HomeMy WebLinkAbout17295-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-17869 Date MARCH 22, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 2925 SIGSSEE ROAD LAUREL NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 6 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 21, 1988 pursuant to which
Building Permit No. 17295-Z dated AUGUST 4, 1988
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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to ROBERT NORELL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-044709 - NOVEMBER 9 1988
PLUMBERS CERTIFICATION DATED MARCH 10 1989-WALTER GROGAN, JR.
Building Inspector
Rev. 1/81
aosai xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
' COMPLETION OF THE WORK AUTHORIZED)
N~ 017 2 9 5 Z Date ......V...r....~.~ 19 ~f,
Permission is hereby granted o: ~ , ,
v
~ ~
. `
1' .......1~...~~L::~``~'
.'~..~.~:1. .
r
ct premises located at ...o~..;~~..5
.....~.~.(I..~.~..L:.........................................
County Tax Map No. 1000 Section .......~.e~'...KT..... Block Lot No........ ~ ~.l......
pursuant to application dated 19 r~.~ and approved by the
Building Inspector.
Fee $..~.~...:3i
Buil g Inspecto~V~'
r
Y
Rev. 6/30/80
o•
r~, FORM NO.6 ~ L5 l L~^ ~I \ :~a,~-. ~,l'~ , "
rl TOWN OF SOUTHOLD y I i
Building Department ~ ~ a ~<3~
~ Town Hall
Southold, N.Y. 11971
765 - 1802 gLDfi. DEPT.
APPLICATION FOR CERTIFICATE OF OCCUPANCY y'OWN OF SOUTHOLD
Instructions
A. This application must be filled in typewriter OR ink, and submitted as~.~s~ to the Building Inspec-
torwith the following; fior new buildings or new use:
1. Final survey of property with accurate location of all buildings, property tines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S•9 form or equall.
3. Approval of electrical installation from Board of Fire Underwriters.
4, Commercial buildistigs, industsiai buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 19571, Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing alt property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $100.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 10.00
4.Vacant Land C.0. $ 20.00
5.Uodated C.O. $ 50.00 Date
New Cons truction••q•p••OldorPre-existing 6uilding;~............ Vacant Land
l.ocationofPropesty ..~tsi.+~.r~...~{~5~~.~....~~€?la.d.,........ .~.~~U~~L
House No. Street Hamlet
Owner or Owners of Praperty~~L'.l~T/~•!.~~?~r./.~••••/•••••••••••••
County Tax Map Ne. 1000 Scc*.ior. ....eFP~-G?...... 3{cck ~Sr.•....... Lct ~fd.~..... .
Subdivision ./.r./.../,~
.....................~.~....Filed Map No. ..........Lot No. .
Permit No. ~YSZ Date of Permit l~lT/..~g.Applicant gSEp~:•.~~~~1~~. • ~~=I1LT C S
Health Dept. Approval • ..............labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $
Construction on above described building and~p/ermit me/ets~Il applica a codes and regulations.
Applicantlt~'~ .4
Rev. 10.10-78
3{~est
~a~i78loP
TBL. 765-~ 802
OF ~upgOLD
FFOCK~ sr~ .~~n~~,~
YIILDING ~ CTO
~c~ 0(~~ OFFICE OF
TOWN YIALL `~u-.~..,`'..
~ g0 ~ 2 0 « ~
~ ` ~
~ ~
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C ~ ~ I p 1~4•A
C E R~ Y F I
Date
permit No . ` "O
guildin5 n K,,E
Owner~~' ' please Printl
~
2 .
Eta
plumbesil~lA~please pry,nt) supply system
e solder used in the water
le
I Certify that 211p °f 1~ ad.
n ~
Contains less tha
Si atu
s
4Plu~'ber
c
efore me this ~ Pu
b
sworn to b MAre-4+ Notary
~t~.~,daY LLY
County K~~~ ~Yack
19 ~ ~u ~~kfSu~~g0,18~
Notary public ~ ~rtion
_ _ T ~ _ _
THE NEW YORK BOARD OF FIRE UNDERWRITERS
7ooousa
EIUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NgEW YORK 10038
HtiV>::>~CRF:R 09,79R13 57F7F~1}~8l8St Pi 044"joy
Dote Application No. on file
THIS CERTIFIES THAT
only the electricd equipment v dsecri6ed 6shuo and Introduced by the oppNcant named on the abode opplicetien number in thepxmises of
jAOR N; I', f,. 2925 SI:GA BFIK ROAD, NA'C'('ITYICK. N.Y.
in thefolbleinlT h,eotio~R,NB~err~t~ ~ Ist Fl. ~ Ynd Fl. .Section Block Lot
um examined on Ntll)) Ft~,M 2} andfound to 6e in cmnplionce with the reyuirements of this Boord.
