HomeMy WebLinkAbout21309-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22315
Date MAY 11~ 1993
THIS CERTIFIES that the buildin~
Location of Property 750 MILL ROAD
House No.
County Tax Map No. 1000 Section 107
Subdivision
ALTERATION
MATTITUCK, NEW YORK
Street Hamlet
Block 1 Lot 1
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 6~ 1993 pursuant to which
Building Permit No. 21309-Z dated APRIL 6, 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 CONVERSION OF SEASONAL DWELLING TO YEAR ROUND ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to ELIZABETH FOX
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTHAPPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
PENDING - APRIL 26, 1993
Rev. 1/81
~~i~di~ng~In~pector
FORM NO. O
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PER~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~T.° 2130S Z
Permission is bereJ~y g_rartted tc~
'
..... ~.~.~~....:.~ ....... ~~...~. ................................
o~remises I~at~ ed at ...~....~~~~ ~ ...................................
.......................................................... ...................................................................
Coun~ Tax ~op No. 1000 Section .~...~ ......... Bilk....................../ Lot No ........ ~. ............
pu~uant to application dat~ .... ~ ....................................... , i~ and opprov~ by the
Building Inspector.
Fee
Rev. 6/30/80
Form No. 6
TOWN OF SOU~HOLD
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: ~
i. 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 i% 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 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, Co~nercial $15.00
New Construction ........... Old Or Pre-existing Building.~.. .............
Location of Property .... ~.~.~ .................... .~,~.T, .N!%~..~P ....... .....
House No. Street Hamlet
Onwer or Owners of Pro ert ~ATJJ~.
County Tax Map No 1000, Section .... % ~.~ ...... Block .... J ........... Lot ...... ) ...............
Subdivision ..... ~ ........................... Filed Map ............ Lot ......................
No %~ O~ ~ Per~it.~.. .Applicant.~Y.
Permit ....~ ......... Date Of ...................
Health Dept Approval ~[~. ~B.~ Underwriters Approval
Planning Board Approval .... ~ ..................
Request for: Temporary Certmf~cate .......... Final Certicate ......
OUNDA'TION (1st)
OUNDATIOU (2nd)
0UGH FRAME &
.PLUMBING
21~SULATION PER N. Y.
STATE ENERGY
CODE
Fi~;AL
ADDITIONAL COMMENTS:
ROBERT T. BAYLEY A.I.A.
Architect
150 Lakeview Terrace
P.O. Box 595
EAST MARION, NEW YORK 11939
MILL, -.-~T. - ~AATTITu~K. "FoX ~/~LL"
P--'/.ISTIIxlg-I- FLO01~ F~A~.-I~
ROBERT T. BAYLEY A.I.A.
Architect
150 Lakeview Terrace
P.O. Box 595
EAST MARION, NEW YORK 11939
(5'16) 477.5024
~nce Repor.~ , , , ! , ,
..... ,'""": .... [""-! ......., , ~ i' ~. '; '" ................................... f ' ~ ' ~ ' " ' Cod~' '~ /
I
i N~w~iYork ,State Energyr Conserwatzon Construcbzon i ! ! I I
.... ~. . ~ , ~ ~ ~ ~ ~
.-, ........... Buzldzae Deszgn.-Dy ,Accepta.ble....Pradbz~e.,-%Par~..5¢----t ...... ,- -
A.. Scope ....
a PrO3ect,zs a.reszdenbial ~utldz~g less tRan 5,00.0 sq.ift
[ b. pro3ect~s~ less' than, t~ree ~to~zes zn he%g~t.
~ . ~ (a~bual'~s, two storzps) ' ;
......... ~'"'""'~ ........ i'"'""~" Pr°~e~['lha~"a'w~l~ g~.a~-~ng-area ~ha~-..~oes .~o.b.
bf %h~ gro~s;wall ;area' (hcbual is 15%)
I ~ .......... ! /EnvelOpeI.....I ................ 1 .........,....,, I ~ '~Code 1 .... Non~elec~r z&] .... ' ..4..~, ....,i ...... Ttzs" ........ pro3~"
~. J ................... i. ~om~o~en,t ,, .......... h,~at~r~,---6,-6 l.de ~ee-.~aps .... ~ ............ ,--....,
I ~ ] ' ~ ' ' ; ~,
" ~ Sxterfor Wall . :R ~8 . ', ' ,' . R 17rz
) Roof/eeltzSg : .R ~9 , . .
~. . I Gl. azzng I ............. R..1.7 ..........................
f C. Notes; ' .
a. ~bis.-~nrhje'cb wi&l have
I sp~ce' w~thI R219 insulaSion vit
I ~ ~ warm
........................ b.......Ali., exterlor.~w~ndows . (double hUng..wood.sa.sN).
~ alumznum f.rame ~ouble hung gla~sfw~th
i lnflltratz~onlwlthln code &1mits.
