HomeMy WebLinkAbout29987-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29954 Date: 01/0.9/04
THIS CERTIFIES that the building ADDITION
Location of Property: 1435 WOODCLIFF DR MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No- 473889 Section 107 Block 6 Lot 17.2
Subdivision. Filed Map No. Lot NO.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 2, 2004 pursuant to which
Building Permit No. 29.987-Z dated JANUARY 4, 2004
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 ENCLOSED DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to THEODORE E GRIFFIN
(OWNER)
of the aforesaid building.
.SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 363247 09/11/95
PLUMBERS CERTIFICATION DATED N/A
An o ize Sig re
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 90. 29987 Z Date JANUARY 4, 2004
Permission is hereby granted to:
THEODORE E GRIFFIN
PO BOX 554
MATTITUCK,NY 11952
for
ENCLOSED DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR. THIS PERMIT REPLACES BP#22826 .
at premises located at 1435 WOODCLIFF DR MATTITUCK
County Tax Map No. 473889 Section 107 Block 0006 Lot No. 017 . 002
pursuant to application dated JANUARY 2 , 2004 and approved by the
Building Inspector to expire on JULY 4 , 2005 .
Fee $ 150 . 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
„
Form No.6 ', Hfl 2 9r.1 1TOWN OF
L )FM
BUILDING DEPARTMEl T --
TOWNHALL T N ° Ti0' D
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
I. 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 l%lead.
5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate
of Cade Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. 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. Aproperly completed application and 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$25.60,Alterations to dwelling$25.00,
N Swirmni ig pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
Date.
New Construction: + t Old or Pre-existing Building: (check one)
Location of Property: 1t �J� -C�A Gx�4 (Z
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section /D -7 Block O Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
�j� �� Applicant Signature
THE NEW YORK BOARD OF FIRE UNDERWRITERS PA(Z 1
1195204 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date SEPTEMBER 11,1995 Application No.on file 89003395/95 N 363247
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
GRIFFIN TED, WOODCLIFF DRIVE, HATTITUCK, N.Y.
in the foilowinR location; ❑ Basement ® Int Fl. ❑ 2nd Fl. OM Section Block Lot
was examined on SEPTEMBER 08,1995 and found to be in compliance"h the National Electrical Code.
NXTUREACLES fYY1TCMEf RXTURES RANGES COOK DECKS OVENS DISH WASHERS EXHAUST FANS
LET
OUT : INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.O. AMT. K.W. AMT. M.P.
1 6 2 1
DRYERS FURNACE MOTORS FUTURE AMUANCE FSRDERS SMALRIC11TI TIME CLOCKS I Ku UNIT HEATERS "TI-OUTLET DIMMERS
AMT. K.W. OIL M.P. GAS H.P. AMT. AO. A.W.G. AMT. AMP. AMT: AMPS. TRANS. AMT, I M.►. SYSTEMS
NO.OF RET AMT. WATTS
SERVICE DISCONNECT NO.OF c \ S EAunt - R V I C E
AMT. Amp. TI?E 1/tw 10 7W. �v 3,I 4W �'°PER 000ND. OFC W.COND. NO.OF HIAEG OF,HI LEO �. NEUTRALS OF ALL
S� •
OTHER APPARATUS:
r
PADDLE FAN-1
MOTORSII-F H.PC?
G.F.C.It-1 �
V�
KENNETH F. SCHUHMANN, JR.
P. 0. BOX 422
CUTCHOGUE, NY, 11935 ODOM MANAGER
11
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.
OC + {CY O
USE IS UNLAWFUL
WITHOUT CERTIMTE
OF OCCUPANCY
F
APPROVED AS NOTED
DA J. r•BP.N =I —
BY.-
NOTIFY
BY:NOTIFY BUILDING DEPARTMENT AT
785-1802 9 AM TO 4 PM FOR THE
O .
1. FOUNDATION - TWO.REQUIRED_
FOR POURED CONCRETE
2. ROUGH - FRAMING `Fa PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
_-_BE COMPLE.-Te .Cst,-
ALL CONSTRUCTION HALL MEET
THE REQUIREMENTS p THE NY.
STATE CONSTRUCTIQ , . BNERGY
CODES. NOT RESP SISLE FOR
DESIGN OR CONSTRU ION ERRORS .
UNDERWRITERS CERTIFICATE
REQUIRED
I
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765-1802
BUILDING 'DEPT.