NxTURE RXTURES RANOK C'OOKINO DECKS OVENS DISH WASNERS EXHAUST FANS
OUTIlTS SPTACUS SWITCHES INGNDESCENT. F1UOefSCENT AMT. K. W. AMT. W. AMT. K.W. AMT, t. W. NAT. M. F.
7 I) F< 7 D 3 0 5 r'
DRYERS FUENACE MOTOES NJTUR! AFFUANC! IMDMS fFlOAI RRC'K fUAE CLOCKS RNL UNIT NEATERS MULi40Uf1lf DIMMlRS
AMi. N. W, pl N. F. GAS N. F. AMT. NO. A. W. G. AMT. NM. AMT. AMFS. TRANS. AMT. N. t. ~
~T AMT. WATTS
SERVIt7 OISCONWECT tq.tl! 5 E R V 1 C E
AMi. AMF. Tt'PE pIHF. 1 / TW 1 R ]1A' ] 6 ]V/ 7 / AW ffkCrCOND. Of CC. COND. NO. OF N4LEG ~ NO. OF NEUTMAlS OF NEUTRAL
7. 20o ca ~ t x 7. 2!D zlt,
OTNER AFPAIIATUS:
)!,].RC. RrH>M H1T.ATIsRSt2-1.25 K.Yi.;L-;1.0 K.N..-?._.'!h R.ki.
F~t,ht~. RCH>M xt.AT>rRS.2-,5 K.K.
SrAt1KB DRTM:CTOR:-7
HON'S f;t,I;t"fRiC SE!tsltc'F
2i) YUPI,AR AYF:.
kARHCNGDAI,,N„ NY, 71715 Otli~SHW1A9RR
?7
!,11'F;N4N: Nt>, h44 Per h ~
This nrtificats must not bs altered in any manner; return to tM office of the Board if incorrect. Inspectors may be idamifiad by fMir credentials.
COPY FOR 6UII.DIMIi DEPARTMENT. TNIS COPY OF CERTIFIGTE MUST NOT 4E ALTERED IN ANY MANNER.
TEL. 7G5-1802
f0
~pS~F ~~COG.c TOWPI OIL SOUTIIOLD
~ ~c OCF'1CI: OF DUILDING INSPECTOR
~ lit..
s P.O. BOX 7Z3
~ TOWN HALL
.Y4~~o~ ~ r~~`~' SOUTIIOLD, N.Y. 11971
////6/C~
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
An;~,application'~or Certif.i,C~te bk':.Occu~ancy
is .not bn file.
/K/ No..,.Underwriters_.Certificate'on"£,i,l~:,
The check is (outdatedlnot ~oi%"f,,le~~)
No Flealth Dept. Approval on file.
P:o final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit 11 ~ 1 ~ ~ g Z
Building DepL-.
~.x..`R• k,i .i.n
C•lo_.Plumber Soldor'Certifica`te-~on file':
( all permits involving plumbing being
issued after April 1,1989 )
y~e-w~ ~ .
r
l,~~ce ~ ~ ll7s ~
r'1ELD i;:S:'~CTiUN ~~llATE ~ %OMMENTS
-v p _
m 'CvJ~~
FOUNDATION (1st)
c ~
c
m ~
FOUNDATIOW (2nd)
2.
z
o ~
ROUGH FRAME & ® ~
PLUMBIN~ ~
ti
H
3. ~
/ ~
IIJSULATION PER N. Y. y
STATE ENERGY
CODE
o ~
. a . 1 ~
FIiJAL
ADDITIONAL COMMENTS: ~xc~
x
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9
H
O
z
1
9
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ca
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/~ig.~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T C ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] IN CATION
[ ]FRAMING C FINAL
REMARKS:
l v~
i~ DATE D oZ ~ ~ INSPECTO -
i
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] !ROUGH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ]FRAMING ~ [ ]FINAL
REMARKS: ~'"~"'~y"~-~'
f
t
DATE INSPECTOR ,t%~h/
' 765-1802
BUILDING DEPT.
