HomeMy WebLinkAbout17558-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219619 Date DECEMBER 28 1990
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property 700 NEW SUFFOLK AVE. MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 114 Block 12 Lot 06
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCT. 14, 1988 Pursuant to which
Building Permit No. 175582 dated OCT. 26, 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 ADDITIONS & ALTERATIONS TO REPAIR FIRE DAMAGE.
The certificate is issued to THOMAS MERCIER
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N124123 APRIL 30, 1990
PLUMBERS CERTIFICATION DATED STEVEN BURNS PLUMBING MARCH 7, 1990
~~~'V
Building Inspector
Rev. 1/81
Fosas xo. a
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)
~ ~ ~ 17 5 5 8 Z Date ,1,7/1..2. ~ 19...~,~
Permission is hereby granted to; ~ ~
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taG~,~i~.l.G~~.e~.r'~.~r97,~,nsTi. .~~..~'f`.~.r'l~k...:...~.1.~~-~...ir.....1...t..
•
ct premises located of ......70.0..... y~Gl% ....t~!/~F6~
Caunry Tax Map No. 1000 Section Block ~-2::.....CC Lot No....s~~...........
pursuant to application doted 19..A.~ and approved by the
Building Inspector
Fee ~~`3..Y' "y`." _
0
Building ector
Rev. 6/30/80
Form No. 6
3 ~ ~ ~ J~'" " TOWN OF SOUTHOLD ~
~N U 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/C Commercial $15.00
Date .
New Construction... Old Or Pre-existing Building...... .
r
Location of Property....~BU....f~?~?,r~if:f.~?~C..~:.....~i5?-~/?~~(~1~-................
House No. Street Hamlet
Onwer or Owners of Property..... .~l?"??!~...C ~L
County Tax Map No 1000, Section...../.~ .....Block.../..~::........Lot....~
Subdivision ....................................Filed Map.......... .Lot..
Permit No...1.~~.~....Date Of/~Permit..f~j/~'~~..Applicant
Health Dept. Approval.......~f" :..............Underwriters Appro al.........................
Planning Board Approval......
Request for: Tempo//r~~ary Certificate........... Final Certicate...........
Fee Submitted: $.4.`:h.'.~ ~
~lit.'~~~(. .
# 6 ~~0 ~ `
~ y~ APPLICANT
TEL.7G5-1802
l" Or,~FF~t,~-~0~, TOWN OF SO~JTIIOb.D
r:•" ,.y 't OFFICE OF BUILDli•IG INSPECTOR
~
o ~ ~t~, ;T P.O. BOX 728
~ TOWN HALL
O ~ ~ OZ- SOUTHULD, N.Y. 11971
i~~l
C E R T I I C A T I O N
pate 3/ 7 C/D
Building Permit No. ~'~5'-~ ~ ~ ; , z ~ ~ i
-vim 7~
Owner ~~/l>l'I'JdS s~i>°O'L/E('"' '-''1~,'..
t ~,i
(please print) ~<< i:~tx
~ ~=f ia~,ui~ t
P1ucWer ~Sr~V~h L`- 4~U~1f.-$ ,~G(1o~e~i/!G- " ~~PGt7A.i2G~ ~n~ -
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
(plumber's signature)
Sworn to before me this
day of ~~C~./a
19 /CD.
T- Notary Public
tlotary Public, County
LOTTI~ II PO„4AINE
'.OTARY PU9I 10 Mete of New York
No. 5?-3334625 - iutfoll< County
Commission F.xplras May 31, 79.--~/
~ ~
r THOMAS R. ME RCIER, M. D.
LDVE LANE
P. D. BOX 1423
MATTITUCK, NY 11952
DIPLOMATE
AMERICAN BCARO OF PEDIATRICS TELEPNONe 516/296-5454
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o a~~ OGy TOWN OI' SOUTIIOLID
:s~~ lam'`, k~ ~ OErICE Or BUILDING INSPECTOR
:`il P.O. BOX ?2$
~ TOIVN HALL
`a~~- SOUTIIOL]), N.Y. 11971
I Y+
July 31, 1990
JOHN SCARAMUCCI CONSTRUCTION
P.0. BO% 1403
MATTLTUCR, N.Y. 11952
RE: THOMAS MERCIER
To Whom This.May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
nn application for Certificate of Occupancy
is not on file.
