Loading...
HomeMy WebLinkAbout19909-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20683 Date APRIL 27, 1992 THIS CERTIFIES that the buildin~ ADDITION Location of Property 670 THERESA DRIVE House No. Street County Tax Map No. 1000 Section 115 Block 13 Subdivision Filed Map No. MATTITUCK, NY Hamlet Lot 19 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 24, 1991 pursuant to which Building Permit No. 19909-Z dated JUNE 4~ 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 FLOOR BEDROOM IN AN EXISTING ONE-FAMILY BWF. I~/NG AS APPLIED FOR. The certificate is issued to of the aforesaid building. ROBERT FLORSZ & WIFE (owners) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N 204618 SEPTEMBER 23~ 1991 PLUMBERS CERTIFICATION DATED APRIL 24~ 1992 ' / fBui~[ding Inspector Rev. 1/81 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) ,0_ 1C~c~O~ Z Date ............. ..~...~......~.. ............., ,9..cJ...l. Permission is hereby granted to: ...~.~ ...... ~ ....... ....%...~. .......................... ........... at premises Iocat~ e~ at ....~..2.0....' ~ .~~j~.....U~...~.~. ..... ~...~.~ ................... C~n~ Tox Mop No. ~000 Sec*io. ..... /./.~. ........... Block ....... L..~ ........ Lot No..J...~ ................ pursuant ,o application doted ....... --.~....~.......~'...~. ................... , ,9..?.~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Form No. 6 TOI~N 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: I. 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/i0 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. %. 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 .... ............. ..... ~ew Construction ........... Old Or Pre-existing Building ...... ~ ........ · ocation of Property...~,.7~) .......... :'J~.~L~, ,r~.~..g~(f..,~.,/~,,t~'.~ ........ ~4T~.~ ...... House No. Street Hamlet )nwer or Owners of Property.. J~0~.~.~..~ ~ounty Tax Map No 1000, Section .... ~.~.-~. .... Block ... ~.~ ....... Lot ...~ ~ ......... ,ubdivision.__....__........,.._. ............... ~iled Map ............ Lot ...... ~ ................ ~ermit No.~'?''~'Da~e Of. Permit.~/~ ....... Applicant.~O~.......,.................. ealth Dept. Approval .......................... Underwriters Approval::..-..j ...... lanning Board Approval ................... equest for: Temporary Certificate ........... Final Certicate .... ..~..... ee Submitted: $ ............... ,j~ ~~ .~~ ,,~ ::~- ,~.~Z'/'~ ' ............... ........ APPLICANT .' InLD FOUNDATION {1st) FOUNDATYON (2nd) ROUGH FRAME & -PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR C TY ~' 85 JOHN STREE~ NEW YORK, N~ ~W, YORK 10038 Dete Application No, on file THIS CERTIFIE~ THAT and found to be in compliance u'ith the requirements of this Board. Lot FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: $ E R V I C OF CC~ COND~ OF HI.LEG A. WG GENERAL MANAGER ~ 'ibis certificate must~ not be altered in any monher; return to the office of the Board if incorrect, Inspectgrs may be identified by their credentials. Co.. ~.o?!?~?~,~._~:._.!?.7 0~ ~,~!~? ~?~ ~"i~F"",~" !"~"' TOWN OF SOUTtIOLD OFFICE OF BUILDIHG INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 ~ E ~,,T ~ F I C A T I O N Building Permit No._iq 90 q 2- /~ (~_1 ea~ e print I (please prznt) I certify that the solder used in the COntains less' than 2/10 of 1% lead. Water supply system Sworn to before me this Notary Public LINDA J. COOPER Notar~ Publi~, State of New Yo~ No. 48225~3, Suffolk Count.t.t.t.t.t.t.t.t.t~ Term Expires December 31, 19 '/ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No.. ~ 91.57 ..... Date ........... kuguak .8, ...... , 19 7.8. THIS CERTIFIES that the building located at .670. Theresa .Driv. e ....... ma}tx Map No...4.256 ...... Block No .... xxx...Lot No .... 1..5 ............................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 5. ~L y.. 2. .0 .......... , 19.7.8. pursuant to which Building Permit No.. 9. 8..5.7.z.. dated .... Jul.~ .24., .......... , 197~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... AC¢gSSORZ..t~UILDI~qG ............................................... The certificate is issued to . G~.~.. V....~d..v. icg£nia, lq... EttZemy. er ................ (owner, lessee or tenant) o! the aforesaid building. Suffolk County Department of Health Approval ...N/A. .............................. UNDERWRITERS CERTIFICATE No ........... I,I/.~ .............................. HOUSE NUMBER ...6.7.a ....... Street. Theresa Driv, e, Mattituc.k, New ........... York ................................................................ Building Inspector STATE OF NEW YORK) COUNTY OF SUFFOLK).: Gary V. Ettlemyer, being duly sworn, deposes and~ says: I am the original owner of the' home located at 670 Theresa Drive, Mattitu~k, N.Y., SCTM # 1000-115-13-19. This home was built for me in 1972. The survey of Young and Young, first dated July 13, 1972, Job N. 72-522 correctly depicts the perimeter of the home. However, the survey depicts the home as a one story frame house whereas it is actually a one and one-half story frame house. The house was originally built as a one and one-half story frame house and the~e have been n? changes or modifications made to the house since it was built that would require a building permit. The Certificate of Occupancy issued by Southold Town for the house, number Z4884 da%ed October 31, 1972, is for the one and one-half story frame house constructed on the premises. Sworn to before me this 26th day of June, 1987. HENRY S. SAXTEtN NOTARY PUSUC, State of New Yo~ No, 4686817, Suffolk County ~ Gary V,~t~lemy~r FORM NO. 4 TOWN 0F SOUTIIOLD BUILDING DEPAIITMENT Town Clerk's Office Soulhohl, N. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at . ./-:~,] .a-4. ~:~,,.~.-...~..~w.. ~. ........ Street ~ap No. ~ ~.,.~locl~ ~o .'.~ ' .~o~ ~o. ~.~ ...~~~.. ~-/' ]% x V~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office 7pursuant to which Building Permit No ......... dated .............. ~ ........ , 19.1.~, was issued, and conforms to all of the require- ments of the. anplicable~. . provisions' of the law. Tlm~ occupancy, for which this certificate is The certificate' is issued to..~ .... ~d4 ~ ...... ~~ .... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of tteatth Approval .C~2'~ ~q/~ .~. k. ~ .~ .~.~'~ UNI~ERWI~ITEI~S CI~RTIFICATIE No.. 2 .t.~ .¢ ...... ~r~-: ~ (~ ~ ........... lhfilding Inspector 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~ING [ ] FINAL DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~H PLBG. INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [ ]~ULATION [ ]FRAMING [~'~ FINAL .-~,JR,~S-- OK~rn_ ~ DATE ~ INSPECTOR 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO~H PLBG. [ J FOUNDATION 2ND [~INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ DATE I NSPEGTOR~.~/~ / !3LDG. TOWb~ OF SOU'D~OLD · .~.~ .~ .... 19~.1. ~pproved .~..~ -., 19~t.Pe~itNo.~.9~.~. 3isapproved a/c .... . ......................... ""~ .............................. (Building Inspector) ~PPUCATIO~ FO~ BUIkDI~G FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 INSTRUCTIONS BOAKD OF HEALTH . SURVEY .~. ....... : ' : ....... ""'. SEPTIC FORH .............. CALL . . . . ....... HAIL TO: 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- xtion. ¢. The work covered by this application may not be c~mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit roll be keRt 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 t; the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or hgulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with ail applicable laws, ordinances, buihling code, housing code, and regulations, and to lmit authorized inspectors on premises and in building for necessary in~l~/ctigpss. --- .<.. , .<e<, ................... (Mailing aaaress of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. - 0 {as on the tLr~ roll or latest deed) applicant is a corporation, signature of duly authorized officer. .' (Name and title of corporate officer) Builder's License No.. 0..(.0. ~ Plumber's License No...0..~. ~ ............. .... Electrician s License No .............. Other Trade's License No ...................... Location of land on which proposed work will be done ..................... House Number Street Hamlet County Tax Map No. 1O0O Section ...... / ............ Block .................. Lot .... [ ............ St bdivision ~ .~9~..~.. ~ ...... Filed Map No..~.~ ...... Lot .... [~ ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: E i ti nd eec ' a. xs ngusea upancy ..................... . ' 3. Nature of work (check which .i apph~able): New Building .......... Addition ........ Alteration .......... Repair .............. Remove! .............. Demolition ..... Other Wo~a .a. ,. .......... 4. Estimated Cos . .. , ' .......... ~ ....................... Fee .. (to be paid on filing this application) 5. If dwelhng, number of dwelhng umts ........ Number of dwelling units on each floor ............. . If garage, number of c~s ....... [... · · · 6. If business, commercial or mixed o~cupancy, specify nature and extent of each type of use ~ . ~ ~(~T] ~ens, ons st~cture with ~lterations or additions ~b ~.' ' ~'t~' 8. D~menmons ~f entire newennstm~tion- Front //~ O ~ // ~/~ ' ' ' ','~ t ~' · · Zone or use district in whmh premmes are situated 12. Does proposed ' ~ . ' .................................................... construct on wolate any zomng aw, ordinance or regulation: .~.0 ............................ 13. W~I lot be regraded ..... ~0. , ~ ............... Will excess fill be removed from premises: Yes 14. N~e of Owner of premises ~ ~,. ~.~. Address ~0 ~. ~t.~ Phone No ~ . ... Nme of Architect .............. Address · · · Phone No ................ Nme of Contractor ................... Address ................... Phone No ................ 5. Ia this property within 300~ feet of a t~dal wetland? *Yes ........ No..~ .... · If yes, Sout~old Tow~ Trustees Permit may be required. ~ ~40'40'~. ~ PLOT DIAG~ Locate ~ lO, Ct ~ --~ indicate ~1 set-back d~ensions from )rope~y H~ ntefior or c /~,o'~'LOf /~ ' -~mas and Mdicate whether ~ J~o ~ 20020 ,¢ ft. ~ THERESA ' DRIVE 'ATE OF NEW~OR~ z ~ ~ (Name of individual signin c6ntract) ove na~ed. i (Contractor agent corporate officer et~ ........................... said Owner or owners, ~d is duly authorized to perfo~ or have perfo~ed the said work and to m~e and file this :lication; that all statements contmned lm this applfcafion are true to the best o~hfs knowledge and belief; and that the rk will be perfo~ed in the m~ner set forth in ~he application filed Uterewith. om to before me thi~ . , Ou.llfl.d ~. S~.d~ C~u~._ ~' (S,gnamre or apN~cant) ~mml~lon E~res ue~m~r u, 18~ i, sJopunoS ~ X~lsxoqoi '~