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HomeMy WebLinkAbout29808-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29791 Date: 10/27/03 THIS CERTIFIES that the building ADDITION Location of Property: 455 VILLAGE LA ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Nap No. 473889 Section 25 Block 2 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 15, 2003 pursuant to which Building Permit No. 29808-Z dated OCTOBER 15, 2003 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 EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR, & AS PER CERTIFICATION OF PROFESSIONAL ENGINEER DATED 10/24/03 . The certificate is issued to SUSAN E MADIGAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N-130371 05/23/90 PLUMBERS CERTIFICATION DATED N/A E Authorized Signat 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. 29808 Z Date OCTOBER 15, 2003 Permission is hereby granted to : SUSAN E MADIGAN PO BOX 626 ORIENT,NY 11957 for CONSTRUCT AN ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. REPLACES BP 18675-Z at premises located at 455 VILLAGE LA ORIENT County Tax Map No. 473889 Section 025 Block 0002 Lot No. 003 pursuant to application dated OCTOBER 15 , 2003 and approved by the Building Inspector to expire on APRIL 15, 2005 . Fee $ 150 . 00 y ` Authoriz Signatu COPY Rev. 5/8/02 MRM NO, f 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° 186 15 Z Date .�(,l.✓��................... Permission is hereb ,grante o: _ r -40t,07 *W ................................. ...... ..........Q......... to 4*t..C�t'{/.e4 t,......� .... .... :�.h: ........ .. � : ...... ..... ... .-.................................................. ................ ct premises 2ated at ... / s. �.. ..6�G1-.1f' .......................................................... ............................................ ............ ................................................................................ ..............................................................................l................................................................................. County Tax Mop No. 1000 Section ...........A, ..... Block ............... Lot No. .......... ...... pursuant to application dated .....� - G ............................... 19..R...., and approved by the Building Inspector. Fee s.• a.J/c ............... uil g Hsps or Rev. 6/30/80 FORM NO.6 1, TOWN OF SOUTHOLD �� Building Department APR 2 Town Hall Southold, N.Y. 11971 765 — 1802 TOWN OF SO u' _ V " APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted n G> to the Building Inspec- tor with 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, a certificate 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: 1. Certificate of occupancy New Dwelling, $25.00, Accessory ,$ 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 . 00 3. Copy of certificate of occupancy $ 5 .00 , over 5 years $ 10 . 00 4 .Vacant Land C.O. $ 20 . 00 5.Updated C.O. $ 50 . 00 Date . �,�r : . l.(y�� . . . . . . . New Cons truction , , Old or Pre-existing Building . . . . . . . . . . . . Vacant Land . . . . . . . . . . . . . . Location of Property . . .7 .¢.cl.".. . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Owner or Owners of Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section . . . aJ�. . . . Block . . . . .. .. . . . . . . . Lot. . . . .0. . . . . . . . . Subdivision . . .�. . . . . . . . Filed Map No. . . . ..... . . . .Lot No. . . ... . . . . . . . . . a9 �� �fo1%�ias -- - Permit No. — Date of Permit . . . . A licant ,r��c 2✓er nC Pp �l. . .!1. . . .� . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . . . . . . . . . . . . . . . Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . . . . . . . . . . . . . . . Fee Submitted $ . . . . .010-6.,-' . . . . . . . . . . . . . . . . Construction on above described building and pe mi//t meets all app icable codes and regulations. Applicant . MCCI�., � . . .l!: . . . . . . . . . . . . Rev.10.10-78 c9.