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Home My WebLink About21084-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22808 Date 'DECEMBER 21~ 1993 THIS CERTIFIES that the buildin~ REPAIR Location of Property 9395 MAIN ROAD House No. Street County Tax Map No. 1000 Section 122 Block 6 Subdivision Filed Map No. MATTITUCK~ NEW YORK Hamlet Lot i8 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 5~ 1992 pursuant to which Building Permit No. 21084-Z dated NOVEMBER 17, 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 FIRE DAMAGE REPAIRS TO EXISTING ONE FAMILY DW~.~.IN~AS APPLIED FOR. The certificate is issued to of the aforesaid building. LEROY COLLINS (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N-297722 - DECEMBER 2, 1993 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~-N? 2108JZ Permission is hereby granted to: -- ~:'~'"'~"~'~'"~~'"~~'~/~'~ ,_ ~ ...:~~.,...~...zz~¢ at premi:es I~ated at ...r~.~..~...~ ........................................................ ................................................. ~:~~ ........................................................................... co~ ,~ uop ~o. ~0o0 s~t~o~ ...Z..~..~ ..... m~k ......... ~. ........ ~ot Uo....~ ............ BuildlnO ............ .................... Re~ 6/30/80 ~ , . ,, , ,' TOWN OF SOUTHOLD ~' '~'~ ~ '! ( ~ ~I BUILDING DEPARTMENT il ~t, §rr_~ 2 I II~ ,~; t TOWN ~gLn ~ ~b-Of~~pL ICAT ION 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from rchltect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing b~-il-dings-(p~o~%o Aprii ~'~5~ non-conforming uses, or buildings and '~pre-existing" land uses: I. 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. 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 ~lS.00,/Co~ercial $15.00 Date ew Construction ......... Old Or P ............. ~wer or Owners of t~roperty...~ ................... )Linty Tax Map No 1000, Sectio~'.~.~.~.%-.~...~k ......... ~bdivision. .................. ............ ................. ~alth Dept. Approval .......................... Underwriters Approval ................ arming Board Approval .................. 'qUest for: Temporary Certificate ........... Final Certicate ........... ...................... : d . THE NEW YORK BOARD OF FIRE UNDERWRITERS [0~)~ ~.1. BUREAU OF ELECTRICITY B5 JOHN BTREET, NEW YORK, NEW YORK 1OO~8 Date THIS CERTIFIES THAT o~y the e{~t~a{ equipment ~ ~serlbed below and int~uc~ by the applicant ~med on the o~ve opplication nu tuber in the premises of in t~ followtng h,catlon; ~ Basement ~ Iai FL ~ ~nd FI. 0[I~ Section Bilk Lot u~s examined on ~0 ~ ~{~ ~] ~ 2~ ~ 1.99,~ and fouttd to be in compliance with the Naffonal Elect~cal Code. RANGES SPECIAL REC'P! S V I C E EXHAUST FANS DIMMERS ?,,62 ORtl~OCO DR~ BItZ,ttTWAg~RS~ }IY, 11'718 GENERAL MANAGER Ihls certificate must not be aJtered 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. STRUCTURAL CONTRACTORS, INC. THE RESTORATION AND BUILDING PROFESSIONALS SUITE N, ;3555 VETERANS MEMORIAL HIGHWAY RONKONKOMA NEVV YORK 11779 [51 6] 471-2300 December 8, 1993 Town of Southold Building Department 53095 Main Road .. .. P. O. Box 1179 Southold, New York 11971 RE: PERMIT# 21084 Suff. Co. Tax Map #1000-122-06-18 Leroy Collins 8995 Main Road Mattituck, NY Dear Sir: Enclosed please find an Electrical Underwriters on the above captioned location. Please issue a Certificate of Occupancy. If you have any questions please don't hesitate to call me. Sincerely, ~l%C · OU~T~ON OUNDATIOU OUGH FRAME & (1st) (2nd) .PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL :NTS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION~ FRAMING REMARKS:~ DATE y/,~///~_~ INSPECT~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]!N.~SULATION [ ] FRAMING [~FINAL REMARKS: /~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION / FRAMING [~INAL REMARKS: DATE INSPECTOR ~/~..~ 2~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~~1NA~' INSPECTOR /~ ~"//~'~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] R/OUGH PLBG. FOUNDATION 2ND [*/] INSULATION [ ] FRAMING [ ]FINAL REMARKS:,. / F L ~/;~/ ~/~ L,Ui'/~'~ a~ .5 * DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ;ZND [ ] FRAMING [ ] ROUGH PLBG. [ ].~.ATION [~" FI NAL DATE INSPECTOR 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 October 26, 1993 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 Mr. Leroy Collins 9395 Main Road Hattituck, N.Y. 11952 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) No Underwriters Certificate on file. The check is (~utdatcd/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ BP// 21084Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 3. Nature of,~vork (check w. hich applicable): New Building .......... Addition .......... Alteration ......... '. Repair ~/. ~F-u~ .O/'-y~t)~..