HomeMy WebLinkAbout20280-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-21088 Date OCTOBER 14, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 505 PVT. RD #11-OAK LEAF LA. MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 113 Block 9 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 13, 1991 pursuant to which
Building Permit No. 20280-Z dated NOVEMBER 15, 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 2ND STORY ADDITION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ROBERT G. & MARY ANN SMITH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-247427 - AUGUST 20, 1992
PLUMBERS CERTIFICATION DATED OCTOBER 1, 1992 - PECONIC PLUMB. & HEAT.
~
ld'ng Inspector
Rev. 1/81
FOBS NO. E
TowN of sovTHO> D
Bf3fLD1NG DEPARTMENT
TOWN HALO
SOUTHOLD, N. Y.
BUILDING PIwRMfT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL
COMPLETION OP THE WORK AUTHORIZED)
N~ Z O 8 ~ Z Date .......i~..A':~:'^.:1~..... 5..........., 19.`~.~..
Permission is hereby grante1~d,,,to:
..!:.lla~r~ ~
.`~f .9..
to r!...... :4? 4.M..... d?:
tR
. ~ -
at premises #oaated at ...~?~.....,~........P.'.'f °4~... .,~~:~1.......
County Tax Map No. 1000 5ectian .......~~.~i....... Block 9......... Lot No.......~..~
pursuant to app#ication dated ~:?~.~!:'.^!1... 19.`.1..., and approved by the
Building Inspector,
. ^..r-
Fee ~
.l c~ 1" r~-t.
Bui ding Inspector
Rsv.6/30/80
d//~!w r (
Form No. 6 ~~11 ~,1~11~~i~.~~~~, ~ i.
~~/ly~¢j,)} TOWN OF SOUTIIOLD ~ i
BUILDING DEPARTMENT MAY Z 7
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OF, 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 Pire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
~ less than 2/10 of 17 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.
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 - Residenti'~a~-j~l~!~$15.00, Com~gmper~7cial $15.00
Date .C~ / ''..//~~~.~7/0L
:ew Construction.... Old Or Pre-existing Building...l/,..
.ocation of Property~~s, ~o~'+Fa~.-~~~ .........~7~:~ • ,,Cc~/~Uc~,1l~i~
IIouse No, l ~ Street Hamlet
nwer or Owners of Property. CY; $!?7e~,dr-~2~.~y :/~~~h,;~!yli~(._... .
ounty Tax Map No 1000, Section... ~~3,,,,,,,glock.....Q./...,,,, ,~f .
.Lot.
~bdivision .............................qq.~~......Fi/flegqd Map............Lot.............[.........
'rmit No ................Date Of Permit~Y~:P.I`3Jf,5/~,,,Applicantf!`c1~2iU Ci;~~/lari/~........
~alth Dept. Approval ..........................Underwriters Approval.........................
anning Board Approval
quest for: Temporary Certificate........... Final Certicate......
e Submitted: $
•
~ ~bg APPLICA.*1'r
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1@@0121 BUREAU OF ELECTRICITY ~
85 JOHN STREET. NEW YORK, NEW YORK 10038
pate AUGUST 20,1992 Applico[ionNo.onfile 76490692!92 N 247427
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above oppfication number in thepremisea of
ROBERT SMITH, WESTPHALIA ROADII,--IIMATTITU.~~.C77K, N. Y.
in the foUmcinp !oration; Rasernent LJ fal F'l. AJ 2nd F'!. OUT Section Bfork Lot
uoa examined m, AUGl38T 18,1992 and found to be in contpfimu•e with the rryuiremerzta q(this Board.
