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HomeMy WebLinkAbout21088-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22365 Date MAY 27, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property 170 CHABLIS PATH SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 3 Lot 3.18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 12, 1992 pursuant to which Building Permit No. 21088-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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & OPEN PORCH AS APPLIED FOR. The certificate is issued to PETER & LINDA VAN MATER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-75-MAY 10, 1993 UNDERWRITERS CERTIFICATE NO. N-276153 - MAY 17 1993 PLUMBERS CERTIFICATION DATED APRIL 27, 1993 - PECONIC PLUMB & HEATING /Building Inspector Rev. 1/81 MILK Na 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) N°-N° 210882 Date 7 r99..2 Permission is hereby grante t ~,1.......... - . ! . . . . moo.. , . ..,......1/...g. to e e l.I, ~G.. ~ ...e e... Cl~G~(l ~ . . . ` " at premises located at .....1.7..Q......... .Q... ~1~43"~..~I•.• County Tax Map No. 1000 Section ......5:1.,./ Block Lot No. p pursuant to application dated ....1111 19.`gK and approved by the Building Inspector. Fee / B ing 1 for Rev. 6/30/80 i Form No. 6V, I TOWN OF SOUTHOLD 1i# MAY { 4 193 MAY BUILDING DEPARTMENT ! 765-1 02L k'v 1=L„w_,_ . 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 ..5 .l. y..~13... New Constructional......., Old Or Prye~-existing Building q Location of Property Li rJe.),.Fs. FRT s C 41.0. t V9 . House No. Street gg M Hamlet 4.- e, A ri Onwer or owners of Property .....Q p, N County Tax Map Not 1000, Section.. P,Block.. Q ....Lot v~. C am ( f~ Subdivision``. C.6 0.RibDAil(VA WOO .....Filed Map............ Lot . 'ermit No. P V ,;,,,,.Date Of Permit ................Applicant.........,................... health Dept. Approval ..........................Underwriters Approval......................... 'lanning Board Approval tequest for: Temporary Certificate........... Final Certicate..le-:1 'ee Submitted: ~ Ud Tw)3 . . . APPLICANT u2:7a 13tS. 0 i( ::CC-SiILNiS ~'7 a Qyl .9 OUNDATIO*I (1 stl GO ' OUNDATION (2nd) OUCH FRAME & U -PLUMBING n IISULATION PER N. Y. STATE ENERGY CODE 51- Fl NAL r e ADD IOI L COMt4EPITS: x om H • y H O pw m cl TEL. 765-1802 ~UL TOWN OF SOUTHOLD Ol~~ 1 OFFICE OF BUILDING INSPECTOR R, P.O. BOX 728 -c TOWN HALL SOUTHOLD, N.Y. 11971 g5 C E R T I F I C A T I O N yr, ~r• r Date k, r Permit No. >l~ s,, (please print) j ~vr f~(please pr~.nt) w~ X,'certify that the solder used in the water supply system SIC less than 2/10 of 1, lead. „t zr (p u er's ignature) Air before me this ~Gx of Notary Public #Public, J )J County Sfaj OWSla No, 4844752 O0M, oww" op"Ve Sept.Z) count), 1s'' Hof; THE NEW YORK BOARD OF FIRE UNDERWRITERS £`AGE 143O1.3f31. BUREAU OF ELECTRICITY 88 JOHN STREET. NEW YORK. NEW YORK 10038 Date MAY 17,1993 Application No. onfile '79878993193 N 276153 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of PETNR VAN MATER, 1,710 CIIFIFLIS PATH, SOUTHOLD, N.Y. in thefollowing location; 51 Basement [R 1st Fl. ® 2nd Ft. CillR/AT'l'MOUT Section Block Lot .I8 was examined on APRIL 2E , 199:3 and found to be in compliance with the National Electrical Code. FIXTURE ECEVraclles SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER MIT K,W. AMT K