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HomeMy WebLinkAbout27530-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28118 Date: 12/14/01 THIS CERTIFIES that the building ADDITION Location of Property: 14695 MAIN RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 114 Block 8 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 18, 2001 pursuant to which Building Permit No. 27530-Z dated AUGUST 7, 2001 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 AN EXISTING DENTAL OFFICE AS APPLIED FOR. The certificate is issued to ALEX & AFRODITE BOUKAS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 56157 10/23/01 PLUMBERS CERTIFICATION DATED 12/05/01 MATTITUCK PLUMBING & HEAT I /c Auth ized S gnature Rev. 1/81 FORM NO. 3 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) PERMIT NO. 27530 Z Date AUGUST 7, 2001 Permission is hereby granted to: ALEX & AFRODITE BOUKAS 14695 MAIN ROAD MATTITUCK,NY 11952 for CONSTRUCTION OF AN ADDITION TO AN EXISTING DENTAL OFFICE AS APPLIED FOR. at premises located at 14695 MAIN RD MATTITUCK County Tax Map No. 473889 Section 114 Block 0008 Lot No. 005 pursuant to application dated JANUARY 18, 2001 and approved by the Building Inspector. Fee $ 150 . 00 Author ze Signature COPY Rev. 2/19/98 .f Form No.6 w TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN PHALL ----- 765-1802 �: _,��UMI APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: v"11. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or topographic features. 1�fa2 Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). ✓ 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 I%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. Photocopy of Certificate of Occupancy-$0.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00 Date. >V—.G . '��fLya New Construction: X Old or Pre-existing ►Building: (check one)) Location of Property: .14 409 5 "/1ws ROAD '"'/�IA—%11-t 1)G'1< House No. Street Hamlet Owner or Owners of Property: l-�C7` Ffi0�1 CG. �4� AS Suffolk County Tax Map No 1000, Section 114 Block 4 4013 Lot o®5 Subdivision Filed Map. Lot: Permit No. 2.1 5'3Q Z Date of Permit.ANk; JI 121141 Applicant:N'r.A A A,Feas1-W.- &&jjlAj Health Dept.Approval: tjdT R&q�.I jptp Underwriters Approval:*50M %d�2T1 Planning Board Approval: Request for: Temporary Certificate Final Certificate: ( eck one) Fee Submitted: $ 5b .o Applicant Signature 2/0512001 137:17 6M984753 PAGE 01 Fax(1331).765-,18.3 Town Hall,ssoo Main Road � � 7elapbene(.031)765 18(}2 p:0.fox 1179 Southold,Naw York 11911-0454 1 BIJ IDINO DEPARTMENT TQWN OF SOrT HOLI) cERTIFIfAT12N Date: Buildting Pe�Git oto: _�..1 Qwna:,s► Ata, �rCA' T (Please wi nt) iust�ber: A" � G TT M&jea i_ft-r (please print) I eertifY that the snider used ii,the watez supply system contains less tban 2110 of 1% lead, lumbers SlIpature, SWOM to before me this .. . day of PrCE?"OEX Notary Public, le- County Tor rv�rM'Ju�r g Electrical Inspection Certificate Electrical Inspection Service, Inc. 375 Dunton Avenue East Patchogue, New York 11772 (631)286-6642 Date: 10/23/01 Application No. : 56157 Issued to: Alex Boukas D.D.S. Street: 14695 Main Rd Village: Mattituck Zip: 11962 Town:Southold Section: Block: Lot: Introduced by: Lademann Electric Inc. Lk.