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26672-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28147 Date: 01/07/02 THIS CERTIFIES that the building ADDITION Location of Property: 985 ELIJAHS LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No_ 473889 Section 108 Block 4 Lot 7.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 1, 2000 pursuant to which Building Permit No. 26672-Z dated JULY 25, 2000 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 ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOSEPH P SHIPMAN & WF (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N 555679 04/11/01 PLUMBERS CERTIFICATION DATED N/A //,111tho y1ized Signature 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. 26672 Z Date JULY 25, 2000 Permission is hereby granted to: JOSEPH P & WF SHIPMAN 985 ELIJAHS LA MATTITUCK,NY 11952 for NEW CONSTRUCTION OF A FAMILY ROOM ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 985 ELIJAHS LA MATTITUCK County Tax Map No. 473889 Section 108 Block 0004 Lot No. 007 . 005 pursuant to application dated JUNE 1, 2000 and approved by the Building Inspector. Fee $ 75 .00 Authorize Signature COPY Rev. 2/19/98 'MAA. 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 - :2 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, (Commercial $15.00 Date . . . . . .off-f a. /•� ` : . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . .q�� . . . . . . . . . . . . . .64:! ,r v c t, . . . . . . . House No. Street Hamlet . • Onwer or Owners of Property. . ,0,SC�f�! ��7' L�C►`�. . .�_, ,p �/'�. . . . . . . . . . . . . . . . . . . �i • O cam . County Tax Map No 1000, Section. . . . .� . . . . .Block. . . �. . . . . . . .Lot. . .d . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . 6 b.�. .?-:-. .Date Of Permit. . . . . . . . . . . . . . . . . . . . . . . . . . . . .J.��1.��AffY1 . .Applicant Permit No. , Health Dept. Approval. . . . . /. . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . l.. Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . / Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submit ed: $. . . . . . . . . . . . . . . . . . . APPL ANT. . . . . . . . . . . . . . . . . . . . . . . . 765_1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: �- DATE /o/o � °� INSPECTOR 76S.Z802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU PLBG. [ ] FOUNDATION 2ND [ NSULATION [�RAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ( ( l � INSPECTOR lq(,)-JA- T65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ION [ ] FRAMING [ FINAL [ j FIREPLACE 8 CHIMNEY REMARKS: ,DATE 30-101' INSPECTOR n u A II II II II - -- - - - - - r FOUNDATION ( IST) ii II - ----- – - -- ---- - - --- ------- ---- - --- - ---- I-- II II FOUNDATION (2ND) II 11 ____________ _________-__________________________� E. �---- --ii--- ------- - - � ori► ROUGH FRAME: & a __�I _---_--- — --- - --- — ir u PLUMBING u --------------------------- n cn �II II H II INSULATION PER N. Y. u STATE ENERGY CODE I - 1� ii II u--moi - II II If �y � H II ll _.1 II FINAL if II 1 --------------- - II --II H -ADDITIONAL COMMENTS: rhe H_0 H O IP z ro !' JUNI 2000 g BOARD OF HEALTH FORM NO. 1 .3 SETS OF PLANS TOWN OF SOUTHOLDSURVEY - BUILDING DEPARTMENT $CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 DEC . . . .. . . . . . . .. .. ... . . . . S TEL: 765-1802 TRUSTEE . . . . .. . . . . . . . .. . . . . NOTIFY: ��.q b l�. . CALL . . . . . Examined# ` �4.,�...., 20a?. MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved� AV .P.� . Permit No. 7.F. .................................... Disapproveda/c .................................. .................................... •(Building Inspector)•..•.. . APPLICATION FOR BUILDING PERMIT Date id-J. .a,p. . . . . . . 20.o:Q . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wit 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 application. 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 issue a Building Permit to the applicant. Such permit shall be.kept on the premises available for inspection throughout the work. e. Ito 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. APPLICATICN IS BERM MALE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane Ordinance of the Town of Southold, Suffolk Canty, 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. • • • •(S•gnature of applicant, or•name, ifacorporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............Q:: !