J / No Underwriters Certificate on file.
Ttic check isioutdated/not on file.)
No ilealth Dept. lapproval on file.
No L-inal ins.pcction has been made.
Pleaae contact our office on this matter.
Thank you for your cooperation.
Building Permit l) 1 7 5 5 8 Z
Buil-di/n~ Dept.
***!~Y! No Plumber SulQer Certificate on file.
i all permits involving plumbing being
.issued afL-cr Rpril 1,1984 )
l
A
~../.Y
a war fiSr.tF.. .~v.
765-1802
BUILDING DEPT.
~ INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING t FINAL
REMARKS: ~,~-Y ~
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r )
! DATE 7 ~-S~ INSPECTOR
f 7 ss~
765-1802
BUILDING DEPT.
INSPECTION
[)FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ~ SULATION
[ ]FRAMING [ ]FINAL
REMARKS:
{
~
4
s DATE lA ~ INSPECTOR
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17ss ~
tsS-iso2
BUILDING DEPT.
INSPE~TIt,~N
[ ]FOUNDATION 1ST [ROUGH PLBG.
[ ] FO NDATION 2ND [ ]INSULATION
[ FRAMING [ ] FI_N/AL
C~~.~
REMARKS:
_
DATE 7 '1 l i INSPECTOR
T65-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ J FRAMING [ ]FINAL
REMA/R~KS: r~
DATE ~ INSPEiCTOR
~ _ ~ ~
765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [)INSULATION
[ ]FRAMING [)FINAL
REMARKS: D. , a Q
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~ 2 7 INSPECTOR
DATA
~
.THE N.EW YORK .BOARD OF FIRE UNDERWRITERS '
::..a-l~h4,IT2a.
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
"FFt 11. 311, 9•~,>uU '.iR hG4il fS fl)Y1t N 1IL115
Date Application No. on file
. THIS CERTIFIES THAT
only the elecerkd puipment as described below and introduced by the oppHcent nomad on the oboes spplicstion number in the premiws of
I IN If7"`; M!`t?1.dP.N, :1111 NI'41 '.,UFt OIM "V;:, Plll r. Ydl. I, t.. ti, t1Ai I11'IIi:X, N. Y.
p~, A711C~UU7
in thefdlowinp lucot~~yil., l{~~q~'at ~ Ise Fl. ~ Ynd FL Section Block Lot
ww esomined on endJound to 6e in compliance with the reyuiremenes of lhu Buard.
NxTUq RXTURES RANGES COOKING DECKS OVENS DISH WASNRRS EXHAUST FANS t
ACtES SWITCHES
OUiIETt INCANDESCENT PlUORESCENT OTHER AMT. K.W. AMi. K.W. AMT. K.W. AMT. K.W. AMT. M. P.
DRYERS FURNACE MOTORS RITURE AM71ANCf IEEDlRf SPECIAL REC'FT TIA1E Cl00tf MLL UNIT HEATERS IAlILT40UTtET gMMlRS
AMT. K. W. 011 N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. AMT. N. P. ~
~T AMT. WAITS ~
I 1
SERVKE DISCONNlCT NO.OF f E R V 1 C E
AMT. AMP. TYPE p
' 1 R ]W 1 / JW ] H ]W ],e AW PER .7C~D. OF CC. OND. ~ X4lEG a~H NO. OP NEUTKALS Gr ~NEUIGRAI
i J(IU L: Ni j K I 3/11 1 ,ill
01NER M?ARATUS: f
I KA1.-i,tiK Alk tSANhl IKS-;'
Mlill'I pt'i; I ~~11. !iq il. h'.
