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HomeMy WebLinkAbout28727-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30080 Date: 03/15/04 THIS CERTIFIES that the building ADDITION Location of Property: MANSION HOUSE DR FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 6 Block 5 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 6, 2002 pursuant to which Building Permit No. 28727-Z dated SEPTEMBER 6, 2002 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 EXISING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALLACE CALNEY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-520954 05/21/81 PLUMBERS CERTIFICATION DATED N/A "--Z/- zk 7AXhoriz�ed Signature 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. 28727 Z Date SEPTEMBER 6, 2002 Permission is hereby granted to: WALLACE CALNEY & WF 742 PLACIDO WAY NE ST PETERSBURG FL, 33704 for CONSTRUCT AN ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#11731 . at premises located at MANSION HOUSE DR FISHERS ISLAND County Tax Map No. 473889 Section 006 Block 0005 Lot No. 008 pursuant to application dated SEPTEMBER 6, 2002 and approved by the Building Inspector to expire on MARCH 6, 2004 . Fee $ 150 . 00 Authorized Signa re ORIGINAL Rev. 5/$/02 FORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N: Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) X1911731 Z Dgte ........................... .. ........................ 19....... Permission is hereby granted to: 4�A ....................................... � ....... ' � '� ........................... .s.................... ... ... �'. o��►©' to ................................................................................. .......... ... ......................... at premises ....T .�.. premises located at ........./%.�.A�Q�!1.. .......... ........... ...�......... ................ ........... ................................................................................................................................................................ ........................................................................................................... .. ..................... ............. County Tax Map No. 1000 Section ..............!..... Block ....... ........ Lot No. ........................ pursuant to application dated ......................................................... 19........, and approved by the Building Inspector. Fee $g-................. � I�MW�7r"'"1� ... ......�............................. Building Inspector Rev. 6/30/80 y Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT �yWN HALL 6 �V D!xy QD 765-1802 W l L-j'o N < LIF 06 g°?- 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: MR 9M 1. Final survey of property with accurate location of all buildings,property lines, streets;and-unusual naturalor topographic features. Tr„ 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 1%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. 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. A properly 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$25.00,Alterations to dwe.14ing$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- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. Al~ Pt ?°ox, New Construction: Old or Pre-existing Building: (check one) Location of Property: /l 4-/fS1 D pi '46 Usk �(Z 5 l,S Lof) House No. / r Street Hamlet (,✓ Owner or Owners of Property: Lt-4-c5-! C.9-t-AJC Y Suffolk County Tax Map No 1000, Section (p Block Lot Subdivision Filed Map. Lot: ""� � Permit No. 2? l Z - Date of Permit. Applicant:�T'r 647 t—L Ad Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Z 9 Oy A plicant Signature c0 27 300ga THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY OM M ep 21 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date May 1 1781 Application No.on file 11254-81 N 5 Ln O 9 5 4 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the plicant named on the above application number in the premises of