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HomeMy WebLinkAbout21010-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22756 Date DECEMBER 1, 1993 THIS CERTIFIES that the building ADDITION Location of Property 2105 MILL ROAD MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 100 Block 3 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 6, 1992 pursuant to which Building Permit No. 21010-Z dated OCTOBER 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SUSAN PARKHILL & MICHAEL & MARY GAYDOSIK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - NOV. 29, 1993 PLUMBERS CERTIFICATION DATED JAN. 13, 1993-PECONIC PLUMB. & HEATING ~C Building Inspector Rev. 1/81 roast 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) W N9 2101O Z Date .....lei 19 2 Permission ishereb rante g k /!II..r.........c.. ~ r.....l/.PO~x to /.V.xqw~ of premises located at l.Q..J~ .........lel ...................................................1f County Tax Map No. 1000 Section /0-5R Block Lot No....... j........ pursuant to application dated .,IOGs 19.R.0-1 and approved by the Building Inspector. Fee S.or. - B ing I for Rev. 6/30/80 I6 ' FuL 'M~ (XV cnQ~£~1~Y.~~J~ FormNo. 6 TOWN OF SOUTHOLD ;,r BUILDING DEPARTMENT TOWN HALL 02'9 ` 765-1802 ~_y ' v.. Towns of souvfioc_ APPLICATION FOR CERTIFICATE OF OCCUPAN 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 - Residentnilal $15.00, Commercial $15.00 / Date .!Vod o2.2~.l New Construction....Y...,.. Old Or Pre-existing Building.. Location of Property.... I S Gfa~ (Yl{ LL ~Z~...........m F!...I House No. I Street Hamlet Onwer or Owners of Property. 5Av5PN fAQ~Y~,1.~~p(~,~/ G70yptJsl I[ J j J?~~L~p~,~ ~AJ{ County Tax Map No 1000, Section.. o.0 .......Block....3 ..........Lot....1.3.........1....... Subdivision ....................................Filed Map.............~~LotlI.,,,,..../............/...... Permit No...l.w ~0.0.~,.-..Date Of Permit.... ~.f .....Applicant..l:'.a!:~e.~. Gf!S!/~... ~c health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate..~, iee Submitted: ~ ~ ~ ~ G~:C~G~'v`^' t ~~Ib APPLIC Ca~a~75~ - TEL. 765-1802 TOWN OF SOtT HOLD 1 OFFICE OF BUILDING INSPECTOR P.O. BOX 728 yE.. TOWN HALL . SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date Building Permit No. Owner (please print/) J/ Plurnber,~°~j///G P1'e'M1g11y Y/YW'wo (please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. ~4xav~"r (pl m is Si ature) Sworn to before me this ~a day of 19 Notary PuJ lic BARBARA STEM 9111 Votary Public, County NofaryPublic,Stateo) Cy . No. 4844752 OuaGlled In Sulblk Commission Eq*es SeP1.30,19 CC) 5 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1199773 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date W9MfiVR 02' 1993 Application No. on file 05339693/93 IT 2976412 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant homed on the above application number in the premises of Id.T_,KE GNYDO`d1K, 2105 EMIT MI' LL ROAD, MATTSTU(%, H.Y. in the following locotio Ba@@~mGnt 'At Fl- ? 2nd Fl. Section Blork Lot N OI'i M.SF., P 4 , t "19 uwsexaminedon and found to be in compliance with the National Electrical Code. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W AMT K W, 11 PMT KW. AMT K W T. H P 6 ~ TL DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RFC'?T TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. OIL H. P. GAS H P AMT. NO A. W G AMT AMP. PMT AMPS, TRANS. AMi H, P. SYSTEMS AMT. WATTS NO.OF FEET SERVICE DISCONNECT NO. OF S E R V I C E METER NO OF CC COND A. w. G. A. W, G A. W TR AMT. AMP. TYPE ROUI0. IaaW 1%3W 303W 3,e AW PER% OF Cc.COND. NO OF-HI LEG OF W, NO. OF NEUTRALS Of NEUTRAL OTHER APPARATUS: I{~1,QgJt7."F I{,{~. PANP,LI39ARDNoI-f. Ci,I1. J99 fi F.C.t: I SPtDKI~ 17~;'PECT{YFt r - t I R&T.f1UR A. HUk?Oh,llk; f,LL',N2:134-F1 MAIN ROAD ` OMLEIIT, NY, 11957 GENERAL MANAGER 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. INSPECTORS