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Home My WebLink About21264-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-23579 Date MARCH 30, 1995 THIS CERTIFIES that the buildin~ ALTERATION Location of Property 1395 FLEETWOOD ROAD MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 137 Block 4 Lot 31 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 6, 1993 pursuant to which Building Permit No. 21264-Z dated MARCH 11, 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 AN EXISTING OWE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MORTON COOEN & MART~A ANNE HOWARD (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N279365 6/10/93 & N325807 9/2/94 MARCH 27, 1995 PERFECTION PLUMB & WEAT FOILM[ leO. O 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-°I",,T? 2125~ Z Permission is hereby granted to: , ~ ., ~- / , \ . . . . . . . ..................... ...(..~,...~,.m...,..~. ...... ,../../...~./...~... at premises located at .F~IF.~....,~:,t~-~. · .,~.......,,~..~ ....................................................... Count'/ Tax Map No. 1000 Section ...... ?.....~......~...... Block ...... ~ ........ Lot No....'~.../... ............. pursuant to application dated ...... .~ ...................................... , 19 ,~....~,., and approved by the Building Inspector. Rev. 6/30/80 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. 6. Submit Planning Board Approval of completed site plan requirements. 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 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 .......... · Location of Propert/y..]..l,.~.~.~. ......... f2.~.~OO.~..:.[.i~.~jiil] j. House No. Street Hamlet Onwer or Owners of Property..~. O' County Tax Map No 1000, Section .... ~ .... Block ...... ~ ........ Lot ....... ~.l ........ .. Subdivision Filed Map ~ Lot Perm~ .~.Applicant.. No. Health Dept. Approval ....... ~/~ ......... Underwriters Approval ......... Planning Board Approw~l ...... .~/~ .......... Request for: Temporary Certificate ........... Final Certicate...~ .... Fee Submitted: Town Hall, 53095 Main Road P. O. Box 1179 $outho[d, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 1, 1995 Mr. Fred Milner 870 Bray Avenue Laurel, NY 11948 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) 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. xx No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21264-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit No. Owner: C~o~ ~lease print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this ~ ~ day of Notary Public, ..ROBERT I. SC~, JR. NOT~Y ~BUC. State of N ~. 472~9, S~olk Cou~ ~rm County THE NEW YORK BOARD OF FIRE UNDERWRITERS 11750~3 BUREAU OF ELECTRICITY ~ BE JOHN STREET. NEW YORK. NEW YORK 10038 Date ~P'[~]~]~ ~)2 ,1994 ~pplication ~o. oa fte (A6348~94/94 N 3258~7 THIS CERTIFIES THAT o~y the el~tricaJ ~uipment ~ &scrlb~ be~w and intr~ced by tl~ applicant ~med on the a~ve application n~ber in the pr~m~es of ~L~]R~ I{06~, 1395 t'LEETWOOD ROAD, CUTCHOGUE, in the fotlowlng locatlon; ~ aasement ~ Ist FI. ~ 2nd FL Section al~a ~ot ~s exatnined on ~U~IJ~T 29 t ] 99~ and found to be in compliance with the Na~'on~ Elect~cal Code. DRYERS RANGES OVENS DISH WASHERS EXHAUST FANS SYSTEMS OTHER APPARA1US: E R V t C NO. OF CC, COND. A* W G. NO. OF HI-LEG A. WG OF HI.LEG NO OF NEUTRALS OF NEUTRAL Q,C. ELECTRIC INC. P.O.BOX 518 LAUREl,, NY, 11948 LIC,#3823 E GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. TH S COPY OF CERTIF CATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~am ~ I---- 8,5 JOHN STREET, NEW YORK, NEW YORK ~0038 THIS CERTIFIES THAT in the followlng location; ~ Bosement ~ Ist ri. ~ 2nd FI. ~; al~ / O II*P .Section Bilk Lot u~s examined on JU~ <~7 ~1993 andfoundtobeincompliancewiththeNaHonalElectdcalCode. FIXTURE L~ECEPTACLESI SWITCHES I FIXTURES RANGES [COOKING DECKS I OVENS [DISH WASHERS EXHAUST FANS OUTLETS r INCANDESCENT FLUOIqE$CENT OTHEFi AMT K W. ~T. K.W. ~L K.W ~L K.W ~T. H P. 23 ~3 2 25 ~3 , 1 o..s I ~RNACE ~,oesIFUTURE A"UANCE ~EDERS SPECIAL REC PT TIME C[OCK~ BELL ~ MU[~I;~J~T___.___ DIMMERS OTHER APPARATUE: P.M~ELBO~RD~:t"I CIR. G.}',C.Z,-7 SMOKE DE~'~ICTOR~-2 EAUR~IE, NY, 1.1.948 GENERAL MANAGER This certificate must not be altered in any manner; 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. 765-1~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION :I. ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INS~.J. ATION FRAMING [//']/FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ~OUGH PLBG. FOUNDATION 2ND [F.~' INSULATI4 )N FRAMING ~.. [ ] FINAL DATE ~//~///~ (*/'~, INSPECTORt [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [~'~'RAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION ~Z/]"FRAMING [ ] FINAL DATE "-'c'///~~ INSPECT~~:~ I SPECTION [ ~F/~NDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~!1 DATE ~/~ 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RQUGH~,.,,.,, PLBG. [ ] FOUNDATION ZND [~'i/~SULATION 765-1802 BUILDING DEPT. ~ INSPECtiON FOU~4~TION 1ST [ ROUGH PLBG. [ ]~UN~ATION 2ND [ ] INSULATION [/I,~FRAMING [ ] FINAL REMARKS: ~~._~' ' S£N~NHO3 'X 'N H~J NOI~Vq~N/ DNi~NRUJ' (puE) NOIiYGNfl03 OUNDATION (1st) OUNDATIOU (2nd) :OUGH FRAME & -PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE Fi:IAL ADDITION~L COMMENTS: 9unv~ Y ~ ~t SURV£'¥~O 8 JANUARY, 1993 DESCRIBED P OPERTY S/ru~r~ 0,$48 ~ HAMLET OF CUTCHOGU~ TOWN OF SOUTHOLD SUFFOLK COUNT~ ~ SURVEYED FOR A~OR?ON COGEN ~ MAR?HA ANN~m HOWARO Gu~RANT££D TO r'HE R(~G~WO00 S,4V(N¢$ BANK TOWN 0£ $OUrHO~D 1993 ,e;I*.