Wild* Carney, ftwiran Hmse Drive, Fi skiers Island, N. Y. in the following location; Basement � Ist Fl. 1:1outside 2nd Fl. Section Block Lot was examined on May19,1981 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS ECEPTACLES SWITCHES FIXTURES M RCU RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS INCANDESCENTI.FLUORESCENT I VAPOR AMT. I K.W. AMT. I K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PTJ TIME CLOCKS I BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. I H.P. NO.OF FEET SYSTEMS AMT. WATTS = SERVICE DISCONNECT NO.OF S E R V I C E T. TYPE METER �,2W ,B'3W 3 Ar 3W 3 0 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A•W.G. NO.OF NEUTRALS A.W.G. EQUIP. PER Z OF CC.GOND. OF HIAEG OF NEUTRAL 1 30 CB 2 x 1 4 1 4 OTHER APPARATUS: Ray FAmn-ds/Edwalyds Elec. Box 511 Fisherit Island, N. Y. 06390 Lic S#1292 .. GROW MANAGER Pei~- 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. '� BUILDING PERMIT EXAMINERC CKLIST DATE REVIEWED: / /03 APPLICANT: DATE SUBMITTED: _/_/03 SCTM#DISTRICT: 1,000, SECTION: , BLOCK: , LOT: SUBDIVISION: ADDRESS: CITY: ZONING DISTRICT: CONFORMING? BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO SINGLE & SEPARATE CERTIFICATION-REQUMD NOTES: [ATS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ. FRONT PROP. FRONT REQ SIDE ACT. SIDE REQ. REAR PROP. REAR REQ. HEIGHT PROP. HEIGHT PROJECT DESCRIPTION: ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: WATER FRONT? DESCRIPTION: PANEL # FLOOD ZONE: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #): DTE: / / PERMIT#: TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or NO DTE: / / PERMIT#: SOUTHOLD TOWN TRUSTEES: YES or NO DTE: / / PERMIT #: TOWN ZONING BOARD APPROVAL: YES or NO DTE: / / PERMIT #: TOWN PLAN. BOARD APPROVAL: YES or NO _ DTE: _ / / PERMIT #: _ TOWN HISTORICAL PRE (SPLIA): YES or NO NEW YORK STATE CODE COAIPLIANCE (SEE PAGE 2): YES or NO NOTES: �5 ! !s FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1. ( —SF)- ( —SF)= SF X $-=$--+$ +$ = $ 2. (-SF)- ( SF)= SF X $ _$ +$ +$ _ $ 3. (._—,__—_SF)- (— SF)= SF X $ _$ +$ +$ = $ FINAL TOTAL: $ NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: Ground Snow Load: 45 Wind Speed: 120MPH Seismic Design Category: B Weathering: Severe Frost Depth: 36" Termite:M-H Decay: S-M Design Temp: 11 Ice Shield Underlay: YES Flood Hazards: USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE FULL FRAMING DESIGN ELEMENTS: Y/N HEADERS: Y/N WALL STUDS: Y/N GIRDERS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS: Y/N ROOF RAFTERS: Y/N LUMBER SPECIES AND GRADE: Y/N DESIGN LOAD CALCULATIONS: Y/N LIVE: Y/N DEAD: Y/N SNOW: YIN SEISMIC: Y/N WIND: Y/N WINDOW AND DOOR SCHEDULE: MISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N VENT 4%: Y/N NAILING/CONSTRUCTION SCHEDULE: Y/N MEANS OF EGRESS: Y/N PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N TRUSS DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 cp �9 g- i A C l nw► 4XI IJ'I 3 /, pt yr► CI. Q, �� � G��� y � Ik 9� �y i9�y Jw- J 74 /33-J �� 07666 l/ 7 / 6 0 ' 11731 c7 -23/ate FIEF D«INSPECT;04,,* liDATE COMMENTS44 r tn tn N FOUNDATION ( 1st ) c � FOUNDATION ( 2nd ) Sy, 2 . ►1' ✓ ,�2�d yrs u_ 0 ROUGH FRAME & I ; (� - - PLUMBING c 3 . . rn INSULATION PER N . Y. y STATE ENERGY CODE x a 3 r 4 . H FINAL o z ADDITIONAL COMMENTS : (.v� cq, ,, a cel . a r e ,� dog i _ -� . awy Cui c4(�moo, o,-, �n�t.d s �n d•c �.e,,, aL �,�.d ^� f- H H H O Z • x a r H d C+7 H r FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 / Examined . . . . . . . . . / �, 19 �- Appiication No. . . ( � .`� !. . . . . . Approved . . . . . . . . . . . 19 . . rmit No. . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . .yip>� . .!��i • ••, /.fir?� (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . 19 . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted. to the Buildin 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 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 issue 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 Occupanc; 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 o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in buildings for n(�✓ ssaryinspections. ...!. . . ... . . . . . . . . . . . . . . . . . . . . . . (Signature of applicant,or name, if a corporation) avlailirg address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . Name of owner of premises (�a�l Q c E'_. . . La-lh e X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) !` Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M�NS'roN . . . . . . .-b•ki✓E .SA-PAf+0. . .�o� . . . . . . . FQ5fiEk1 -MhkNb House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . . . . . Block . . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . , . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .`S. .. .. . r !r. .Spar. . c e b. Intended use and occupancy S v�rj e ►': /!.e sed .ac. . . . . . . . . . . . . .` t: . . . . . . . . . . . . . . . . . 3. Nature of worti (c,,i�ck whim appiicajla): :\;O,.v Building . . . . . . . . . . Addition .!. . . . . . . . Alteration r: . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . OAU. �. . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . 111S'... . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of ex'stin structures if an . Front . . . . r'S— �� g y' . . . . . . . . Rear . . .�s. _ . . . . . . Depth .7,0'1. . . . . . . . . . . . Height . . .� . . . . . . . . . Number of Stories . . . J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . ss . . . . . . . . . . Rear s1". . . . . . . . . . . . . . Depth . . . .7P... . . . . . . . . . . . . . Height . . . .�? . . . . . . . . Number of Stories . . . . !. . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . � . . . . • • . Rear . . . . . . . . . . . . Depth ,30�. . . Height . . . . !?=. . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front Rear /. .v Depth 10. Date of Purchase . . .-�.e!'7�� !> 5 s.. . . . . . . . . . . . . . Name of r . . . . . . . . . . . is�f�rS . .Zs/g y, .. . .,. . Former Owne7 . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ./7�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . .h� Will excess fill be rem vel from premises: Yes No 14. Name of Owner of premises !1 h Y. AddressS F,rs - scary !I lbhone No. �. . ff. 's.�. . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . `Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . 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. 7L ` STATE OF NEW YO S.S COUNTY OF . .•. . ` . .j �G�a • N . C. .��. . . . . . . . L l �L117 being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the._.-:-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .::'�-:rr�. (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 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 manner set forth in the application filed therewith. Sworn to before me this �f MARIL M. CC)CO-y'.1 -•'1 �-L . . . . . .: . . .day of. . . . . . ,^4... . ., 19 Jy. A NOTARY PUBLIC OF iiE:' .Y �A MY Commission Expires 1an,W'1933 Notary Public, AAA-" i.�, . �!u���A'• • • County .�.�/. " I (Signature of ap. icant) i GARAGE .0' Id / BEDR06M OCCUPANCY OR USE IS UNLAWFUL p i WITHOUT CERTIFICATE OF OCCUPANCY APPR VED AS NOTED DATE: � y p �#,, 1 1 7 3 1 — IDRaoM BATH TNOTIFYNG 'DEPAR MENTAT /'11 765-1802 9 ALLOWING M TO 4 PM FOR THE BEDROOM i 70� 1.OFOUNDATIONPECTIONS: BF-DR66M FOR POURED - TWO 'REQUIRED CR 2. ROUGH - FRAMING & PLUMBING I INSULATION 4. FINAL - CONSTRUCTION MUST BE C'1MPLETE FOR C. O. -� ALL CONSTRUCTION SHALL MEET THE REOi 1IREMENTS OF THE N Y. STATE TIO&. JZONSTE1 CODFS. NOT C — & ENERGY RESPONSIBLE FOR -r DESIGN OR CONSTRUCTION ERRORS. 76' Q _ �opose 7o wid KITCHEN F1 Whd 7e enc/ase- h-w '" qh ehc%Sur2 of '/w, 'q J` /ass doors, eaalers �. �or y�aSS �ocr} e doa lPd �X$s C. - 'V"pase -/ o add '/0 X /a II addiyJ' ®our-ed Ce h,-eh 3 ' rEEIt=LOW G1zR:Pl T b� `�.,�sehfly b arldih s a �narne c- 1-lbAoo>`d LIVINGIR66M pew b57�cl�llzjl 4// r s cyNcd h/ 9/ er/a �s Orvhal /h r / b'