Victor Lessard gUFFI](,y Principal Building Inspector pti~ LQ~ Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector o Southold Town Hall Thomas Fisher 'v+ P.O. Box 1179, 53095 Main Road Building Inspector Southold, New York 11971 Gary Fish~lOl << Jtr Fax (516) 765-1823 Building Inspector {may " 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 DECEMBER 23, 1992 BOB KEHL'S HOME IMPROVEMENT 28545 MAIN ROAD ORIENT, NY 11957 RE: SUSAN GAYDOSIR & ANO To Whom This May concern: we are unable to complete your Certificate of occupancy because of the following reasons: ffi An application for Certificate of Occupancy is not on file. (Enclosed) ZZx No Underwriters Certificate on file. ZKK The check is , _ W-____-, not on file.) $25.00 No Health Department Approval on file. No final inspection has been made. RZx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21010-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: SUSAN GAYDOSIR LNiC OUNDATION (1st) • c ti OUNDATION (2nd) p L7 E ~2 a OUCH FRAME & .PLUMBING o • I H N ' I m n NSULATION PER N. Y. I y STATE ENERGY CODE r 21- m p FI;JAL o ADDITIONAL COMMENTS: x Q ' r , n Z,5_2 6:2 • x H A ' H h1 • O T - m • r H m H 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND INS TION [ ] FRAMING INAL REMARKS: C~ i i 4 DATE VINSPECTOR 1765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: i DATE 1® INSPECTOR w /o 102~ M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ROUGH PLBG. [ - ] FOUNDATION 2ND [ "SUTION [ FRAMING [ ] FINAL REMARKS: DATE fi INSPECTOR 1 BOARD OF HEALTH 3 SETS OF PLANS . tit.;! 6 FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL vOUTHOLD, N.Y. 11971 NOTIFY d~ CALL . L. s / TEL.: 765-1802 MAIL T 0 : ,~/~z-L L•~ 7C~r/~ Examined A09 ..f........, 19®9Z Approved ~I! 19/. vYermit No.. 7. Disapproved a/c uildin nspector) APPLICATION FOR BUILDING PERMIT Date 19, 2 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 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 necessary inspections. [1 /e~4....~°.~ (Signature of applicant, or name, if a corporation) r O. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~~Vi22fIO C'oivT2~geTO~ Name of owner of premises 1:~~.r!t^!..~gR /~!ce t eM9 % ~ItYP~s K, ,ihiF~l6r?c.~~yoas/y~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . Plumber's License No . Electrician's License No . Other Trade's License No. 3 a .?.?..'.-L..... 1. Location of land on which proposed work will be done . _fi t_ .............!yA77.- c/C House Number Street Hamlet County Tax Map No. 1000 Section L~ Block 3 Lot.. f 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 ~~J2 C C 0 s.. . b. Intended use and occupancy ...1~«! Nature Repair . of work (check eck , . which h applicable): New Building Addition ....Alteration Removal Demolition , Other Work (Description) 4. Estimated Cost 0 Fee . s ` (to be paid on filing this application) S. If dwelling, number of dwelling u iiits 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 ty a of use 7. Dimensions of existing structures; if any: Front Rear ...3Yr^?.:.. Depth ,Ya. 'Y . Height ..G Number of Stories , . Dimensions 'of same structure with alterations or additions: Front Rear , tr . Depth ~°.~.Y . Height .....;G................ Number of Stories ....1 y . , Dimensions of entire new construction: Front Rear v1. L?. Depth ..16 • • . , , , , , , eight Number of Stories O.^~ E . 9. Size of lot: Front ..I.........,. Rear 9%., F.3 _ , , , , • Depth 6.? . 3 z' .'FL , l N,, a o 10. Date of Purchase /'9.7.F , . i Name of Former Owner 11. Zone or use district in which premises are situated ...,TiefC 12. Does proposed construction violate any zoning law, ordinance or regulation: :..4l/,°? . . 13. Will lot be regraded N . , c Will excess fill be removed from premises: Yes fo y~i~Y,ogsi a!os FKSricc fO, 14. Name of Owner of premises X. . Address Phone No. Iwnfi•~rk e . Name of Architect Address Phone No.. . Name of Contractor . 