INSPECTI~JN
FOUNDATION iST [ ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[~RAMING [ ]FINAL
REMARKS: ,~~.,L. ~i?-~;"~-.,~
DATE ~ ~t/ ,_1NSPECTOR'
765-1802 L~
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ROUGH PLBG.
[ ] F UNDATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMARKS: ~ X~--3=~--~~--'~--
Lz~ti c._
~ ! ~ ~
1~ ll w~
DATE INSPECTOR
'E
NEW YORK S1'h'PE ENERGY CONSERVATInD7 COUE
SUMMARY OF TCIfRMAI, I2A'CINGS
THERMAL 'LADLE
AREA U - VALUE RATING USf:U, ,
T
A. ROOF / CPILING 980 0.50 -0- ~ 6-1
D. NET WALLS
725 SF 0.50 -0- 6-1
C. GLAZING
WINUOW3 391 0.42 -0- G 3
TOTAL T}{ERMAL RACING -0-
4
s.',4
^-a.
1L`~ ' KjC<~,*
y
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~`or I~Ic a~
BOAR OF HEALTH
FORM No. 1 3 SETS OF PLANS .
SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORDS .
' TOWN HALL C?ff~/S
EOUTHOLD,N.Y.11971 NOTIFY
' 19 I TEL.: 7G5•tII02 CALL-
7. O~ ~ MA -
Examined p-~• e~ n G.~.,e._
Approved ..~-T.........., 199UPennitNo.!~~~./.~~ ~ ~ tl
' ~ 0988
Disapproved a/c
S
•
•I~~~%~~~ Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 .
. II
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to_ the Building Inspector, with 3
`sets 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
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 app tcation 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
Re;ulations, for the construction of Ibuildings, 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 nspectio
(Sigr?,at re oz' alnt, or name, tf a corp~ ~ n) • •
i pp
. •.7~J. l~~`.~!~-.~Q?"~.. ! S t,i P.1.~~:~~~../Y.Y l17S2
(Mailing address of applicant)
State I~wh,~/~therg~----applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
G~~r~~
7lP?l.C_C;
Name of owner of premises
(as on the tax roll or latest deed)
of autYtorJzed gfficer.
IC a licant i c p r ti , stg t re ~ l//~-r~(
.V.Y.`~.°.i.......
Nam title of carpor~te officer)
Builder's License No. ~Lp... L .
Plumber's License No. OC~Qr! ~u~l S~YU.Rd ^I~ ~ ~ (og? p
Electrician's License No. ~:~:~F*.~. ~Ry.
Other Trade's License No. ~}~D`3~`~~ ~
1, Location of land on which proposed work will be done. . ^2902'5...r~.~,"~~-; .`p'~~
~1 d .S ,YY~eie./Z .
Ilouse Number ~1~oet\ Hamlet
County Tax Map.No. 1000 Scctioh • • •,02.6 • • • • • • • • • • Blpck , .Jf.. Lot ~ .
Subdivision.... Filcd Map No. Lot .
(Name) tl
State existing use and occupancy ~C premises a~n~d`~in~tjended use and occupancy of proposed construction;
a. Existing use an¢,occupancy • iZ.~i,.u:r~+ti; . / .
b• Intended use and occupancy . •~j
14•'•~n.`
J ' !+`~O````~4~r~~r' • • • !~f
~4?'v':~G9',' .
3. Nature of work (check which appSicable): i3ew Building Addition • • Alteration .
Repair Removal Demolition Other Work .
(Description)
A. Estimated Cost 4J> U: • Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...-y~-~Z"e'- Number of dwellitt units on each floor .
If garage, number of cars ...........eC .
6. If business; commercial-or mixed occupancy, specify ature and extent of cacti typ fuse .
Dimens#o'ij~„~~:~ixuiihd' ructures, rf any: Front S..... Rear ~ y
Depth ...0.~•.........
Height Number of Stories ....~Q~• • , , , , • , • , , , , , ,
Dimensic~s> 9~~ cttire hvith alterations or a ditions: Front . t ~ Rear ..c~7.~. C
Dq{~th .....3n2 IIcight ...~~,)f Nurnbcr of Stories ...`1".f~.
.
8. I~rtuaggtoas t ew con ructron: Front .....,3v r S, , , , Rear 3 ~ Depth . ~ a,. ~ . , , , , , •
Height iEJo n nber of Stories ~.....r .
9. Size ront
Rear ....l,Od.............. Depth .~~`~:\.~3
10. Date of Purchase .............................Name of Fotmer Owner .
1 1. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law,\,;rdinance Or regulations y~s .