~NLEY J ISAK$~'N, dR' N~'W SUk',mOLK, N Y, 11956 ~'ep~el of fhl~ murvey map not bear~n ROt be condd~rod to bo = valid ~ly ~ ~e per,on ret w~m the 11 prcpared~ end on h;s behalf to the f~tJa CO~DCn~ (oV~rn et~t~l Agency, tO fhe es~gnee~ of ft~ /en4;ng Guaran~ee~ .re ncr I~<~n~'t,:~bte to 1993 FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL Examined ............... ,19 Approved. ?.~Z ........... 19fi~. Permit No. ~..../.~.. ,ff~, Disapproved a/c ..................................... BOAED OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK~ .................... SEPTIC FORH .............. SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (Bfiildino~Zfspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS q3 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 publ/c streets or.'areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ca~tion. 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa~2(~Dtions. ,~0~,~_ ...':~ ....... t'~..-~-. ......................... --' (Signature of applicant, or name, if a corporation) .. .... ................. (Maili~ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ............................................................................. Name of owner of premises .V~ .o .~.'.~... ~.~...~.~....~.... ~ .tlx~.. .... .~.~-7%. c~.. :-. ................ (~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth,,orized officer. (Name and title of corporate officer) Plumber's License No. ~.'~. '.~.'.~*~ . .~td~%~'~x Electrician s License NO. ~.. ~,~9~'.~ ....... Other Trade's License No ............... 1. Location of land on which proposed work will be' done .................................................. ...~5.%~..'.~k.e~¢pg. .......................... Lv .... ~, .: ............. llouse Number Street co,,ty ,~ ~, ~o. moo s~,io, .. I% q mook .~ ~o~ ~ 1 Subdivision ...................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy. · .~'..~.: . . . ~O~.~ "~~ '~ ~ ..................................... ................................. b. Intended use and occupancy ........ ~.~.~ . . ~ 3. Nature of work (check which appiicable): New Building .......... Addition .......... Alteration ....... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ..................... F ' (to be paid on filing this application) 5. If dwelling, number of dwelling u~its .. ! Number of dwelling units on each floor. · If garage, number of cars ...... ! ......................................................... .. ........ 6. f business, eo.mmerclal or mixed Occupancy, specify nature and extent of each type of use ............. 7. Dimensions~t~e,xistingstructures,iifany: Front ...... .~.~. .... Rear .... ~..'3 ..... Depth ~')i". .... Height ....d.~ ........ Number of Stories ~,~ ............. Dunensmns of. same structure with alterations or a~dditions: Front ~..D .... Rear ^c~ "1 .... Depth . ~)~ · Height ,,~'l ,. - ~, ~. ' ' '9 ........ .............. i' ~- .................... rqumoer oi ~tones ...... -q- ....... · ....... 8. Dimensions of, e.nt.~ire new construction: Front ..... ~Z ...... Rear... ~.~. ........ Depth ...~.' .~. ..... Height .... ~ ,~ ....... Nun~,bbr of Stories ..... . .d.w. ...... , ' ' ' 9. Size oflot' Front ,. .-~.~ Rear I 5,~'r ......... &"~.''"',h~;i .............. .... ' . · '~ :' -_' .............. ~..,'~.,-t ........... tJepm...o(.l.'r/. ........... 10. _uare ox rurcnase .... /. 1[ aB/.~.,T)-, ...... ......... Nam, e.or Vp, rmer Owner ..... ~,.'e'{-IMZ ........ ' " 11. Zone or use district in which premises are situated...{~,C/3~t~tA~,~ G,\ .................................... '12. D · , i. . ocs proposed construction yiola~e any zoning law, ordinance or regulation: .... lk~.q3. ...................... 13. Will lot be regraded .... .~qS.. i .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises ... ~<)~....Q.O.~..~.... Address .. '.'-['.e.O, BIZc~. ~) ~... Phone No. Name of Architect .-7~....:..., ........... Address ................... Phone No ................ Name of Contractor .-~,~.... ~.~lb-~ ......... ,Address..(~."/0.. 5~. ~t.~-~, f~,., Phone No...~iq.~.~ .~.~..~. .... 15. Is this property within 300 feet of a tida± wet±and? *Yes.x?~q... No ......... · If yes, Southold Tolwn 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 fines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.~ c°u rv' ....... ....... .i (Name of individual signin4 contract) ~bove named. ~ being duly sworn, deposes and says that e applicant ~{e is the .......... (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this ~pplication; that all statements contaiffed in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner s~t forth in the application filed therewith. ~wom to before me this .... .¢..¢.-L ...... .......... day of ........ 19.. qotary Publ'ic ............ ~...~., ' . · .~ ...... County _ no._48.22563, Suffolk t,~,_,r:Ta [~ ....... / (Signatt:re of applicant) 'erin ~'xp,res December ~'~. ~'~..L~' I mol - -~m~ .. ~ m; ~ --~ - 4 , : ] , i