4Q4~Ken!C,r H Sr„ Address EsY?. j-°' ....Phone No..3 15. Is this property located within 300 feet of a tidal wetland? *Yes _ *If yes, Southold Town Trustees PermitPmay be required. DIAGRAM Locate clearly and distinctly all buildin er existing or proposed, and indicate all set-back dimensions from i property lines. Give street and in er or description according to deed, and show stre t names and indicate whether interior or cornetde(~ - ° ' y f~An,e Tf 6' I 'S I gart/ I p~ Ly 4 35 (9. r» ~itr o ,F 1' i s :b i ~ N o STATE OF NEW RICC,~ rr COUNTY OF. Sr i 't3 .b Vr i~Zc . ~l . above being duly sworn, deposes and says that he is the applicant (Na e o"' fin di idual signirig contract) `.,Heisthe (Contracto 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. i Sworn to before me this "day of 19.9 Notary Public,C County CLAIRE L. GLEW : ` 1.... P-. Notary Public, State of Now York (Signature of applicant) No.487®505 Qualified In Suffolk County Coromiselon Expkee Doornber 8, p, S • L 5d' F a1. M " 14 KAR , t N, i N'/2°0~~20e~~ e ,33.1 ~ osc 'eo w aBVr4~ ' ro SP -34d z° C < ARE O 7- 82 A° , a s ~as~ fc n ~ ARE ooi~'i = 9 a beast ~*Yei ~ , i F c i 1 t N 11 2p0,00' . G n. 9014'10"w.p D "da NAILL . A. A i fr - , •Unauthorized. alteration or •addition to tthis survey is a violation of 't "section 9209 of the NettYgrk ,£toto Ediioafion Law. 3 - _s......n._ Copies.of this surveYy -ma ot bcorm the - P n g land surveyors inked z- r-seal or embossed soal s' c6 not be coris.derod to be a 'valid copy: ~ 6 p Guarantees or cerhf lobs irr of he pn Shall run only to the "i -7 r. t 1 i C.~ ' person forwhom n w Is proji.r - and oily his be'palf to the g - - title company, gov rnmontol oq~ncy and, londing -institution listed a ' hereon, and to the assignees of the lending institution. Guarantees 6; ?,1-tr^} or certifications are not -transferable to additional institutions or 57C aVbseclue nt, owners., - - "f?`Vf~t w yj r t c SURVEY FOR ro 4NJ/~11T GAYDOSI K of NEW ` AT MATTITU k TOWN OF SO-UHOLD -SUF#OLIkCO NTY, N.Y. cuARANTEEiS-70 - SECURITY TITLEAN 0 RA mPAN ~ Ste SUSAN t)A 7 OAY O K 4 . n r SOUTHOLD S' IN6S SCALE:, 1. = 40 ' F2 <S 2872'P FS° -'AUGUST lot 198 s NOK 19, 197G-s LAND SURVEYOR - N.Y.S. LUC. NO, k87,25 RfVERHEA0, N. Y. 'fir.', ~ e 'P 1 2ff i-t( l 4 M- 'T _ C fly 77,1 7 tl 1 ~ t ~J j Y Y tl u~ 4 it nIL~ .'I {1 I y l PLUMBING ALL PLUMBING WASTE ' & WATER LINES NEED - TESTING BEFORE COVERING r OCCUPANCY OR :SE IS UN"LAWFUL ;r WITHOUT CERTIFICATE I'll I If coPPertubing is usedP~N 9FJ~~Cf~~i - _ for Water distributing 0 ~af~I n system; Piping shall be 56 of types K or L only _r_ L~ Sao Loo ooh 5 (Koo p4 I P4- ` APPRO ED AS NOTED DATE: /O 9Z B.P, p ~~b /0 ~ I I r - i FEE: BY. i ; NOTIFY BUI G DEPA AT - i PLUMBER CERTIFICATION 765-1802 9 AM TO 4 PM FOR THE . ' CERTIFICATE OF FOUNDATION - TWO REQUIRED 1 OCCUPANCY FOR POURED CONCRETE ILI I__ ON LEAD CONTENTBEFO FOLLOWING INSPECTIONS = 4 SOLDER USED IN WATER 3. INSULATION FRAMING ! PLUMBING SUPPLY SYSTEM CANNOT 4. FINAL - CONSTRUCTION MUST EXCEED 2110 of LEAD. ALL ECOCOMPLETE FOR C.O. NSTRUCTION SHALL MEET ' - THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS UNDERWRITERS CERTIFICATE REQUIRED - d ~/i! U /~O Sle ~ ~Q~ //Ta o? ~U~ ' Ale 9 'Y S AZ + wz~ r Y 'd i 04, x ~G I j ~G x I t r:, a ~~r 0. ~tQG "'.9 5 1 dtPS i `r dGr 3 k o4 .r I f4 1 ; `I I ~y ~ f \i'I i ~ ~ ~f AF f ~ G it i n- i 0 ~1 II t ~ f 1 ; JJ I ry ~ ~ \ d4 `a I I ~5 fS {5 CFO I Al ``~~o¢ M `9~ it n Q' GW i' i 1T u '19y2 7 ('(('a 55 S'EC 7~anr - I /S 1 I ~1~, ~6 J ~G~ /fQ~~ ~TOS? /T//'[Mme. ti a V/yy / ~c ~~y~Aa F `ytlY~ k i _.~„~__._~.1~.~~._.~ 1 TI! I }lea4~ P 4 _ r +~y NCNB s' 't.' ~ f o+~ Sic c C'~'~ k1AG{. i i f Y_ f f µ ~ u . . I nay Q~~. ~~~sr Q - sry 1 ntk~ { CIO Ike r 5 1 ~ I 1 ' S k i F ! ~ f 777 "ld a,P .r O Th>.,i ~:T _ - Vej , rµ. , Ye.e~h~ ~ a d u ,.u ~ ..e._.. _ u~..u_ ..r_.... _ r W i u. v w..