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HomeMy WebLinkAbout21009-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Nc Z-22760 Date DECEMBER 2, 1993 THIS CERTIFIES that the building ADDITION Location of Property 445 WOOD LANE PECONIC N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 6 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 10, 1992 pursuant to which Building Permit No. 21009-Z dated AUGUST 8 1992 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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD & REGINA NORDSTROM (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-291963 - OCTOBER 8, 1993 PLUMBERS CERTIFICATION DATED NOV. 15, 1993 - HARDY PLUMB. & HEAT. NORTH ldin Inspector Rev. 1/81 rosai xo: s 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) i N °-N° 21009Z Date l~/W 19~2- i Permission is hereby granted to: to ....cam!.. :~~....ii......-........R It p(S s located at t l - ~?.i County Tax Map No. 1000 Section sf.4........ Block Lot No. j pursuant to application dated .............lJ../ and approved by the Building Inspector. Fee S...r~..7~/. /Build t Rev. 6/30/80 Form No. 6 1}E-'`F TOWN OF SOUTHOLD ~~f w BUILDING DEPARTMENT ' ^ TOWN HALL 765-1802 F.1iSaL t!k r''1, j MOWN U4' SUU~~ s~~ ....APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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. , 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, Commercial $15.00 Date y - 1973 New Construction........... Old Or Pre-exi(~s®®t~__i~~n~~g Building... ~p Location of Property ......................`.":Gis ..IAe.~ ............T. N(fi House No. 4A.1-0 Street Hamlet Onwer or Owners of Property... 4~ °R pp n 1~.e&!N~4.... /l0 l1/~I~ S954OvV1 County Tax Map No 1000, Section... .?0! Block 0.6 .......Lot Subdivision..... ...............................Filed Map............ Lot...................... Permit No.:?-(G?P.qc ...Date Of Permit..(. .....Applicant.. .U~ ~ul f(. , Health Dept. Approval 40i................ Underwriters Approval......................... Planning Board Approval 4 / Request for: Temporary Certificate........... Final Certicate..`......... r Fee Submitted: $ APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE' 1 1(71]0$`! BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date OC1P0[>t'R P)8, I793 Application No. on file 8:1013393/93 N 23!.963 THIS CERTIFIES THAT only the electrical equipment os described below and introduced by the applicant named on the above application number in the premises of 80 NORDSTRIJU, 775 1~NnDTAN NECK i,ANK, POLE A AB, PEIC,ONT,C, N.Y, in thefollowing location; L2 Basement /01PT © /st Fl. ®2nd F'!. A'PTCC Section Block Lot was examined on O C 7.10 B Ei R 0 5 , 19 9 3 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W AMT. K, W. AMT K.W. AMT K.W. AMT, H.P. 35 n :t0 I I 3 1 1 1, DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS REL. UNIT HEATERS I MULTI-OUTLET DIMMERS AMT. K. W. OIL H. P. GAS H. P AMT. NO A. W. G. AMT qMP. AMT gMPS. TRANS, pMT. H, P SYSTEMS AMT WATTS NO OF FEET 1. E 1 30 LEE SERVICE DISCONNECT NO. OF S E R V I C E "T. I "P. I TYPE METER 1.0, 2W 1.9 3W 3 a 3W 3,e 4W NO. OF CC COND. A. W. G. NO. OF H1 LEG A W G. NO OF NEUTRALS A W.O. EQUIP PER0 OF CC. COND OF H1 LEG OF NEUTRAL 1 700 CH 1 % 1. 2/0 1. 2/0 OTHER APPARATUS: NOTORS.8 F 11.0. G.F.CJt-9 SMOKE DFT13CTOR;-2 TRACK LIGHTING 8 G Fc G CLECTEILC CTC4373:1 18 W. LAND LNG RD. HAMPTON BAYS, NY, 11946 GENERAL MANAGER !.9 Per 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. ' TEL.76 -1802 i C CUI~ TOWN Oi- SOUTHOLD ; tY: < OFFICE OF BUILDI;•IC INSPECT'OI~ P.O. 130:, '128 TOWN I:.'.LL y4 SOUTHOLD, N .Y. 11971 ~s -c C E R T I F I C A T I O N Date /S g3 Building Permit No. Owner ®,ed>ST~',p~ (please print) PlumberAocjv P`6/1 n!1 j 4 Re-,+J 1Q IV©f fk (phase print) J I certify that the solder used in the water supply system contains less than 2!10 of 1% lead. r ^ i J\ i c (plumber's signature) Sworn to before me.this _day of ~ r~~ . 