HomeMy WebLinkAbout21421-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22576
Date SEPTEMBER 8~ 1993
THIS CERTIFIES that the building
Location of Property 445 BUNGALOW LANE
House No.
County Tax Map No. 1000 Section 123
Subdivision
ADDITION
MATTITUCK¢ N.Y.
Street Hamlet
Block 3 Lot 6
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 14, 1993 pursuant to which
Building Permit No. 2142t-Z dated MAY 20¢ 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - AUGUST 31, 1993
PLUMBERS CERTIFICATION DATED N/A
BERNARD M. TURCHIANO
Rev. 1/81
/ ~ldin~ Inspector
FOig,~ NO. II
TOWN OF $OUTHOLD
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? 21~21Z
Permission is hereby grante~:
................................ ~ ........... ..~. ...... ~/. ........ ~. ....
.... .......
,o....~.~.~..~ ...... ~./......~:~.~:~.~ .......... ~.~ ......... ~ ....... ~. ................
...~~ ....... ..../....~.......;.~ ....... Y...~.~ ........ /...~.....~~....~: .....
~t premises located ct ........... ~......~...~...~.. ......... ~.~.....~....~.~....~.......~.. ............................
............................................................ . .~...~.~ ../..~ ..................................................................... /
County Tax Map No. 1000 Section ..../'~..~... ......... Block ....... ..~.ff. ...... Lot No.......~...~.. ............
pursuant to application dated ......................~ ~.~.... ................... , 19Z.~..., 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 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.
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 d}~elling $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, Commercial $15.00
Date ..... ~ ...........................
New Construction ........... Old Or Pre-existing ~Bu~ilding ....
Location of Property....~..~..~...~.~9. n ~..~.O..~. ....... ~...~-... .............. ~,..~., .~'~5: 5.[.: ......
House No. Street Hamlet
Onwer or Owners of Property ....................
County Tax Map No i000, Section...~.~....~ ...... Block ..... ~. ......... Lot... g .....
Subdivision .................................. Filed Map ............ Lot .................
Permit No...~. ~.~..~... ! .... Date Of Permit...~...~..Tr.~A! .~3pplicant..~..~...~.A..~..'-~..t%.~..~.i .~.. o
Health Dept. Approval ..... ... ..... ... ....... Underwriters Approval...~...~g D ~
Planning Board Approval ........................
Request for: Temporary~ertificate ........... Final Certicate....~. ......
Fee Submitted: $ ...................... ~ ~ ....
(~'~' ~/¢~ ~ APPLICANT
INSPECTORS
Victor Lessard
Principal Building Inspector
Curti~ Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire 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
Fax (516) 765-1823
Telephone (516) 765-1800
August 27, 1993
Bernard M. Turchiano
207 Euston Rd.
Garden City, N.Y. 11530
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)
XX 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 9 21421-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
00oo
/-~0~ E C/FEEl<
00'
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND ~ ~'
FRAMING
FINAL
765-1802
BUILDING DEPT.
INSPECTION
~-~/~ N
FOUNDATIO2ND [ ] INSULATION
[ ] FRAMING
FINAL
76S-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]/~.UNDATION 2ND [ ] INSULATION
[,//]' FRAMING [ ] FINAL
REMARKS:
New York State Department of Environmental Conservation
Buildin~ ~ ~_~.)S UTNsY1 _S ~:~ ~ 9B r o o k, NeW, l,iYC~I;I~:51 ~1~ 9 q .-2 3 5 6
Based on the information you have submitted, the New York State
Department of Environmental Conservation has determined that:
Therefore, in accordance with the current Tidal Wetlands Land Use
Requlations (6NYC1ER Part 661) no permit is required under the Tidal
Wetlands Act . Please be advised, however, that no construction,
sedimentation, or disturbance of any kind may take place seaward of
the tidal wetlands jurisdictional boundary, as indicated above,
without a permit. It is your responsibility to ensure that all
necessary precautions are taken to prevent any sedimentation or
other alteration or disturbance to the ground surface or vegetation
within Tidal Wetlands jurisdiction which may result from you~
project. ' Such precautions may include maintaining adequate work
area between the tidal wetland jurisdictional boundary and youn:
project (i.e. a 15' to 20' wide construction area) or erectinq a
temporary fence, barrier, or hay bale berm.
