HomeMy WebLinkAbout19370-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19716 DATE: February 7, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 1052 SOUTH DRIVE/CANOE PATH MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 106 Block 12 Lot 3.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 5, 1990 pursuant to which
Building Permit No. 19370-Z dated SEPTEMBER 7, 1990
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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to GEORGE HAMMOND
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NJA
UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 31, 1991
PLUMBERS CERTIFICATION DATED FEB. 6, 1991 - HARDY PLUMBING & HEATING
' 1 0-d..
uilding Inspector
Rev. 1/81
I\ ~IOp~ y
f VY~ i~®.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THiS PERMi7 MUST BE KEPT ON THE PREMISES UNTIL FULL
- COMPLETION OF THE WORK AUTHORIZED)
N° i ~ ~ % ~ Dote ........JS?!+:•.,~-...7.........., 19.y.S?
Permission is hereby granted^to: ae~^^ea /
...~.a..~.....N.....~.~.?~...~t.........
n~.... y.......
to ...~r.°..'.'.:9~,:4:,.t~.'...frl,.r.,.....Q.:~:ekc<rr~!?~,...~T..~ ....art.^.......Q<~:ia~....~=,.~......
' Y.Y.I...4. r~-
i of premises located of
/0.5 a ~a+<.°tl~~~~~~r-H.ae- IK~FPc..
a 4......~'a.9.......~.
~!r!'!~'t~ 4'"'1~
County Tox Map No. 1000 Section`..... ~..p.~........ Block .......~.3........ Lot No...~~..-.
~..'~g.°..~
pursuant to application doted ....s~:~",t./..R!!x~.~:.....~J 19.q and approved by the
Building Inspector, v
' Fee
~ ?'4...~yl.
Budding Inspector
Rev. 6/30/80
w Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION 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-4 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 19 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) 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 Copographic 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.
v. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
AlteraCions 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./0/,p, Commercial $15.00
Date ...1.~ ?1.~ / -
'~ew Construction....~Old Or Pre-e sti g Building.. ~h
Location of Property... .~C~~2..........v~ C~~.L:C-. ..~a:~.`.?a
House No. Stree[~. Hamlet
Onwer or Owners of Property.....~::I~:~~,-,..~°:`:C^.::<::tT r
County Tax Map No 1000, Section..1U`..~......B1ock..........Lot...A !
iubdivision Filed Map...... ..Lot...
'ermit No.~?~ ~.~.?l~ °Dna/t~e Of Permit....1~7~~U....Applicant. ~~~?~~1~..~:;; ~~~e-~
lealth Dept. Approval.....!~W~:':~..............UnderwriCers Approval
Tanning Board Approval
equest for: Tempotrrtary Certificate........... Final Certicate....Y......
ee Submitted: ~6~~?L~~ ~~C''~..~
~ic.~ t-i I ~2 6 5. ~ - .
~r~-
~ ~ f 9 ~ APPLICANT
T'-E•L. 7G_+-1:802.
mac, p. T0~~11i Eat Sg3:~J.'T~OI,1J~
s~
~ OFFICE OF %IUIZDIY~iG IA1S4~£GTOZt I2
~ y' ~ • rn P.Q. I1O;' ; 28 D ~ ~ ~ ~ IYI l5
, .mss SOUTHUID,,i.Y. 11421 Ai•rt~
Q
• BLDG. QEPT.
W OF S UT110LD
C E R T I F I C A 1+ I O N
Date l`X - b ~ .
Building Per~aitnn No • r
\~`~1
owner w ~ PN .~.P ~ ~ ~ ~~S ?YlC3^'O~
(please p((rint)
Plumber H N ` ,Y~1 Nil £ ~C~.~o,~.~e~~~~ v.~L .
(pleas print) 6 ~
I certify that the solder used _n the water supply system
contains less than 2!10 of 1~ lead.
C ~ ~ Q
(plumber's signature)
Swo n ..o befo a e• his
day of ~
Rotary Public
Nota.•~ 1~t+?~_ic, Coun:.y DOR~MANIBHARRtS~I
3"Jotary nu6;?g State of Naw Vork
tdo. 6I~~805206 • Suttolic Gou
Cs>rttma',an ~pfeas tk~ril 30. t8
765-1802 U
BUILDING DEFT.
