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HomeMy WebLinkAbout20417-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23370 Date NOVEMBER 23, 1994 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 19475 MAIN ROAD MATTITOCR, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 108 Block 4 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 3, 1992 pursuant to which Building Permit No. 20417-Z dated FEBRUARY 5, 1992 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate ie issued is PORCH ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate ie issued to JOAN P. HILLIARD & UBALDO GONZALEZ (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-333177 - NOVEMBER 10, 1994 PLUMBERS CERTIFICATION DATED OCT. 11, 1994 - HARDY PLUMBING & HEATING i ilding Inspector Rev. 1/B1 rows xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL n COMPLETION OF THE WORK AUTHORIZED) Na ~ ~ 4 ~ ~ Z Date rK~.y,.t~~..~ 19.1.. Permission is hereby granted to: ~ .....~.d .......y~r.~ll:..Cl....... ..~~93' to . .~,p,~. ~.~'.4..-..,... ....................................................C'.~. Grr~.~~"''__".~...................................................................... : County Tax Map No. 1000 Section .......~.Q.B... Block ..........f`.......~~~~Lot No......~ pursuant to application doted 19T'-:.:, and approved by the Building Inspe/ctor~ Fee 5....1~.t~~.,liy'~' r Build 1 for Rev. 6/30/80 ~ ~ ~}I Fornt No. 6 i ~ ~ R, . . -s~'} , TOWN OF SOUTHOLD i j~l(1\I ~ ~ ~99Q BUILDING DEPARTMENT . Y' TOWN HALL ~ / p~ ,_,_,.m..........._,., 765-1802 Fw Y`t0 . ?LD:~~. i7tNti r-y^~ k "rpydiJC)i; SOI_iHi;11`, p'V APPLICATION FOR CERTIFICATE OF OCCUPANCY ^ « ~t5 ~ A. This application must be filled in by typecariter OR ink and submitte/d-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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $1/5.0 y, Co ~eirrc~ial $15.00 Date J.~?.,1.~. New Construct ` ~ r ion........... Old O~~r[[Pre-existing B ilding Location of Property......... ......~.~.~4-,f, j~~ ......~/.~1i~rG~, y^ , , House No. Street i _ Hamlet , Onwer or Owners of Property ...~~rr:-):~~~yy... j~ .~..Y~,1~~W.~40~y . County Tax Map No 1000, Section...../. ..J.....Block.......j.........Lot......4 Subdivision....../ . .............................Filed Map......... .Lot......... Permit No. ~o.~fj ,Date Of Permit ................Applicant. G~%./~~'~A~S-`~%41~,-.. Health Dept. Approval ..........................Underwriters Approval..... Y. Planning Board Approval Request for: Temporary Certificate........... Final Certicate..'.....Ll . 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P N N J ' u ti s m h p J N V --..i r' ~1 ' ate. abP~-.-,..m.. e,..,..._f.i. ~`~..lJ~. f~i_~~ i. - TEL. 7G5-I 802 S~FFOL,` c ~o o~~ To~a?rr or sor~T~oao ~ < OFFICE OF B[JILDIbIG INSPECTOR o ~ r,' -c P.O. BOX 728 u' .~i. rn TOWN HALL ti v%'D~ ~b~~ SOUTHOLD, N.Y. 11971 . C G R T I F I C A T I O pI Date ~~t 11~ I S R y Building Permmit No. ~Q~/ t7 01•mer u ~ln F-d~ r~r~n2a 1~.C (please print) Plumber ~ (please print) I certify that the solder used :.n the water supply system contains less than 2!10 of 1; lead. (plumber's signature) Sworn to before me this - , ~~(t "day of (~~~"'LP~~_.' 19~' Notary Public Notary Public, SU County DEBRA K. WOERNER Notary Public, State of New York No. 01 W05018069 Qualified in Sulfolk County Commission ExP+res Sep1.20,1995 ~~o~~gOFFO(~-~OGy o ~ Town Hall, 53095 Main Road y Z Fax (516) 765-1823 P. O. Box 1179 0 • yC Telephone (516) 765-1802 Southold, New York 11971 .ji ~~l ~ ~a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 28, 1994 Ms. Joan Hilliard 10 Cabin Lane East Setauket, NY 11733 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) xx No Underwriters Certificate on file. xx 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 # 20417-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. =1~LD i;:Rk;, .