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Home My WebLink About21042-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22131 Date JANUARY 29, 1993 THIS CERTIFIES that the building. Location of Property 240 DONNA DRIVE House No. County Tax Map No. 1000 Section 115 Subdivision DEEP HOLE CREEK ALTERATION MATTITUCK, N.Y. Street Hamlet Block 15 Lot 24 Filed Map No. 4256 Lot No. 23 conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 17, 1992 pur%uant to which Building Permit No. 21042-Z dated OCTOBER 23, 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 CONSTRUCTION OF ROOM IN PART OF EXISTING ATTACHED GARAGE AS APPLIED FOR. The certificate is'issued to KATHL~RN M. SIMPSON & VENETIA A. McKEIGHAN (owners} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-262377 - JANUARY 8, 1993 PLUMBERS CERTIFICATION DATED N/A f Building Inspector Rev. 1/81 FORM NO. o TOWN OF SOU'I~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N -No, 2104 Z County 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-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY JAN 2 8 1993 This application must be filled in by typewriter OR ink and submitted to the building insp&ctor 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 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 Building ................. Prop erty... ~.~ P ........................ [ND b.fj~.% ............. ~.' ~.dq ...... Location of ,~o.~ . House No. Street Hamlet Onwer or Owners of Property ..................... ~ ............................. County Tax Map No 1000, Section...jj~. ....... Block ..... /.? ........ Lot ...... ..~....~.~. ........ Subdivision ............... .................... Filed Ma . . ot ................. . . Permit No ............ Date Of Permit ................ Applicant. .}. ........... Health Dept. Approval...?~ ................... Underwriters Approval..~..~./~.3.~.~. .............. Planning Board Approval...~.L~ .................. Request for: Temporary Certificate .......... ~ Final Certicate ........... Fee Submitted: $ ..............................,, /soz .......... · ............... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CERTIFIES THAT only the el~trical equipment ~ ~scrlbed below and intr~ced by t~ applicant ~med on the a~e application number in the premises of in thefollowlng Iocation~ ~ Basement ~ Ist ~7. ~ 2nd ~, Section Bilk Lot ~sexaminedon ~[k~[~ ~4~1993 andfoundtobeincon~pllancewlththereq.lrementsofthisBoard. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEOERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET OTHER APPARATUS: NO Olde RCC~,CON D. AWG, OF CC, COND c NO. OF HI-LEG A W.G. NO. OF NEUTRALS A.W G OF H~4EG OF NEUTRAL 8. J, I~I',Bf], CO. 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. d -' IN. SPECTORS Victor Lessard P~dp~l B~ik[ing l~pector Curtis Horton Senio~ Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fi~e Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD DECEHBER 23, 1992 KATHLEEN SIMPSON & VENETIA MCKEIGHAN 240 DONNA DRIVg MATTITUCK, NY I 1952 $CO'IT L. HARRIS, Supervisor Southotd Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 JAN 2 8 1993 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 ~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 ~ 21042-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. INSPECTORS Victor Lessard Principal Building Inspector Curtis 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 DECEMBER 23, 1992 KA'I'flLEEN SIMPSON & VENETIA McKEIGttAN 2/,0 DONNA DRIVE MATTITUCK, NY 11952 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) / xxx No Underwriters Certificate on file. XXX 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 ~ 21042-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. OU~DATIO~I (2nd) OUGH FRAME & -PLUMBING NSULATION PER N. Y. STATE ENERGY CODE 765-~802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING [ ] RO,~' PLBG. /'/~/U 765-1802 ILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [ ]~.ATION [ ]FRAMING [~] FINAL DATE ~ INSPE~O~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING ~]FINAL ! DATE 76S-'t802 K BUILDING DEPT. INSPECTION REMARKS; ~'~/0 ~ DATE /~/~ ~/~' ,~- INSPEI~rOR *~ / Examined ............ , 1 Approved · .~/~/~..~'~. ..... , 19 .~.gT. Permit No..~../.~..~..'