HomeMy WebLinkAbout18229-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19445 Date OCTOBER 15, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 2415 BAY AVENUE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 144 Block 4 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 7, 1989 pursuant to which
Building Permit No. 18229-Z dated JUNE 16, 1989
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 INGROUND SWIMMING POOL & DECK ADDITION AS APPLIED FOR.
The certificate is issued to WILLIAM & LINDA MERCIIRIO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-085073 - AUGUST 4, 1989
PLUMBERS CERTIFICATION DATED N/A
i
Bui' ing Inspector
Rev. 1/81
s~oas>< xa s
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)
° 8 ~ ~ ~ Z Date ...rr?..~1'6 19...~.~.
Permission is her r ed to• ^ , ~/f / J
.9 ,~y g ~ 9~c~e~d.....y.'!.`.G . 9G......1~...4-~la~a. ~ ~G ti'/~2 ,%~iZC'`t•~`6~
G~~
at premises located ot .........r.~....T...lr~......ff?~..... "~k
County Tox Map No. 1000 Section .......f.~T„ Block ........fem.'.`....,.... Lot No.........~`"'.........
pursuant to application doted 19(~~1...~, and oppro/oved by the
Building Inspector. / ,
D v
Fee $.,lY....~ .
uild g Inspector
Rev. 6/30/80
A . wi
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-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 2/10 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.
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.
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 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
Date October. 15~. 1990, , , .
New Construction........... Old Or Pre-existing Building
Location of Property..... Y~~3 -AixENl1E,....MA~TITIICK, NEW YORK
.
House No. Street Hamlet
Onwer or Owners of Property......, WILLL9M ~ LINDA MERCIIRIO
County Tax Map No 1000, Section....144.......B1ock....4...........Lot....4 .
Subdivision ....................................Filed Map............Lot......................
Permit No.18229:Z........Date Of Permit., 6/16/89 ..,,Applicant. A. REILLY ~ SONS. INC:.
Health Dept. Approval ..........................Underwriters Approval..,N-085073_,...
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $,,,,,,,,?5:00
p~pQQ,/ ~f 067y WILLIAM MERCURIO
('Q~, f9~1`fS APPLICANT
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THE NEW YORK BOARD OF FIRE "UNDERWRITERS `'~r"'"'
r ~ BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 0038
itfr,'tir;I' {7~x, "9r1$") ~ 9-91')ttn f39 IS" Clti~ti`t3
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment os described below and introduced 6y the applicont named on the shove application numher in the premises of
WThS13'APi i~I~RC'Ctk1Y1,. }ia1V iltJf~i~7lif;, ~fi, +d?!'f'"k'7:CU:`kr IS~Y.
in thefollowinq lncatr~p,y 77r. Bq~sig j ent (if~'I'
~1 Cn ? lst F'l. ? 2nd F1• Sertion Bioek Lot
wos examined on arzd found to 6e in conFplianre with the requirements q/ [his Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECE?TACLES SWITCHES INCANDESCENT FWOREECENi OTHER AMi K.W. AMi K.W AMi. K.W. AMi. K.W. AMT. H P.
1 w L
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNI7 HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. ~ On H. P GAS H. P. AMT. NO. A W. G. AMT. AMP MIT. AMPS. TRANS, AMT H P, SYSTEMS AMT WATTS
NO.OF FEET
1 s e~i3
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP. TYPE METER I,e'4W I,e'JW 3,9'~W 3,b"4W NOAF CC COND A.W G A W G. A W G.