FI%TURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS '
OUTLETS ECEPTACLES SWITCHES INCANDf SCENT FWORESCENi OTHER AML K W AML K.W AML KW AMi K W AMT N P <
~ 6 6 6
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MSYSTEMS ET DIMMERS
AMi N, W Oll N p GAS H P AMT. NO. A. W. G AMi AMP. AMT AMpS. TRANS. AMT, N P NO. OF FEET AM{' WA{ii
2 fi00
SERVICE DISCONNECT NO. OF 5 E R V t C E
METER NO OF CC COND. A W G NO OF HI-tFG A W NO OF NEU{RAtS
AMi qMp TYPE EQUIP. 1.e'RW 1,e'3W SR3W 394W pER9 OF CC.COND OF HI-LEG Of NEUTRAL
1 20@ CB 1 % L 2(@ L (0 p
k
OTHER APPARATUS:
PANELBOARDS:1-16 CIR. 100
G.F.C.I:-1 ~
SMOKE DETECTOR:-1
TRACK LIGHTING:-24
IC
r
PAUL R. BURNS LIC.N282-E Gl/~~
275 TOWN HARBOR LANE
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
Per S'
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.
~iZ
TEL. 765-1802
o ~Ol,, TOWN OF SOiJT~OL~
o f
~ ~ . ~c OFFICE OF BUILDItQG iN5PECTOR r
~ P.O: BOX 728 )r t i ~
ay ty ~ 'a , a' PPP
rjJ ~'ZJ!' ;-~•~;r},~ r=n 5~i§~'~'~~.n 0."',~i~;r~~~~jr~z r~r y.~
.r ~ ~ TOWN HALL 1 = i
Oj~~O~ ~ SOUTFIOLD, N.Y. 11971 - ~s ~C"r _ ~ f~~~ ' t ; ,
i. ;
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k• ,'~~.+tfJtiel iak~ rod 3r§'i Yr ~ .
C E R T"I F I C A T I O N ,
Date /=~(r~~
Building P11ermit ~~N^^o.~~// pZ ~C~
Owner ~fiO~ JJ~y/~+Td'1
(please print)
Plumber ~~°'ZC~/ ~ /mil i~;+ lnonrr ~~p~/q~
(please print) -l
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
.~n~~// ~ ~ `y~f
p~umber's Signature)
Swo n to beforo me this f,
day of
~1 Notary Publi~ ~
t7otary Public,J County • gpp~a~~~ ,
- ~ ~?eryPubifc, Sate of New York
No.48g4752
Oua61)edfnSuliOlkCounty r,~
Comm(eslon E7gr6es Sept. 30, t? / ~
c1ELD I;:S:'ECT'_U;! ~~Un:c I i;OMMLNT°
~ ~
1 . "O
mp
A~
_ _ _ y~
FOUlJDATION (1st)
- ° A~
~ U
FOUNDATIOIJ (2nd) ~ ~
2. - - - m
o
POUCH FRAME & ~
PLUMBING ~
N
3. ~ -3
IIJSULATIOIJ PER N. Y. m
H
STATE ENERGY
CODE
4 . ~ ~
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FI;JAL ~~d ~
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ADDITIOIJAL COMhfEPlTS: m
x
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ) RO H PLBG.
FOUNDATION 2ND [ " INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~ ~
4__-_ ~C~Le`~
i
DATE ~ Z~ INSPECTOR
0~7~0
765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUN TION 2ND [ ]INSULATION
[ FRAMING ~ [ ]FINAL
REMARKS: /
~~-t~~
DATE -3 ~ INSPECTOR / V~
DESIGN CRITERIA 6,000 Degree DY.ye
(FOR NON"ELECTRIC fiEAT) O,A. l0°F LA. ~0°F
v 2 2„cs~',-} ~ B
r~ s yS ~F M~ ~ a E ~ Da-sic' -rp,~nn~ i 1Z E Ml~ R It 5 .
. J AtiNG
Exteriar Walie (Opagae) ~`7~
Clt.lnq ~ ~ /6 ~ ',j3 ~l3 1'~ /lr57+ ~ar~~»+,.._ ,r e~„~
DinfR
ch111najnaet (Onagne) 34f,~^ u ~
_
. .