* ^.... .................................................................................................. nn Nape of owner of premises .vQk. N.�l: �!iAY.�19.^.'.. !�u.el�jTf/ceeti?.L:..S.uym.:�r.✓.t. �"........................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... 1. Location of land on which proposed work will be done...�/............................................................ �� �. ....1 $.....^�:.............e?7:r.t...�t�l..... ., .... .... ... T T l N�...�t1��.............................. House Number Street Hamlet dd , County Tax Map No. 1000 Section ...../.0 p........ Block ..`i!.....��JJh....... plot ...7:5.......... Subdivision ...................................... Filed Map No.T 1 3 �.1...... lot ............... (Nam) 2. State existing use and occupancy of premises and intended use aux] occupancy of proposed construction: a. Existing use and occupancy ...AKS -A R(M T1 A L...✓? ............................................... b. Intended use and occupancy ...k6 A:M C.................................................................. 3. Hature of work (check wlhidh applicable): New Building .......... Addition ../... Alteration .......... Repair ............ Removal ............. Demolition ............ Other Work ................................. (Description) 4. Estimated Cost .. � fee .............................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ......t..... Number of dwelling units on each floor ................ Ifgarage, number of cars ...................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front....4�........ Rear ...4.3........ Depth ... ........... height .............. Number of Stories .... .......... Dimensions of same structure with alterations or additions:. Front ....0* ....... Rear ....V........ Depth .....6.6............ Height .................... Number of Storiesi..I ........... 8. Dimensions of entire new construction: Front ....PIj..... Rear .4P Depth ...V........ lleight ........1................. Number of Stories ... ................. 9. Size of lot: Front ....Ag........... Rear ......i11 g.......... Depth ........2.70........ 10. Date of Purchase ..................... Nae of Former Owner ........................................ 11. Zone or use district in which premises are situated .....1)C S. IA 4........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .V 0.................... 13. Will lot be regraded ....N 0............. Will excess fill be removed from premises: YES 14. Names of Owner of premises ql V.SC.PJYJ.0 SA:-4'!n4b!.. Address ... Phone No. Nameof Architect .................................... Address .............................. Phone No. .............. Name of Contractor A �Q . IJ.�.s��:(�t71:4 t�:. .. Address g��.G.�l�cA.11.s. !:...........Phone No.-0? 15. Is [his property within 300 feet of a tidal wetland? * YES .......... ND .k........ *IF YES, SWMUW IUM IIS MS PERMIT MAY BE WgHRED. PLOT DIAGRAM a Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen$ions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corier lot. its'mTmo" ao' / Ca Aa�'� A i smir, or w w Y(W, SS 0"17 (lr ....................... iM.i r ..........................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, Ileis time ..........t.0 w.tq,A(-T9R............................................................................ (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; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .... !zC�........day of N.-/.tS/1:........�20..i)v.. Notary Public ... ..���"a ........ ............. Si of Applicant) LINDA J.COOP[. Notary Public,State of New York No.4e22563,Suffolk Cnunty Term Expires December 35,",ZDccu) BUILDING PERMIT REVICHECK LIST Applicant/ Date Owners Name: Jy s(l � S,�„�,•«I Reviewed: Architect/ Date Engineer: Submitted: 6 SCTM M District: 1.000 Section: /06- Block: Lot: 7� Project f I Subdivision Location: �5 � � Name: Single&separate Required certification: (Yes/No) r Req. C¢ Req. .1/6616 Zoning District: [Lo(size: Actual: / [Lot coverage Proposed: >S j ,$9SO Req. / Req. / 4 /1 Req. le / _t .4 4'�A [Front Yard Sa Proposed: ,/"'A 1 [Side Yard A� _ Proposed: [Rear Yard _ Proposed: Project Description: t�J ���-�— a2 X 2_ AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES S Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plai4f Elevation ??? Flood Zone: Notes: 100, Ams f � o« !, iso LC /7<Jr✓F' G /�Z c�'�S AJQ ..