# 4141-E was examined and found to be in compliance with the National Electrical code .:` ❑ Commercial ❑NV Defects ❑Pool ❑lstFloor ❑Indoor ❑Basement ❑ Hot Tub Residential ❑ Det. Garage ❑Attic ❑2nd Floor ❑Outdoor W Addition ❑Survey Switches Receptacles Fixtures GF/ Heaters A/C Fans r` y 7 19 8 2 Dishwasher Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal Furnace Oil Gas Circulator Smoke Detector Bell Transformer Meter Amps Phase UG/OH Telephone Television Carbon Monoxide ❑/ ❑ Other Equipment: s 3-e177ergency/fights Hugo S. Surdi President Building Permit No. This certificate must not be altered in any manner Inspectors may be Identifled by their credentials Final Inspection: 10/23/01 Rough Inspection: Inspector: Quentin Reynolds STATE OF NEW YORK ) ss.. COUNTY OF SUFFOLK ) , being duly sworn, deposes and says: That deponent is over the age of 18 years, and resides at (OM OLA:-;3UL;B LN P-I'T1, Ili 4') Z00' That on the q day of -'P-"OPf,�q ,499% deponent, being the architect/engineer, licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the New York State Fire Prevention and Building C e (9 NYCRR). Architect/Engineer m to bef me this Zcx0l �1� �Y of t9w. - i N a blic JOYCE M.WILKINS Notary Public,State of New York No.4952246,Suffolk County Term Expires June 12, 00) cc: applicant -2 S-3 C-L-- suaniNo DEPT. ,.--.'NSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: DATE A LO� INSPECTOR suiwINa DEPT. INSPECTION [ ] �FNDATION IST [ ] ROUGH PLBG. [ j FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: �, DATE � �� _INSPECTOR BUILDING DE". INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FO DATION 2ND [ INSULATION�E�� [ FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: - a/- DATE 9, INSPECTOR BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ROUGH PLB6. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 90L�l ati 46��� ryW- cm �,j 4& &a - (2ze rZ�� 7t, DATE j INSPECTOR BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH BG. [ ] FOUNDATION 2ND [ ] IN CATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CFIIMNEY C R ARKS: _ DATE �l INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLB6. [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING [ FINAL [ ] FIREPLACE & CFIIMNEY REMARKS: DATE 1 INSPECTOR \ FIELD INSPECTION REPORT ' MATE �. COMMENTS ` .rte, FOUNDATION ( 1 STY -6 FOUNDATION —ND) cot _ z ROUGH FRAME PLUMBING r r INSULATION PER N. T.' STATE ENERGY CODE FINAL © (� ADDITIONAL CONSENTS: T WlH� H x 'r BOARD OF HEALTH . . . . . . . . FORM NO. 1 J SETS OF PLANS . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . _ . . . . • . . • • TOWN HALL SEPTIC FORK _ . _ . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 O c I F y ; Examined . . CALL . . .(L.�8 =54�Je . . 19 MAIL TO: Approved 1 , .4J.i'. . F h��.�s . �• 5u'.� Permit No. . . . . . Disapproved a/c . . . . . . . . . . . . . . .e . 2. . . . . . . . . . . . . . . . . (Buil g nspector) APPLICATION FOR BUILDING PERMIT Date . . . . . Ae x.19 t . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with= 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 street= 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 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 in tions T4� (Signature of applicant, or name, if a corporation). (Mailing address of applicant) State whether applicant is owner,.lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . ..4L+—�- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . �F-r►,D, Vin(�. . . . . . Plumber'slicense No. Electrician's License No.... Other Trade's License No. . . . . . . . . . . . . . . . . . , . 