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HomeMy WebLinkAbout17098-z FORM NO. 4 TOWN OFSOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z16977 June 13 1988 Date .......,....t....... THIS CERTIFIES that the building A l t e r a t i o n Location of Property ,,,,,600 Rosewood Drive Mattituck House No. Street Hamlet County Tax Map No. 1000 Section ...1.1.3 ......Block .........Lot . ~ ~ $ . Subdivision.Rosewood,Estates ,,,,.,,,.Filed Map No. 5240 10 ...Lot No . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Junk , 3,,, , ] 588, , , pursuant to which Building Permit No. 170982 dated June ] 3 ; ] 988 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 . ,,,,F,i,nish„2nd, floor ,of.existing, one family dwelling. The certificate is issued to ROBERT AND PATRICIA HORAK (owner, ~~~gtgpg7q~g1 of the aforesaid building. Suffolk County Department of Health Approvaf , N / A . N735656 Feb. 13, 1986 UNDERWRITERS CERTIFICATE NO . PLUMBERS CERTIFICATION DATED: Robert E. Horak 6/10/88 ~w~ Building Inspector Rav. 1/87 iirosns xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHI5 PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Nq 017098 Z Date 19.~Gd Permission is hereby a ed o: ....~Q ..............r....~~.....~~..... //~~(~J/y/////~ to {Y'/ ...i...~...• //'/J f u///(. • .e. .../.~..A.. ..u J~~/~S u u • • .....u.u• ....uuu........u. • .......fie( at premises located at ......,l...Q.~:.G.~.......... Caunty Tox Map No. 1000 Section Block ..........~..~r.. Loot No.........~~Gf..... pursuant to application dated ..........,~/,~r 19.d.Gl, and approved by the Building Inspector. O p Fee $....~f..' ~B a~~ a~ ul ing I or Rev. 6/30/80 s-~ yo ~ ---g-~---~....s FORM NO. 6 ~ P! ~ D TOWN OF SOUTHOLD ~ 3 Building Department Town Hall Southold, N.Y. 11971 BLDG DEPT; 765 - 1802 ~WNOF§ (~ypLp APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~A~~I to the Building In~ec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 1 0 . 0 0 4.Vacant Land C.O. $ 20.00 5.Uodated C.O. $ 50.00 Date ~ NewConstruction,,,,,,O1dor~Pjr~e'-existing Building Vacant Land Location of Property ..o~..©o...::?.5!S~~!OQ~. , , ,~i~ide ..../f~y-i/~/c/r House No. ~ Street Hamlet Owner or Owners of Property . ~G.°. =~t'..~~..`~..:".`.?!~'P~C/"9 i'" ~2.9/~ County Tax Map Nom. 1000 Section ...~~:3...... Block es...... Lot . Subdivision f!~`~f'.'~~~?...~sT-s>C.S.Filed Map No. ~°?.'~r©..Lot No. pp PermitNo.~Zo99..Z. Date of Permit~~~'~~..Applicant.~~o,/--~,~'e~„~, ~o?;g,~C Health Dept. Approval ..~5.!.SP~?.s6 ...Labor Dept. Approval Underwriters Approval . ~.f.:~~.~.'~~.-.~~......Planning Board Approval Request for Temporary Certificate .....................Final Certificate I!............ . Fee Submitted $ . Construction on above described building and permit me~eJts all applicable codes and regulations. Applicant Rev. 10-10-78 3 y ~~/0 ~ /~3/~ ~P ~7a y~z ca z ~by~7 ~ TEL. 765-1802 c+,_~;~ ~~~"~©~C TOWN OF SOUTHOLD yt, OFFICE OF BUILDING INSPECTOR ~ z P.O. BOX 728 r°Jr ~ TOWN HALL `rp~0~ ~ ~~0~ SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date _'~.~2~. l~ Building,~Permit No. ~?d -I,/O~~ Owner rJ.BE•~T i'""'2~~ (please print) Plumber /f pv°F~ ~'~'~'g'C (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. (plumber's signature) Sworn to before me this lU day of ~ ~ .(Y~f/o_,/ ~A~y(~D••e- 19 . Notary Public Notary Public, County HELEN K DE VOE ~M~47078~'/8 Su~HaIN Counh6.