HomeMy WebLinkAbout19108-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19365 Date SEPTEMBER 18, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 2400 OLE JULE LANE MATTITUCK NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 4 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 1, 1990 pursuant to which
Building Permit No. 19108-Z dated JUNE 8, 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ROBERT & NARGARET WHITE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF NFAT,TH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-148539 - SEPTEMBER 11, 1990
PLUMBERS CERTIFICATION DATED NJA
Building Inspector
Rev. 1/81
I
x®..
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHALD, N. V.
BUILDING PERMIT
' (THIS PERMIT MUST BE KEPY ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZEDD
No ! ~ ~ Z Dote .....5~:~[~ 19.f..~~..
Permission is hereby gmnted 40:
e~~
at premises located at ......s~....7~C/~y....~...`ft~~i~~bC~'L......1~
j County Tax Map No. 1000 Section .....r~.2........ Block Lot No.....~1......
pursuant to application dated 19.9., and approved by the
Building Inspector.
Fee 5....~~...4. ~j~/...
.r'v°l•.ext
Building Inspector
Rev. 6/30/80
a
• Form No. b
P ~ ~Q p TOWN OF SOUTHOLD
~ BUILDING DEPARTMENT ~ n ~ ~ ({~S
'`~p~~ TOWN HALL U g 1r.
765-1802 ~ '
AUG 2 81990 ± , ;
~
' e1PPLICATION FOR CERTIFICATE OF OCCUPAN
' BIOG.
CYES'T.
' T. F.,O TNO D.
This application must be filled in by typewriter OR ink and ~ae~~iu~ehi g
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 bf electrical installation from Board of Fire Underwriters.
A. Sworn statement from plumber certifying that the solder used in system contains
~ less than 2110 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, 195,j) 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 ~ ditsuns to dwelling 2 D
Alterations to dwelling $25.00, Swimming pool $25:uu, Hccessory uut.iuuig .r~~.00,
Additions to accessory huilding $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. UF,datnd Certificate of Uccupancy - $50.00
S. Temporalry Certificate of Occupancy -Residential $15.0/0~, Comom~ercial $15.00
~~j//0~~~9' °L._ Date ......7ra. .°.~,1 ~~g~
(j . r
::ew Construction.........~j..~O/ld Or,Pryrje-exist/ing Building........,./~..~y...~~
Location of Property....?:.7,.QQ..Kt•Y:.~.Nf~•+~7•~°••~••~'~~~•:f•u`t4t•~v~'••%1~~.~^'
House No~ Stre~ayt ~f~ of
Onwcr or Owners of Property.:
o J:: ~:a~~.
• r. ~~~!•~•~r• ~ z ° • • • • • • • • • •
County Tax Map No 1000, Section... f °?°.~....B1ock....~........Lot.... ll
Subdivision.//........G.~.y
........................Filed Map........~..y/oC......{.,//.~......~:........
PcrmiC No. , i. ~
f0 a i'.•:.Date Of Permit.:~~~~~~....Applicanl,7~,Y ~°~4'~.. • •"•i'~{~~ - •
{iealth Dept. Approval.........-•• ...............Underwriters Approval......................
,
Planning Board Approval
Request for: Tempor7ary Certificate........... Final Certicate.•..~,/... ,
Fee Submitted: $.v.~d~. ~
. . . . .
0.310.• L~~JUp APPLICe~,NT .
nn~ ,n 2C~C'
"Ff#f Nf W YOLK BOARD Of FIRE UMDft~T~RS PAGE i
1000744 sanewu oR e1.ecTlaclTY
BS JONN STRltT, Nt!VV YORK, NEW YO1Nt ~t003/~
ate SEPT$!lBER 11,1990 gppflcattonNo.onJile 70316390/90 N i48539
THIS CERi1RIBS THAT
only tho dectrto~t pri'mant ~ ducrihad kslete and tntroJrcotl by the gp(lcrtt waatsd on tMafiaes appliwtkrt nrmkor in tM paatLee aJ
OBER? W82TE, 2400 OLD JEWEL LA., POLE117, NATTi?UCH, M.Y.
in thejdbainR low~jpp ABaupy/pt ? let Fl. ? tnd FI. r*AR/OUT Ser[inn Bloek Lot
ores examined un A11Crt1S L 3 , lYYU andfornd to he in wntpliance Tetth the requirements g(tAia lwrd. "
_ _ _._-T - _
11711tIM p~ITtIMf RAMOli 1f1CRS. i UJIIIio
twtt!}{ ~ f~~~ INCANDtSClMT PRWIRSClNT OTNER AMT. R. W. AMT. K. W. AMT. tW. AMT. K. W. AMi. n. P. RA
6 4 6
- _ - - -
rlRrws RIRNACE tROrclRS ttnllr arulwtea RItR?~[ I?KWIMCR 11W UOCR>; Mu PINT 11~/' tWlfFQ111W 1 MR1~6
AML K. W. Oll N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMI. AMT. AMIt. TRMIS. AMi. N. 1. f AML ~~WATft
1 15
fIRRVK7 OIfOONNlCT NO.Of S R R V 1 C
AML AMr. Trrc 1AHN I r tw 1 A aw a i aw 3 / Aw No. a RcecoNG. aP ~c
' No. aP NiatG ~ w. W NtYTMIi tN w..