1. Location of land'on which proposed work will be done. . . . . . . . . . .4. . .�. 4 C° `� .r. , , n'1n.N [" l TOS_. . . . . . . . . . . . . . . . . . . HouseNumber . . . . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Hamlet County Tax Map No. 1000 Section . . . . .(AQ . . . . . . . . Block . . . . .. - ... . . . . . . . . Lot . . . . 0� ? . . . . . . . . . . . . . . . . . . . Subdivision . . . . "-- . . . . . . . . . . .(N.ame) Name) . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . , • ; ,1�, ,`,1!, .oFf G . ... ... . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . all r 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . .V/. . . . . Repair . . . . . . . . . . . . . . Removal , , , Alteration . . . . . . . . . . • • . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . 4. Estimated Cost ►P ,� , , , (Description) . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) . S. If dwelling,number of dwelling units . . . '�. . . . . . . . . . Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage,number of cars ^ 6. If business, commercial or mixed occupancy, specify nature and extent of each type.of use 9M�• 7. Dimensions of existing structures,if any: Front . 2'�' Height . . . .? ' . . . . . . . . . Rear . ?-t'. . . . .... . . . . . Depth . �•� . .1 • . Number of Stories . . . . .1. . . . . . . . . . •�• Dimensions of samestructura with.alterations or additions: Front 4 3 . Depth . . 9 " " " " " " Height '�. . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . 3�. . . . . . • • • . . . . Number of Stories . 2- 8. Dimensions of entire new construction: Front . . .'�. Rear . ,`f•!' . . . ' . ' ' ' Height . . . . .�$� . . . . Number of Stories . * . . . . . . . . . . . . . . . . . . Depth . . 39� . . . . . . . . . 9. Size of lot: Front . . . 171 •1y • •• • • • • • • • • . . . . . . . . . . . . . . . . . . . . . . Rear . 9 . . . . . .Depth . . . .2!..'. 10. Date of Purchase Name of F . . . . 11. Zone or use district in which Former Owner . . . . . . . . .,. . . . . . . . . . . . . . . . . . . premises are situated . . .�,A 12. Does proposed construction violate any zoning law, ordinance or,regulation: N o ' ' • ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 13, Will lot be regraded ^!0 . . . . Will excess fill be removed from premises: • •�Yes • . N . 14. Name of Owner of premises . .. . . , , . Address �?�`?►� a0 (b/. M 3,9° Name of Architect . VWPV. „�.r1 L.8(2- . . . ... . . . . . . . • • •Phone No. Address ". Name of Contractor :f�0i 6 b , , , , , , , , • , , , . Address � ' � � � '66 ' ' ' • ' • • Phone No. 15. Is this property within 300 feet of a tidal wetland?. . . . " " ' • • • • •Phone No. . . . . . . . . . . . . . . . *If yes, Southold Town Trustees Permit may be required... . No.X' . ." 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. TATE OF NEW YORK, 'OUNTY OF . . . . . /�' . . . S.S • (Name of individual signing contract) • • • . . . . . . . being duly sworn, deposes and says that he is the applicant rove named. e is the . . . . . . . . . . (Contractor,agent, corporate officer, etc.) • • • • • • ' ' ' ' ' ' ' ' ' ' ' ' • said owner or owners, and is duly 4uthorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ork will be performed in the manner set forth in the application filed therewith. vorn to before/me this : . . . . . . . . .