-J;i ~~J„:.. I .:i:.`ti9f.NT~ ~ I J '9 1 . ~ ~ ' m \ v l H~ , 'OUIIDATION (1st) 'I a f_ 'OUNDATIOIJ (2nd) _ _ ~ s 0 ;OUCH FRAi1E & ~ PLUMBING I 'O ~ ~ V • ~ CG.. "1 y 3 . m \ IIISULATIOf1 PER N. Y. y .~,~,p „ y V(,~Oll STATE Ef1ERGY CODE C~'L~,.. ~ r/'C L~ o - /J ~f /Q y~ r . ~ `~^~'~?~C G~ KCB L~G-aQ,~j y FI;lAL ~ Qh-J'~o,~w~riu2~a .~+~I7oe~YF~i Cofe..,.~,bm ~ v ~~n)~. ~i~watl~~Fi~okt,~ ~ ADDITIOfIAL COMMEflTS: P..C~ ~'~O~/~ x IT} X b l`~~ H O ~ W - x M ? - r '-7 °A ~ T 'v H ~ I T5S-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING INAL REMARKS: 4 DATE a2~ ~ INSPECTOR r"~~ 765-1802 v BUILDING DEPT. / INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] I SULATION [ ]FRAMING [ FINAL w( r~ P ~~~C~ q~ DATE lG INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~m ' " ~wr ~ tee.. DATE cJ INSPECTOR ~~r 7-~- 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ) RO PLBG. [)FOUNDATION 2ND INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~d~-~+-- DATE INSPECTOR ``77 ~T~/~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE (C ~ ~ INSPECTOR o^-r-2, / i~'"v(~ 765-1802 Gl/~ ~ y BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST OUCH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMAR S~~ < < / n ~ DATE O v L- INSPECT i 2, 4 n ,~rz .Teti f6~l-81A~ p p7 TOWN O SOIB MOLD la~s ~-l~a~l o't¢QCQ ~Vlew'• ~eeR d~uc~c. ~ SIC G~EY~nA^a~, a^CW~ ley , ~ ~p ~2 fz Ly ~4Ym we.~ . t ~ t S- V W~u°Qoun ~ nnd-a't.~.w-~/':~R ~ d'vt~~}}-r 79 ~ldCt~ CVl ~.t aJ w ih+ O'°~ ~J 12l Y 6-ecQ Y'o~w . U/dQY. 4P- ;1e er,~..~.. IQ,e~ h,~ wt ~io o r 4 Ie~' 00 ~ vh dia.,~r ~ ~o na a.t if aeo4 r 4 ' i n m v e, cL~ d~o~ ~aG H~ p4.~~. ai.rr ~ ~G ~ ob o ~.2k, i ~ ~c..cy ~e S ~3i i^a+ vn ~ ~G~ ¢y Gluec . r vv ~I2e~-o, c l2` ak o v~ Jf~ w; K-J' .FrO ri+ ®~yi 8{Cd (;O+TJ ~~°t~ V THE NEW YORK BOARD OF FIRE UNDERWRITERS ~AUk, a 18A0062 BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, NEW YORK 70038 Date NnV~~I~~R a,Ch, 14)9 Applbcation No. on file 7f.3~4~1aCY9^/92 N ~3~a~~ THIS CERTIFIES THAT only the electrical equipment oa described below and introduced 6y the opplicont Homed on the ohove application number in the premises of t~1S .70AN I?HII~li7 ARD, 19-47 ~ MAI~-'N~{ RIt. (aN~-~p-~ul:f)P) , F9ATTITUC'K r N. Y. in thefollowinq location/ L"J Basement L1 /st Fl. LJ 2nd F'l. P+'P"l'1nC'/f)CT1' .Section Block Lot as ~A was examined on NOVL'ilZF31vR r 1994 and found to be in colapl(ance with the National Electrical Code. iIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K W qMT. K.W AMi. K.W. AMi K.W. AMi. H P. H9 iii ;~3 2 a 1.2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RFC'?T TIME CLOCKS EFLL UNIT HEATERS MULTI-OUTLET DIMMERS AMi K. W. OIL N. P. GAS H. P AMT. NO. A. W. G. AMi. AMP. AMi. AMPS TRANS. AMT, H P SYSTEMS pMT. WATiS NO.OF FEET 1 F' 1 343 SERVICE DISCONNECT NO.OF S E R V I C E PMT. AMP, tYPE METER I ~ RW 1 q 3W 3 ,a 3W 3 q 4W NO OF CC COND. A W. G. A. W G. A. W. G EGUIP. PER .e' OF CC. COND NO.OF H4LEG OF MbIEG NO OF NEUTRALS OF NEVTRAI OTHER APPARATUS: G.E.C.'.Ia -6 SI~(OICE pF,TEC'PfIR: -3 GUSTAV L?ARTRA LYC.#1.529 E C~~~~ r18 }?INEHURST f3LVA. C'AT_IVERTON, NY, 11933 OENERAI 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 by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST,NOT BE ALTE~IED IN ANY MANNER. _ _ ' _ B0,\RO OF HEALTF{ FORMN0.1 J SETS OF PL.\i7S TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT C11CC1 : . . . . TOWN HALL SEPTIC FoR:F . SOUTHOLD, N. Y. 11971 TEL.: 765-1802 t:o<IFY;p~7~ ,.C A-L~L s 7~" Examined , 19 C~~ r . . . {'B t~ i~ j~htAII,L+ TO ~PProved 19~°~dPermit No..G~,~,~~i1'• 15 l!