orRel A17kRhrtlk
Q
WIRING /OR OARAGE EXTENSION ONLY-1
PANELBOARD3:1-3 CIR. 100
O.F.C.I:-I ~
' ~
RICBARD C. RELYEA LIC./214SE
P.O. BOX 372 t
LAUREL, NY, 11948 ~ -
11
Per
T11ia. mIM- in tllalwr;. rNurn eP 1M.offia of Nla Mtlttl W ' ya..'.
coPV fat WILDIN16 ~awrr~r ~s carr cr ~tTe rr~uiT ~ ~+~_aBlr~.
zr~ TEL. 7G5-1802
~pS~FFQI/fCOli TO1VN OF SOUTIIOLID
.;a y~
~ ; , ''a,,t ~ .c OPFTCE OP BUILDING INSPECTOR
, ~i'~ ~ P.Q. BOX 728
TOWN fIALL
0~0~ ~ SOUTHOupuN.tY.239711990
Robert & Margaret White
Box 206
MaCtituck, N.Y. 1]952
To Whom This May Coztcern,
We are unable to complete your Certificate
of- Occupancy because of the following reasons.
An application for Certificate of Occupancy
~.s not on file. {ENCLOSED)
/_/~o Underwriters Certificate on file.
/J_?J The check is (dl~Y~aYfS~B$not on file.) $25.00
/ / No ttcalth Dept. 1?pproval on file.
No final inspection has been made.
Yleaae contact our ofL-ice on this matter.
Thank. you for your cooperation.
Building Permit 1 9 1 0 8 2
Butldi.nct Dept.
/ No Plumber Solder Certificate on file.
{ all permiL•s involving plumbing being
.issued after Rpril 1,19II4 )
~y~,,p TNSi'~TSOr~ iW~#T~ I~ CO>r:•7~.uT.S
h ~
t . _
FOUtIDATI0;7 (1st
_ _
~£J C
ro
FOU'IDATIOU (2nd1 _
2. o
ROUCH FRAME & d
.PLUMBING
H
m
3. ~
H
I17SULATIOPI PER N. Y.
STATE E1IERCY
CODE ~ _
c ~
O m
H
4. '
FI;IAL ~
° ~
ADDITIOPIAL C014Mi;P7TS:
~ p\`
x U
H
~
o
.
a
x
d
M
ro
.d
3ifi' =Ct
r
I~/~ 765-18~Z
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FO DATION 2ND [ ]INSULATION
[ FRAMING [ ]FIN"AFL
REMARKS:
DATE ~ D fNSPECTOR
1 ~r a~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~n~
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION ZND [ ]INSULATION
[ ]FRAMING ~ [ ]FINAL
REMARKS: ~ mar/ G~["~.®iz-
~ a
.1~~~~~Z~~r ~
^A~
~ ~
DATE ~ ~i ~ INSPECTOR
- ..Y~.fn
"n~}r ~`.{I~~'iv p~f.~..~13~ S `~':as ~ 4~jy~ GC [ _ - - - ~ rW~'„
- .e~ t .A,~'~
~ ~ ~ 'sUrP. Co. HiALTF14[PT. APPROVAL N. s. NG.
~3 ovvM[RE
1 k~B~1Z~' ~ tNA7` 1NF't/7"~ ,
tIYLELT"t' L7fclVE~ - P.C'i,~iGX 2L7~ ~
r`'r'fa'~, yFAL1
N?A'T"
1"t'1':lCtG ,1`J.Y. f1952 ? SEA, N Y N
x'. (ale. 2'S?8-~g3)
~ ARMF I$, 10$ SQ.~: '18 JAN y AA! IQ 2y
DcsD:`.592`9, P. 323 f2e{.)
/ ~ AP'ALTA DEPARTM16112
` ~~~~j,E. -T$.O //J SUFFC7,R CQVnTY
' _ - - I ~DATF~FIAN O 19~~ 9. D. tt~'"' •s'~_d..:.`..a:=
•-.SO
c f,` :•_~^iL, d .v~,,... ~.~.a found ~~~~/y
k! d~ tp insPact°d~by ~ -
2 ~ ~ t11 to be satin°actory.ry ^ ~ ~ r /f ~
ua to ~
N ~ Z AhieY oY General Engineer
~y Serviaea ij
~-ss'-4~` ~ ~
rx. ~ ~
~»--T _ /
' N {..y.,fr,'s.frnu8t' ~ ~
ai':~~'ks ~ _ y'~~. w: 'i+. Va ~4". ~ L•l~ttrorwerta~efi
Gam'A? ~y • \ ~/c~ _ c.~sa~1
~ L yf7~~ se~ec f'an~
S~ a~._.
S„ _ , , ~
i0 i};;5 SU2: CY IS A YlCIATICN Of
@ ff~~jj ~q SECPC^I ]2~9 CT T4:E NEW YCZ:C STATE
~~7 ~J.~l7 ~ EDUCAIIJN IAW.
' ~J• CCi16 CF T: IS SU:.\':Y !.'.>w' `IOL FLARING
THE LAKi $LL9-.~. . _ J b.AL CR
\ ~ FMBCSS.^ SCAL C i..,( eE CCNSID[z!D
\ ~ /~~1) d f/ t~AL /E"' TO EE A VA':D i.h FY.
~ \,.w£7i.y, ~rJ~r/ I'Mf M~+. CUARJ: ":3 i~"`. a£ L ;I1A14 RUB
.1 % ~ CK:Y 1G L:: ; . 5 F.=. a •n ilf# SUAY
~V IS F;CC.:, l: . £i:J C' TC T71E
£ TITLE Ct e.: ~Yi;`.: C:r:rA4 AS:ddCY
- i ! ten Ekrtt LSNCh.G Iss;r~,:.;,::_,•£:d e_~~~+, At~9
ro TtlE Asr.:;,,cs cF tDh;G INSTn•
TITLL CSRTIF. TLLi(ON. GJABM~ALLE Affi i^vT TehN5ftM9
TO ADDETN%~A1 AFST ttL~YlONS QK SWdR#5!WB
OWM6„ '
' Guaa'LY/tfanal fo ¢/re STAMP
MAP C3F` F~QP~'&'TY ' -`'!e'eurify Tifls eer-GUara+rly Co~yba,ry s[AL
arnd fv ~N+e So~,HeoGy Sav,'ngm Boni
MArz'rTUC~c ~ sE„-„aye ~r~,. aa. ~~z~
ROD[RD4lC VAN TUY4 P. C.
TOWN G%~ r.X~l.1TF{C1LL?~N.Y. jG . ~Ir'
' LlIG. LAND SURV[YOIH.QR[~•
Y.
Ca tkr: q/ ,R.yQ10 3ta•7+:123z i~bGk:'~rL.c7t /l.
T[ST MOLL s4lPF. Oh. Dt1~T. M[ALTN s~R1/K:~ iTAT[M.[NT OF INTrNT
O•
- FOR APPROVAL OP 00l157R11CTION ONLY
3cMtEd.
+r. lOa11H TM[ WAT[R SUPPLY AND Be:1NA8Y
DAT[F DISPO!lAL sYfT[MS POR THI® Rlxi.
CkD?' DENC[ WILL C+~dN~ttA TO THB
SeYI1ef
N. 8. R[F, NO.: STAND~itDt OF sUFFOLK GO. D[PT.
yp{sr `fir OP Ni11LTN. fLRVIC~l.
APPROY[D:
(6)
17' APPLICANT
f~°`~°""' BO.1FD OF HEALTH
U f~a~~ ? 3 SETS OF•PL.1YS__-•-••••••••
~ FORFANO.1 SURVEY
I
r
~ 6 ~ ~ ~ ~ TOWN OF SOUTHOLO CHGCTI
~ i~~ BUILDING DEPARTMENT SEPTIC FO[tCI
' ~ TOWN HALL
Nf.U ttr;~, $OUTHOLD, N.Y. I tcJ71 NOTIFY I ~--~,~3
TOVetW CtN 9~rP~'rP-; 7r.~'~ ~ TEL.• 7GS~1II02 CALL .
Examincd.pP/~ry...........19~ / P1AIL T0:
Approved . }`~A I~. Permit No. f.~fO~f..~ . . .
DisaPProved aJc .
D
(B dine Inspector)
OF 6Ot
HD![)
APPLICATION FOR BIJILDING PERMIT
Date 15...
INSTRUCTIONS
` 2. Tlris application must be completely filled in by typewriter or in ink and submitted to the Buiidi~ Inspector, with J
sets oC plans accurate plot plan to scale. Fee at:cording [o schedule.
b. Plot plan showing location of lot and cic~ 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 isparz of this appli-
cation.
C. The work covered by this application ma}- not be commenced before issuance of. Building Permit.
d. Upon approval of this application, the Budding Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspectictin throughout the work.
t. No building shall be occupied or used in whole or in part for any purpose whatever until a CertiScne 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
Rc=ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agcees to comply with aSi applicable laws, ordinances, building code, housing code, nd reer:lations, and to
admit authorized inspectors on premises and in building for necessary i ct ns.
r Signatur~icant. or name. if a corporaironj.. .
/ ~y r
• - (Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Q~!,rr~~~
Name of owner of premises Y.::: h P!2 ~~1~.!~.~~?'.~-t. T... !it/..~1 ~~r......_........... .
(as on the tax roll or latest deed) -
Ifapplicant is a corporation, signature of duly authorized officer.
• • • • • (Name and title of~~jjc~~orporate officer) '
Builder's Liccnsc No. ..'::ju~t.:• . .
Plumber's Liccnsc No . . .
Electrician's License No . '
Otl~cr Trade's Liccnsc No . .
1, Location of land on which proposed work will be dorc: . .
Etouse Number ~ Street Hamlet ~ ~ ~ ~ • '
County Tax r\fap No. 1000 Section ..~d.~m~-. • • ~ • BI'ock . • . , , , , , , , , , , , , Lot !r, ,
Subdivision Filed Afap No. Lot '
(Name)
- State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ - 1
0
a. Existing use and occupancy • :f{~ri~• ,
b. Intended use and occupancy •W~•~~~~~-
II •
3. Nature of work (check which applicable): New Duildin5 • • • • • • • Addition . ~Utetauon .
Repair RFmovpl Demolition , .......Swi;n~tin~) +~oqh;.`.......... .
Tennis Court . Accessory IIuilding..........Fence .......Other Mork..
4. Estimated Cost ~ ~v.~ Fcc
(to be paid on filing this application)
5. if dwelling, number of dwelling units Number of dwelling units on each (loot .
Ifgarace,numbcrofcars
. .
6. if business, commercial or mixed pccupancy, specify n/ature and extent o(cach ty c off use .
7, Dimensions of existing structures; if any: Front o~Fa n.... Rear . ;~.,1 ~~.t4. . Depth ; , . .
Hci_ht Numb;cr oC Stories ..l... . .
Dimensionf,~l,8a "•c sLith alterations or additions: Front r Rear . .J~,j~p, , , ; . .
Depth . ; 'c,.!,{< IIeit;ht ~ ..........Number of Stones .
S, Dimensions of ehtirc new ,ghfnt~tion: Front o1.t-4........ Rear 1....... Depth . ,
Hci~;lit ~ tttber oC Slorics . •
9. Size of lot~~ca(?• it I. Rear J..~........... Depth ...o2C~4.;A~ . ~ . .
10. Date of Furchase~,,,,Et, t...r~' ~ . ~ . .
p P , ~ ~ r . Nantie of Former Owner
h
11. Zone or u ~ V V uses are situated . ,
.
l2, Does roe ose ict'ft1"sTi'f`i'c"ti<~n violaFe any zoning law, ordinance or regulation:
l3, ~Vdl lot be regraded , , , , , , tiVill excess (ill be rc ovcd tom premises: Yes Not!
l4. Name of Owner of premises er~~o(d,Y~/,
~ ,fry, , , , pddresso?`,~+7~~~/?:-CPltone No. a~~8.: S :~d'3 . .
Name of Architect ...............Address ...................Phone No................ .
Name of Contractor ..Address . .Phone No.. •
IS.Is this property locaded within~100 feet of a tidal•wetland? °YES....NO.. Y"~:
*If yes, Southold Town ,Trustees Permit may he required. t
PLOT DIAGRAi~1
Locate clearly and distinctly al! buildings, whether existing or proposed, and.indicatc all set-back dimensions from
property lines. Give street and block riumber or description according to deed, and show street names and indicate whether
interior or comer lot.
1~1 .
f t
~ , - ~ ~
t
~ 1 y~ ~~(~t' me;flause
ur
w'
3
• ~ ~5 !
3
~ ~
I 9s _
STATE OF NE1V YOR1:, $ S ~ ~
~
COUNTY OF
• ~ • . • • • (i\amc of individual si nil ~ • ' ' ~ ' ' ' ' ' being duly sworn, deposes and says that he is the applicant
• g itg con[ract)
above named.
licistltc
(Contractor, agent, corporate oCficcr, etc.)
of said owner or owners, and is duly :tutltorizcd to perform or have performed tltc said work and to make and Glc this
application: that all statements contained in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the mannerjsct forth in thu application rlcd thcrcivith.
Sworn to baforc me this r•
i\btary Public, , , , , , ~;I:e:~-~•v, ~~.r!.~;~ County - .-z
HELEN IC DE VOE : ~
~~m47078t&S~uHWkf~uwyY~a,N ~ ~ ~ • ~ (Si;natureofapplicant)
Term Eepires?Mereh 30.18._.7,1