Please be further advised that this letter does not relieve you of
the responsibility of obtaining any necessary permits or approvals
from other agencies.
CC:
Very truly yours,
Deputy Regional Permit Administrator
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[[~00.378 BUREAU OF ELECTRICITY
[~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
Dat~ 3 ~ ~ T~ ~tl~ ~ R ~7,~993 ~pplicationNo. onfil~
THIS CERTIFIES THAT
o~y ~he e~rrlca~ ~ulpment ~ ~scr~bed be~w a~d intr~uced by t~ applicant ~med on the a~e application ~umber ~n the premises of
8. ~UR(',iI[~NO, 455 }3II~G~LOW
in the follmving It,catlon; ~ B~ement ~ Ist FI. ~ 2~ FI. Section Bilk Lot
~s examined on ~ ~ (~ ~ ~ ~' ~ ~ t [ 99 ~ and found to be in compliance with the NaHonal Elect~c~ Code.
FIXTURE
OUTLETS
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
DRYERS
SYSTEMS
R V I C
A. W, G, NO, OF HI-tEG A W G NO OF NEUTRALS A.W.G.
OF CC COND OF MI,LEG OF NEUTRAL
OTHER APPARATUS:
1269
t~Y, 11971
GENEllAL MANAGER
This certificote must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their cr~tlals.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER,
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
,~amined .... ~ ..... , ...
Approved ..... '.~..o~.~ .....19 ?.'~.-- Permit No.
Disapproved a/c .....................................
BOARD OF HEALTH .........
~"-3 SETS OF PLANS ..........
SURVEY ...................
SEPTIC FORH r.%. ..........
CALL ...................
· . . . 9guiq'ding Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3
~ets 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 sti'eets
'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 tiffs 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 glADE 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 and in building for necessary inspections..~[_; ~.;. ~ r,~ ~
- (Signature of applicant, or name, if a~orporation)
-
(Mailing address of applicant) I t S' ~ o
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
Name of o,vner of premises...(~?...~-:.~. ?~., .~ .~., . .}~.: .'-~...~¥/.'~..<~..~. :~-..c~..~..0 ...................................
(as on the tax roll or latest deed
I£ applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrm~an s L~cense No .......................
Other Trade's License No ......................
................... ,. .,: ..............................· ............... .
House Number Street Hamlet
County Tax MapNo. I000 Section ... :.~,.7-:..3..i ...... Block ~ ' Lot (CD
Filed Map No. Lot ...............
Subdivision ........ . ...........................................
(Name) ,
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~.....~..'~.~ ."~.."5...k..~...'~...~......~....'~U-~....~...&?... :...~....~.'..~...o.~.. '....~..
b. Intended use and occupancy ....... .~'..~--T...~..', .~...a?~':..'.~YS. ~....~. .....................................
· 3. ~N tur. e of work (check win~ch ~Pph.cable): New Building .......... Addition ..... Alteration ....
. Repair .......... ~4;~. Removal .............. . Demolition ..... : ......... Other Work ............
~ ' "' ' ! '¢" [' O~ .' .... ' . (Description)
4. estimatea t. ost ........ '.9 .I.!9: ........................ Fee ......................................
i . [ (to be paid on filing this application)
5. If dwelling, number o f dwelling units Number of dwelling units on each floor.
· If garage, number &cars .... i ...........
.6. ~.buan.ess, co.mmerc,al or m~xCd occupancy, specify nature and exte;l't ofleach type'of'tile i '". i .......
,. uxmens~ons of existing structures if an,,' Front Lt,h r ,, tt.~, r ...... :-: ;q '/ .......
,. · , -- t' , , ~ ..... :*~ ....... l~ear ..... TV ....... Depth ...r_.~. ....
height ..... t~ ........ Number of Stories . .~..'9 .~.. . ' .....
