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HomeMy WebLinkAbout18414-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219620 Date DEC. 31, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 415 RACHELS ROAD MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 108 Block 04 Lot 7.2 Subdivision Filed Map No. Lot No. 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 1989 pursuant to which Building Permit No. 184142 dated AUG. 28, 1989 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 ONE FAMILY DWELLING WITH WOOD DECK AND STEPS. The certificate is issued to TOWN OF SOUTHOLD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-32 DEC. 26, 1990 UNDERWRITERS CERTIFICATE N0. N148514 SEPT. 12, 1990 PLUMBERS CERTIFICATION DATED HARDY PLUMBING ~ HEATING 11/19/90 1- ui ding Inspector Rev. 1/B1 msx rra s TOWN OP 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) N°- 18414 Z ate ..L~%~....~'..~i 19.~~ Permission is hereby granted to• to ..........~,....o..xr-r.. ~ at premises located at ...~.,?~~y./...,1~..~~.~tG'ufr~%F• .........1.1....cG.......... .........................................................~~//.1.. : ............................................................../..D... ~ti-i... ...........7............... County Tox Map No. 1000 Section 8......... Block ©.`~,1....... Lot No..i.p5..'...L~.... pursuant to application doted ........~..G~ 19~G~., and approved by the Building Inspector. Fee S.BdI.i . J.../~r//.....~.f~. Building~~lnspecfor Rev. 6/30/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE ' 1000968 j BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10036 t Date SRPTSMBER 12,1990 gpplieationNo.onfile 65066489/89 N 148514 THIS CERTIFIES THAT only the e/ectrlca! puipment a described belots and introduced by the applicant nomad an the oborre application number in the premises of VO BEARS BUILDERS, S/S RACHEL RD., LOT/4, MATTITUCR, N.Y. in the folbwinR lac t /st F/. OUT 108 k04 P 107.2 , gEfPGUST~~4~d` L"J TJ Ynd Fl. .Section Bloc Lot waa exomined on N ~ ~ + and found to be in compliance Erith the reyuirementa of this Board. BXTURE W%TURES RANOES cOOKIN6 DECXS OVENS DISH WASHERS lXNAUST FANS OUTLETS TAdK SWITCHK INCANDESCENT ~ P1U011ESCENi OTNEN NAT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P. 14 S 12 14 j i - DRYERS'. RJRNACE MOTORS 111TURF AFMIANtX MEDEK SFlCIALRK'Fi TIME CLOCKS MLl UNIT HEATERS MUITI-OUTLIT DIMMEK AMT. K. W. Oll N. P. GAS N. I. AMT. NO. A. W. G. AMT. AMI. AMT. AAVe. TRANS. AMT. N. P. SYSTEMS AMT. WATTS Iq. OF RET 3 ! 3 - - ] 30 1 SlRVICE DISCONNECT NO.Of 5 E R V 1 C E AMT. AMI. TYPE METER 1 A tW 1 / TV J / DW a / AW ~ CC. COND. A. W.O. NO. OF N4LEG A' W' G. NO.OP NEUTRALS A. W. G. WUI?. PER A OF CC. COND. a NIiEG Of NEUTRAL 1 100 CB 1 X 1 4 1 OTHER AFMIIATl15: MOTORS:1-.75 A.P. SMOAE DETECTOR:-2 E tiILLIAM T.STOCR LIC./889E 1250 SMITBTOIIN AVENUE BOHEMIA, NY, 11716 O~~ MANAGER 11 j Per -'"~L- This cerfificata must cwt be altered in any mariner; return to the office of tits Board if incorrect. Inspectors may be identified by their crodsntials. COPY FOR BUILDING DEPAR E MUST NOT BE ALTERED IN ANY MANNER. E T:L• L. 7G. -1802 ,'.C -O. TO•tYN O,L' S.UkJT~~~,ll i ~ - < . O6FICE OI: 4UILDd34G INSPEC-T;OR ~O. ~~~Z- SOUTFIE)L,D.. f.Y. 1: L•971 ' zs C E R T I F I C A T Z O.N. Date NOVEMBER 19, 1990 Building Permit No. 18414 z Owner TWO BEARS/NORKLIN (please print) Plumber HARDY PLUMBING & HEATING NORTH, INC. (please print) I certify that the solder used '_a the water supply system contains less than 2!10 of 18 lead. " (plumber's signature) Sworn to befo'rell ire this day of IV ~ 19~ ~ ^ 2 ilotary Pub c Nota•:• puh=ic, Coun:.y Nfi ~WN~ IY ~'~t~'% sly -1:;LD I;:S:'EC;iU;1 ~~UniE ~ CONMGNTS 1. H~ FOUt1DATI0N (1st) _y'~ ti FOUNDATION (2nd) _ 2. z 0 ?OUGH FRAME & _ PLUMBING` ~U ti / - H 3. ~ m H I1ISULATION PER N. Y. STATE ENERGY a CODE x c~ 0 4 , .3 FI;JAL ~ 9`- y 03 ADDITIOPIAL COMMENTS: ",.t n...{1 n ~ w ~ u 10. ~ n~ ~ 1 ,~i / A / ~ l'~` ~t` H ~ N 9~ FFF--p~~~\~n\` x rr Hy - xo ,r . BOARD O1~E.\LTH 3 SETS 0 PLANS FORM NO.1 $URVEY TOWN OFSOUTHOLD CEIECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL EOUTHOLD,N.Y.11071 NOTIFY • TEL.: 765-1802 CALL James.t,.1~s=(lahpn..... 19a~ MAIL T0: Examined . p Town Hall, Main Road Approved er4~I...., 19~Permit No. I C7...;1.