HomeMy WebLinkAbout20651-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF O~CUPANCY
No Z--23060 Date JUNE 23, 1994
THIS CERTIFIES that the buildin~ ALTERATION
Location of Propert~ 3430 WICKHAM AXrENUE MATTITUCK, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 9 Lot 16.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 13, 1992 ~ursuant to which
Building Permit No. 20651-Z dated MAY 26, 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 ALTER EXISTING ATTACHED GARAGE INTO A BEDROOM & BATHROOM
AS APPLIED FOR.
The certificate is issued to
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. H041357
PLUMBERS CERTIFICATION DATED
JUNE 20, 1994
JAMES D. BARNEY SEPTEMBER 2, 1993
Rev. 1/81
~~uilding Inspector
TO%VN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BF_. KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~N? ~0651Z
Permission is hereby granted to: ~
pursuant to application doted .... ~.~ ........ ----/.,..~. ........... , Jg...~.~?h- and approved by the
Building Inspector.
Building Insl;ector
Rev. 6/30/80
~. Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
365-1802
BLDG. DEPT,
TOWN OF SOU~HO!m
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for now 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:
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.
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 - $i00.00
. 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 .................
Location of Property .........................................................
House No. Street Hamlet
Onwer or Owners of Property...~.~--~. .... ~.~... ~,~. ~../?.~..' ...............................
County Tax Map No 1000, Section .............. Block ................ Lot ......................
Subdivision .................................... Filed Map ............ Lot ...................
· ·
Permit No.~.~.~.-'~..~ .... Date Of Permit ............ Applicant ...........................
Health Dept. Approval .......... Underwriters Approval ...........
Planning Board Approval/ .......................
Request for: Temporary Certificate ........... Final Certicate..'.~. .......
Fee Submitted: $..~.~.~.~L- ~ 7 ~
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
September 14~ 1993
James & Pamela Barney
3430 Wi~kham Avenue
Mattituck, N.Y. 11952
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
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 (~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 # 20651Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
TOWN OF SOUTLIOLD '
OFFICE OF BL~ILDING INSPEC,~FOi~:
P.O. BOX 728
TOWN HALL
SOUTI{OLD, N.Y. 11971
TEL. 765-1802
C E R T ~ F I-,C A,T~ O____~N
Building Permit No._~2~7 ~
(please p ~ i~'t ) ~-~--'~z-c~' ~/
P e prmnt)
I certify that the solder used in
contains less than 2/10 of 1% lead.
the water
supply system
Sworn to before me this
4ff~O/t//..) day of ~f~/*/~'~'
NOtary Public,_
Nota ~J3~lic --
County
~F.~
'THE NEW YORK BOARD oF'FIRE UNDERWRITERS
8038801 BUREAU OF ELEci~RIcITY
~'-- 85 JOHN STREET, NEW YORK, NEW YORK 1003B
Da,. ~ 20,1994 Applicution No.o,/,e 8e125e93/93 H 041357
THIS CERTIFIES THAT ~ . ~ .
o~y t~ eJ~trlcal ~uipme~t ~ ~scdb~ be~w a~ int~uc~ by t~ applicant ~m~ on the a~ apphcat~ numar in the
J~S D. ~, 343~ WIC~ A~, ~I~CK~ N;Y.
exa,,i,ea O, JUNE 13,1994
FIXTURE
OUTLETS
DRYERS
SERVICE DISCONNECT
and found to be in compliance with the National Electrical Code.
RANGES
~'ECIAL REC'PT
E R
FIXTURES
S
TIME CLOCKS SRLL
~T. ASPS. TRANI
V I C
1~'2W 1~'3W 3~I'3W 3.~4W NO, OFCC. COND~ A.W.G.
pER ~' OF CC. COND
~THER APPARATUS:
RLEC. ROOM HEATERS,i-i.O K.W.
MOTORS: 1-F H. P ·
G.F.C.I.'-3
SMOKE DETECTOR, -1
NO. OF HI-LEG
UNiT HEATERS MULTI-OUT/ET
SYSTEMS
NO. OF FEET
EXHAUST FANS
H P
DIMMERS ~
A, W, G NO OF NEUTRALS
OF HI-LEG
3430 WICKHAM AVENUE ~ ·
GENERAL MANAGER :
m~P
lhis certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectorsy y their credentials.
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieezorek
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
September 14, 1993
James & Pamela Barney
3430 WickhamAvenue
Mattltuck, N.Y. 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)
axx No Underwriters Certificate on file.
The check is (outdated/not on file.~$25.00
No Health Department Approval on filer
No final inspection has been made.
No Plumber Solder Certificate on file.
(Ail permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 20651Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOW/~ BUILDING DEPT.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
8~388(~[ BUREAU OF ELECTRICITY
~-- 85 .JOHN STREET, NEW YORK. NEW YORK 10038
Oate J~l~ 20,1994 ~pplicationNo. onfile 8~125093/93 H 041357
THIS CERTIFIES THAT
o~y the el~trl~al equipment ~ ~scrlb~ be~w a~ int~uc~ by t~ ap~icant ~med on ~he a~e application number in the premises of
J~S D. B~EY, 3430 WIC~ AV~, ~UCK,
u~s examined on 13,1994 and found to be in compliance ;vith the NaMonal Elect~cal Code.
FIXTURE
OUTLETS
RANGES
SERVICE DISCONNECT [ NO. OF I S E R V I ¢
~ AMT. j AMP. tYPE ~I~J~'PR. I~e'2W I.'e'3W 3~'3W $-~4W NO'O~ECRC#COND' OF~C~O~D NO'OF HI'LEG ~ ~.L~6 ,
ELF~C. ROOM HEATERS ~ 1-1. O K.W.
