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HomeMy WebLinkAbout20510-z ` FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22029 Date DECEMBER 15, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 925 DONNA DRIVE MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 16 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 24, 1992 _pursuant to which Building Permit No. 20510-Z dated MARCH 27, 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 AN ATTACHED GARAGE AS APPLIED FOR The certificate is issued to MARK E. & TINA M. BERRY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-09-DEC. 1, 1992 UNDERWRITERS CERTIFICATE NO. PENDING - DECEMBER 10, 1992 PLUMBERS CERTIFICATION DATED DEC. 1, 1992 - PECONIC PLUMB. & HEATING Building Inspector Rev. 1/81 FORM NO. 2 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° 2051OZ Date 7 19..2: Permission is hereby granted to: ° ....7 '..r~.~ .;.".d . to 4.dw....a.......`~.~ X-777 .G,L,~.......~~ at premises located at t~ 1ffLr1"f~ . County Tax Map No. 1000 Section ~ Block Lot No pursuant to application doted 19jo and approved by the Building Inspector. ...i•••4!.!•• Fee $ Ate.. is { uilding for Rev. 6/30/80 i Form No. 6 TOWN OF SOUTHOLD 1 41992 BUILDTOWNING NT 765-1802 U3C~`XJ7740LD "•°°°°°ICATION 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 - $50.00 5. Temporary Certificate of Occupancy - Residential J)$e115.00, Commercial $15.00 Date . Lc~`................................. New Construction.. Old Or Pre-existing Buiilding........ Location of Property... ~......dJ 1: ......~1~..........41.1h f~ House No. (I (J v Street Hamlet Onwer or Owners of Property !1 y;n,n 1 ZlA.V County Tax Map No 1000, Section.......... B1ock....I(je......... Lot Subdivision..':?.. ..Filed Map..........,,..n..qLot Permit No..:'OS I Z ,,,.Date Of Permit ....Applicant. .LKI ~0.~ . Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: Z ~ ` LAPP ANT , TEL. 765-1802 S~FF~~ LO TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR o r - P.O. BOX 728 TOWN HALL . SOUTHOLD, N.Y. 11971 C E R T I F I C A T I"O N Date Building Permit No. Owne r_~~ (please print) (please print I certify that the solder used in the water supply system contains less than 2/10 of to lead. (p1u er's sig ure) Sworn to before me this day of CSC'-rte ___~5~. f 19 Notary ublic Notary Public, z #L(,1 County BARBARA STEPPIOWSRI Notary PubSo, $10 01Naw Yodt NO.4844752 Qualified in swuk Cgnyy Commission Expkes ssq 30,19 3 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS:- DATE INSPECTOR s THE NEW YORK BOARD OF FIRE UNDERWRITERS 1'A 1000744 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 7£{416Et9?/9'L N 7fs941."st Date DECEMBF;f. 16,1992 Application No. on file 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 MARK & V14A BERRY, DOf1NA T)R„ uAT'n-TJCK, N.Y. in thefollowinq location; ® Basement © 1st FL M 2nd Fl. GlIDt OUT Section Block Lot was examined on DEVEROP,R 10, f992 andfound to be in compliance with the requirements of this Board. FIXTURE EcEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W. AMT K W. AMT. K.W AMT K. W. AMT. H P. 2r 49 3h 25 T-7-71- to 1 1..4 3 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K. W Olt H. P. GAS H. P AMT NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT H. P NO. OF FEET AMT. WATTS 4 N :3 a SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP TYPE METER I,e]W I%3W 3%3w 3q 4W NO.OF CC COND. A W G. NO OF HLLEG A W.G INC. OF NEUTRALS A. W.G EQUIP, 1 1J PER % OF CG COND OF HI-LEG OF NEUTRAL 1. 200 C. ll I 1 2JI 1 210 OTHER APPARATUS: ROp110R0,r1.