~,~ - W . _ f i~ . ~a~ Disapproved a/c " ~ ~ 9.#~ _ . 6L.F)G.pEPT. ..................p ) ' Tp19Vtd pF SOiBTNtSLR~„„_K,. ui dma s ctor PPLIC TION FOR BUILDING PERMIT Date 19 . INSTRUCTIONS a. T}us application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 its 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 .gall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occupancy .tall 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, acd other applicable Laws, Ordinances or :egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. :hv apnlicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............i~~ lame of owner of premises , , ~~;~~-;c~c~ !J. . ....nom............ (as on the talc roll or latest deed) a f applicant is a corporation, signature of duly authorized officer. • (Name and title of corporate officer) Builder's License No. ~ I~ Plumber's License No . . Electrician's License No . . Other Trade's License No . . Location of land on which proposed work will be done. . ,9. Ilot,se Nuinbe f ~ . fF ~ ~i'•c'• ~ ......~i,~~%~t~t.'tfir4?,~YC.., . ~ . ~ , . , Street / (ryy Hamle Q~ County Tax Map No. 1000 Section / ~.b...... Block ......L~........... Lot S> Subdivision Filed Map No. Lot . (Name) State existing use and occupancy of prem' es and intend d use and occupancy of proposed construction: a. Existing use and occupancy . s33~;~ ~ b. Intended use and occupancy , , - - s-... ate 3. A'ature of work (check which applicable New Buildin ~ L,.i Remov • . • • • • g ~ • ~ ' ' ' ' ' • • Addition Alteration . Repair ial Demolition ,r,/, , , , .Other Work . (Description) 4. Estimated Cast..~~S~.G~v,,,••.•..••.•.••.,,•,,,Fce......... e u (to be paid on filing this application) 5. If dwelling, number of dwelling fits Number of dwelling units on each floor . •Ifgarage,numberofcars 6. If business, commercial or mixed 'occupancy, specify nature and extent of each t YPeofuse g , 7, Dimgensions of existin stru Numb if any: Front Rear Depth , . Hei ht ~ecof Stories,; , Dimensions of same structure with alterations~o'r ddditi~: Front • • ~ • • ~ • • ~ • Rear.................. P .Height . Number of Stories . e g Numb~tion: Front Rear Depth Hei ht • •~r of Stories . imensions of entire new c ~ s~ ~ • • • • • • • • Rear J~. ~ epth , , : , l,~i,~ 9. Size of lot: Front ~ " " " " " " " " ' • l0. Date of Purchase 1 1. Zone or use di$trict in whit)) ~e ~ ' ' ' ' ' ' • • Name of Former Owner . p rrlises are situated . P P 12. Does ro osbd construction. violate any 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 l ...............Address i ...................Phone No. Name of Architect , ....Address Phone No . Name of Contractor } ~ • • ~ ~ " " " " " " P yP y ...............Address ...................Phone No If es, Southold Too feet of a tidal wetland? ~c " " " " 5. Is thi~ ro ert within 30~n Trustees Permit may be required. ~o • PLOT DIAGRAM Locate clearly and distinctly all bµildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block ny'mber or description according to deed, and show street names and indicate whether interior or corner~lot~. o ,~"'ti- °i ~ ~ ~ ~ ®0 i J , ll ® C~~~X,E: I o~~~ CAti r~ o~~ ~ ~ ,~'^z' PATE OF NEW YO]~I~ OUNTY OF S~ l~ S.S'~ ~Q~:N'~~~.L.~ fT'~•'• • G4~~~'~+~~•. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) rove named. wry rrsthc '~i ©wwWS , (Contractor, agent, corporate officer, etc.) • • ~ • • ' said owner or owners, and is duly at}thorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the irk will be performed in the manner seG', forth in the application filed therewith. porn to before me this I ' ..day~of. A•N~,nN' 199. Mary Public, , ~ County • ROBERT I. SCOiT, JR, G~\~'N''~ s~~~~~ NOTARY PUBLIC, State of , NEttlAiy~~ ~ (Signs r ofa plicant)