HomeMy WebLinkAbout20262-z FORM N0. 4
TOWN OF 50UTHOLD '
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20431 Date DECEMBER 30, 1991
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property 1100 SOUND BEACH DRIVE MATTITUCK
House No. Street Hamlet
County Tax Map No. ]000 Seetion 99 Block O1 Lot 04.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this o€f ice dated NOVEMBER 6, 1991 pursuant to which
Building Permit No. 20262-Z dated NOVEMBER 7, 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 TO ADD AND ALTER EXISTING ONE-FAMILY DWELLING AS APPLIED FOR
The certificate is issued to NICK CYPRUS
owner
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. 755820-91 PENDING DECEMBER 24, 1991
PLUMBERS CERTIFICATION DATED DECEMBER 20, 1991
~
Building Inspector
Rev. 1/81
sosai xo. s
TOWN OP SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N 2 0 2 6 2 Z gate ......1.>~..~:::~~.^.:~:....7 19.q.c.
Permission is hereby granted to:
w.:~ c :0.
...~.l.
~..~.~:a'.~:..:v :.y.....!. ~ 70.4..-..x.....
at premises located at ..,~~4..4.....~f5...1 ......1.~~.........1'):.1~:.W.ll.1M4P~............
County Tox Map No. 1000 Section`,.....~.~.~,...... Block Lot No....~.~t...E.......
pursuant to application doted ..../Y.~.'!:'.?~...~ 19.~.~..., and approved by the
Bulldfng Inspector.
Fee $...o`~,..~3..~..:...."`
.........a.>:.~--~
Building Inspector
Rev. 6/30/80 ,
+'~IBLIjgJ• J//~//~ Form A'o. 6
~ / .[.w) Z-- TO(dN OP' SOUTIIOLD t° $ , v ,
BUILDING DEPARTMCNT _ ° '
"h ^:I
//~°y~i--~~~~j~ ~ i6s~ISOZ~ , UEC 2 4196 ~ !lY
y`
APPLICATION POR CBRTIPICATh OF OCCUPANCY . s
This application must be filled in by typewriter OP, 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 t}te solder used in system contains
' less than 2/10 of 17 lead.
S. 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) uon-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 I're-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
/ Da t e ~y~~iS°'~~.1
i/ . .
::ew Construction.... Old Or Pre-existin Buildin /
g g..Y.......... .
Location of Property....,~~U`?„•,~(/~~?•;~~~~~ ~'t~ ~%~7r%9"I,/G~
House No. Street
Hamlet
Unwcr or Owners of Property... C}-,~'~
Cuunty Tax Map No 1000, Section...~l.~......Block.. ..r~•/
/a ........Lot...
Subdivision......../"~./7
.......................Filed hfap............Lot.///
i crmlt No.. .~'~•«~'~~,,Date Of Permit. ~~/~•~~~,•,.Applicant .l: (~?~~/J'G~"~~~'c-.•
acalth Dept. Approval........
• • • • • • • • • • • • ......Underwriters Approval.... ~;a~,r,~i,~.
:Tanning Board Approval •
~,equust for: Temporary Certificate........... Final Certicate...........
~ ~
'ee Submitted;
~ i3s - .
APPLICANT
- o ~ ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS r~l>;<
1 I eg BUREAU OF ELECTRICITY
r 85 JOHN STREET, NEW YORK, NEW YORK 70638
,~ASVfInR+? ill; ra$2 "Y~rCY!'t?tr~!!=~~ 1L1 ';;7"3JaE'~E
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described belou+and introduced 6y the applicant named on the above application number in thepremiaes of
Id I,C){~leAfi C`lTRl15r 1'I p(I ;?("lUll i! ii1'~iTl,h' gR 1: 5's~~: p!i3 `eii'Y'C1C En, {ti.Y
in the following loca eqq• Rps me t.„ 11l PSI.(()i l`1'
? Ixt Fl. LJ End F'l, .Section Bloek Lot
i~N,1;1ti1d ,s R, ! ~v r.
uas examined on and found to be do cmnpliance with the rerluirencerv6s q(this board.
FIXTURE ECEPTACLES $wITCHE$ FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FWORESCENT OTHER AMi K W. AMi. K.W AMi NW. AMi. K W AMi H P
fl~ J4 ~7 J~3 J 1..