I . r., l ~ -k
tiry11Nl. !14.11.(: fUf2: -.i
teca~
tNRd_F "1'" IL(_i I~L1, LCC.ft;;7l-k
I+l , dd t , MOX ~4 Ih ~
OIINd1 "Vt.Nltt ~Al _
I? 1 Vi W.lit AIS, N'. , 1 "t 5+i! i 1 1 j`
Pn i
This urfificah must not bs altarod in any manner; return to the office of tha Board if incorreN..InsReclorsmoy bs idsptifiad by 1Mdr-credentiab.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NDT BE t11L~t~ Bi ANY MAtNER. ~r
_
THE NEW YORK BOARD OF FIRE UNDERWRITERS ('Al..1 I
11.5 `i0)1 BUREAU OF ELECTRIGTY
BS JOHN STREET. NEW YORK, NEW YORK 10038
Doty AYft11 "i b, i94(I APPlication No. on file `'f:bG4k KY I£t 3; M 174]?1.
THIS CERTIFIES THAT
only the electrical equipment ca described below and introduced 6y the opplieent nomad on the oboue epplica[ion number in the premises of
IHUMA3 fliiF2l: Tt(K, IUO NFtd •SUfPryUb AVI, Pr}I. t- IY I.CL. b, MA I'I'IIUCK, N. Y. s
in the following Iceation; ®Baeement ~ Iat FI. ®Pnd Fl. A I I 1 C / Oll ~f .Sertiun Block Lot
um examined on liAKl't1 19,199!1 andfound to 6e in cumplionre with the reyuirementx of Chia Boord.
RxTUp RXTURES iGWOES Ct10KIN6 DECKS OVENS qSN WASHERS EXHAUST FANS
OUTIETS ECBTACLES SWITCXES INCANDESCENT f1U011ESQNi OTNEFI AMT. R. W. MAT. K. W. AMT. R.W. AMT. R. W. AMT. N. P.
6% 6 f,4 61 .7 1 1. h i
DRYERS RIRNACE MOTORS RITURE AMIIANCE REEDEItS SMOIAt R[C'?T TIME CLOCKS RNL UN17 NEATEK MUlil-0UTEET DIMMERS
AMT. N. W. Oll H. P. GAS N. P. AMT. NO. A. W. 0. AMT. AMT. MAT. AMPS. TRANS. AMT. N. 1. ~
~ y AMT. WATTS
~ I 1
5lRVK! gSCONNKT NO.OF S F R V I C E
AMT. AMT. IYP! Migg~, l,e tW t F ]W 3 H 7W 7 / AW ~.OE CC. COND. A. W. G. NO. OE NFU:G A. W. G. NO.OF NEUTRALS A. W. G.
PER 4 Oi CC. COND. Di NI-LEG Of mUTMI
z .nu cts 1 x ; s/u a s/u
OTMRR ARARI1TUf.
s 1/2 row Alc urdfrs->
F I<AC~I . NR AlN tiANUI F H8-
f..f.(:.I:-4
:i MlaKp pliIU.CTOR~-S
INRt: P; "f,' ti l_F: f,INU: 1. il:. lt32%~/1' /9~/~
kT. lll, t1UX lT'~M
t3pUNl) AVI`: Nllt( ORIRAI MANAfif1R
KIVIr.t<Hf_AU, NY. .i1NU1 It
Prr
This carlificate must not be altered in any manner; rNurn to the office of the Board if incorrect. Inspectors may be idamHisd by their credential:.
y_ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MKTl10T' BE ALTERED IN ANY MANNER.
D U ~ 30SETSOOFHPLANS ....c~.....
FORM N0. 1 SURVEY Mo..`- . , , . , , , ,
! 4 ~ TOWN OF SOUTHOLD CHECK , , , , , ,
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
e~t~c.t~~rx SOUTHOLD,N.Y.11971 NOTIFY
Towns ar- suurwtaLa
TEL.: 765.1802 CALL
~f
Examined 1 v MAIL T 0
Q
Approved 1~~PennitNo..~7```w
Disapproved a/c
,
G// ~ . .
(B'Gilding ~ector)
APPLICATION FOR BUILDING PERMIT
Date ~v~. Irl~.`
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 appB-
' 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
shag 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 Occtipancy
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 or alterations, or for removal or demolition, as herein described.