................ C. Al..1 ex%e~zor~.doors.w.zll rece.z.ve
, , , removable ,olaz~nd,panels
, , ~ 8. T~er6 are twe chimneys bu~ no firep~aces
......., '..,.,,e. The-.new .,heia~ing., system-,wi~.lqbe...a. _gas'"~lrea'"-not
~ ', ~ with ,Dower v~ntlnq through %he, brick
............................... &oea.~ed -.&,n ,.
- ' ................... eaeh..., fl~or~. '
ROBERT T. BAYLEY A.I.A.
Architect
150 Lakeview Terrace
P.O. Box 595
EAST MARION, NEW YORK 11939
(516) 477.5024 ~_~N~__.~]~ gON4FUAN!Cp___ ~z~_p'~F_.T
i Compliance Report ~cont~nued), ! ~' ~ , ]
...................... i ............. ~ "i - --~ .... !- -:r ] ,- . ~ i :
~ £~ ~Ioli w~ter heat~g p:].p.~ng ~.~ be .~aSula~ed ~A Z~..o~ ........... ]. ..........
~nsul~%~on when p~,p~n~ ~s, outside a,cond~t~oned space.
, (such~ as ~he ~celi~r/crawl, s~ce) , . ~
........ ~. ~h~...ex~stln~ hot..~ater ~heater w~ll ~e ~uppl~ed .w~..th a-sepa~.a.~.e..
I ............. .~ ........................................................ ~ ........ ~-- -...~... .................. :
. ] D- ~aZ~.A.~oa~_., ............ ~ ............................. . , ~ ~ ~ ........ , .....................................................
......................... ~." ~'"'~iAAi~9' a~ea e~p~e~ ,a~'a ;% O~ ~Ae q~o~ ~a~1 a~ea:
....... [- ', ............ ~"- ,, r'"" l'"'"'"'l: .......... t' ": ..... :'' :'' '; ............ :',"r'"'"":" '/ ' '"'" : ....... i ;
. ' ~ g~e~o~ ~al~ A~eAa . ~ ~ 91a~9 ~a8 ~Gl~e~ ~o~
........................... ] ~ . ~ ,. ~ · :
.......................... ~o~.~A~ 59~ ~A.E~. ~ 22~6 ~ ~ ~ ............. ~M,A. J......], ..................
............................ ~ -~ -~ ............. ~ ............. ~ - -: .... ~ ~ ..................... m
.................... ( S .dt.h .725 .......................... 87, .I ....... ~ .......... ~ ........... L~ .... .~........i ..............
] . 2,,209 sq. ft. , 2,67,7 sq. f~. , 69 sq.f~.
. , . . 268~69..- ....... 337 .... 15.3% ~mndo~s..+ l~z~d., o ~s ....... , ......... ~ ........................
] ' 2,20~ ~ ~, 2,209 . ~ ' a.s a ~ of wall area)
~ ~. Heat ~low Ca~cula%lons for exterlor'walls (g2o lnside,0, ou%.
.... ~.. Still a~r....fllm (indoor) ............. R ............ 6.8 .................... ~ ........................
I / r ' , ,
...... A.. cskuiose~%o..be blow~ ~nJ ......... R .... 14.A ......... , ....
~ ~x8 v~r~cal drop s~n9 [ ', ,R ' .79
............ ~1 [ '' }''-' '''~ OU~obr' ~ ........... ,alr~ .......... ~llm at 15' :MPH 'vlnd'~ ............. ' :R ...... ~ :'"'"":.I7' '~ ' ' ....... : ..................................
.................. I"' ' ~ ................. F.....'F" ~ ~" : ...... ' '" ........ "' ':' '?"'""~ " ........... :' '""F" ' T ......................................
, , , ~ ~ ~ , ,
g'. Statement: ~ ~ , , ~ : , , ' ~ ~ ~
......... ~ .............. '.. L......:.. : ,.......~ I. ,'. , . ~ .... ~.....~...,......~ ..... L...,...~ .......................................................
:~.0 ~ Desb. of ~y knowledge, b61lef, and professional
[ Such speclflc~tions are' in. c0m~llance With the N~w~~~ork tte
....................... l ..................... '~ ...................... ~ .......................... ~ ............. '- ~/r~ ~'~'"fq~'~ "~ ..........
................ ~ ........... ~ .............................. T"-"T' "- ~' .................... ~" 'r'"'"~ '"'"~ .............
3. Nature of work (check which applicable): New Building ........... Addition .......... Alteration ..... ' .....
Repair .............. Removal .............. Demolition ' Other Work TO .OI>'rAII,~ .C,.d),..
4. Estimated Cost [ -~/fl~ ' ' ' ~ ; (Description)
(to be paid on filing this apphcation)
5. If dwelling, number of dwelling units ...O~ ~ ....... Number of dwelling units on each floor...~.8..
. If garage, number ofc~s ........ OM~ .............. · .......
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....
7. Dimensions of existing structures if any' Front ~¢~ gUCCI Rear Dep~~ .......... '" '"
iJJ jjj .......................
si f fie stmctu or addit nt'
Rear ...~ ........
Depth ....~&~ ............ HeiSt ..... ~ ........ '.. Number of Stories .... Q~N[ '
8. Dimensions of entire new construction: Front.. ~ . Rear . Depth ....
Height Num bet of Stories .. ...... . .........