1 SPEA"TION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
] FO DATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
[ I FIREPLACE A CHIMNEY
REMARKS:
DATE � INSPECTOR _
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ NAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
1-2r
DATE .1171f, INSPECTOR
FIRL'b INSPE9TION REPORT DATE COMMENTS .
j� it H
FOUNDATION ( IST)
ii it
t;^
FOUNDATION (2ND)_ II n
Of
ROUGH FRAME 5 n
PLUMBING
If If 6g
=---===w -- ----- --=_-- —'__
if if
If It
INSULATION PER N. Y. It
It
n
STATE ENERGY
CODElf
lf y
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fIt If
It
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It
FINAL u u
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ADDITIONAL COMMENTS
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80,190 OF hEAI_TII . . . ... . . . ,
FORM NO. 1 7 SETS OF PLANS . .
TOWN OF SOUTHOLD SURVEY . . . . . . _ . . . . ., . . . . . .
BUILDING DEPARTMENT CIIECK . . . . . . _ . , . . . .
TOWN IIALL SEPTIC FO 11H . . . . . . . . . . . . . .
SOUTHOLD, N.Y. "11971
TEL.: 765-11302 110-F€FY
` CALL . . . . . . . . . . . . . . . . . . .
ExaminedIF./.� . . . 19 .�� 11A 1 , TO:
� p . . . . .
Approved . . . . . 19/ Permit No.?/�!!?P .
Disapproved a/c . . . . . :
(t3tl i 41spce tor)
APPLICATION FOR BUILDING PERMIT
.Date . . . . .. . . .. /3. . ., 19 5.
INSTRUCTIONS
a. This application mush be completely filled fn by typewriter or in ink and submitted to the Building Inspector, with 3
sets of{flans,accurate plot plan to scale. ,Fee according to schedule.
b. Plot plan showing lgcation of tot and of Buildings on premises, relationship to adjoining premises or public street!
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 permi
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 Occupanq
shall have been granted by the Building Inspector.
J APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to fit(
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o.
Regulations, for file constnrction of buildings, additions or alterations, or for removal It demolition, as herein describe(]
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t(
admit authorized inspectors on premises all(] in building for necessary inspections.
(Signature of applicant or name if a corporation)
(Mailing address of applicant)
Stale whether applicant is owner, lessee, 'agent, archflect, engineer, general contractor, electrician, plumber or builder
. . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner ofprenrises - /;�cGJ�>cc'�
as on the tax roll or latest clee d)
If applicant is it corporation, signature of duly authorized officer.
. . . . . . . . . . . .
(Name and title of corporaallee officer)
j
Buildel's License No. ��r•: .�� 7 '�.Sj . . . G. . !/y7j
5 zi
('lumber's License No. . . . • . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . • . . ... . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . .
I. Location of land on which proposed work will be ]lone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . .
/ 3j. . . . . . . . . . . . . . (. opt :/iF . . 1�2 . . . . . . . . . . . . . . . . f ��`r� c.c . . . . . . . . . . . . . .
louse Number Street / Hamlet
Cott illy Tax Map No. 1000 Section . ��.7. . . . . . . . . . . . Block . . . . .C 1 . . . . . : . . . Lot . . l 7- . . . . : . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. ... . . . . . . . . . . . . .Lot . . . . . . . . . . . . . . .
(Name)
1 Stale existing use and occupancy of premises and intended use and occupancy of proposed cq'nslrucUon:
a. Existing use and occupancy . . .�7!l"?{ . . .. . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . . . . . . . . . . .��/!7�. �Cl !ff . . , telly
iJciv ruui ,III tt; Addition . . . . . . . . . . Akcratiun . . . . .'. .�
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . ; Other Work . . . .. . . . . . . . . . .
(Description)
. . . . . . . . . . . . . . . . . . . . . . . . . . . Pee . . .zo..' . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
4, fistinuded Cost .
(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 . . . . . . . . . . . . . . . . . . . . .
G. If business, colunercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . .
7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear Depth . . . . . . . . . . . . . . .
JHeight . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . : . . . . .
Dimensions of same structure with alterations or additions: Front Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . ... . . . . . . . . . . . . . . . Height . . . . . . . . . , r. . . . . . . . : . : Number of Stories . . . . . . . . . . . . . . . . . . . . . .
8. Dimensions of entire new coushuclion: Front Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . .
lleight . . . . . . . . . . . . . . . Number of Stories . . .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Frout . . . . . . . . . . . . . . . . . . . . . . Rear. . . . . . . . . . . . . . : . . . . . . . . Depth
10. Dale of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former 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 excess fill be rem ed from premises: Yes No
14. Name of Owner of premises4. It ,� Address //.✓YY.�'S.'/ ia/f Phone No.-
Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . .
Name of Contractor . . . . . . . .'. . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . .
IS, is this property within 300 feet of a tidal wetland? *yes. . . . . . . . No. . . . .. . . .
*IE yes, Southold Town Trustees Permit may. be required.
PLOT DIAGRAM
Locale 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 navies and indicate whether
interior or corner lot.
i
STA I f OF NFYJ YOR L S.S
COUN1 i
being duly sworn, deposes and says that Ire is the applicant
(Name of individual signing contract)
above named.
Ileis the : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... . . . . . . . . . . .
(Contrac(or, agent, corporate officer,etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to snake 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 perforined in the manner set forth in the application filed therewith.
Sworn to before me this
rHi
Notary Public . .SJ' . . . . `. . . . . . . County
ROBERT P.STARON
Notary Pubs e,State of Now York
No.4164850 ' . . . . . . . . . . . .
Omitted InSuffokCaunry (Signature of applicant)
:,orr>mission�«�t.at,,tp �5 • -
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FORM NO.3
TOWN OF SOUTHOLD
BUIIDINO DEPARTMENT
TOWN HALL
SOUTHOLD,N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
` Date............�1!4.................................. 19...1
NO 22826 Z
Permission Is hereby granted to:
....... .�,�..%... ....... /.e-eiY'.......
...��.'1�i1..y4.'.�...
Vis......�yr°1,...,,.... .....................................................................................................
..................................................................................................................................................................
.................................................................................... ........................................................................ ...
.......................................................................
...................... .......................................
at premises located at..............�T� ........ Od. /.. ......f�.!e:..................................
..................................now. 7 c, .....................................I.............
County Tax Map No. 1000 Section ....102......... Block.....00...... .... Lot No. .../..0,4.........
pursuant to application dated .............
(49-1.�-3................I............• 19.J/�GJJ .... and approved by the
Building Inspector.
Fee S.� .......
........ . ... .:... !�'J........................................
ding Inspector
Rev. 6/30/80
,,�•.rttrt SUFF. cu E,LEAL r' /e: PP Rt7VA'L" t) GIK 't.1dSNT__ _.
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C 1eY Of uuneral E B1jae iuy
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TITLE CERTIF.
CA AlANCA400
GuaYaRrr'�a.� to
REAL STAMP
North Fork ¢ 8a..e <j 7rwaf .:o.
y a Guararr/�
04 euvet�ed Dec .2$R I�T7
RODERICK VAN TUYL P. C.
. v.L -`•., :i' �>O:J f l;.:u _i_J r(�!.'t . �� Y o. �----�+ir \
LIG.MdD SU RYEYORS GREE ?ORT. N.Y.
TcxA M1J/ C)c5il IfaiiUrr: Di 3f IOUO„' e,cf /U7, dloc:k F;,Fvrf ,,,f L,7F I r.
T ST HOLE SUFF. CO. DEPT. OF HEALTH SERVICES STATEMENT OF INTENT
O'
. 1 I ' FOR APPROVAL OF CONSTRUCTION ONLY
THE WATER SUPPLY AND SEWAGE
DATE: DISPOSAL SYSTEMS FOR THIS REST.
DENCE WILL CONFORM TO THE
H. S. REF. NO.: STANDARDS OF SUFFOLK CO. DEPT.
OF HEALTH. SERVICES.
•i .„ f APPROVED:
tS)
17' APPLICANT
/ ry TOWN OF SOUTHOLD PROPERTY RACORD CARD 4�
OWNER STREET L�/ VILLAGE DIST. SUB. LOT
�, �j/Pl��/N 1h/aopCL /f DlP /'�r�7r, %ucr DEsc
FORMER OWNER N E ACR.
w#p ESL A S7S
S W TYPE OF BUILDING
C-D SLS 9 A q, I Woos C14F a R, 73. Es nEivs�
,ES.,vo SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
�S'G
040 3T k&9177 -7k-177 fou 4r /=Mom E, 9,4A A i W l- �.foc, FAA IL I' 3
U 0 �r v Vo G l /7 7 13LD. PER. -* 9,V,/.2 81 Pv t Dw, Ec )11`e18 �---
ltOu � zDU 3 �4o i
W,7
'illable FRONTAGE ON WATER
Voodland FRONTAGE ON ROAD
1eadowland DEPTH A V „� D
louse Plot BULKHEAD
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