~7./ Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 CAt. .......... HAIL TO: APPLICATION FOR BUILDING PERMIT Date (9cj¢' /./'7 19 q'~' INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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. ,,~ The work covered by this application may not be commenced before issuance of Building Permit. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shgll be kept on the premises available for inspection throughout the w6rk. ' 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 in~s~e~ions. // .... ................ --' pplicant ~~ corporation) · , .... .... f/c.. ,, .3. (Mailing address of applicant) State whether applic, ant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... d~.C~l,.9 ¢,C:. ~ ................................. Name of owner of premises .. i~&t~. [L¢.~..../~.: ...~.~.~. ~.q~.... a.~ ~/ .... .~e. 0 .e~/~... fl..... ~..c_. ~/q ~.k4~l ............ (as on the tax roll or latest deed) If applicant is a corporation signatlure~ of duly auth~0rized officer. " (Name and title of Builder's License No-.'?). Plumber's License No ....................... E' Electri~ian's License No ........ Q ............. Other Trade's License No ...................... Location of land on which proposed work will be done House Number Street Hamlet County Tax Map No. 1000 Section .../j?. ............ Block .../...~. ............ Lot....~.¢ ............. Subdivision .~)ecp...~.0k..(~.e?.~.....~.3J¢.~.%~ .......... Filed Map No..~..5'.~. ........ Lot...~.~. .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exmtzno use and occupancy' ' o . _~_ c.,?.ofl<' 0.~? - .~.~.: l~' d~e// ' '~ ":'"' "~ : ' ' ~-~' b. Intended use and occupancy ....~.c.~ .dS.4x.~ O:f :~.~..~.."-/a qJ..c:°.¢./[¢.2- . '~. '. :i; ';: ' ":2 ...... 3. Nature of work (check which applicable): New Building .......... Addition ... Alteration Repair .............. Rmnoval · · 0 Demolition Other Work f~, (3 ! (D ripti ) 4. Estimated Cdst . . .'./c,~ .Q .... i ........................ Fee .~...d_). ~ (to be paid on filing this application) 5. If dwelling, number of dwelling[ units ...... [ ........ Number of dwelling units on each floor .... ./ ........... · If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mix'eld occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ..... ~,~. ....... Rear · · ~ ......... D ' ' ' epth., .,~. ......... Height ............... Number of Stories .... / ................................. anensions of~sa~e structure Mth alterations or additions: Front ~3. f . Rear 5-~?' 8. Dimensions of entire new construction: Front · · · ~.J.~. Rear .... .5~.' Depth .,~ ......... ' Height .............. .. Number of Stories /. . 9. Size oflot: Front . . /~c~ ,b'A; ...... ~ear ..... /./.c/. ............. De~pth .../2'.~- ... . ... I1 . i " ................... ::", ............... 10. Date of Purchase . .. '. ~" 'l ~:l.v. ~ .... . ......... ~Name o[Former Owner ...'d.a..m~.J . ./~qqer,~ ...... . ' ' 11. Zone or use district in which premises are situated . [~.s ~ .-4. ........... 'J i ........... 12. Does proposed construction viol'ate any zoning law, ordinance or regulation' ~10 ....... 13. Will lot be regraded ~.oI ........ ' .... ;, ................. ..... : .................... w,!ugxc, ess nu se removed Iropl p, remises' Yes No 14. Name of Owner of premmes e'*'~' 'St ' P' s'~'. q e'¢~d~:es~' ~ · · .d~.°. O.°':~.~..~. c · hone No. ~.qY.-.q/.q ~' Name of Architect I ...... .......... ................. Address ................... Phone No ................ Name of Contractor ......... ~ ................. Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.....~F~... · If yes, Southold ~own Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whett~r interior or corner lot. NOTIFY BU~I31~G DEPART~rI' AT 765-1802 9 AM TO 4 PM FOR TH[: FOLLOWING INSPECTIONR 1. FOUNDATION 'r~IC" qE¢)tu?~,: D FOR POURED CONCRETe: 2. ROUGH . FRAMING ~ PLU~/~ING 3. INSLJLATION 4. FiNAl. CONSTRUCTION MUST 8E COMPLETE FOR C.O, ALL CONSTRUCTION SHALL "MEET THE REOUlREMENT$ OF TNE N.Z STATE CON$TRU~ON & ENERGY CODES, N~ 8ESPON~BLE FOR DESIGN OR CONS~U~ION ERRORS STATE OF NF~--V-YORI(~-~? ......... ~ ........................ being duly sworn, deposes and says that he is the applicant dqame of individual signing contract) · above named. (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 sdt forth in the application filed therewith. Swam to before me this. ' Qu,llfled I. Suffolk CoumY '/ "i~;g~ature of applicant) Commission Expires December 8,, 19 ._9 t~*