19 X13 1 6ta~ Pub c Nota.° Pi+h' ic, 5 oLh CounLy Notary Publliic ate of New York No. 4979701 Qualified in Suffolk Corny , a Commission Expires April % 19 j~ INSPECTORS r Victor Lessard ,~±)rF1a(,~~ Principal Building Inspector 1`~ Curtis Horton s. d a SCOTT L. HARRIS, Supervisor Senior Building Inspector' .c Thomas Fisher --e! Southold Town Hall P.O. Box 1179, 53095 Main Road Building Inspector ~ Grp i;~9 kn p! Southold, New York 11971 Building Inspector .7 Fax (516) 765-1823 Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD November 17, 1993 Edward Nordstrom 445 Wood Lane Peconic, N.Y. 11958 To Whom This May Concern: We are unable to complete your Certificate of occupancy because of the following reasons: XXX An application for Certificate of occupancy is not on file. (Enclosed) ~J Xxx No Underwriters Certificate on file. Xxx The check is (outdate /not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. XXX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # EP# 21009Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN 13UILDING DEPT. saazS+ii:e,.?Z,a..,up..w+a... , _i,.G~:.... W ...w ,,..«.rv:w'.~,~,s,-.:~:b"~ss:f.,,::ss"ssa3ty~ 1_LJ ~:(i•tLNT OUIIDATION ( 1st) t OUNDATION (2nd) _ I ~ .eti _ o OUCH FRAME & fn .PLUMBING ~I 3 /tee V1 n H IlSULATIO?! PER N. Y. ' STATE ENERGY CODE rr r ~Q y FINAL 41 ADDITIONAL COMMENTS: s x x 9 1-i VJ\ O~ • m • r vJ v t -i' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS: YZ 7d j' c ~cr~ /~ccy D*EiJ, 2 Ceps DATE 11112- INSPECTOR Z-r 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROU PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL ,f REMARKS: d'- c,~ c DATE l~ INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ . FRAMING [ ] FINAL REMARKS:i DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [v'~/FRAMING [ ] FINAL REMARKS: 6 DATE cam` 3 INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ FO NDATION 1ST r ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ [ ] FRAMING [ ] FINAL REMARKS: . n a11~,,~ f 4 Y DATE INSPECTOR f 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE 04L INSPECTOR ;f A ENFRGY LWE REVIEW i OX electric) ' t 7014 (Part 5) 6,DOO degree days For /V Pr W,5 I ro r~ Per Dwga Dated f~t F/ rt Envelope Component R-Value a Exterior Wall R-w 2 3 _ Itoof/Ceiling R_lcy 2 6 Floor Ii-19 Foundation Wall R-10 slab Edge Insulation R-10 Glazing R-} Z Entrance Doors R-2.5 All IIVAC Equipment to meet requirements of 7814.11 All IIYAC Contra, j Systems to meet requirements of 7814.12 All Duct Systems to meet requirements of 7814.13 All Ventilating Systems to meet requirements of 7014.14 All hlPing Insulation to meet requirements of 7814.15 f All SerVice Water Ileating Systems and Equipment to meet requirements of 7814.21 All Electric Systems to meet requirements of 7814.31 3 To the best of my knowledge, belief, and professional judgements these plans are in compliance with Lhe code qG.~'F f•'t`iyY vy'r' lf.i t_1% f 7, c •F 032254.1 ~C.. 40f4810'6 '~.__z s"'.=. •3.T~'i - - i~r f""~...ir:',~-'.+zcv3Q~ 1° 51.22 , t 4.! 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A ~3 9 ~ 7>Q 5 ~ C0 ~l _ N N ~~w 3 S9 j ~1 N~ D_ s3 00 to N y o - N rv o W ~ r CA N N L" rtl 3 " o RI N 0 L3 < I Is S N 7 S N N T 7 1 3 n (p~ S 04 -Z 71~ ~y ro D5 o3m s o l tp Q- o n r S 5 l r (pl3~T 5 i 9 5 N 10 t7 0 0 U ,~Nm Q 9 a CA 5 4 D N ~ 5 ~ 3 33~ +~a~ 3 4~ 3 9 5• N DD 3 'I) m W Np3 R E BOARD OF HEALTH FORM NO.1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY _ - . BUILDING DEPARTMENT CIICCK TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 Qn TEL.: 765-1802 t:OT I FY q19/. CALL Examined CA TO: • _ - . ' • • - • - • M AT kPproved /.d/il....... , 19AZ Permit No. . Disapproved a/c _ _ . ( ildin~ Spector) APPLICATION FOR BUILDING PERMIT Date ...41. f l 19~L_ „ INSTRUCTIONS ~a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 =t,. 