`.7 5 11.P.,7._T FI.P. ;3g1L)CCI; 11E'x'E(:Y'pRlt itlOftARp G. fiGGYEA 1ITC42948_g P,0. BOX 372 LANNxL, NY, 11948 GENERAL MANAGER 19. i 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 F CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FOUN ATION I - - ~p1 (1st) FOUNDATION (2nd) _ cn m ~ Z ;OUCH FRAME & -PLUMBING p 3. a m INSULATION H STATE ENERGY CODE II I ~ m FINAL ADDITIONAL COMMENTS: pf _ Y • X H O_ ~y 7v A H o ~ x S 7(.~ m p, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION FRAMING [ FINAL REMARKS: DATE INSPECTOR A 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ "NSUTION [ ] FRAMING [ ] FINAL REMARKS: DATE 'F Zol INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ST [ J ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: t ~r DATE Z' INSPECTOR 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST 4.116000H PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [RAMING [ ] FINAL REMARKS: D ~z DATE 1/ INSPECTO 80,1RD OF HEALTH FORM NO.1 SETS OF PLANS TOWN OF SOUTHOLD ,,SURVEY _ _ . BUILDING DEPARTMENT ZC11CCK . . . TOWN HALL SEPTIC FOR:1 SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:oT r CALL ..1. Examined ?v........19MAIL TO: Approved 2..... , 19ermit No..f~ Disapproved a/c . Bing nspcc ) AOR BU ILDING PERMIT / ' 19~ Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and Submitted to the Building Inspector, with 3 -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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- adon. 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 tall 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 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, 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 imit authorized inspectors on premises and in building for necessary ' •cti s. (Sig (Signature opplic ant, name, tf a corporation) ID~......u'{C (Mailing address of aicant) tate whether applicant owner, see,.agent, architect, engineer, general contractor, electrician, plumber or builder. ......................1.... 1....,................................................................. ame of owner of premises (as on thnta.xroll rlatest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No. 151. !.1J . Electrician's License No . . # ~r Other Trade's License No. v.~smS Location of land on which proposed work will be done. , i ~as .................n~... ..................~,c ) C~ (louse Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision V* k~-..CI.KeP,k . L5, IA}C,5. Filed Map No. . , , , , , Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~.1 b. Intended use and occupancy/nq)C, . - ;6~JhA ~1 J . • . . . . . . 3. Nature of work (check which ap'plicable): New Building . Ra air Addition .Vtetation P • • • Removal , , , , , , , , , , , , Demolition Other Work . 4. Estimated Cost (qfirr ' (Description) J.l9f Fee (to be paid on filing this application) 5. If dwellin I g g „ number of dwelling units I Number of dwellin units on each floor . g If ara e, number of cars 6. If business, commercial or mixed' Occupancy, specify nature and extent of each type of use g nncnslons o extstin structures g Numb if any: Front 7(~0.~.... Rear Depth . Hel ht Dimensions of same structure with of Stories , , , , , , De ti . , It alterations or additions: Front , , , , , , , , , , , , , , , , , Rear . • • • Hei •ht • • ' RcarNumber o Stories De th . . / : 'R 5 7 8 P 8. Dimensions of entire new constrtllction: Front ' ' ' ' ' ' ' Height 2I{ Num b,'er of Stories . , " " " " ' • 9. Size of lot: Front (7, • • • • . " • " • ' • • 10. Date of Purchase Q a ; Rear . , ~(Q . . . epth , . I?-, . •~Rqa Name f Fon er Owner C~GS~ e( ..R....21f. ' 11. Zone or use district in which premises are situated , . ~r,Qj G 12. Does proposed construction viola e any zoning law, ordinance or regulation: , , Op, . , . , 13, Will lot be regraded , , , , , Will ex ss fi be removed from p emises: Ye 14, Name of Owner of premises t 1)(~ , j 11 A-r tu x~f, Vt . ~ QQ Name of Architect ~(ZW,Ce>7Grri, ,r>) ul[l Address , , , , ( t ne No. /~7T~.at Name of Contractor y~ l • Address ~1C1(o~ ,C~seenPgf_ hone No. 77:./.6,~~, , ~.h~~+.~ (.1~... ~2C~u (L • Address 4~ p, .lYll?~}.Phone No. ~j.: ,S7y~.. . * pro ert within 30' 15. Is thisIf es Southold Too feet of a tidal wetland? Yes........ No......... Y 'tan Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bluildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ntfmber or description according to deed, and show street names and indicate whether interior or corner lot. I I ! I! " ~I TATE OF NEW YORK OUNTY OF . `S!~ F dl_ k S.S'i! (Name o d a signing being duly sworn, deposes and says that ate is the applicant )ove named. contract) I , :isthe (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the )rk will be performed in the manner set! forth in the application filed therewith. nom to before me this .a, off Y~JH2efv d1ay of 19 ~~°7 tary Public, 1 , GCJ : • County KAREiV W. BOE \ NOTARY pUBL1C, Rof N • A^ State of Now YorvP ' ' ' ' ' "r° lS~ ,I' , No. 1842180 cammtaalonied to swfiollk (Signatur o applicant) BNPIroe;Z~/ 7 j WELL } i ' ..8 RE~i17EtJ~C'S - ~~P'("fC LOCr~.Ut~`JAif..A1~Lfi ~ j ! tip r~ ror I ; I l ' I ~ i ~ z .._-542.677 TO t'We WSA~ DQfV( 44~ u~;, tEf7.~ ~ WELL 'N FtON1-„ m J U 'u'~ °1° i d° rn . irn d oc QQ J J o~ ti ro ,''[f I N q ~ -w ~ - PfJ -tt p -o a m m j C, tic m ire yx w , zM "o CJ ~~'f" f s n cn I+~s f~f{ s1 p t vs, t ~p# n r m i r m n a H + IC7 '~t) c~ C p ~M C n c . c #r ire ~ ~ b to th, 40 03 C%) .tm11 LU 2 .~dy DpmU) (A ''n 'n p (A m w Z ;U C7 , 2 C 1 4 < *q m c p~mp cnp Om m NOT Q 't aE Ft E+M/}f' 2 N m m~ c - , p r 3 a O trit d- o U' n r o -i 'n ~~i n h O z I Z ? O O~ c m p K i y N O 0-4 2 'n 2 r` 3 m 1 - " ` X' - ((fill { m Z 2 A . (n G1 Z u p r n 1° a C3 m b cn 0 Z _ Z ;a cn f I i ~~T i~M1~J ` 2 I j c i n r v •0 > Q V1 z 7h~`i? D p p 2 O m'p 2 y. z. 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VW EM - - V/I i ~7~7777-77-7-77 - I ~ _ j I I I =1 ( -'I III Ik II'd II ~I I h~ III- ~I I~ I ~I ~FR(?,wi rJFr _l ~ {I 1i/ ~~l l~ l I III f I ~ DO NOT PNCGErU uJITR~ r - r " - L-_ SURVEY OF OUNDL ANION LOCATION _ L-- _ - F HAS BEEN APPROVED L L PLUMBER CERTIFICATION AP ROV OAS NOTED ON LEAD CONTENT BEFORE DATE. 7 z B P s~20 t5-/0 CERTIFICATE OF OCCUPANCY FEE: BY: PL.U PURNMWMVOM - ' &VOMtM OM g SOLDER USED IN WATER NOTIFY BU D DEPARTM T 765-1 9 OLLO02 WING AM INSPEEC C A PM FOR THE _ _ - 7ES71N6EffW1ECt7NENINO S ,yRey ]PA NC tl 7 ~"~=aNY OR SUPPLY SYSTEM CANNOT F FOLLOTIONS: USE IS U~~ U g p~~,P e9 EXCEED 2110 oft%LEAD. 7 FOUNDATION - TWOREQUIRED u FOR POURED CONCRETE ~e 2 ROUGH - FRAMING & PLUMBING 6 UT CEI OUT CEIMFIC TE s INSULATION u. - CONSTRUCTION MUST 96F EI FOR 4°Cl,,JPA C,Y OCCUPANCY OR ALL L CONSTRU TRl1 CO~ E C7ION ON C SHALL MEET if copper tubing is used 4 ~g LI PA for water distributing d Po N system: piping shall be of typos K or L onl USE IS UO~r.AV FUL f,E REQUIREMENTS OF THE N.Y ':-`.TF CONSTRUCTION & ENERGY -FS NOT RESPONSIBLE FOR INITHOUT CERTIFICATE .nR r.ONF, FRUCTION ERRORS Of OCCUPANCY UNDERWRITERS CERTIFICATE REQUIRED - - - --7 P .x P ~ W i I a Yl, i J / J t A, ri 4 ' of NEW), o9 ,E M. o C321544 ZU a. s o- v, ~ v ~ s t ~ r a5 K u' r - ._..L, ~.1 27 1 r r~~4r ~~L^^F ry4f.r'Ty. u Y ~..hqe - .s:.- bar:, k!- E V P, R -r 0 I 3 9 r ~scaLE tar S PLAN NO - AIX : AT? 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