MOTORS: 1 -F H.P.
SMOKE DETECTOR
JAMES D. BARELY
343~ WICI~{AM AVENUE
HATTITUCK, NY, 11952
MULTI-OUTLET
SYSTEMS
NO. OF FEET
EXHAUST FANS
F
DIMMERS
E
NO OF NEUTRALS A, W G.
OF NEUTRAL
GENRALMANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identiJ~J by their credentials.
COPY FOR BUILDING DEPART~,,~ENT. TH~$ COPY OF CERT~FICATE MUST NOT BE ALTERED IN A~Y MANNER.
Town H&I[, 53095 Main Road
P. O. Box 1179
Southo~d, New Yor~ 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 18, 1994
2nd NOTIFICATION
James & Pamela Barney
3430 Wickham Avenue
Mattituck, N.Y. 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
XXNo 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 ~ 20651-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
765-~802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] I~ULATION
FRAMING [//]' FINAL
INSPECTOR.,//~~~
FOUNDATIO|,! (2nd)
ROUGH FRAME &
-PLUMBING
I~;SULATION PER N.
STATE ENERGY
CODE
FI;IAL
ADDITIONAL COMMENTS:
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined ....... 19
.\pproved~;~ ~,` .~,.. '.., 19~'~Permi, No...~. ~. ,~,
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTI1 .........
....-~'1 SETS OF PLANS ..........
z~'~SUKVEY ...................
CIIECK
CALL . . · . ·
INSTRUCTIONS
'a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
3ts 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 pubI/c streets
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
c. The work covered by this application may not be cbmmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
mil 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
mil 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
/mit author/zed inspectors on premises and in building for necessary inspections. ~
/,t41gnature of applicant, or name, if a cor~ration)
(Mailing address of applicant)
tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
ameofownerofpremises ..... '~ ,~/4,'w~"C// ~ .~/it4/V~-~'....
................. : ....
(as on the tL~x roll or latest deed)
applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .........................
Plumber's License No ..............
Electric/a,n,;s License No ...................
Other Trade's License No ......................
Location of land on which proposed work will be done .................................. ~. ..
ouse Number Street ...............
Hamlet
.......................... Lot .... ~ ...........
SubdMsion ..................................... Filed Map No.
(Name) .............. Lot ...............
State eMsting Use and occupancy of prcmisgs and intended use and occupancy of proposed construction:
· . . '""'" '"'.?;' ........ "'"
; ' ' ; .......... nolition ..... ,,, ........ Other %~,ork .......
4. Estimated Cost ..?.~..CO.O, .a.~u..I ' ' ' ~/~4o,,,.~, ,.~ ,,~ (Description)
....... · ....................... Fee .~...~.t e/- ~..
. . .. (to I id fill j thi ppli ti )
· v ,,gum .... ii'"i ..... m ero we ngunitsoneac our ................
6. Ifbusiness corem ...... '--" ',. ........... .' "; ................................
q Y fY d tel h t~pc of use · · · ~: · . .',,',i ....
7 D , *..-.,,- ut mlXeu o CUpanc , spcQl ne.tuft an exten cac
· ' pfc ' ' i~a y:F ' '
· lmenslons XlStlng structures, n rent ...........
~H.e'gh.t Nub t, CSt its ..... " ' ' D pth
........ '. ·; .... Rear ........ c
I ............... IU e o or ...............
sip f ith hit ..............................................
~atmen ns o samestmcture w erations or additions: Front
Depth Heit,'bt Rear
8 .......................................... Number of Stories ~
· Dimensions of entire new construction: Front ' ' ' .....................
· Rear Depth
He it ............... Number of Stories .' .............
..': ..... ~ R~ "" ' .........
9. Size of lot: Front .............. ! ar ....... ' ........................
10. Date of'Purchase ... ~ ............... Depth ....................
........... ! ............... Name of Fenner Owner
1 I. Zone or use district in which premis:es are situated .............................
12. Does proposed construction violate ny zoning law, ordinance or regulation: ...........
13. Will lot be regraded ...................... ;... Will excess fill be removed from premises: Yes No
14. Name of Owner of premises ...... "· · ress ...................
Name of Architect ...... I .......... Add Phone No ...........
....... i .............. Address ................... Phone No ............... :
Name of Contractor ...... '.. ~
· , ' 'i ............. Address . .
~5. Is this property within o ............... Phone No .....
O0 ifeet of a tidal wetiand~ *v~= ' ..........
· If yes, Southold Tow~ Trustees Permit may be required. ~
... ,' , PLOT DIAGRAM
Locate clearly and distinctly all buiidings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or descriptio~ according to deed, and show street names and indicate whether
:nterior or comer lot.
TE OF N~V'W~nK.~.._ rtl
,('Name of individual signi~ ~;;,'}/a~ .......... being duly sworn, deposes a)ld says that lie is the applicant
~ve nameu.
~(Contractor agent corporate officer ) ...........
said owner or owners, and is duly anthdrized to perform or have performed the said work and to make and file this
lication; that all statements contained inl this application are true to the best of bis knowleflge and belief; and that the
'k will be perfumed in the manner set forth in the applicatiou filed therewith.
~m to before me this
a~ Public, ~(. County
NO. 4879506
O '
oalifled in Suffolk Cou~
"' Commission Expires De~mb~8, ~9~~ "