~.1~~ Southold, NRRew YMOrRk 11971 Disapproveda c D~~ L5 ~ V l5 D .>t11N 2 2 1959 ~.e~~!~F'! :KC...'~'~.i~ Tom' ~~`.7 + (Building Inspector) "~n" APPLICATION FOR BUILDING PERMIT - Date ,May, 8, , 1989.... 15 . INSTRUCTIONS a. Tltis 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 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 iemoval 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 inspectots on premises and in building for necessary inspections. ,.Town of Southold - Community Develop. (Signature of applicant, or name, if a corporatron) Town Ha 11, Southold, NY 11971 • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWNER Name of owner of premises .TOWN. OF SOUTHOLD.._..••..•.....•.....•....••...._._•.......•........,. (as on the tax roll or latest deed) IC applicant is a corporation, signature of duly authorized officer. James C. McMahon, Administrator, C•D. (Name and title of corporate officer) Builder's License No . . Plumber's License No. ..1.~~.J.~ . Electrician's License No. .~~~.G . Other Trade's License No . . 1. Location of land on which proposed work will be done. - l.,a t41tG1~~~ -S.. flaA~........1.1?4Tr~ mc~ . House Number Street ~ ~ • ~ ~ • Hamle[ County Tax hlap No. 1000 Section l Q~......... Block Lot ..r~.! Subdivision Filed Atap No. Lot . . ..(Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy VACANT b. Intended use andocCUpancy Single-Family Residence ~ ~A Nast ~ l U'~ /~e>•u - B'~/!~A/V 3. Nature of work (check which applicable): New puilding , x,', , , • • Addition Alteration Repair • • • • • Removal . Demolition Other lyork . ~t-J (Description 4. EstimatcdCost.... ..................Fee.W,~}yed,-•Town Project (to be paid on filing this application) 5. If dwelling, number oC dwelling units ..........1 Number of dwelling units on each floor N.~? . If garage, number of cars .NlA......... , • • • • 6. IC business, commercial or mixed occupancy, specify nature and extent of each type of use . Jy/.A , . , , , , , , • • • . 7. Dimensions of existing structures, if any: Front , N•%A , , , , , , , Rcar . NlA. , , , , , , , , , Depth . !y/, A, , . • • • . Height N/A. , , , • • , • Number of Stories ..N%A imensrohs of same structure with alterations or additions: Front . T{~A , . , , . Rcar,NlA............ cpth ..NlA }Icight . N/A Number of Stories N/A• • ' 8. Dimensions of enti~ new construction: Front ~Q,', , , , , , , , Rear , . ~ ~ ~ • ' ~ ' ' Hci~ht .oZ,3 8~~, , Number of Stories . ,q7 ' ' • • • • • • • • • Depth .cr?,•S , • , > 9. Size of lot: Front ..'1S:a~/.' Rcar 9La!t.~,sa • • • • ~ • De cn 3:?~•5?.'j.?fo • • S ' • • • !0. Date of Purchase 3 • • • • • P 5: , , , , , ' ' 'r • • • • • • • • • • • • • ....Name oC Pormer Owner .~(/ff01~K C.O.tf~j~ 1 1. Zone or use district in which premises are situated .l.9: ~P~¢,/Aty(/~ E - {?~C~uc.72rj?~g~, ' ' ' ' ' ' ' ' ' ' • 12. Does proposed construction violate any zoning law, ordinance or regulation: . ~ 0 . . . . • , , 13. \Vill lot be regraded • • • • • • • • • • • • • • • • • 1Vill excess fill be removed from premises: Yes } 14. Name of Owner ofprcmisesT.owo.uf,,$put;ho}d ,Address Ma}n';Rd, Southold Name of Architect ..NiP..... • • • • • • • • • Phone No.7,f35 -1892 • • . •.fAddress..N~Q .............P fy/A Name of Contractor.TWP..Hga!^,s•Buil.rlers, ~~it7ress P.O,,f)px, 2117, Amagp}~~~~.329-,gg3P.... IS.Is this property located with in 300 feet of a tidal wetland? *YES....NO.X... *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 Cro pcoperty lines. Give street and block humber or description according to deed, and show street names and indicate wheth interior or corner lot. SEE ATTACHED SURVEY r ~ C " / STATE OF NEN YORK, COUNTY OF S.S „•James C. McMahon ' ~ ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. HcisUte•,Community Development Administrator ' (Cohtractor, agent, corporate officer, etc.) • ~ ~ • • ~ • • ' ttf said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this atthlication; that all statements contained ih this application arc tare to the best of his knowledge and belief; and that the work wdl be performed in the manner set forth in the application filed therewith. Swom to before me this ' ~ ........day of . , 19 ~6 Notary Public, ,,,,Suffolk••••~ County HELEN K DE YOE • NOTARY PUBLIC, State of New York ~ . 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