( . . . . . ay o . . . . . . . . . . . 1•g?.Od )tary Public, . . County .\. JOYCE M.WILKINS • • . • . . . . . . , Notary Public,State of New • • • . • . (Signature of applicant) • • • • ' - No.4952246,Suffolk County Thrm Expires June 12,�Ci/ JOHN `OFR 89I6 N/O/F- • E• 3 N• Th 74•°130 s *; N rn 3.84 �• .a C 7- m 7- cr N a O r � w f/, c,s Q �4 c9 Qo 4• Z C as G C� 3 CI. • � N L 9.Z O ` aA\ .b. M 9,x;(6 n'J _ 93. M N - AAP D .o g,�.QA .� C 5• l�• M z POP. PO C a°• R0 1� �P SURVEY OF PROPERTY A T MA TTlTUCK- TO WN OF SOUThV LD SUFFOLK COUNTY, IV. Y. SGa/S. 1"= 30' The locations of weft and cesspools Feb. 18, 1994 shown hereon are from flak observations NOV. 24 2001 and or from data obtabed from others. AREA - 21,051 sq.ft. aNNoF 1O 0 AL TITAN OR WTA2N TMS MVEY IS A VIOLATKW V M. it N.Y.S. LIC. NO. 496/8 b UR MORS, P.C. l - 7 FAX 163/1 765 - l 797 TD MtPI dr1D TIhE' 1s1c' pp�� rr�vpp t• SMUT . w�ot>bwr - m - t>t�r AIS neat bt c 1� SOU , N.Y. //97/ 94-103 a N. uF. 5� ttN Lo =w GJ I T f� L T 4 <jCl m U° 1000 - 114 - °G_- 05 a I INDIhI Ro>V, M�Tf INK. ,, , �qE N . -74 G,, �" E . x.16, Z(aNE � K,D FLESIDENTIaL oF°FIcE P 3� \_ 6,R Ill PUI pIdQEDS: EVISTING� 1 FL oR Bao s,F. R / �\ - /ry p pwo P05rn DPOI r1oN X36 S,F, � � �( ,`�C T o T P L 13 RG S.P. 2e _ L°T CoveFA,,F, r-l.AAZE) 6.5o/. -6+y eb v.,Nrj Re.Gu lREro- b ISI�T ccr`�.r 5 5pb ``'j N — . 1. 3 � oDRw1ti1U P'rtovlr�ex� rA sFnr.� 4LF "5 MP., / m o r '7I , o5spS � 'JGi✓•1-V5 r--I= N° G10 - -1 -1 - '08 �f - GK, I=- --- _ TµER.F �iZIe.NO WE1d-S W1tHrri N f�Pv�.vT SON T7ENSITY 26h1c. 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AA' WC ✓' ,0 ` B,+nwn J SDx10lf GROVEL ~ 'Q SN-IPV I'LL 2.J Y \ twc>",�� uoyev IL MSv r-i p Pb LC ORD+,[iE. F— I�ALE P.-upyN G�AUhIO WDTET2• 12.3' --.. C ROUAID WaT IIIYrrrr�(!! ; w 9L FTO 1 e _ co0 eravc ]`- NohUJ ,� � DnT4 -(AKIN FRgrn SITS PLMI EW fe�-eo1-I le SURvS-l,-Cale;:, Dt,T� 212,19G , a pp GDNTOU ftI. IN6S 6W6 R6F6R1rt.IG�V TO lH� pNE El>S'(�'*{T�,ns rpt-�eFulc MpP. O 1'tf30 OCCUPANCY OR PLUMBER CERTIFICATION etm MEW= A FR VEDAS NOTED - ,,�„ with _. 431 o II aIS3 D USE IS UNLAWFUL ON LEAD CONTENT UPAN�Y All ami s', ow caorwAvoL n comply DATE: B.P # F QP OCC _ ITHOUT CERTIFICATE CERTIFICATE mw Ya�r>�Er,Mr�r�ra +o►+Cod.. _.. u� l INgMdinODwk�nby �Perfoe,eence. FEE: D`�: --- -- ------- -- ----------- -- --------------------------- ---- NOTIFY BUILDING DE RT NT AT OF 04'CUPANCY . SOLDER USED IN WATER _ f, _ _ 765-1802 9 AM TO 4 PM FOR THE. SUPPLY SYSTEM CANNOT -�- -- - �P2lb FOLLOWING INSPECTIONS: UNDERWRITERS CERTIFICATE EXCEED 2110 of I% LEAD- _ - - - Q VMS WkxI �U. 0.20 U. 0.17pmvkbd 1, FOUNDATION TWO REQUIRED REQUIRED W OAS U. 1.04 p avI&W FOR POURED CONCRETE _ ._.__.____ ¢ S' b _ - 2. ROUGH - FRAMING & PLUMBING PLUMBING 0.05 W 0.01 RMolor M�diewan Ur �� 3. INSULATION ? ALL PLUMBING WASTE ! � _ r WATER ONES NEED "1oftbeetofnVWiaAeft I„beWim bred 4. FINAL CONSTRUCTION MUST 8 Lbs I �w �piemam4c,crompftmwith Oft codp�- BE COMPLETE FOR C.O. TESTING BEFORE COVERING J„n�G Z ALL CONSTRUCTION SHALL MEET o THE REQUIREMENTS OF THE N.Y. ,, G `>~- S STATE CONSTRUCTION & ENERGY I v -F { 24 CODES. NOT RESPONSIBLE FOR NI►CTION ERRORS DESIGN OR CSTR qp C� p '� �� 5 , V\ D06L AS H�►.T H f _ S Il_ES f i �J �Ex4�jT lH X97 V 2 Imo# ld i � Ij? Q �° t4AM Mom. SIS. R,x7F►ne1�►DP ac 2 x b i=J _ ,�� �.� 4,F ( + k I , &L.UNt C UT1ek. 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