HomeMy WebLinkAbout26216-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26895 Date: 01/26/00
THIS CERTIFIES that the building REPAIR & ADDITION
Location of Property: 900 PARK AVE MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 123 Block 7 Lot 13.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 20, 1999 pursuant to which
Building Permit No. 26216-Z dated DECEMBER 20, 1999
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 AND FIRE DAMAGE REPAIR TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to VIRGINIA S PETERSON, AS TRUSTEE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. PENDING 01/26/00
PLUMBERS CERTIFICATION DATED N/A
c
tho zed 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. 26216 Z Date DECEMBER 20, 1999
Permission is hereby granted to:
VIRGINIA S PETERSON
PO BOX 1231
LONG ISLAND CITY,NY 11101
for
REPAIR FIRE DAMAGE AND ADD TO EXISTING DWELLING. THIS PERMIT
REPLACES BP#11764 .
at premises located at 900 PARK AVE MATTITUCK
County Tax Map No. 473889 Section 123 Block 0007 Lot No. 013.001
pursuant to application dated DECEMBER 20 1999 and approved by the
Building Inspector.
Fee $ 75 .00
Auri ed Signature
ORIGINAL
Rev. 2/19/98
FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTH'OLD, N, Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 11764 Z Date ....-� *2e.......10................... 19.d(7
Permission is hereby granted to: s' ��'���J/� �• r- •��
A5,-�7 1/211 t��.JC....f ....... -7
.. .. .r'-'"�...... .............
.: ... ........ti:`f`..................��l �
to ..
..... l..l.,�. �. .................... ..................................................... ............................
. .... ..... .... ..
of premises located at ...........T...�!... ...1.C.G .� .......
......... .... ....................../` .SSZ (...1.. �:.�.t+...../.�1...... .:....
..:................ ... c,�l.1.0..�:.1..i..
County Tax Map No. 1000 Section I ZT. K......... Block .42,7............ Lot No. ,fQ."/. ...ln��•
pursuant to application dated ..................... 19.eand approved by the
Building Insp'ecto'r. ,
Fee �..1`:�.............. f
..... ! i •es►.
uilding Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD 3 c�
BUILDING DEPARTMENT
TOWN HALL G�'"`t7 ' 1 /• ►I 9 Y 7
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the buildinf
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. f
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form)
3. Approval of electrical installation from Board of Fire Unniters.
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 buildii
and installations, a certificate of Code Compliance from 'architect. grsedgeer
responsible for the building.
6. Submit Planning Board Approval of completed site plan req irements. '
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings ai
"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 Buildine - $100.00
3. Copy of Certificate of Occupancy - .2.5V.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . Old Or Pre-ext ing Building. . . . . . . . . .
C�
Location of Property. . . . . .!DQ. . . . . . . . . . . . .! ....... . . . . . . . . . . . . . . . . . . . . . . . . . . .
House No. S reet Hamlet
Onwer or Owners of Property.. . . . . . �`. .�� . . . . . . • • • • •
County Tax Map No 1000, Section. . .
VV�C.'�`�. . . . . . .Block. . . . . . . . . . . .. . . .Lot. . . . I . . . . . . . . .
Subdivision. . . . . . . . .//. . . . . . . . . . . . . . . . . . . . . . . . . . .Failed Map. . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . .
Permit No. . .L7 �1?�: .Date Of Permit! : . . 1.�. . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certic e. . . . . . . . .
Fee Submitted: $.a . : �. . . . . . . . . . . . .
�D _a a . . . . . . ... . . . . .�-�. . . . .
C' APPLICANT
aa�b off, 5"
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
8078649 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK; NY 10018
Date FEBRUARY 01,2000 Application No. on file 1979f 300/OO H 067000
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
PETERSON, 950 PARK AVENUE, MATTITUCK, NY
in the following location; ® Basement ® lst Fl. ® 2nd Fl, OUT Section Block Lot
was examined on JANUARY 26,20W and found to be in compliance with the National Electrical Code.,
FIXTUREFIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS RECEPTACLES SWITCHES INCANDESCE FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS I N.P. AMT. NO. A.W.G. AMT. AMP. ItMt "AMPS. TRANS. ,AMT. H.P. SYSTEMS AMT. WATTS
NO.OF FEET
t
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC COND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. 1•2W TO SW $0 3W 30 4W PER 0 OF CC.C ND. NO.'OF HIAEG OF HIAEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
ELECTRICAL SURVEY AS PER 1/26/00-1
*NO VISUAL DEFECTS: "An electrical
survey has been made of the exposed
electrical equipment in the
premises indicated. " "No obvious
unsatisfactory condition was found.