DRYERS FURNACE MOTORS FUTURE APPLIANCE ~FEEDEAS SPECIAL REC'PT TIME CLOCKS eEll UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMi K W Oll H. P. GAS H P AMi NO. A. W G AMi. AMP. AMi. AMPS TRANS. AMi H. P. NO. OF FEET AMi WATiS
I
SERVICE DISCONNECT NO.OF S E R V I C E
AMi. AMP. TYPE EQUIP. e ~ 1W 1 q EW 3 ~ ~W 3 ~ AW NO.OpECRCeCOND OF CC
CO~ND NO OF HbLEG OF HI LEG NO. OF NEUTRALS OF ~NEULFAL
OTHER APPARATUS:
fAtdr:f dill. {i [t;i'l C`Ih. i(Y(1
,X I),~~.tr_ cf;119`R73C'1itAG 1~i4.1#2'r;12't-~;
Ut7JU 3''.AP.AftiQlf,K -
rr GENERAL MANAGER,
f.AY:~IfORF:, PJY, 1 i 7114, 7's
E~
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 ALTERED IN ANY MANNER.
INSPECTORS
r
Victor Lessard t~'~~;~D Ft7!„„,~
Principal Building Inspector c3L~' ~
Curtis Horton ' a rfl' ~x;r ~ SCOTT L. HARRIS, Supervisor
Senior Building Inspector c~~ "r ~
Thomas Fisher ~ ~ ~ Southold Town Hall
.~6'( 'A'J P.O. Box 1179, 53095 Main Road
Building Inspector e' '
Gary Fish ~~9 :j~~ S 8o Fax 516) 765-1823971
Building Inspectar Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
DECEMBER 20, 1991
D. W. P. CONTRACTORS
1483 RICHLAND BLVD.
BAY SHORE, NY 11706
RE: NICR CYPRUS
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
7QIg An application for Certificate of Occupancy is
not on file. (Enclosed)
x~t 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 # 20262-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
CC: NICK CYPRUS
I
TEL. 765-1802
~~~~F~~~ppG TOWN OF SOUTHOLD
=i ~ OFFICE OF BUILDING INSPECTOR
~ ~ P.O. BOX 728
r r TOWN HALL
y0~01 SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date /02~~~/
Building~P~ermit No. ~
Owner G'~/G,~ ~y~°l~IJS
(please print)
Plumber ~/~~/Ili~' /UI.EyG l~~Uvv/~~~5~,9~;-
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1°s lead.
~
(plumber's sig ature)
Sworn to before me this
day of
/ ` -
19~f Notary Public
Notary Public, ~ County
(S Ir;7ii:) P,7A."'S".'"'OF E4. 6W.OEM
N-.,,,_ 3't" ; C n. flew York
O~_e.1r'.e_='m ~=~i~olk County
Cemmissicr; Expires y~ ~
i-~/3
~~L'~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] iNSU~.ATION
[ ]FRAMING [ FINAL
REMARKS:
DATE G~ INSPECTOR `
c'1::LD I::S: i '_U:J IIUAT= I~ OON:iENT°
. .a a.1
t__, I ~ ~
H ~
FOUIIDATION (1st) _~L1
FOUNDATIOIJ (2nd)
f
~ ,
`o =
P.000H FRAME & i(ir c
PLUMBING
P~ y
3. ~ ~
IIJSULATZOf! PER N. Y. cn ~
"j
STATE ENERGY
CODE
L C
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4. ~m~
FI;:AL
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ADDITIONAL COMMENTS: ~ ,
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BOAFU OF HEALTH
FORMN0.1 ~ SETS OF PL 1:75
TOWN OF SOUTHOLD SURVEY . . .
BUILDING DEPARTMENT CIIECl; • • • • • • - • • • • • • • ,
TOWN HALL SEPTIC I'OR:1 _ _ _
SOUTHOLD, N. Y. 11971
TEL: 765-1802 t.oTl F~t ; n~
CALL . J~~.7.v.3+.~".'.......
Examined ../.VA?•~1~.7. 1991,
rtnlL To:
Approved . <`a.Q~!~4!"I~!'. 7 194. Permit No..e~0 PZ.~oa.~. .
Disapproved a/c _ .
(Building Inspector) : , ,
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS '
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
;ets 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
x aieas, 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 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
.hall 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
hall 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
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Zegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
fhe 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 inspections.
(Signature of applicant,~Ao".rname, if a corporation)
/l2.. c~.sLlA%d?...®1/S/~. r .~.1.
d+~<.~~/f./Cl~ , /1 ~a1
(Mailing address of applicant) ~ tr
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
i
.....~~~.V.•~~z.~-~.. ~+.~.z~'~ 5.. ~
.1..~~-7-rid-~ .