~ Term Expires March 30,1 THE NEW YORK BOARD OF FIRE ;UNDERWRITERS:-' ' tl'I _ - ~ i1 - ~ ~ ' BUREAU OF ELECTRICITY I " t11 i!' li I - _ ~ r a 1 ti , i ii ~ _ 85 JOHN STREET,,NEW YORK NEW YORK 10038 ' ' - Tpg ~ - 1-_11 lit-i .:Data ~ ~ _F'ebruaxy 13,'3986 - - ~ appl¢eatlan /Ya an fide -;337.771,85 ~ i = ' N: ~ ~ 5 ~ ~ ~ I I. , THIS CERTIFIES THAT ~ - ~ .=P~}37.7,72 - ~ ,I ~ I I'_ - ' 1- ~ ~ i;-.1' only the electrical equipment os described below and introduced by the applicon£rwmed on Lhe abode application'number in the pneiniaes~bf Robert &-Patricia 7iorak,"'Rosewood Drive,'Mattituck, N,Yr-II ~I- ~ - I , in the following location; ® Basement ®Ist Ff• ®2nd Fl , . 11 I j i~, ' : Sectron11.3 BlocT~02 i Lot 018 ~ was examined on Februa 6 1.986 _ ' 1 - ~ ~ ~ and found to be in comphancewly$ the requirements of thes: Board : ~ i ,j.- _ _ ._~a i... i,_~'.-1_I!...irc•` ._I.I!~ ql. '~!1=;: i.."111=1_,:.?_'. FIXTURE FIXTURES ~ - RANGES -COOKING DECKS OVENS--'~ DISH WASHERS EXHAUST FANS: 'OUTLETS ECEPTAClES SWITCHES INCANLIESCENT.FWORESCENi MvgFOeY AMT. "K W "1~-'NAi-'%:W-. "AA1T. ~ KW9i pMT.,, KCW ....AML== zH~F_I ~ I - 1 t-1.- - I_ ~ 22 46 22 ~ 2 = - ~I i '~~'11i-! ~+~2 a k` . " ° r__. -='DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS $PEC{AL REC'PT ,TIME CLOCKS, -BELL UNIT HEATERS' MUI7FOUTlET - ;i DIMMERS -=i ,-SYSTEMS ' AMi. K. W. Oll - H. P. GAS H. P. AMT NO. ~ A. W.G. AML ,'AMP. ,AMT; AMPSr: BRANS AMT ~ 'H?Pt . _.NO. OF-FEE7 AML; I: I WAII$-~ .",SERVII[ETDISCpNNECT.,~1H NO.OF . : _ - S ~L-.,.E 1,-r: R d ~ flNl lll, ui:= LL. O ~J I 6 M- tl, ==m W ~I= METER NO OF <C CONp. A W G ~ A W.G ~A W G ;.p. AMT. - AMP. ~ TYPE QUIP 1$ 1W 1 $ dW 3 $ 3W 3 $ 4W p~ % OF CC COND. ' NG OF Hh1EG ~Op HFIEG NO.OF NEVTRAlS . OF NEViRAt 1 209 CB X 1 2J0 _ ~ , "1 210 . OTHER APPARATUS: - _ _ - _ ' . - r 7-l0amp Disposal _ ~ - 3-C.F.C.I. i 2-Sno1~e D,~tectors _ IIectric Water 7ieaters: T:,4,5kw. =i Electric Roan 1iL~ters 2r-2,Okw, 2 1..5kw, la.,Okw~ 1 ,5kw - , ~ u:r - ~ I ~ - Y~bert II Horak P. 0. Box 663 - _ ' Cxreenport, N.Y. 11944 " - " - _ _ i' s ~ GENERAL MANAGya ' ! xx - _ << _ met This certificate must not be altered in any manner, return to the office of the Board if incorrect, Inspectors wag ~6'e' Identifief? bytheir c e e tYy Is:'=`- I ~ 765-1802 ~ /p(¢t7 ~gyj~.. BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: CD DATE D INSPECTOR ~l7 ~ / n BOARD OF HEALTH . l/""""t// ~ 3 SETS OF PLANS , , , FORM NO. 1 SURVEY Z /333 S I{~,~/t~/I/~ry~y~[~/~ TOWN OF SOUTHOLD CHECK ~ h .j. . BUILDING DEPARTMENT Serrlc FORM TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.:765-1802 CALL Examined . ~ 19 tY. ~ MAIL T0: Approved .c:!~~~ 19~Pennit No.~~~.r~..~~ . Disapproved a/c (Boil mg In ctor) D APPLICATION FOR BUILDING PERMIT / 3 r ~ Date 15 ;g~,-. 6OF LD INSTRUCTIONS a. Tlris 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. TE.e work covered by this application may not be commenced before issuance of Building Permit. ~_,d. I;pon 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. t 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 inspectors on premises and in building for necessary inspection~s./' 4~ ~ , (Signature of applicant, or name, if a corporation) ' " , ..~a./J.~ , /Z°"OSPdvOD/~ PD,e~ae ~ ~7~rrir~ ............yrr'r-Z• ' (Mailing address of applicant) State whether applicant is,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. d ~~t°2 t_..,........ Name of owner of premises....... ~~z°!~~.: e~ ~ '~~C~"~ ~ (as on the tax roll or latest deed) If applicant is a c'o"rporation, signatCtre of duly authorized officer. (Name'and title of corporate officer) Builder's License No. ~ Plumber's License No. ...-`.E'~;~ . Electrician's License No. „Sc°L~ Other Trade's License No . . 1. Location of/lpa~nd on which proposed work/will be done . . Elouse Number ~ Street Hamlet County Tax Map N~o. 1000 Section /~3......... Block a, . , , , , , , , , Lot . Subdivision ...!.t. Ps'~°<*!eO®. , ~S'/~~~. s Filcd Map No. ,-S""°7f/f~ Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , ,.oy~ F~9.~iL y Aco°r>clivj' b. Intended use and occupancy .........1~~~^.°-,".....i~:...'S .SCeeovp FGOO~ Fi..~ist~A 3., Net~iofwork check which~~iapplicable):NewBuilding ' . ( • • • Addition . P Removal , • • • • • • • • • Alteration , , , • • • , Demolition Other Work . (Description) 4. ~ ~ Estimated Cost....... Fee..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . • Number of dwelling units on each floor , , , , , , , If garage, number of cars 6. If business, commercial or mired occupancy, specify nature and extent of each type of use , , , , , , , , , , , • . , Height s.... Nures, if any: Front Rear Depth . mberofStories,,,,,,,,,,,,,•„•,••• rmensrons of existin struct wrth alterations or additions: Front • • • ' • ' ' ' ' Rear.................. Depth height......................NunrberofStories...................... 8. D'mensrons of entiresne v cons Her lit traction: Front Rear Depth Number of Stones , Size of lot: Front P , Rear Rep'~h • • • ~ ~ • ,?~9,~ 10. Date of Purchase " " " " ••••••••••••.......,NameofFormerOwner P P remises are situated.........,,.•,,,,,,,,,,,,;~~ 1 I. Zone or use district in which .olate any zoning law, ordinance or regulation: " ' oes ro osed constructron vi g 13. Will lot be re raded \Vill excess fill be removed from premises: - -Yes No 14. Name of Owner of premrses e°~°.~r??; ~!~•P-9~ • . ,Address 6.4~!E'?s?°~~ )',)/on~~~I~`'ka_ S'~.-ss'6 Name of Architect .Address . .Phone No.. Name of Contractor . ,Address ~ • • ~ • • • • • • ,Phone No.. • • • ~ ~ • ~ • • 15.Is this property located within 100 feet of a tidal wetland? *YES....NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly a#1 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 whetl~ interior or corner lot. I APP~AS NOTED DATE: ~ B.P. AF ' NOTIFY IL G DEPA NT A7 766-7802 9 AM TO 4 PM OR THE ' FOLLOWING INSPECTIONS: li 1. FAUNDATION • TWO REQUIRED FOR POURED CONGRETE ~ 2. ROUGW -FRAMING & PLUMBING 3. INSULATION & Q. FINAL CONSTRUCTION MUST tit t~At~ ~ 4~T I~~6,tTi., ALBECO STRUCTION SHALL MEET plr Dd~d THE REQUIREMENTS OF THE N.Y. ~ STATE CONSTRUCTION $ ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS i STATE; OF NEW YORK, COUN'T'Y OF 5.S • • • • • • • ' ' ' ' ' ' ' ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. fie is the . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl, 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 mannerlsct forth in the application IIlcd therewith. Sworn to before me/this ...............1P..... .~~.//da~^y,of.I'..~~.//n//.//....... , 19 ~c~ Notary Public, ..........c!~„~(,., . k~!L(//L. County ~j1 f~y~~ NOTARY LEN K. OE VOE ; ,i!i!~~'~~ t~ j'~- PUBtIC, State of Mew Yank . N0. 47018'/8, Suffolk County ~ g Term Ez~ires March 80,19..-/ (Sig~tature of applicant) a I