn w 1/ ~ ° vb.#' rt !f z ,ti"" ~ v'+v i x¢ t aF T ' E AS lAf2'vY" fi" > 5 1 y~5 t t b . , r d y[u 'ALL X~,.. r J y' ` T K ~ 1 p r?• 1. ti Y~~ r 2 ? ~lv~ " .kp( rj~ t t M, - 44 ~OLO'd - - - was O. Lu:. 9 1 • ' LY ~ ~ S 1 M,FY, t - e E 7j t N 1 ;n a i. ~ ...E 4 "A. M 41 ~lyr 1 t(Ys~t imp