T}te 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 'n pectic`
.~GcC.~
(Signature ot""applicant, or name, if a corporarton)
' (Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
~y~.~F.-~z .
' Name of owner of premises . ,/,~es-~ .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. 3.b
Plumber's License No. ~ ~ .7 . ~ .
' Electrician's License No. , 3 2~ ~ . .
Other Trade's License No . .
1, Location of land on which proposed work will be done. .....W~S.....N~"J, ~'f~t/~.
Ifouse Number Street Hamlet
County Tax Map No. 1000 Section Block ~
Lot
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intende~d%use and occupancy of proposed construction:
i ....si. P~Ice
a. Existing use and occupancy ~ ~ • . .
.
b. Intended use and occupancy ....7.. 1~•~°/• • • <Y"%`~~~~-e-
,
.~.__.v......
,p ~
. i ta'f`
3, Nature of work (e k which ~
¢pplicable): New Building Addition Y.... • `Alteration G~
Repair ~ move! .....~6, Demo',lition .....tl~ ~thet"YVork .
Re
(Description)
4. Estimated Cost .........290/ o00 ~ .Fee .
Nu (to be paid on tiling this application)
S. If dwelling, number of dwelling units {nber of dwelling units on each floor .
If garage, number of cars l J, .
6. If business, commercial or mixed occupancy, specify nature aid extent of each type of use .r, i .
7. Dimensions of existing structures, if any: Front Z g ..ii Rear y Depth g , , , .
Height Z. Number of Stories ?c'. i. .
Dimensions 3same structure with alterations or additions: Font Q• ~ • • Rear . , , , , .
8. Dimensions of entire new cons • Hetght Number of Stories .
• . ~ • • 'traction: Front , lJ~...L Rear lY....... Depth (Y........ .
Height . z b.:...... Number of Stories , . Z" ~ .
9. Size of lot; Front . ~ D~ Rear I.~IY...~.......... Depth Z 6 .
10. Date of Purchase : Name~of Former Owner , .
1 1. Zone or use district in which premises are situated ~ . .
12. Does proposed construction viplate any zoning law, ordinance' or regulation: ......tt•t P .
13. Will lot be regraded 1N.
, S~ Will xcess fill be removed from premises: Yes ~o
14. Name of Owner of premises7~q~At, ~2v.!jt r?, ,Addres ~.°~.!'teW~~t~.-/~v :..Phone No. e?`{a:' ~9~~.... .
Name of Architect (pasta .~'Jt~.~'~% .....Addres$ 6/.\H, ,o~,csHj~, ~;r~;g, ,Phone No. Z~~: 5.?-s:~
Name of Contractor ~al~r~.. ~~~4~:~ haei•...... Addres$$ I3a{. l4 °.3~ t'he':... Phone No..~~+.&':. P6
IS.Is this property located within 300 feetl~of a tidal wetland? *YES./I.NO....
*If yes, Southold Torrn Trustees Permit ma~ be required.
PLOT DIAGR~
Locate cleazly and distinctly ajl buildings, whether existing r 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 .
i
STATE OF NI3W YORK, ~ 5 S
COUNTY OF .
• • • • • • • • • • • • • • • • • ^ . • • beirSg duly sworn, deposes and says that he is the applicant
{Name of indivtdua] sie~ing contract)
above named. / / • •C~~
aLctor a ent corl~
He is the Gyti1-~/jca~!~-t ! ~ti , i~ . . .
111 ( g orate 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; that all statements contained in this application are true to the best of ]tis knowledge and belief; and that the
work will be performed in the manner set forth in the application fil~d therewith.
Sworn to before me this
..d~~a//y of, ,.~1... ~Q/CX', 19
Notary Public, , .~...?~1.-.. 'i../f!G:~l.~-Pte..... County III
HELEN K. DE VOE ~ :~Gf'C!4t~ , .
NDTARYPUD1tC,StatmulNewYorN I (5ignatureofapplicant)
No. 47Di87R, Suft~~~k Ca~rdy~9 I
Term Expires March 3D, 19.-..fL-/