Skrttol,tn 96' 2.~ ,3i ~ /t^ Prf~ ~r~ ..._sr.._ u, ~~Wz
!'l~or -
?anndatlen Nally
Slab Insulation
- . 6
TOTAL a 5
r
Notea~ '
Rrildlrq Ehaelopr, S7str«r+ to Meet require«tntn of 781~¢.i
HVAC Equifi«rn~s to «eet regaite«ents of 7N1~.11
NVAC- Sintr.«++ to «ee! regfdre«ents of 7Rl~,lf, ,
Diet S~«te«K !a «eet require«ents of 7815.13
VFntilo.lianK Syste«h to meet require«entn of ~R15.14
insulatlen of Pinina SysteMe to meet require«entn of 7N1'S.15
Service Water Neatina Srste«e and Equip«Ant to rAeet Aegiilretnentn of 7815.!1
F,lectrical ah~t Likhting Srnte«n an~i Equip«ent t° «eet require«enta of ~A15.31
..mss- re..
y.
~q
T6 tie boat of «r KMexledge~ r;~~
c`- ~'°i;~.
t+ellef~ anA prot'ennirnal a~z~ ~a.~~,~ ~°~r
,jt+fae«ent~ thena nlann arro in ! °a ~ r
Via, c~
co«rliance Nith the code. l~°~`
,
_~4 l y
~~'~.~fi. Y4>
@'°
' a.
~~~E',t"a3$1~t'4
LAWRENCE M. TUTHILL
PROFESSIONAL ENGINEER
P.O. BOX 182
GREENPORT. N.Y. 17944
(516) 4779652 ~
,
/ ~
~ a ~l ~ ~ ~v y ~ ~ ~ ~ 1
r CJN
u
` ~ a
Z~ J ~j~cl ~i~ ~ f~~'' ~ ~ y ~ ~
//,I h ~,~y ~_s-~
~ "~~'-:1 Sf.,K ~~5S+`~'" BOAFO OF HEALTH
~~~Y~rg"~lre.l.`,.7 I:'~-,~ % ~ FORM NO. 1 • .
J SETS OF~PL.1aS
l(t,`~ ~4 TOWN OFSOUTHOLD SURVEY
J ~RJY ~ ~7~~ did ClICC1; .ls~~.. .
BUILDING DEPARTMENT • .
' t TOWN HALL SEPTIC I'OR.1
s-~'13!=_..~ '_.;F';r SOUTHOLD, N.Y. 11971 . . . .
"r'
?~-''~'`s~'~~`.;•~p~~ Mkt TEL.. 765-1802 t:0<IF'f,
Examined .A7,tt'~e^^,,~i!.~.e: IJ
, 19~91 enLL ....7.~~= .
PfAIL TO:
Approved /4 ~...,~,y, ~ S , 19`~L .Permit No. 2 o a,2~0, ~ . .
Disapproved a/c _ .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date : i ~ 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
>r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:ation.
Ic. 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 Bui]ding Department for the issuance of a Building Permit p~rr~s~nt to-the
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
fire 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 inp~/sp~~'ecti-o~-ns~.-- ,y
/,l4cJ~~ . / ~~lG'~ .
(Signature of applicant, or name, if a corporation)
poi%< ~a,~.s~~~„c..,~~~y .i~~~............
(Mailing address of applicant)
State wltetlter applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. Cr~.h ~rac~or ee~ rAFiaa!~
\amcofownerofpremises ..!:o;~?E'h~.Ga,~!?i~,~h;,S~,~Q-~"y~/)r{ ~,S~y/fJl
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. •
(Name and title of corporate officer)
Builder's License No. ~.~),77y°H~
Pluntbcr's License No. .
Electrician's License No .
Otltcr Trade's License No . .
Location of land on which proposed work will be done . . . . .
~L ,A,1 .I d~
Ilousc Number Street Hamlet
County Tax Map No. ] 000 Section I1,3 Block ......Qr/, , , , , , , , , Lot
Subdivision FiledAlap No. Lot...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...~1?? ,r~^??1i. ~eS/~~nee
, .
b. Intended use and occupancy ......S~n~. a:~ ..f4-~m.~`,;, " ' ~ •
3. Nature of work check which
r P ( Re applrcable): New Building , , Addition , Alteration
Re air groval , . , .