13. Hill lot be regraded . , IVill excess fill be removed from premises: Yes o
14. Name of Owner of premises .1~aBEi~r• /t/oe~~G, ,Address 4?9.Q'•$ ~S/rss$~'~ ~l~ ,phone No. ~~6 `3~ -
Name of Architect SSE"PNrzr?$,~/!z'-~, • . , , , . , . • Address . ~~~..clC Phone No~~7.~ ;
;j~~.~ .
Name of Contractor S??f7.~~!yJ~..~j1JiJ,G,~!.. , , , . ,Address .c3~.b. ;Pipe ~y~6/Phone No.~y~~.l.~:~~6 : ,O~.~Q~.
IS.Is this property located within X00 feeC of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
. PLOT DIAGRAM
Locate clearly and distinctly all 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. S~~ PG.ggIS
-
'
STATE OF NE1V YORK, S.S
\ COUNTY O_F` .
• • • • • T'~s~*~~• • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
,above named.
lie istlte.. A~~!~.T
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; [hat all statements contained in this application arc true to the best of his knowledge and belief; and that the
work tvill be performed in the manner set forth in the application filed therewith.
wom to befo//re/m~e tfig ` \ \
l..~ .day of , ]9
rotary Public, County , ,
HlrrH M. RVAT•1 ~ - -
13pt9ry Public, State of New Yor • • . .
tdo. et'34t04 (Signature of applicant)
-Corrtrnlw{a+ FxpfRi~c'irn~n~d" aQ'n
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SURVEY FOR ROBERT E. NORELL
LOTS 116 81 117 '
"AMENDED MAP OF MATTITUCK PARK PROPERTIES, INC.°
AT MATTITUCK DATE JUNE z , 1883
TOWN OFSOUTHOLD SCALE: 1°=30~
SUFFO!_K COUNTY, NEW YORK NO. 33-400
itUNAUTHORI2ED ALTERATION OR ADDITION TO TNIB BUARANTEEO TO'
SURVEY IS A VIOLATION OF SECTION 7209 OF iME
NEW YORK STATE EDUCATION LAW CHICAGO TITLE INSURANCE COMPANY
M COPIES OF THIS SURVEY NOT BEARING THE LAND
' SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL ~r~^
NOT BE CONSIDERED TO BE A VALID TRUE COPY ,?~°`"^F NEW O
N GUARANTEES INDICATED HEAEON SHALL RUN ONLY TO ~~~~t ~ Y y R~.
THE PERSON FOR WHOM THE SURVEY IS PREPARED,
AND ON HIS BEHALF TO THE TITLE COMPAN Y,GOVf RN- ~j ~ nC\
MENTAL AGENCY AND LENDING INSTITUTION L197ED ~ ;Yrp`v'
w.
NEREON,AND TO THE ASSIGNEES OF THE LENDING - ~
IN9TITU710N. GUARANTEES ARE NOT TRANSFE RABLf I ~ k~ ('-o 1
TY7 ADDITIONAL INSTITUTIONS OR SUB9EOUENT ;f ~~k`~'-.~' ~=j: {
OWNERS. ' ' ~ yyyl
M DISTANCQS SHOWN HEREON FROM PROPERTY LINE9 ~ ~ _ ~y : ? yi
NOTE: Y"'t a`-s_~~ jfli
TO E%IS TING STRUCTURES ARE FORA 9PECI FIC ~ 'P+.~~ ke.~-;
I. /=MONUMENT FOUND PURPOSE AND ARE NOT TO BE USED TO ESTABLISH = "'~r'"°"'1 ~\x~ /
2. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF PROPERTY LINE9 OR FOR THE ERECTION OF FENCES. ~ " `4. ,'t~ ~.~,/,o f~
SUFFOLK COUNTY ON JAN. 12, 1926 AS FILE N0. 801 ,,aa~~
3. SUFF.CO.TAXMAP~ DIST. SECT. BLK. LOT YOUNG a YOUNG RIVERHEAD,NEW YORK E
1000 126 06 004
4. AREA= 14,000 S. F.
ALDEN W. YOUNG,PROFESSIONAL ENGINEER
AND LAND SURVEYOR N.Y.S. LICENSE N0.12343
HOWARD W. YOUNG, LAND SURVEYOR
N.Y.S. LICENSE N0.43883
6RANDIB b SONS. INC}{. 1618 '