L L
SALAND REAL ESTATE INC.
MAIN STREET P.G. BOX A GENERAL MANAGER
JAMESPORT, NY, 11947
Per
This certificate must not be altered In any manner; return to the office of the Board if Incorrect.;Inspectors may be identified by their credentials.
--------------
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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ALTERATIONS TO THE SAKISIAN RESIDENCE THOMSON ARCHITECTS PC Scale: 1/4"=1+-0" /�D_
MARRATOOKA ROAD,MATTITUCK,NY NEW YORK, NY 212-932-2028 Dr By: ST /`1
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MARRATOOKA ROAD,MATTITUCK,NY NEW YORK, NY 212-932-2028 Dr By: ST
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FIELD `INSFtCTION IDATE COMMENTS ,
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FORM NO. 1 .�
O'.i"i C= SCUT:-;OLD
BUILDING ✓E?AR 17viENT
TOWN HALL
SOUTHOLD, N.Y. 11971 ' f
TEL.: 765.1302
E�atninrd f. . . . l9 z Application No..�l,provcd !! ./�l. .�`f?. . . ., 1perrnit No. . r`�7.`':
Di,:al)provcd a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
. . . . it
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . . . . . .(V . . . . . .. 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submittedi:#triplieaft to the Bui,(
Inspector, wit!, 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Ply;t plan sltowin- location of lot and of buildings on premises, relationship to adjoining premises or public st--
or areas, and riving a detailed dcscription of layout of property must be drawn oil the diagram which is part of-this aY
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon apprc:al of this application, the Building Inspector will issue a Building Permit to the applicant. Such per
shall be kept on the premises available for inspection throuC'hout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa
shall have been granted by the Building Inspector.
APPLICATION 1S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to
Building Zunc Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance
Regulations, t•or the construction of buildings, additions or alterations, or for removal or demolition, as herein descrit-
T' c applicant a trees to comply with all applicable laws, ordinances, building code, housing code, and regulations, anc
admit authorized inspectors on premises and in buildings for necessary inspections.
7 `v`� (Signature of ap/Ilicant, or name, if a corporation)
(Mailing addresslof appiicafit) -
State whether app!icant is owner, lessee, agent, arc'iitect, engineer, general contractor, electrician, plumber or buil(
. . . . . . . . . . . . . . . . . . . . . .a �'`'•' >f;. . . ` . . CJS . . . . . . ./� . . /, ��-y . . . . . . . . . . . . .
\'vire of owner of i-ciniseS
(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. ILt�s g�,w:•J a„/a • jyi
PIunr ber's License I\-o. 1.111Tf /.:c� e/C��u-/,r %?r• ��--
Elzctrician's License No." .��.: Z t 4,, �( ,:, • • • •
Other Trade's Licens- No. . . . . . . . . . . . . • • • • . • • • •
1. Location of
land on wliicli proposed work will be done.
. . . . . T:�:��. . . . . . . . . . . . . . /. 6-Y. . YiY o c,t'.� All: . . . . . . . . . . M.A . � � cte A.. . .. '. . . . . . . . . .
• House Number Street � '
. Hamlet l/a_/3)
/.�3. . . . .
County Tax Map No. 100Q_Section . . . Pa,—k-
. . . . • . Block o. , . , , , , Lot .l.0-.�3Subdivision . ,/! L?r-/7-qToPka. . . . . . . . . Filed Map No. 1?:#9 ! . . . . . . . Lots. ��.' !! . . . . . .
(Name) / 17
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . S u k #1!4! * .'.-.-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Intended use and occupancy .. K :f:.14An
J
I. Nature q v.-ork (check %v.hich applicable): New Cuildin; Addition . . . . . . . .
Ripa ,r/le Remo•it . . . . . , . . . . . la. ,, .on Alteration . . . . . .
r mc,: .:n . . . . . . . . . . . . . . Other lVorr: . . . . . . . . . . .
Estimated Cost . . . . . •�� Q�� ��� � (Descriptio
�'• • • • • • • • • • • • • . . . . . . . .
Fee If • • ' ' • •
(►o be paid on filing this application). •
�i�tiellia_„ number of dwelling :nits . . . . . . . . . . . . . . . Number of d:velling units on each floor . . . . . . . . . . . .
