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HomeMy WebLinkAbout18415-Z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No. 219532 Date NOV. 23, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 245 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. 1 conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 8, 1989 pursuant to which Building Permit No. 184152 dated AUGUST 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-30 NOV. 13, 1990 UNDERWRITERS CERTIFICATE NO. N148451 SEPT. 11, 1990 PLUMBERS CERTIFICATION DATED HARDY PLUMBING 6 HEATING NOV. 19, 1990 ~.~t~l~ Building Inspector Rev. 1/81 rosy rro. s 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) N 18 415 Z Date G.......~P 19v.,1 Permission is hereby granted to• ~j li/.:itf/..7.:1.......~.~/,i......~~n~:~1'G71rQ./7~.~.1...~. ~r lJ..-~fl~Y`. 7..J..,~ 1....~ . ro ..........P..1........1~:7'kc.. . of premises located at .....a.5//:.y,~~?........l..Z...~l~ .Q.`.~f~,,,,._ .......................................................'l'1....~~~~~.~.................................................... ~ County Tax Map No. 1000 Section ...~1~....~••.... Block ....~f...~...... Lot No..~.~. pursuant to application dated ........(~}G ......L....~t1 19.1I..~ and approved by the Building Inspector. Fee S..fr)!`~t~t i ......:fY....... Building nspector Rev. 6/30/80 Form No. 6 ~ ~n~T ~U~~ TOWN OF SOUTHOLD wD ll BUILDING DEPARTMENT 1 TOWN HALL ~ ~ ' 765-1802 ~ ~ "'i ; ~`g~p~ri. DtP7. APPLICATION FOR CERTIFICATE OF OCCUPA TOWN UPSOUTHOID 1. 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 17, 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. 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. 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 - $50.00 5. Temporary Certificate of Occupancy - Residential/I$mm15.00, Commercial $15.00 ' / Date `'l S ~.Q. . ew Construction. f.~ Old Or Pre-exi ting Buildin a y s' ' ocation of Property..~:~,~.~.~.~,..y'~~r. ~?ctYa;,D House No. •-'-~S-treet Hamlet nwer or Owners of Property.~l~Sr1~./'~'.~t~724~:S.y ~7~~ C:'~i.3.. ounty Tax Map No 1000, Section....(L?~......B1ock.... C~.~........Lot.. r..r.7. p~„ ubdivision .Filed Map............L~otp.._,.~........... ermit No...~.~~S~..Date Of Permit..../.l~":/~.....Applicant. ~.C~7.~~~e ealth Dept. Approval ..........................Underwriters Approval...,..................... lanning Board Approval equest for: Temporary Certificate........... Final Certica e........... ee Submitted• 1~ ri~~ 6 yp Ce a z / S- j y APPLICANT _ ' y ; s re THE NEW YORK BOARD OF FtR~"UNDERWRITERS PA4E i s 144496$ BUREAU OF ELECTRICIT`/' 85 JOHN STREET',.MEW VOiE~hW YQRK 10038 SEPTEMBER 11 ~ 1994 gppfiration No. on file 65466789/$9 N 148$51 THIS CERTIFIES THAT only the electrical equipment w dsacrihed helore and Intradutred by the applicant named on the ahooe application number in the premisea of r TW4 BEARS BUILDERS,r~t~r7tt S/S RAC.NAEL'S RD. L4T 1, MATTITUCK, N.Y. in thefolloteinq hPCation; lJ' Bwement Of1T 148 ~4 P147.2 ® lat Fl. ©Ynd Fl. Section Bloc Lot mas examined on AUGUST 2 3 ~ 1994 and found to he in compliance with the reyuirernentx of this Board. RXTURE ECErTACLE4 SWITCNES pKTURES RANGES COOI(R10 DECKS OVENS DISN WAENHS EifNAUST FANS WTIETS INUNDESCENT FlUOI1ESCENT OTHER AMT. N. W. AMT. N. W.. NAT. R.W. AMT. t. W. AMT. N. P. 13 )5 15 17 DRYERS RJRNACB MOTORS lUTIRiE AAIIANC! REDERS SPEGAL RECeT TNNE ClOCK4 EEIt .UNIT NEAT[RS MUlil-0IBtlT DKRMERS AMT. N. W. Oll N. P. GAS M. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. P. ~ a ~T AMT. WATTS F ~ - 1 so 1 SlRVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP. TYPE METER 1 / ]W t ,I 3W ~ / ]`N 3 A tW NO.OP CC COND. A. W.O. NO. OF MI-IEG A' w' G' NO.OF NENIINS A. w. pp LOUD. PER a Of CG COND. OF Nf1EG OF NEUraN 1 ]44 CB 1 R 1. 4 7. 4 m orNEa At+?AUTUS: MOT4RS:1-3/4 M.P. G,F,C.I:-3 SMOKE DETECT4R:-2 s .Po'( WILLIAM T.STCCK LIC.N889E 1254 SMITHT4ii1T AVENUE B41lEMIA, NY, 11716 E~A11AOL1 ! 11 ~ ^ i~ Psr This ceAificaN must not ba aMsrsd in any manwr; rNUrn to the office of the Board if incorrect. InspMOra moy ba identified by their creMntials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT 8E kLTERED IN ANY MANNER. ~..,w :a...F. TL• i. 76: -1802 CJ's '~O,'~3{1zI O~ S~~EJ-TH03.I,): . ~ ~ os~ler ar nu~u:Da~rc cvsPf~ott ~r~ m P a tab , ~s 22 u' TOIY~i 1 LI: D ~ L~ ~ ' ' s r~~~- SOUTH~O:.D, N Y. k L971 ~ ~ ~ ! 2 4 BLDG. DEPT. ) TOWN OF SOUTHOLD C E R T I F I C 11 T I O.N Date NOVEMBER 19, 1990 Building Permit No. 18415 Z Owner TWO BEARS / JACOBS (please print) Plcaber HARDY PLUMBING & HEATING NORTH, INC. (please print) I certify that the solder used .a the water supply system contains less than 2!10 of 1~ lead. 11 _n - (plumber's signature) J Sworn to befog^e1 ~m~,pe this - ~day of J~LL1.~u...~-1 hP;Q , ~ 11 ~ 19 llotary Publ' Nota:• Pvh=ic ~ y~ounLy ~ K CATHEiti A.1J~AGiNN NdarY Public, Siala of Nara Yak Nc. S966S'~o ca~aart~ in s,,:u~r~ c~u.<<s G?nmission Expires biay iG, 18~ LLD ':SP""':iUN ~~U6.E I, ~ OOMMLNTS m ~ ~ ~ u- "`1 _ y FOUtJDATION (1st) ~n c N ~ " FOUNDATIOtJ (2nd) V 2. o P,OUGH FRAME & PLUMBING / 3 y ry H I~ ~ m 3. ~ H ItJSULATIOPI PER N. Y. STATE ENERGY ~ x CODE > J, c~ r H 4. i~ FIiJAL o O z m ADDITIOAIA COMMENTS: 7° p'~ ~ ~ V e 1a. b M ~ 9 y\\ Lxl~v~w~ ' 1 H Cv-` o~ m(, .y "V H Q - BOARD OF HE.\LTH 3 SETS~F PLANS FORM NO.1 SURVEY TOWN OFSOUTHOLD Cf1ECK BUILDING DEPARTMENT SEPTIC FORPI ' TOWN HALL SOUTh1pLD, N.Y. 11D71 NOTIFY • TEL.: 765-1802 CALL James. tr . C1L(7dhPN.... . Examined 1..~f....., 1~ ( MAIL TO : , QQ pp~ ` Town Hall, Main Road :\pproveci~~.pC(~/......, 147.~Perrnit No.,O.. , ~J ~ Southold, New York 11971 Disapproved a/c (Building Inspector) 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. T}re 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 petTrrit 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 Duildin; Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Itcculations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Tl~e 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. Town of Southold - Community Develop. . (Signature of applicant, or name, if a corporanon) Town Ha11, Southold, NY 11971 • (Mailing address of applicant) State wftether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. OWNER \amcoCosvncrofpremises ,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• ..............................................r (Name and title of corporate officer) Builder's Liccnsc No. ...........p Plumber's License No. u_ ~ Gcctncian's Liccnsc No. SL.1.l. G........ Otltcr Trade's License No . I . Location of IanJ on which proposed work will be done. ' x.4.5 ..~PRC~fIk~~ S.. !?oAt~......... /~~t~inxK........ , Ifouse Number SQtreet ~ Hamlet County Tax ptap No. 1000 Section ....,1~~ • Block ~y........... Lot . 7on~. . Subdivision Filed tap No. Lot a! . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy VACANT . . . . . . . . . . b,lntendeduseandoccupancy .Single-Family Residence - Tli~OBS - Si[iT /li9NC~ e 3. Nature oCwork (check which applicable): New Ouilding ...x.•..... Addition Alteration Repair Removal Demolition O[hcr 1Vork . a,J (Dcscnption 4. EstimatcdCost.....4.7.t.~~~••••••••••••••••••••-•. Fee.,Waiyed„-,Town Project • (to be paid on filing this application) 5. lC dwelling, number of dwelling units ..........1 Number of dwelling units on each Moor N,/,Q , , , , , , , Itgara^_c,numbcrofcars .NIA 6. IC business. commercial or mixed occupancy, specify nature and extent of each type of use . N1.A . 7. Dimensions oC existing structures, iC any: Front .N ~ AN•J•A Rear . N(A.......... Depth . Jy~ A • , , , , , , , Ifci_^_Itt ..N/A.......... Number of Stories . Dimensions oC same structure with alterations or additions: Front . NSA Rear .NlA............ Depth ..NlA licight . N f A , , . , , Num~er of Stories N!A• , g. Dimensions of er)~ire new constntetion: Front ...~oZ Real ..~.?a ~ Depth . %1Cis , , , , , , llcigltt .~f. ~ Number of Stories t~. , ~y 9. Size o(lot: Front ~yS ~ Rear .../.7y.Q,~~.......... Depth .I q,3. ~ ~Y.~.4717R./.9 ~ 10. Date of Purchase 8~P?,9~H.$ . Name of Former Owner .Ss~F~X 44Uiv7 f . 1 1. Zone or use district in which premises are situated ~/1.R.~(A~NL.~:..ffrrsj?l,CUf;'7t~~[ . . . . . I'?. Does proposed construction violate any zoning law, ordinance or regulation: l3. 1Vill lot be regraded ............................1Vi11 excess fill be removed from premises: Yes t 14. Name of Owner of premisesT.own. Af, .$pxtho~d ,Address f1d}n';Rd, SoutholdPhone No.Zh~`-1892, • • _ Name of Architect ..NtA. Address A1~A.. P ~ NiA.......... NamcoCContractor .TWA.Qears -Builders, .~.~fclress PQ,QgX..~117.,AmagPe o. 329-.Qg3P..:. IS.Is this property located within 300 feet of a tidal wetland? *YES....NOX.. *If yes, Southold Town Trustees PLOT DIAGaRAM a required. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate wheth interior or comer lot. SEE ATTACHED SURVEY ST.\TG f" NEw YORK, S.S ' COUNT OF . • • J a s C • McMahon , , , being duly sworn, deposes and says that Ite is the applicant (Name of individual signing contract) above named. Ilcisthc.,Community Development Administrator (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 pplication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the ',work will be perCorntcd in the manner set Cocth in the application filed therewith. Sworn to bclorc me this y ...j • .........day oC... 19~(• Notarylublic, ....Suffolk.. /t~,~UG~.CountY ~ kfLEN K. DE V(tE • NOTARY Pi18uC, Stn!: et NewYarM (Si;naiure of applicant) No. 4707818. Sufw~a ~r3nty Term Ezpres tAetch 3D, i9~~ ~ CTJ Q. ~ ..+4 Y}~fr`~L 1'~ C .w ,r ~ '.5t4" ~y f7 ~ cCi 4 ~ . 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