W. AMT K.W. AMT K.W AMT. H P. 5 55 55 60 1 k3,f 1 1.5 3 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRECTT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K. W Oil HP GA$ H. P. AMT NO A W, O, AMT AyyMP. AML AMPS. TRANS. AMT. H. P NO. OF FEET -T WATTS 1 I 1 Q 1 2 6OC4 SERVICE DISCONNECT NO, OF S E R V I C E AMT. AMP. TYPE METER 10 2W 10 3W 3 .e 3W 3 % AW NO. OF CC COND A. W O NO, of fZlto A' W G. NO OF NEUTRALS A. W G' EQUIP. PER A Of CG C D OF HKEG OF NEUTRAL ~f e 17 I area 1 20 OTHER APPARATUS: - JACUZZI-1 MOTORS;3--F H.P. G. F X. I; --13 STROKE DETECTOR a I ® t' JaDY >?ur11110 LIC,1I2304-E PAT LANE MArMUCK, NY, 11952 GENERAL MANAGER 11 Per. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified III II COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATI NMI I I . y/o O 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ G}' ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [k] FRAMING [ ] FINAL uy~ REMARKS: I DATE / 7 ' 3 INSPECTO M-1802 BUILDING DEPT. 1 NSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ] FRAMING [ ] FINAL REMARKS:( Cyc_ r DATE 1 ! INSPECTOR f a7 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING [ FINAL REMARKS: d-c CZJV Y" 6Y., 2 CG~r DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FO NDATION 1ST [ ) ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS E - Y i 4 i E DATE °i INSPECTOR ' ` -7 765-1802 BUILDING DEPT. I SPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: 01. O i DATE ` INSPECTOR ~jj 0 5 ENERGY CODE CALCULATIONS (tor Noh-vJeCx(:rla nest) Design Criteria 6,000 Degree, Dnyn O.A. I0°F I.A. In"1 - - - DATED: c. ?c L_-Lf j'_ - - - - - ;DNSYS'rEM AREA DESIGN THERMEL RATING REMARKS Exterior Walla (opaque) , - 172.1 r,lnzIng /11.7 Doors p rc•t ling/hoof (Opaque) - ylights g ~ - - - F'lcxir - I TL oS n r'oundstaon Walls - - - filnb insulation TOTAL f IC Notes: lhriiding Envelope gy"temg to meet requirements of 7815.2 11vnC Equip@rWit.to Meet requirementg of 7915.11 11vnc Systems to meet rlquiremehtg of 7815.12 Duct Sygtettlg to Molt t@quiremehtg of 7815.13 ventilation" System" to Meet requiremehtg of 7815.14 tIrulAtion of pipitlg gygtlM" to meet requirements of 7815.15 service WAtlt Nlgting gyntlm" & Equipment to meet requirements of 7815.21 Electrical & Lighting gy9temg & Equipment to meet requirements of 7815.31 To the best of My khowledge, OE EWI0 be.lieft & prof069ional y~P~NCe 'r4 9~ judgement, thegl plan" are in rompliatice with the code. a r a Ii w w il~ 225 -1 A90FEss1QN~~~ BOARD OF HEALTH FORM NO.1 /'3 SETS OF PLANS TOWN OFSOUTHOLD /SURVEY BUILDING DEPARTMENT ~~CItECR _ . N(V TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (f -C ALL _ <f.. Examined 19... MAIL T0: Approved 7 , 199LPermit No.. . . Disapproved a/c/ uildi nspector) APPLICATION FOR BUILDING PERMIT Date (.~Z...... 19rT~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 I se-ts 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 li, 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 II'I 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 inspe 'o Signature of applicant, or name, if a corporation) x Sc~/%/fUL /Jv1 (Mailing address of applicant) (State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................