EQUIP' PER .e' OF CC. COND NO.OF HI-LEG OF HbIEG NO.OF NEVTRAlS OF NEUTRAL
OTHER APPARATUS:
PO~t, I,TU~Ff9'-J
*{f>G7aM!~1~'G Y~C)h) 'P1'<i; t~rxi.i4'i<~itte
C'6Ysq T'f3 <I~?tDjI~1.'L "afLr, ss ,"x t' Y, 11.i~ d.,T 9:c~ 11
tsssTar.ctit;t~ nniY. €ecc<zlts,~ ~,C aTlltrsu~.i
=.irunrn~n'r.s i,f ~ct'~'ls%zi~f~r try
}iitTre C'x~~~urizf: Yc~;,i' tini'tdns T;al~~aarw
rnixlte key ra ca~Uatl s 9~ i~ct Iset. ~+~r~. ~
i:: ("Crltfl(ttiG(1 qXt f%~tl"" ~ )i7
GENERAL MANI'1bER
Per .~`~~'~t`
This certificate must not be altered in any manner; return to fhe office of fhe Board if incorrect. Inspectors may be identified by hit credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT RE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
a~c~ 3;13
~ BUREAU OF ELECTRICITY
5 JOHN STREET, NEW YORK, N Y,. Q 38
~rr~,rr~m o~,as:a~ ~~~I~I~~~l,~ ~ ~s~e~~~~~
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced 6y the applic¢nt named on the above applic¢tion number in the premises of
G13:In71.(I'ii'~Y i4F;RCUttIO„ f31rV :~'1~;'NlJY:1,, {,EIF ~l~f"I''LTUCIY'r
(~Izrx~
in the following GRCatli~n;fir ~KtIsL¢tftent ? lat F'l. ? 2nd F'l. Section Bloek Lot
was examined on ¢ndfonrtd to be in cornplianee with the reKluirementr q(this Roard.
iIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FWOREECENi OTHER PMT. K W. AMi K. W. AMi K W. AMT. K W AMT. N.P.
DRYERS FURNACE MOTORS PUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. K. W. Oll H. P. GAS H. P. AMT. NO A. W. G. AMi AMP. AMT. AMPS TRANS. AMT. N. P SYSTEMS AMi. WARS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
AMi. AMP. TYPE METER I 4W I 3W 8 9 3W 3,e' 4W NO. OF CC. COND. A. W G. NO OF HbLEG A. W. G. NO. OF NEUTRAI$ A. G.
EQUIP. PER k OF CC. COND OF HbLEG OF NEUTRAL
OTHER APPARATUS:
iIIJ'[>Y't'I'1~~~7;L:1,IJ 1+1 C:.~2.3~0-IS
VL1'l' i,AldF;
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1 x lit IC ~ ?y`l' ) 9"9'i GENERAL MANAG@R
1;.
Per i
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified„byt?tfPeir credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
765-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING r:NAL
C
REMARKS: __Ga, ?a ~ ,tea/
'7' c ~ r
L~~~
DATE ~ G ~ INSPECTd~I~
-lELD I;;S:'SO:'_~1;i j~Unic, jI ~Gt`iMENT° ~
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1. ~ _ ~
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~OUtJDATION ( 1st )
TOUNDATIOiJ (2nd) _ - _ m~
z
0
30UGH FRAME &
PLUMBING
3. ~ ~
IIJSULATIOPI PER N. Y.
STATE ENERGY ~
COpE
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ADDITIOPfAL COMMENTS:
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B0~1RD OF HEILTH
FOftM N0.1 3 SETS OF PLANS
SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
- TEL.: 765-1802 CALL
/ e~
Examined .Y 19 U(, MAIL TO:~~~'~t/3
.\pProver~l 1X.1/..Permit No.~~~.~q.:..~ Ei ~ LJ I,~a
• 6l~
Disapproved a/c SI ~ JUN "~~819$9
/ !3LDr. iiEPY~~'
T6VUN OF ~°OOTt-?OLD
til - ,Inspector)
APPLICATION FOR BUILDING PERMIT
Date - - 15
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets ot'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
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
Mall 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 or alterations, or for removal or demolition, as herein described.
The 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, or name, if a corporanon)
(Mailing address of applicant)
State whether applichht i§" owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
,t ~ y?~~t- ~v)?
C~ . ..7u.~-~-.
Name of owner of premises ~ l G-(-)w!~1 ....C.......'.F z~'~~.~u(~~ C)
(as on the tax roll or latest deed)
If appl' n is a Gorporation,'sign ure duly authorized officer.
(flame and tit~f corporate ficer)
•-f ' ~~.~2 - ~2"
Builder's License No. ~ .
;5 :,s'
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
I, Location of land on which proposed work will be done. . ,rJ/rI , - /~Z/~' , „~/~~~1
house Number Street. Hamlet ,
County Tax Map No. 1000 Section k Blpck Lot ' I .
Subdivision Filed M1fap No. Lot .
(Name)
State existing use and occu anc of remises and intended use and occu
P~ y P Pancy of proposed construction:
a. Existing use and occupancy
b. Intended use and ........~~~1`'~~T ~z W l 77~ ~(~t1Z...~4-TT.9e~7j .
occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
parr Rem ~~nn
e oval . . . Demolition , Other 1Vork .
(Dcsctip ion)
4. Estimated Cost .......~Qi~ ~ s9S-:? ..................'Fee , .
5. If dwelling, mm~ber of dwelling (to be paid on filing this application)
units . . . . . Number of dwelling units on each floor .
If garage, number of cars ....I,.......... , ,
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use ,
7. Dimensions of existin structur • •
g es, if any: Front , , , , , ,Rear Depth .
Heigftt .,........NumberofStorics..
[1t tytth alterations or additions
Dimensions of lamest crure ..~•~~•;Front•.•.•.~.••••~~•~~••~~•••~••~••~••""•"'
Rear..................
Depth . • , . IIcight ......................Number of Stories .
' ° Nut ruction: Front Rear Depth
8. HLm1 ~sions of entire new cons Aber of Stories ' ' • ' • ' '
9. Size of lot: Front ' ' ' ' ' ' ' ' '
10. Date of Purchase P ' ~ • ' ' ' ' ' • • • Rear Depth
~r'••••••••••••••...NameofFormcrOwner
I1. Zone or use district in which remises are situated /~.rw$~r?~?'r!J.?~
ose construction vio
P P late any zoning law, ordinance or regulation: . , . • , .~V, , , , , , , , , , •
13. 1Vill lot be regraded • • • • • • • • . .
P ' ' ' • • ' • • • /t'ti • • • • . , 1Vi11 excess till be removed from premises: es No
14. Name of Owner of remises /,y~,Cyt~t;~~~ • . , •
Address ...................Phone No.............. .
Name of Architect ...Address '
P P y ..............Phone No. .
Name of Contractor.... ~:!Y~:~G~Y,>„$;Q7~ , ,Address tyl,~¢ CG 'G~/"d.-•~j(3~;
IS.Is Chis ro ert located with in~00 feet of a t~~wetlandon*YES....NO....
*If yes, Southold Towr} Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly alll buildings, 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. I ~
Y
~I ~~~Ur~
j APP ~ ~p
DATE: y
~~~aR ~ a ~
FEE I ~ ~ ~ BY: .
NOTIFY IL OEPA AT
~ 765-1802 9 AM TO 4 OA THE
FOLLOWING INSPECTIONS;
t, FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH -FRAMING dr PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REpUIREMENTS OF THE N.Y.
' STATE CONSTRUCTION A ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NE1V xORK, ~ S!:S
COUNT F..J~./,"f,,,,,,,
' ~ ~ ~ ' ''X • • • being duly sworn, deposes and says that he is the applicant
(T\amc of individdual signin~~/~~ • ~ ~ ~
g contract)
above named. s,~s,~~~.
IIe is the ............~b!!",/.k~Pi!<-./~..~... ,
(Contractor, agent, corporate officer, etc.) ~ ~ ~ • ~ ~ ~ ~ • ~ ' '
of said owner or owners, and is duly authorized to p5rform or have performed the said work and to make and file this
~ aPPlication; [hat all statements contairied in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the manner sbt forth in ttte application Glcd therewith.
Sworn to before me this
Notary Public, k~~c,~,l,~.-t+~.•f,Q., County
LINDA J. CO P6R " " ' " " • ' '
Notary Public, State of New York (ignatur plicant)
No.4822663, Suffolk County c~
Term Expires December 31,19 i