-ec-. G Y4 2 c02,-aq ?y � Job No: 10003 WARREN A.SAMBACH,SR, CONSULTING ENGINEERS PLANNERS 7675 COX LANE P.O.BOX 1033 CUTCHOGUE,NY 11935 631- (&VK734-7492 October 24 2003 Building Department Town of Southold Town Hall 53095 Main Road Southold NY 11971 Rel' Susan Madigan 455 Village Lane Orient NY 11957 SCTM: 1000-25-2-3 Permit #298087 To Whom it May Concern: Site observation of summer porch reveals concrete foundation wall and framing conform to New York State Building Code. Hand rail from first floor to cellar installed on the left side. Sincerly, Warren A. Sambach Sr. P.F. was: s cc: Owner c{p{ypP 0. RRR ?S THE NEW YOPK BOARD OF FIRE UNDERWRITERS PAGE 1 1001.0 71 BUREAU OF ELECTRICITY F— 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date MAY 4"3'v490 Application No.on file 68147790/90 N 130-371 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Tl1(,1'tA3 MADTGAN, VT1..bAGK LANE., 0RIENT, N.Y'. in the ollowin location; ❑ B ement f`Il'T�T f g 1st Fl. ❑ 2nd Ft. Section Block Lot was examined on 1�PR 1� 1�`�`194i and found to be in compliance with the,requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. I K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT NEATENS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 10 2W 1 JF 3W 3 B 3W 3,0•IW NO.OF CC.COND, A.W.G. NO.OF HIAEG A.W'G• NO.OF NEUTRALS A.W.G. EQUIP. PER,B' OF CC.COND. OF HIAEG OF NEUTRAL OTHER APPARATUS: G & S CONTRACTOR BOX 2.15 SOUTHOLD, NIC, 1.1.971 GIN111% MANAGER 1.1 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. THICOPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. MAGA ING `I 1i1 o -- X51 b"' -� Lr cf 7 L to C - I oil V RUN \ M HE SaW IN lL G 1i .Lf f0 iC: _. WAL ACLHO A•., • F5 n to F R LY ,.,EON A? I FR ; $1GE1 S TV! ;? 1 r r i hJ0 r i coup o7 ., 1. c '. . . _ 11 : � ✓ Ili . .1. .f/�,l, fl !.S`.L ,:, !1• 1. 1 Z,f � M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] IN ULATION [ ] FRAMING [ FINAL REMARKS: --4-0 ez egad DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION ( ] FOUNDATION IST [ ] ROZLATION LBG. [ ] FOUNDATION 2ND [ ] �IN [ ] FRAMING [ FINAL [ ) FIREPLACE & CHIMNEY REMARKS: a of DATE D INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING FINAL [ ] FIREPLACES C IMNEY R51 EMARR}KS: DATE INSPECTO Z. cC:=�:: jU :E ij GYidENTS 1 . Im C l� FOUND_TION ( 1st ] c =0UNDATION ( 2nd ) _ m 2 'OUGH FRAME PLUMBING y H 3 . a m n INSULATION FERN . Y. STATE ENERGY CODE 1 4 . —�r 4 7 G y FINAL ADDITIONAL COMMENTS : ------------- x H � � a H O m C7 m BOARD OF HEALTH . . . . . . . . . 3 SETS OF PNS . . . . . . , , FORM NO. 1 SURVEY . . ! / TOWN OF SOUTHOLD CHECK . . . . . .✓. . . . . . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY G TEL.: 765.1802 CALL . . . . . . . . . . . . . . . . . . . . Examined .11- - • 30. . . . . . . . 19 ! MAIL TO : Approved . . �11.v<2 . . . . . .. 19�Pcrmit No. 1�6.7� 2 anR� Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rrwv- 15 V 28 3 (Bui g Inspector) `• - • TOWNLOF SOUT110LD APPLI ATIO FOR BUILDING PERMIT Date . . : �� zP INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app- 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 perm 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 Occupant 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building code, housin-- code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Y[L{J6YL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .). . . . . . . . . . . . . . . . . . . . - Name of owner of premises . . . O.t 47!*.lu . T.!��' ?!/r '�` . . . 6.vsjiN. .E: . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. f . . . &.0 . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . �V. !. {. /. //7-,�—. . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . ./. . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . 1, Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C A(E d. . House Number Street\ Hamlet County Tax Map No. 1000 Section . . . Q.Z.r. 1. . . . . Block . . . . . . ©, Z . . . . - . Lot . , , . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) V 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . b, Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . .ti. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, Nature of work (check which applicable): New Building . . . . .'. . . . . Addition . . . . ✓ . . • - Alteration . . . .,. . . . . . Repair . . .. . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . :. . . . . . . . . . . r (Description) 4. Estimated Cost . .� 6t!>>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If-ara-c. 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 . .';. . .... . . . . . . . . Rear . ... . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . .. . . . . . . . . . . . Number ofStones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . • . Depth . . .. .. . . . . .. . . . . . . . . . . height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . 8. Dimen�s,io�ts of er�t#e new construction; Front . . . . . . . . . . . . .. . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . , . He,ghf`'' . . . . . . . . . . Number of Stories.. . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . , . . . , . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . �.. . . . . . . . . . . . : tear . . . . . . . 9 Q . . . . . . . . . . Depth . . 9b-, . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name ofFormer Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded Will exc�s; fill be removedm premises: YesNo v ` 14. Name of Owner of premises tY?�F!'ts?? . /1?a�ax .rw. Address C! /-7P -1�. , . Phone No.3.23z Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor .744t OePV.MA4. . .. . . . . . . . . Address /6Gt .dW bA D. D4 Phone No.7�0`.-./ 15 _Is this property located within300 -feet of a tidal wetland? *YES. . . .NO n *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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. sEE Ste-✓�' STATE OF NEW YORK, COUNTY OF . . -.�✓F.fO f K. . . S.S . . . . . . . . . . .? )an. . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ibove named. le is the (Contractor, agent,,;corporate officer, etc.) if said owner or owners, and is duly authorized to perform ornhave performed the said work and to make and file this pplication: that all statements contained in this application are true to the best of his knowledge and belief;and that the /ork will be performed in the manner set forth in the application filed therewith. wom to before me this q . . . . . . . . . . . . . . . . ....day of ..l. . . , ?Pr . . . . . . . . . .. 19 otaryPublic, JN!. 71- kK� •S(16100ICCounty . . . . . . . . . . . NUM HELEN�te of�y (Signature of applicant) Na. wk 4707878,Suffolk Cou Term Expires h4rch 3k t9 !& ' y • " i t f I a I E 1 IT { t. v it 17 UNpOW i 7 - . If a-h �`•,.'"�,"FJ � - �' _ 4 ��"\!`<;:. �"a°�'+vrul�"R .r r_ rMN n.n3i� - � - ` � MRERSCERTIFICATE QUIRED A3'o Y.E. « - SEp[ 01gpA ,pp' pp py ua� 1 a . , T'FICAa f, Pay ; p- NV� RiN.;° w gpp ryp y i - � :� 'tR. r£un u. - _ RiMaJ'. - :�•'u' �v' .a.RT s�� 3`ei. .l'd, � , ' - - . . ✓.:...y. .__. � � 1, ..., 1 .;;W`<a;wq �:� -. _ Cj F'Rr�[ ! � � ' ' � Cr,/ik �4ti� ' � ;' " � . 4. �++64J 'T. E fr`.✓..�!.aaY, .. 2 e AP RDV A! NOTEDDATE w cera ? E ,P , LI?✓Plz:'M?t't: w f 3 NOTIFY 2 OEPA ENT RT -RU _ 76$-7802 9 RM TO d PM FOR THE �Y } FOLLOWING INSPECTfON$, FO ,JOHN,6ERTANI BUIL l� IIdC t .OUNOATION `RNO REQUIRED - -43NO Ozkufoc7r I POUREDCONCRETE ;, - SOUTI-10 - � ......- _ r 2. ROUGH - FRAMING & PLUMBING - ,. INSULAT10NYONSTHUCTIO - - - _ R.'FINAL N MUST - - "BF,COMPLETE FOR C O. - - - ALI, CONSTRUCTION SHRL4' MEET THE .REQUIREMENTS -OF-THE 'N Y. -' Sz_ . ' - - - $TATE CONSTRUCTION .& ENERGY - Cni1FS. NOT RESPONSIBLE FOR .- L ' APAWViR -. - - - - - - t.,SICCN OR CONSTRCIUTION ER99RS - . w -' _ y - YO [` 751�T4Nx[floMa, - _