~. Removal ..... Demolition ...... Other Work ............... 4. Estimated Cost. : .......................... Fee . t .......................... (fO b~ paid on filing this application) 5. If dwelling, number of dwelling units .../. ........... Number of dwelling units on each floor..../gj.~. ......... · If garage, number of cars ...... ,~./A'. ...................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type 7. Dimensions of existing structures, if any: Front .... ~q.~7. ...... Rear . ~.~/.~C. Depth Height .. ):J-.E'~. ........ Number of Stories o~.. Dimensions of same structure with alterations or additions: Front . f&P!..~ ........... Rear . ~:4<?/C ............ Depth ...... 5~. ..... Height .~....~.. Number of Stori,~ ~' 8. Dlmenszons of entire new construction. Front .?//& ~,_A_ ~],_ ... .. ~l~ ' ' ' ....... Height ...... ~t~/~. ..... Number of Stories ./~'././~. ....................................... :-. ......... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ................ 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................... r ............ 13. Will lot be regraded ...... /1/.0. .... -~ .............. Will excess fill be removed from _vremises: _/V/.~ Yes No 14. Name of Owner of premises/.~?.~.¥.. ?.e:g./.~.b Address f~ ~ ~t~u P4{ fda'fr~4'~bL~.,~ ,,~ ~-?B Name of Archztect Jif. ................ Addra~ . P~o e" 15. Is th:~.s property w]_th:Ln 300 feet of a ti. del ~etlan~.~'?/~/e~s'.~t?.' .'.t~.~: No. ~ ..... *If yes, Southold Town Trustees Permit may be required. , PLOT DIAG~ Locate clearly and distinctly ~1 build~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from prope~y ~nes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whether I FEE NOTIFY '765-1802 .~ AM TO 4 FOR THE FOLLOWING INSPECTION: 1. FOUNDatION 2. ROiJGH ,. FRAMING 3, INSULATION J 4, FINAL - CONSTRUC[JON MUST COMPL T ALL CONSTrUCTiON S LL THE REQUIREMENTS Ot TH~N.Z STATE CONSTRUCTION ,~ E~GY CODES, NOT RESPON[ IBL~OR DESIGN OR CONSTRUCTI, ~N ER~RS STATE OF NEW YORK, S.S REQUIRED COUNTY OF ................... · ..~.~1 .l~.l<.J.../~x,....[~.~ .'~tx O~a~ .... ~. .... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. Itc is the ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly aMthofized to perfom or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to ghe best of his knowledge and belief; and that the work w~l be perfomed in the manner set forth in the application flied therewith. Sworn to before me this ......... ~...~ ...... day of..~'9~:-...., 19 g.'~ ~ota~ Public, ~-~/~-~...~?., ,~., ...... County . .. PHYLLIS REIDY' R~iding ia Suffolk Co. ~. 52-461456~., ~ Commission Expire~O ~ ,~ ~ ~ ~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 NOV Examined ..... , 19~.,2~ Disapproved a/c ................ i .................... (Buildi2~Jhspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CI1ECK .................... SEPTIC FORH .............. CALL .................. HAlL TO: Date..~..0...u~...~... ~. 19.~.~. INSTRUCTIONS letely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 County Tax Map No. 1000 Section . .............. Block .................. Lot ................. Subdivision .................. ! ................... Filed Map No ............... Lot ............... (N{me) 2. State existing use and occupancy o? premises and intended use and occupancy of proposed construction: b Ite ded use and et. . · n n occupancy . . ~. ~ c a. Tiffs application must be com sets of plans, accurate plot plan to scale. Fee according to schedule. 'b. Plot plan showing location of ilot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed descripiion of layout of property must be drawn on the diagram which is part of this appli- cation.. c. The work coverOd by this applilcation 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 ifor inspection throughout the w6rk. e. No building shall be occupied ior 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 Buitding 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 Cuildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with~il applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. --' ddJ. i~lt~tt'.u, re ol~fpplj~_nt,~.r name, if a corporation) .. ..... ~),/), ~.,,,L(Mailing a.d~Ire,ss of appli%ant) State whether applicant is owner, Ie .see, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ......... (as on the tax roll or latest deed) If ap~i~corpor~.~on,~ nat~eof duly auth~orized officer. Nam ~' ..... ' ( e and title of corporate officer) Builder's License No....~. ~..-~..~. ~ ~ ........ Plumber's License No. . .... Electn,cmn s L No. lccnse ............ Other Trade's License No 1. L~.~,o,~of land on which proposed work will be done .................................................. }louse Number Street Hamlet