(g~ 6C~ev2 .........................
9. S:ze of lot: Fxont .......... Rear ......... J ~ ' ' ' Depth
10. Date of Purchase ...DN.~D~.O ....... . ......... Name of Fomer Owner . .~g~.~. ' ........
1 I. 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 MO ·
..... : L .................... wm excess fill be removed from premises:N ~ Yes No
14~ Nme of Owner of premises ~.,. N~N.~A~N ..... Addres~[3 ~T[[ ~D~ Phone No/g~0.~g[ ~[0W - '
Nme ofA?hj¢ct ~, ~y¢,.~ .... Addres [ h'0j -- '" ' .... ""
' ~ · ~es...~ .... No .........
. If yes, SouChold To~n Trustees Permit may be required. '
· ". PLOT DIAG~
Locate clearly and distinctly ~I build~gs, whether existing or proposed, ~d. indicate ~1 ~et-back d~ensions from
prope~y hnes. Give street ~d block number or deschption accord~g to deed, and show street n~es and indicate whether
~tehor or corner lot.
"APPROVED AS NOTE
7&,~-1802 9 AM m 4 PM FOR T
t. FOUNDATIO~ - ~O REQUIRED
3. NSU~TION / ' '
4. ~NA[ - C~S~UCTION ~UST
· ' SE COMPL~ FOR
ALL CONSTRUCTION ~ACL MEET
THE REQ~EMENTS OF~THE
STATE ~NSTRUCTION
CODES./ N~ RESPONSlB~ FOR
'/' MOF<TH
..... ~.~..~;!rT.."~....~.~....-~:>....~v..':{..[..~.. being duly sworn, deposes and says that he is the applican
. (Name of individual signing c~ntract) ~ t
is the.., ................ (Contract~orporate office~, ei~.~ ............................
said owner or owners, ~d is duly authorized to pe~r have performed the said work and to m~e and file this
oplication; that ail statements co~ined ~ this application are true to the best of his knowledge and belief; and that the
ork will be perfo~ed in the m~ner set forth in the application flied therewith.
worn to before me this
......... .
C~I~E C G[~ · . .....................
Ouelified.ln Suffolk Cou~ ~
~mmi*~ion Expires Oecem~r 8, ~ ~
FORM NO, I
TOWN. OF SOUTHOLD
.BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Exanfined 19 .~.-~.
' q/
Approved .. 1 ~.. P it N
Disapproved a/c ~
i ;) .' .....
~ i . .6Buildit~Inspe to
[ APPLICATION FOR BUILDING PERMIT ,
BOA'RD OF It~ALTIt
SETS OF' PLANS
" SURVEY
CIlECK
SEPTIC F O R,~I
h O F- ,
.
Date 19
INSTRUCTIONS
a. This application must be com?letel filled in
. y by typewriter or in ink and submitted to the B~ilding Inspector, with 3
sets of plans, accurate plot plan to scz~le. Fee according to schedule.
'~ b. Plot plan showing location of tot and of buildings on premis'es, relationshi to adjoining premises or public streets
or areas, and giving a detailed descrilStion of layout of property must be drawn onp the diagram which is part of this appli-
qation. .
c. The work covered by this appl ication may not be commenced before issuance of Building Permit.
d. Upon approval of this applica ion, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises availabl for inspection throughout the wt3rk.
e. No building sh?!.Lbe' 9ccqpi,e~d or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been grantee by the Bffil~t'~ Ihs'peeler.
APPLICATION IS'HEREBY MA] )E~to-th~' B&ilding Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Tow:~ of Southold, Suffolk County, New. York, and other applicable Laws, Ordinances or
Regulations, for~ the construction' et' )uildi/~gs;~additions or alterations, or for removal or demolition, as herein described.
T.he ap?licant a~i'ees tO Comply withlall applicable laws, ordifiances, bufldMm-~ode, housing code, and regulations, and to
aamit authorizea inspectors on premises and in building for necessary inyiS~cJ't~s~ ~73.
i ' (SjSx applicant, or r(am&/,, if a corporation)
' (Mailing address of applicant) ' '
State whether applicant is owner, lc{see, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner o£premises .... J~TH.[~,~'/2q. A: '.bl.~.q3.Ut/¥N. bl, ~.N.~ oT~..~
, (as on the tax roll or latest deed)
If applicant is a ~orporation,.signature ~f duly autt?rized officer.
(Name and title of c0rporatq officer)
Plumber's License No '
Electrician's License No .......................
Other Trade's License No .....................
Location of land on which proposed' work will be'done ............ , .... ?. Mill- ~..~, ~ATTITUC/'%.
oF:OX HILL
House Number . Street Hamlet
C mty T Mai N 1000 S tioh .[,.0.7 - Block
Ot ax ) O. CC .... .
Subdivision ....... · .}~. {~:v .......
,. ................. Filed Map No.
(Name) .............. Lot ...............
, State existing use and occupancy of ~remises and intended use and occupancy of proposed construction: