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Home My WebLink About20005-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Mall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20920 Date AUGUST 6~ 1992 THIS CERTIFIES that the buildin~ Location of Property 4365 WELLS ROAD House No. C~unt¥ Tax Map No. 1000 Section 86 Subdivision ADDITION PECONIC~ N.Y. Street Hamlet Block 2 Lot i2.7 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 5, i991 pursuant to which Building Permit No. 20005-Z dated JULY 9~ 1991 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to SUSAN HALLOCK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-237799 - JUNE 5~ 1992 PLUMBERS CERTIFICATION DATED AUG. 5, I992 - MATTHEW HALLOCK Rev. 1/81 w~ ~, , Bu~ing ~nspe~tor' IPOnM' NO. 0 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~_ 20005 Z Permission is hereby granted to:, _ ~ ~~...:...~..:...V.., ...... u...~.~ ........... , . .......... .......... .............. :. .............................. at premises located at ....L~..,~.L~.~ ........ ~../~,,,.....,.~, ..........:--.,~.~.~.~ .......................... Building Inspector. Rev. 6/30/80 A. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 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. 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..'~.~ ~...~.. ~. t.~..~.~ ................ New Construction ....... Old Or Pre-existing Building~ .......... Location of Property....~..~.~.~ ............... .~.et(~...~.~ ................. ~.~...C~./~ .......... House No. Street Hamlet of Property Onwer or Owners ................. . ............... County Tax Map No 1000, Section.........96 ..... Block ...... A ........ . Lot.../2'y............ ....... Fee Submitted: Subdivision ................................. . . . Filed Map ............ Lot .................... .. Permit No.. ~..~, .~,-~. .... Date Of Permit..'~.,~.~Z..Applicant. o.~.~..~, o~.F_~..~ ........ Health Dept. Approval ..... ~t~,~. ................. Underwriters Approval ......................... Planning Board Approval ..... ~.~. ............... ~ Request for: Temporary Certificate ........... Final Certicate ........... .... AFPLICANT TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTI~IOID, N.Y. 11971 TEL. 765-18o2 ~E R T I F I CA T i O N I certify that the solder used in the water contains less' than 2/10 of 1% lead. supply system SWOrn to befor~ me tkis ~3-~_day of~~_~,. 19~. NOtary Public,~ County (plumber"s signature) --" LINDA J. COOPER Notary Public, State of New'York No. 4822563, Suffolk County~7o Term Expires December 31, ~1. FOUNDAT~O~ -- (1st). FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITfONA'L COMMENTS: '! THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000127. BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW 10038 yORK Oa£e 3UN~ 05,1992 ApplicatlonNo, onfile 77165192/92 ~ 2377~9 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application nu tuber in the premises of HATTfl~{ HALLOCK, ~(F~LL~ ROAD~ POL~ #29, inthefolimcinglocatlon; [] Basetnent [] IstFl. [] 2nd FI. (~AR/A~IC/O~T Section Block Lot tt~sexatninedon ~{~ 26,1992 andfoundtobelncompllanceu, lththerequiretnentso, fthisBoard. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FAN! ~LEC. RO0~{ H~A~RSII-2,O MO?ORS: 1-F -275 ~'O~N }I~RBOR LAHg S0[~'}{05O, NY,. 11971 GENERAL MANAGER This cert~flcate must not be altered in any mcmner; 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 ALT~ERED IN ANY MANNER. New York State Department of Environmental Conservation Building 40--SUNY, Stony Brook, New York 11794 (516) 751-7900 NO PERMIT NECESSARY - TIDAL WETLANDS ACT Thomas C. Jorling Commissioner Location: ,4/~'~-~ ~/~ ~, A review nas been made of your proposal to: ~~ ~~'-'~ Based on the information you have submitted, the New York State Department. of Environmental Conservation has determined that the project is listed in Part 661.5 of 6NYCRR (Tidal Wetlands Land Use Regulations) as a use not requiring a permit or notification letter of approval. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please note that any.additional work,~ or modif'ication as described, may require authorization by this Department. tact this office if such are contemplated. to the project~ Please con- Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional ~rmit Administrator TRUSTEE~ John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Kmpski, Jr. John L. Bednoski, Jr. Iohn B. Tuthill Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 April 25, 1991 Matthew Hallock 4365 Wells Road P.O. Box 200 Peconic, NY 11935 RE: 1000-86-2-12.7 Dear Mr. Hallock: The Trustees reviewed the application submitted for the above referenced property to construct an addition on to existing dwelling. After an on site inspection by the Board of Trustees, it was determined that this project is out of Trustees' jurisdiction. Ail other approvals that may be applicable should be secured prior to the commencement of tho project. Very truly yours, · Bredemeyer, President, Board of Trustees JMB: jt cc: Building Dept. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ZND FRAMING REMARKS: ROUGH PLBG. ~UL~TION [ ] FINAL BUILDING DEPT, E iNS~ECTOR 765-1802 BUILDING DEPT. INSPECTION [~j~OUNDATION 1ST [] ROUGH PLBG. [~FOUNDATION 2ND [ ]INSULATION FRAMING [ ] FINAL INSPECTOR/ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [ ] INSULATION FRAMING [ ] FINAL FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHQLD.. ~L¥o !.t~17 t TEL.: 765-1802 Approved ., 199.}. Pe~it .No. a 597.~. ~ ,~ .... (~uildin~ Iaspcctor) APPLICATION FOR BUILDING PERMIT BOARD OF' ItEALTIt SURVEY ......... · CIIECK ....... MAlL TO: INSTRUCTIONS Date .... ~..:... (Nmne) .............. Lot ..... Slate existing use and occupancy of prcmisc$ and inlcndcd use and Panty o roposed constrnctlon: ....... occu . f P ' . A. Existing use and occupancy ........... B. Intended use and occupancy.~. Plumber's License No ......................... Electrician's License No ....................... Giber Trade's License No ...................... I. Location of land on which proposed work will be done: Ouse umber Street, ' ' ''' Hamlet ....................... c ,y Va it, N ,000 s 7 ...................... c at) No. a. Tiffs apphcahon must be completely filled in by typexvriter or in ink -;,nd submitted to th~ Building I~ea:tor, vzitt sets of pin.% arcurat~ plot plan to scale. Fc~ accortfing to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which it parr of tkis ap/: cation. ' c. The Work covered by this application may not be Commenced before issuance of Building Permit. -cl. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pcrrr shall be kept on the premises available for inspection throu?.hout the work. · c. No building shall be occupied or used in whole or ~n part for a.ny purpose what~ver until Certificate of Occupant shall have been granted by the Building InspeCtor. a ; APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances ~ Regulations, for the construction of buildings, additions or alterations, or for ~emoval or demolition, as herein describer Tile applicant agrees to Comply with all applicab)e laws, ordinances, building code, housine code, and regulations, and r admit authorized inspectors on premises and in building for necessary inspections. · .. (S:=nature ot apphcant, or name. ff a corl~or-~tlo'n')' ' ' · (Mailing address of applic.ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder f,'o.¢o ,- - 8 ,' I J raise (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. 3. Hamre of ~vork ' ' ' ' ............ Repair'. ............. R#m0va! ..... ~, ..... : S~i~,, ~ Tennis Court ...~ .... accessory Buildin-. ..... - , ~v ~ ~,~ ; ~ .... ~ence .... '..~uuner Work;...~[.~.. 4. Estimated Cost. ~ ~ ~ ~OO ...... ~' -' ' · ......... ~' .......................... Fee. . .'..;:~-:'.. ~," ~ta he pa~d on 5. lfdwelling, number of dwellingiunits ............. Nnmb___~dv., ....... each floor ' ~ garage, hum be r of cars .... ~ .~.~..~ ~ .. ~ ' ~ ' ' ' 6. [.bus'nyss'c~mmerc,al orm,xe~occupanc~spJc~y nat,y;'//d;~/ani~'r'eac]/t~e';/~se ...~ .......... 22222222' ' "' ' 7. ~m~cnmons ox~x sting structures, if any' Front ~o ~ ~.4 z ~, .~ ' ,,.,, ' ~,,;.h~ ~' ., ! " · ,~. · ..,. · .. .... l~oar . ,.~ ........ uepm . .~ ....... ---.= ....... r .......... l~umbcr of Stories ~ ~T~rt~ Dimcnsmns ~f sam%structure w:~th alteratmns or additions' Front . . ~&' ...... Rear ... ~{ .... De th... ' ~ ~ · z ' · ........ , -.- ]~. .P ..... ~ .......... ,.. }Ira t ....... ~ ~ ~ t e,~, ~ 8 .......... ,,~ m cmire new constmctmn: Front .... ~ po,r ~ , ~z . ................... ~ ....... Depth ..~; ..... Height ..... ~. ' .... ~u~ber of Stones... · · . zW, " 10, Date of Purchase ~ ........... Rea ....... &40.~ ........ ~?T ........... · ~. -.-.. ;-. · .. .............. ~,.~U~ l 1. Zone or use district ~ me of Foyer O ........... pr raises ars situated ....................... . ....... 12. Does proposed construction violate any zoning law ordinance , or regulation: ..~ .................... 13. WHI lot be regraded ...... '~' ' ~' '': t ',5"..'~ ..... Will excess fill be removed from prmu~. .Ye 14.Nme of Owner of prem~es '~$l.~..~tle~..Addrem~.~v~e~/~Plmne No. N~e of Architect .. N~e of Contractor 2 ...... ~ ................. Address ..... d ............ Phone No .... ~ .......... · · ....... ~.. Address ~. Z ~/~.~I, ~. !&. Phone No .... l~.[a [kia ~ro~erry located v[thln 300 feet of a tidal wegZand~ '~YES~.NO .... · If yes, Southold Tow6 Trusuees PermiU may be required. ~ Locate cle~ly ~d dist~ctly ~i buUd~gs, whether existing or proposed, ~d. indicate ~1 set-back d~cn:ion: :':' prop~y Hnes. Giv6 street ~d block~number or desc~ption accord~g to deed, ~d show street nines and ~dicate interior or comer lot. ' i i STATE OF NEW YORK, COUNTY OF S.$ o. "' being drily sworn, deposes and says that he is the a c":' (Name of individual signling contract) ppli above nam'ed. ; · He is the ' ' , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed the said work and to make and file th aPPlication: that all statements contained in this application are true to the best of his knowledge and belief; and that work will be pcrfommd in the mann<r set forth in thc application filed thcre~vith. S~vom to before me this ..................... day o .. . Notary Public ~ N~e~ Publlo. 8~te of ~ ~ ~. ~22~. Su~ ~ ~ ~ Term ~ires ~r ~{, ~' C ty . (Signature of applicJn' llll 2' '1