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ition. 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 call 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 call 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to imit authorized inspectors on premises and in building for necessary inspections. L~Or~719- (Signature of applicant, or name, if a corporation) Q~:Bob ? /.9~ ?!Auy. .f'ev%y 1.15.3! (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~j ZN f~/k ~...C o nJ IKAc fz~f? ame of owner of premises .....Uwer2Lb Itl 9 ec~ 1.? /.V ~~D S f . (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. ~R (Name and title of corporate officer) Builder's License No. , , , • , • • • , ` 1 Plumber's License No . Electrician's License No . Other Trade's License No . . . Location of land on which proposed work will be done. . . !louse Number Street Hamlet • • • • . • . County Tax Map No. 1000 Section -,P£.......... Block . , , , • Lot Subdivision Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy SE M b. Intended use and occupancy ...tTt7K5lt;..t •a...',.§........ w'w 3. Nature of work (check which applicable): New Building moval ' ' ' ' ' ' ' • • • Addition , . , Alteration Repair Demolition Other Work , . e l 4. Estimated Cost . v (Description) J f O:.Q Fee........ 5. If dwellindg number of dwelling (to be paid on filing this application) , g units . Number of dwSlling units on each floor.... . . . . . . . . . . If garage, number of cars . 6. If business, commercial or mixed occupancy, specify nature apd extent of e ch type of use . 7. Dimensions of existing structuFes, if any: Front . s? g: , , , , , Rear Height /A Number of Stories p A e- 4- 7 . • • • • • Depth , . • . . Dimensions of same structure with alterations or additions: Front ~g•,1 Depth ....x.3'3.. Height Rear Q : 8. Dimensions of entire new construction: Front . . ' ' Number of Stor es f y . Height Rear Depth Number of Stories . 9. Size of lot: Front . Rear ...S 1 f 6................ . 10. Date of Purchase Depth ••••••••••••••.....Name ofFormer Owner 11. Zone or use district in which emises are situated . 121. Does proposed a construction violate any zoning law, ordinance or regulation: ~ Q re raded 13l4. . Will Name lot of be Owner of remisesN~ ' ' • ' ' ' • • • • • Will excess fill be removed from premises: Yes No P A, NaRosn¢. .Address An4 (et Name of Architect . Phone No... ;'yp7 ¢ ' . " Name of Contractor .IP;ouMM t^^a ~-nt-•"" Address ~,.'8~ 2oY • • • • • • • • Phone No.. Address . 1. AjyM141 • , , Phone No.. 4-yy Lp 15. Is this property within 1300 feet of a tidal wetland? *Yes. *If yes, Southold Town Trustees Permit may be required. No " { PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all Set-back dimensions from property lines. Give street and blockl,number or description according to deed, and show street names and indicate whether interior or comer lot. r f STATE OP NEK/I COUNTY OF • "',S • • • ' • •cvjL ( r• < • • • • • • • • • being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) lbove named, 'lc is the . a (Confrcto agent, c rporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this PPlication; that all statements contain~d in this application are true to the best of his knowledge and belief; and that the York will be performed in the manner set forth in the application filed therewith. ;wom to before me this .:L;dayof..... C.~iC~ 5 .1 19.~ 2 rotary Public, ..,V X (-F?,.......• • • J , County CLAIRE L. Qt.EW Notary Publio, State of New York • • • • • • . . 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