If gar: c, number of cars
i. If business, co::::nercial or mixed occupancy, specify nature and extent of eac}t•type•of use •
Dimensions of existir.-structures if any• Front . . . . . . . . . . . . . . .' ' ' • ' ' ' ' •
Hei_Itt . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . .
. . . . . . . . . . . . . . . Number of Stories .
Dimensions of same structure with alterations or additions: Front • . . . . • Rear • . . . • . . . . . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . .
S. Dimensions of:ntire ne:v construction: Front . . . . . Rear . Depth
Heil:t . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . .
). Size of lot: Front . . . . . . . . . . . . :. . . . Rear . . . . . . . . . . •. . . . . . . . . . . . .Depth • . . . . . . . . . . . . . . . . .
). Date of Purchase . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . .
I. Zone or us-- district in which premises are situated • • ' ' ' ' ' ' ' ' ' • ' '
?. Docs prcpo:ed constrt:ctio!: viola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
to any zoning law, ordinance or regulation:
Will Iot be rcgra,led /J d•
• • • • • • Will excess fill b� removed from premises: Yes • ,t1c
}• i\ame of Own---r of premises
\acne of Arcl: . . . . Address . . . . . . . . . . . . . . . . . . . Phone Nod F. �;33
itect Address
?game of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Add . . . . . . . . . . . . . . . . . . .Phone No.� $, .��,��3
Address . . . . . . . . . . . . . . . . . . . Phone NO.TdJ1�YJc.�4
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existi!?-
roperty lines. Give street and block number or ascription according to deed,iand sho vtstreecate t namesand indicate wh ack dim crisions t
.tenor or corner lot.
TATE OF NEN Y RK,
OIJ\?Y F . S.S
. . . � r . . . .�. . . .� heir g duly ,
(Na :e of individual signing contract) sworn, deposes and says that he is the applica!
)ov•7 natned.
e is the . . . . . . . . . .
'!�(Conimctcr, agent, corporate officer, etc.)
f said owner or ovnLrs, and is dul%' authorized to perform or have performed the said work and to make and file th
)plication; that all statentents contained in this application are true to the best of his knowledge and belief;and that th
-ork will be performed in the manner set forth in the application filed ti!erewith.
worn to before me this
• . . . . . . . . . . .��J�; J .day of. . . . . 19 '
. . . .,
otPublic, , , , �-
p 'j� . . . . . i County
• H.ANN MEtiltt� (/!� Gr;;-�GL ✓. �'
r I M)?111l1' PUSLIc'"sute of W* y • •,N. . .
f
(Signature o:aonli. . . .can t
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LJGAL URZj 11NANG£6 p NE\V YJRK- .STATF� $UILOING L'' � Y p 0 r,,, � — I NR\Y 6'-✓" �f I ! �`o IS I�NINA����
FINER COY CUM SERVATION GPDES LATEJT KI. HL14HT I�vE APPRO ED AS NOTED
Z. EL GGTR IGAL T'L U,411311N C� Wc/RY SHALL. '6E GOVEFkNEZ) ►•�• a -Y F V 9le Pl LA.1..,. •A I I UQ
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DI/AEHSIONJ GT�PE RATE \V ITH OTHER TRADES {' GV/APLF�..T£ N' . b h "O
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\YJRK. Ill AGGOR RANG£ WITH THE -6E3T 6TANDARD U tjp" °i:o' r FEE: By.
PRAGTI G Fi5 . 'H +Y • lb-• I TG I-i En.-iJ
NOT.. BUILDING DEPARTMENT AT
ALL DI/AENSIOHJ AR£ No/AiNAL ;?' YAK£ "P'R£CEDENGE _ , _ Q 0 ��` ���L��Anp.�Y 765-1802 9 AM TO 4 PM FOR THE
oY�R SGA1-E , ALL A's L-�RE.v1AT10N5 ARS STANnAraa. S . s•z. Ia ,Y/ s-vn^ � �" u 1t FOLLOWING INSPECTIONS;
5. ALL \voon -FRA/AE GON STIR ucT ION SHALL C.ONFOR/A Wi--H 2 r =-i„/z +'�Y`vc r4r-r' .� 1. FOUNDATION - TWO REQUIRED
TN6 A/AFRICAN INSTITUTe_ JF TI/Ai,£R a J N 6TR J GTI O N'S 0 - NOK I I FOR POURED CONCRETE
I' TI/At3ER GdHSTRucTION .1'\AN UAL ! LATEST E-:D ON. 't � —n - - - --. —I-, - 1-- . — -- - 0 2. ROUGH - FRAMING & PLUMBING
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