~JNe . Name of owner of premises v HOr ~ (as on the tax roll or latest deed) I If applicant is a corporation, signature of duly authorized officer. I............... (Name and title of corporate officer Builder's License No. Plumber's License No. d'!. G Electrician's License No. . >..e? Other Trade's License No . 1,1. Location of land on which proposed work will be done . 1'70 House Number Street Hamlet County Tax Map No. 1000 Section Block 3........ Lot??c~.(5 dr? a Su ~ D S bdivision .4 .....Q t9:~.. W... ~ 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 pf~ )q er L--a b. Intended use and occupancy ©A/Z , ; 3. Nature of work (check which applicable): New Building Addition Alteration • . Repair Removal Demolition Other Work (Description) 4. Estimated Cost.. Fee (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 mixed occupancy, specify nature and extent of each type of use • • . 7. Dimensions of existing structures, if any: Front Rear Depth Height Number ofStories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories . 8. Dimensions of entire new construction: Front Rear ..(~d........... Depth .1Z. , Height Number of Stories 9. Size of lot: Front AP Rear .4~....... Depth .e?o?................. 10. Date of Purchase ..45-_/5.1 Name of Former Owner , • • . • • • • • • • 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: , N J 13. Will lot be regraded Will exc ss fill be removed from premises: Yes No 14. Name of Owner of premises Pc t e~ I?~Mft Address •.4•.~~ APP ):4?44hone No. - -7&!~' ' ? . Name of Architect Address Phone No............... . Name of Contractor Address Phone No............... . 15. Is this property within 300 feet of a tidal wetland? *yes........ No......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW COUNTY S.S • • • • • V•~~• • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. iieis the D.UJI(Le..r (Contractor, agent, corporate officer, etc.) if said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this Ipplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the •vork will be performed in the manner set forth in the application filed therewith. iworn to before me this ?!.day. of 190 Votary Public, County 7u\ CLAIRE L.GLEW Notary Public, Stete of New York (Signature of applicant) QualifieNdoIn Suffolk CouMy Commission Expires December 8,19.L° Er ir 04 CID 5'rYu x m a c o Z'» fl y f} rt >J err ls~,;, m m v"v-a A.m m ° O.m . Q ..j "1. 4C m2 ;maxu tm W 'v d ~ g mn ?~`'b53cc. tea- ~ iQ;O ~ FF' 41. m O '05 O Ei ~ m m m' m a! c min ~~z ~4 v Dram ~ ~T ~ tP7 ~ ~ d ill .~k' c~ 0 2 4. 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FOUNDATION - TWO REQUIRED )REQUIRED - 2, ROUGH - OR a NSULATION A-A~IIkG F PLUN'81NG PLUMBINC OCCUPANCY y^f~I~~ FOR POURED CONCRETF MON MUST ' . ) Ili PF1 ~i VAN --MATE: USE IS UNLAWFUL 4 BE'COMPLETE FOR C.O.InN MUST ALL CONSTRUCTION SHALL MEET 'T.ALL MEET UNDERWRITERS CERTIFICATE F THE N.Y. REQUIRED ~t . el o sv: ps~wrv axy 3S WITHOUT CERTIFICATE STATHE REQUIREMENTS OF TE CONSTRUCTION &TENERGY & ENERGY BIBLE FOR ` rot`- s_ etnsea ~y y_p_gy- £ DESIGN OR CONSTRUCTION ERRORS OF ONERRORS OCCUPANCY CODES. NOT RESPONSIBLE FOR ,b ~ . - . wawiN67~s T - . Y PAY - - - ' L- jofi~8 M9% 3~6 l50 3~ { D' 5~0, 33 x zb r~ C19 4cJ( 333 to c{o,33X~~ t z3~ 39 kTa Xi r° 1 ~w, z x 3z /99~ N T~ 47 - - a 4 {'CAF MEIr} ; F W ~ 3t:L1 ~jVJfJ i SCAT1 I~~Ey y1T tf_V'r ARPROVEOry t1RAWN ~YV~.¢~.~G. y.fr DA L~~~Fly~~E._ REVAEOJY.-.YNAYY .AZ.~. 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