. ?mensions of_sa..me, stmctnre ?ith alterations or ad_ditionsl ~'r~)n[ ". ~ ~ '? ........ ~.~;" '~'&') ..........
Denth ].-~.~. ' ..... wf,: '~, ~,- r ..................... :,z,:;,t ............
,~ ~,. ,- -- .. · _~ .. :.. ....... ... nexgnt .... m ?.: >.. ;,/.~ ........ Number of Stories ..... .r~...'T:.:.. .
6. Dimensions olentlre new construction. Front . .. t_,:/ ~.o . ~,~ I q ~q:t, ., . H/~"~, ....
Hei -- , ~ r , ........ , ...... ,:ar ..., .... ~ ....... tJeptn ...:t...,= ......
. gut ..... I .......... Nurffl~er of Stories ..... .c~ ~ ' '
9. Size of lot' Front t'O.O' ' ' . ~ . Rear .... )~'~ ', .......... '., .........=,'>,',a'/ ............
...... ' . ' ' ' ' · ~A';-; f' ......... .[."~ ............ Depth . .6~,~ ......
lu ~ate Oll'urcnase a,.-~,l ,,,. . xv ~ ~ ~ , ',..l ' ~, ' ~.~r~.'( ~ ......
..... ·: ........ - ............. ~.................._k~ame otrornter Owner . .V~.o.V.~.~...% :..4w...':~..~..~.,~7..
ii. /-one or use dxstnet xn wl.fich p{emlses are situated....'~...,.,.,.,.,.,.,.,.,~ [.~..%..d~.'..a,.~ ...................... '. ''"
.12. Does proposed construction viglat, e~ny zoning law, ordinance or resulation' ~.~ .........
13 Willl6tberegraded ' t"9.'.'o.. . · ..... ~~ , ' '"':~. .......................
· · .....~ ...... ..,,a_ ..... , ....win excess nix De removea ~rom premises, y, Yes
14. Nam e o f Owner o f p&~mises ', .~q. tgC .xmAa.. f..&..?.~.y..~. % .~yA~ dr~s,,-zo ,/~_,.,~.w.~ i,~ Fa.A ,.. - ,~,-,.l ...,~, ~.~
..... ~ -- :U 5'. 'It ' t' · ~..:..:, u * .... w.'m--.~. ....... q- .... rrlone
Name of Contractor . : .
. · ...... ; ................. Address ........... ., ....... Phone No ..............
15. I.s l:his property within 1300 feet of a tidal wetland? *Yes...~ .... No ......... ''~
· If yes, Southold Town Trustees Permit may be required.
" PLOT DIAGRAM
Locate clearly and distinctly ali buildings, Whether existing or proposed, and. indicate all set-hack dimensions from'
property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether
interior or corner lot. :
STATE OF NEW YCkR~
"" '~'~a"C'A" '°-"('4" 'N~'~'C~' '~.'t' · 'r~' .9 ............ being duly sworn, deposes and says that he is the applicant
(Name of individual signihg contract)
above named.
He is the '
: (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
re eta
1000-123.00-03.00-006.000
(1Bo) INDICATES ELEVATION SHOWN IN USC & GS PL~>~Z
FROM BENCH E-373 AT MATTITUCK AIRPORT
ELEVATIONS ADDED TO SURVEY MARCH 24, 1993,
CONTOURS ADDED TO SURVEY MARCH 29. t993
)"W.
BUNGALOW
TEST BORI
SANDY
LOAM Et
GRAVEL
3'
SAND ~
TRACE OF
GRAVEL
17'
NO WATER
SURVEY FOR
BERNA RD M. TuRcHIA NO
AT MATT/TUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY~ N.Y.
SCALE: 1"=40'
JUL Y 13, 19 76
JAN. zl, 19 77
REFERENCE~
GUARANT;ED TO~
E¥OR
N.~$. LIC. NO. 287'25
RIVERHEAD; N.Y.