\ame of owner ofpremises N..!G~...~y~/:(J.~,..~! ~kf ~/C .~~~~r~~~
(as on the t:rx roll or latest deed) 7~~ ~
If applicant is a corporation, signature of duly authorized officer.
- J~~.
~,FA-:... f~1NY?. C~P.-gyn. .
(Name and title of corporate officer)
Builder's License No. r-r.~V.[ : . , '
Plumber's License No. ~~f?~~~~,5!+~~~'f~tY~'~f
Electrician's License No.~~.-Q.7~ , . ,
Other Trade's License No. -
Location of land on which proposed work will be done . ; .
Ilousc Number Street Hamlet ~ ~J
County Tax Map No. 1000 Section . v'- Block , C~ ~ `/`+1
.,~J~........... Lot
Subdivision Filed Map No. Lo[ .
(Name)
State existing use and occupancy of
p~r~emises and intended use and occupay~ncy._of proposeCd~construction:
a. Existing use and occupancy ~r.'~,~1~,~`-~.... «yi•~
s. /io.
b.lntended use and occupancy
.„u, P s:..- . ~
3. Nature of work (check which applicable): New Building , , '
• Addition .
Repair Rerrj~oval . • Alteration .
• J• ' • • • • , • , Demolition . Other Work .
'~s ~j~ (Description)
4. Estimated Cost 7 . Fee • r'_' .
5. If dwelling (to be paid on filing this application)
o, num er of dwellin
g unit Number of dwelling units on each floor ...1 , , , , ,
If garage, number of cars .
6. If business, commercial or mixed occupancy, specify natar.~e and extent of each type of use
7. Dimensions of existing structures, if any: Front . , ca?,7,
Rear ...~s<.'.'`...... Depth . ~~3 : ; .
g .,.....Nui
Heiht »berofStories..../...,,,,,,,,•
Dimensions ofsa estructur w'""'""""•'•••••••••••••••••••......
it~i~terations or additions: Front 7 . • , • , , , , Rear . ~-i-
i~ oc~~ .
De th ~ eight , , , , , ,Number of Stories r+~... ,
8. Dimensions of entire new const~ttction: Front .~o~,'!p; ; , , , , Rcar . .
~6''G.:~f.~.. Depth •'ill'3~~
Height ..,~!~,'~,L,- Number of Stories . , ,
9. Size of lot: Front ~.ll*a V::..... , Rear , ,/r~t~ . . . .
10. Date of Purchase ..~,/pt/ ,/~".S.
• P C ,Name of Former Owner • Depth ..a~5~'?! i~•.A. , , , , , , , , , ,
1 I . Zone or use district in which r mises are situated , , , , , , , , , • • ~ ~ ~/R' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' •
_
12, Does proposed construction violate any zoning law, ordinance or regulation: ~ • • •
13, Will lot be regraded • • • • • • • .
• • • . • ....Will excess 511 be removed from premises: Yes
14. Name of Owner of premises~~ Cy,
pJ~~s • . ,Address//~~/,.,~ct+/
Name of Architect ~ Phone No. ~~~,es , ,
Nance of Contractor Y' ,P ~ ' ' ' ' ' ' ' ' ' • • Address ......Phone No.... ,
r,~... Addres~~?( ~d.~/A.. av Phone No./~.~-.1~$.3~... .
15. Is this property within X00 feet of a tidal wetland? eyes„ f!,,,, No.........
*If yes, Southold Town Trustees Permit may be required.
I PLOT DIAGRAM
Locate clearly and distinctly all'ibuildings, 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.
_
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` ir~r>na/~d lJ ~ lahnu~ /~v.J~ 1~£s ~
' ' • ' • • • • • • • • • • • . • , being dulyy°sworn, deposes and says-tlia~t he is the ~pplicant
rvidual signing contract)
~ovc named. ~
is the ~~~~.!~loif'•~, .s~{'r';
t.'. ~i?-~?.~~../, !idri.'~~l!/G•4L..!~ ~~GCS
(Contractor, agent, corporate officer, etc.) G
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 are true to the best of his knowledge and belief; and that the
xk will be performed in dtc manner set forth in the application filed therewith.
'orn to before me this I
~.dayof..l /Vd9~/ .,'19G~~ .
tary Public, , c~~'"; ~ , ounty
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CLAIRE 4 QL
NewYoAt
Ncta Pu~c4B7980b~
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