Demolition Other 1Vork , ,
4. Estimated Cost .......~J~,•$l, dU'~• 4d (Description)
Fee
If ara e number of cars (to be paid on 61ing this application)
5. If dwelling, number of dwellins units , , , , , , , , , , Number of dwelling units on each floor , , , , , , , ,
g S.
6, If business, commercial or mixed occupancy, specify nature and extent of each ty~te of,use .
g d es, if any: Front ..:.r0~, . .
rmensrons of ex'stin structu nbcr of Stories , , , . , , , , , • , •
g ....Rear ....~0........ 'Depth ..~5~. , . , .
Her ht ~ } Nu
De t1t , , , , , • • vith alterations or additions: Front SUS ~ • • ~ • ~ ' ' ' ' ' '
p ensrons o sa e structure `nrction: Front ....a:y~ ~ y,. ~ ' • '
Heim 9~ ' ' • Height 7,~ , , , , , , , , , , , , Number of Stones , .
8, Di menstons of en ire new cons~ber of Stories ?L.. , , ,
ltt /`.7......... Nu , Rear Depth a ~ .
9. Size of lot: Front , Rear . • r . . . . .
10. Date of Purchase Depth,..-r3'r?,,,,,,,,,,,,,,,
Name of FormerOtvner .
1 1. Zone or use district in which premises are situated . . . . . . . • . , ~ • • • • • ~ • ~ ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '
12. Does proposed construction violate an zonin law ordinance or rem
13. will lot be regraded y g aulation: 1~0 .
' N4 • • • • • • • • • • • • • . .will excess fill be removed ~fj om~ premises: Yes
14. Name of Owner of premises . /Qob~•o~ .S,qi~ , , ,Address /,ee2ln2 /1¢lli~fphone No...:~~8 :y:3!~ .
P P y ~ • • • • • • • • Address .....Phone No.
ame o If hyees t Southold • • • • • Address '~i19~~'~r. P,eu.
?!L~J,.U~y, • phone No...~d•t`'/z~
15. Ism this orroae>°t with n 300 feet of a tidal wetland? ~ •
~ 'own Trustees Permit may be required No,,,,, " "
PLOT DIAGRAM ,
Locate clearly and distinctly all buildings, whether existing or proposed, and, i icate all set-back dimensions fr9m
property lines. Give street and block number or description according to deed, ands w street names and indicate whether
interior or corner lot.
.c.Z•~ c~-ssvme 7"~ere w~// not be G- nv~l ~c,r ~Fus~tes /~rr,i~'
beca„se ~ rea~o~s~
77/Le bv~/c1n~ iS rmre ~aO~ `~~J~e ueo~I~af~s
u~pr'~ ~ern~ d~+rC cr,. t~o~ m~ L°u'r..sn~y S~ruc~ure qC
~i I'w•G,~ore ><ikre w/// be nm E.)oca,vus~ibi•~ (J
I
TATS OF NEN,YORK, it
a G
• ' ' ' ' ' ' ' " ' " ' ~~r ~"`~~WW~.~•~, ~ g sG~ • • • • • being duly sworn, deposes and says that ]te is the applicant
(Name of individual si nm contract)
rout named.
_ is the ~na.~for ' C~trz~u7~~Y`
• (Contractor, agent, corporate officer, ctcJ • • ~ ~ • • • ' ' ' ' ' ' '
said owner or owners, and is duly authorized to perform ar have performed the said work and to make and Gle this
plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
rrk will be performed in the manner sot forth in the application filed therewith.
porn to before me this
tary Public, .County
41NDAJ.000PER
Notary Publlo, State of New York • • • • • •
No.4822663, Suffolk Cnunty~~ (Signature of applicant)
Term Expires December 31,18
ry tw 3
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