►BT 0GC'/4AO O ,FK/ r- I ! k i 1 \ I LJ BLDG. DE"T. QF SQU-NIOLD c.� 26�h2 �s o, Af� X01 W n � 0 �Op � O Np 8=25.00 �Q L=39.27e s s `OHO OO 2;10 so i Ro r i 11� Vv RP NOTE: AF r MONUMENT SUBD/V/S/ON MAPF/LED/N THE OFF/CE OF THE CLERK Or SUFFOLK COUNTY ON FEB 14 /9M A5 AME S PSE OF NF REVISIONS YOUNG & YOU G .t1 PRD w 400 OSTRANDER AVENUE, RIVERH fO OG ALDEN W. YOUNG HO Y 2G PROFESSIONAL ENGINEER AND LAN YOR Illf LAND SURVEYOR, N.Y.S. LIC. NO. 12845 N.Y. 45 3 UNAUTHORIZED ALTERATION OR ADDITION TO SURVEY FOR: THIS SURVEY IS A VIOLATION OF SECTION JOSEPH SH/PMAN CATHLEEN 45$93 OF THE NEW YORK STATE EDUCATION LAW LOT NO 3 "EL/✓AHS LANE ESTATESF LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY AT GUARANTEED TO: MATT/TUCK HOME T/TLE DI VISION OF CHICAGO GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE TOWN OF TME CO SURVEY IS PREPARED,AND ON HIS BEHALF SOUTHOLD RIVERHEAD SAV/NGS BANK TO THE TITLE COMPAN!,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED BY HEREON,AND TO THE ASSIGNEES OF THE SUFFOLK CO., N. Y. LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL SCALE: DATE: iNST17 uT10N5 OR SUBSEQUENT OWNERS. NO. =50 JAN 7, /975 75-2 r J ENERGY CODS C.ILCULATIONS (For Noce-Electric Heat) Design Criteria 6, 000 Vegree'.Days jO.A. JU'r I.A. 7U'F FOR: 6 G c� �' tA� �PUR: R Y Mt 7, e- DATED: 0h DESIGN 'TIIERMEL SUBSYSTEM AREA "U" RATING ExL erlar Walls (Opaque) 3O V- Glaziccy 2,L g / 0-0 „3 Z + `3 Doors coii.ilcy/ltuof (()Paque) 3 7 L? Skyliylcls Floor roundation Walls G ! 4F ./0 - / 6 3-y� do„w Slab Insulation TOTAL t 1' Notes: Building Envelope Systems to meet requirements of 7915.2 IIVAC Equipement to meet requirements of 7015 .11 I1VAC Systems to meet requirements of 7015.r2 Duct Systems to meet requirements of 7015.13 Ventilations Systems to meet requirements of 7015.14 InsulaUcin of Piping Systems to meet requiremenL-s of 7!115.15 Service Water Heating Systems & Equipment to meet requiremeltts of 7015. 21 Electrical & LighL-ing Systems & Equipcnent to meet requirements of 7015. 31 To the best of my knowledge, ,� CE.. , dq belief, & professional T jUdtjement-, these plans are in concPliance with Lhe code. W w FFG 032254-1 �V AROFESSIO p, �. © rFlazi Sk i `�° law • IM 75--- as a 1167 NOW OWN"jN"�p 4 !M 101t'1ME FOO POtMlp C ONCMM NBULCM 4, FINAL - CONW.MUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET - THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY - CODES. NOT RESPONSIBLE FOR - DESIGN OR CONSTRUCTION ERRORS / l e ��* ,t oa �tS A-G c s she /A�St.JC /lr+,0 s uPParTs as! r o�r/�c y YrN ys,aG a / • / See 4 DO NOT PROCEED WITH - _ - - -Ulf- - - - - - - ' ' �=`� hi' y r FRAMING UNTIL SURVEY _ ._ _ . _ Ail _ 1 E Y? OF FOUNDATION LOCATION HAS BEEN APPROVED. - -- =- - K 13 INS cis A 1pl; P'R P --Icy OR - y i USE IS UNLAWFUL _ .. . WITHOUT CERTIFICATE OF OCCUPANC`1 Sl -O� vim►,/ req/-2 vlr 6' PROVIDE V4 HR. FIRE RATED SEPARATION TO _-PART.717.3(f)(1)OF N.Y. STATE B&DING CODE. s _ - - - =4 PROVIDE OPENINGS FOR i EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OF i ' dcrr3.+e Al o1ar N.Y. STATE BUILDING CODE. - - ` '��'� dF �ooF a"u- ,ja-r Bic co���Q r W/TI/ GJoo� OR pL�TiC, ?�iis UNg"ITERSCERTIFICATE ,� A-Ceeds�tice,F'ao,a Dwecci� . REQUIRED �*low i v /a� S��.wf,.► �/Zq�� , PROVIDE SMOKE-DETECTING gx>� ALARM DEVICES /4 Q AS TO PART.721.1 N.Y.S BUILDING CODE. i L i 4 7YE:r1"V ,< ov kr PLUMBING " ALL,pLUMBING WASTE &WATER LINES NEED W i?f; WF JIVa C I TEST{NG BEFORE COVERING 0 A 3A 6 of NEIyYD 2- zx o s+.rpC1' ccMr✓s NGE PLUMBER CERTIFICATION �P ON LEAD CONTENT BEFORE _ - — s {� Uj CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER \ Cr 0322541 �V SUPPLY SYSTEM CANNOT ! '� op�0 ESS1oN�`. EXCEED 2/10 of I% LEAD, If copper tubing Is used for water distributing J system;piping shall be Z, of types K or L only (� UNDERWRITERS CERTIFICATE Q RE UR C � J I r i