INSPECTION
FOUNDATION 1ST ( ] ROUGH PLBG.
] FOUNDATION 2ND [ ]INSULATION
[ 7 FRAMING [ ]FINAL
REMA v
I~NNE~
2~a
DATE / ~ Z~ INSPECTOR Y
..o..,. _ _ _ _ ~ _ _
v r~
THE NEW YORK BOARD OF FIRE UNDERWRITERS , zaAf=r.,
1U0012i BUREAU OF ELEGTRICIT' ~
83 JOHN STREET, NEW YORK. NEW YORK 10038
Date FEBRUARY 07,7.991 ApplkwtionNo.onfile 70661i9U191t N 173290
THIS CERTIFIER THAT
only [he elecerieel eptlDwtsttt r dreri6ed helole end Introduced by the eppl7cent nomad on the ahooe eppfieeNon numfPSr in [he promlrs of
GE:URr,t: HAMMUNU, PVT. RD.-HTtrF: A-MAY 6:5'lATFS, MA9'TITUt'K, N.Y.
in thefollarinR ?ocetiow; ? Bremen[ ® IAt Ff. ? Pnd FI. GAR/OIIT Section Block Lot ~
uw esomined on JANUARY 3 , a 991. and found m 6e in compliance with the reyuirementAOf thL Boatd.
IlxTlln /dxRC svnTt>~s Rz RANaES QDOKIN6txlcxs ovate 1MW1w r HUK
txIllElf, NCANDlSClNT FIIIORlSCeNT OTNER AMT. K. W. NAT. K. W. AMT. K.W. NAT. R. W. AMi. N t.
l.2 24 16 7.1 3 1 ].2
DRYNS RIMUK! MOTOK tUT11M NIEIAItCE RRIEMt RfICIK TIMECIOCKS EBl IRNT IIEATNK MIxi1.0YTIRT 011RUER5
AMf. K. W. dl N. P. OAS N. P. AMT. NO. A. W.O. AMT. AM/. AMT. AMPS. TRAMS. AMT. H. P. ~QF ~1 AMT. WAli3
1 ~0
fBtV1Q OgC01NMI:T MD.p S E R V 1 C E
AMi. AW. 11'P! per. 11 eV/ 1/7\4 J/SW 7/AW NO.O~RC. COND. .O. NO. Oi N4lEO OF~X~~lO NO.OP NlUnAa OF
PROTOMI
X I 1!0 ] 1
Oi11M ANARAgIS:
A/r. trNTT 3 Tt7N-1
G.F'.C..T:-b
do'(
PAOI, R. BURNS LIC.112A?.-S
27S TUMN HARBUR 1,ANE
SUUTNOI,D, NY, ] 19'11 ORIRM MRNAOR
it
Per ~
Tkit RIaN. cot. in ony monnery refwn M Nn offiu of 1Fie bard if incorrect. 6E . }Mir cndeMials.
-COPY PQR NNt,DING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT u AITERip IN ANY MAtNRR.
rIc:LD IliSP~C:IU~7 ~~Ui,:F. ~ C.OKMGNT~ 1 _
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FOUNDATION (1st) a ~
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FOUNDATIOtJ (2nd) ~ ~
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ROUGH FRAME & J p}li
PLUMBING ~ F
y
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ItJSULATION PER N. Y.
a.
STATE ENERGY
CODE x y
} .3s
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.Z f O' ~ H -G:
4 . .~e,
FI7JAL
ADDITIOA7AL COMMENTS: x L~
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BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY . . .
TOWN OF SOUTHOLD CHECK .
BUILDING DEPARTMENT SEPTIC r•oart
TOWN HALL
$OUTHOLD, N.Y. 11971 NOTIFY
QQ,,,, _~_f',' q TEL.:7~5-1802 CALL
Examincd:~-+~.?,19{~.~ MAIL T0:
Approved NR~~~{7,, . 1., 199 ~ Permit No.~ 9.3.7V .
Disapproved a/c .
(Bus mg Inspector)
APPLICATION FOR BUILDING PERMIT
~j
Date 15...
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~
sets of plans, accurate piot 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
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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
shall 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
shall 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
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described.
Tlie applicant agrees to comply with al] applicable laws, ordinances, building code, housinti code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspt~ect}i ns. t _
4 RRFF(Signature of appli~c°'a~npt, or naame, if a c`,orpopration)
V'~~•\VT,V1~eD {-d~7~til.l.. .~.7v~=Pic\.~l~ ~~~_1 ~
(Mailing address of applicant)
State whether applicant is owner, ]essee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~?':c.-~ , ~ ~n~~-~:~:'r .
Name of owner oCpremises ! .
(as on the tax roll or latest deed)
If applicant is orporation, signature of duly authors ed officer.
(Name and title of c~o7rpo`ra~te officer) ~K"~ '
Builder's License No. ..l . r..:'l
Plumber's License No . .
Electrician's License No . .
Other Trade's License No .
1. Location of land on which proposed work will be done;
House Number ~Str~tm BT ~ ~ ~ Hatt^~t ~a ~ ~ j
County Tax 11ap No. 1000 e do t, • • • • • - Blvck Lot '
JO SoZ ~o.wt''~- ~.v/Cc~o-~- PaN~.. ~ ~ . .
Subdivision ffl, lF.... Filed ~1ap No. ~ol• „ • , , , , , , Lot ..3! .
~(Nauie)
State csisting use and occupancy of prcmiscs•• ame~nd intended use and occupancy of proposed construction:
A. Hxisting use and occupancy...Gr.~.~
B. Intended use and occupancy..... ~s'•`':'::'-~
1
3. Nature of work (check which applicable): New building Addition .l? • • • • • • • A11tration
Repair Removal Demolition ..............Siaimning pool.......... .
Tennis Court Aclcessory Building..........Rence .......Other Work:..........
4. Estimated Cost Fee .
(to be paid on filing this application)
5. If dtvclling, number of dwelling units Number of dwelling units on each Cloor ~ .
If garage,numbcrofcars
6. If business, commercial or mixed occupancy, specify nature and extent of each ty c of use .
7. Dimensions~~QQf existing structures, ~f any: Front Rear , , , Depth ~ , , , , , , , ,
Hcicht ..~'T........... Number of Stories .0 . .
Dimensions of same strut ure witEi' alterations or ditions: Front 6.~........... Rear , , , , , , , , , , , ,
Depth ....e4:~ . Ileight .....~rjd!''.`~.......... Number of Stories .
8. Dimensions of entire new constntetion: Front Rear Depth .
Height ..Nu berofStories. .
9. Size of lot: Front ..JN~...~tt~`~...... P.car Depth ,
I0. Date of Purchase . ame of Fo cr Owner ,
11. Zone or use district in which pretrjises are situated ~E~)'~'~~:~ • • • • • • • • • • • • • • • • • •
12. Does proposed construction violate any zoning law, ordinance or regulation: .
o
l A. Namle of O caner of remrses C~'~~~ ' ' ' • Will exc s tll be re pved from premises: Ycs No
p , r~~.:~m... AddressTo~ ~~44..... Phone No . . .
Name of Architect .Address Phone No..
Name of Contractortl.~N..~'.-t~'Q~^:-:.~T°•:~:3. Address~~`.'1. ~v~~S.`~'^.~,U:~'!~ ~~Phone N ~6~.~.~
IS.Is this property located within 300 feet of a tidal wetland? Y);S. ..NO....
*If yes, Southold Town'~iTrustees PLOT DIAGRAM a required.
Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block nltmber or description according to deed, and show street names and indicate whether
interior or corner lot.
'~f
STATE OP N61V O~~}}~~' I!S.S
CO T OF ..~v:e"l.°1.......
:.W."4""::~'~`!` . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
about named. Q e n \
FIc is the .~'.~"~.~q~...:~...... ~~lQ\1 ~uS1'~v... Y!°'.":^fZS..•~'.Y:°
(Contractor, agent, corporate officer, etc.)
_ oC said owner or owners, and is duly authorized to perform or have performed the said work and to make and Gle this
application; that all statements contained in tltis application arc true to the best of his knowledge and belief; and that the
work will be performed in the manner se[ forth in the application filed thcretvith.
Sworn to before me this
..day of .9~... [1~~~-~~/'/8........., 1~ 9a.
Notary Public, •i: • • :~'.v•~'~... County ^
NO7ARYPUB
NI to~llewYerN (Signature of applicant)
kb. 4701878, Suffolk CouMYr+ .
Term Expires March 30,19
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