HomeMy WebLinkAbout23337-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24886 Date FEBRUARY 5, 1997
THIS CERTIFIES that the building RENOVATION
Location of Property 11600 SOUND AVENUE MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 141 Block 03 Lot 45.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 21, 1996 pursuant to which
Building Permit No. 23337-Z dated MARCH 29, 1996
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 RENOVATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to NORTH FORK HOUSING ALLIANCE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-395919 - SEPTEMBER 3, 1996
PLUMBERS CERTIFICATION DATED NOVEMBER 26, 1996-WALTER MARCZEWSKI
uildling Inspector
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)
Date....................... f
........................, 19.��
P 23337 Z
Permission Is hereby granted to;
...
/.��........ .'�. ..,. �.......................... .........
�?. ....... ... ..►......./..�% .......
to .. �/ f/........!dal' i >. "'.......
f"........................-/ .........................
�// /.�
.T.1........./!!••/•:••'�/..'K ........ ! !/'/i ...........r/...J....... r/.-..�..IV..��.--��„-K.......... ...�..T'..` f...
................................................................................................ .... ...... ....... ......
..................................................................................................................................................................
..................................................................................................................................................................
at premises located at.........,,11�0.. ......... .. .... ......... �..o............................................:...
.......................................................... .....M77.e?.".V.44................................I.............................
County Tax Map No. 1000 Section ..!.. ........... Block....... .......... Lot No. ....T✓..' ........
pursuant to application dated ............... �i � ... 5.......... 19. ..... and approved by the
Building Inspector.
Fee
............... .......................................
wilding Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
DEC 5 6 765-1802
Yf
APPLICATION FOR.CERTIFICATE OF OCCUPANCY
A. This application mustxb� 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 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.
,t 6. Submit Planning Board Approval of completed site plan requirements.
3. 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 - .251�.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . Z j. . . e: . . . . . . . . . . . . . . . . . . .
few Construction. . . . . . . . . . . Old Or Pre-existing Building./ �.�'+.a4/. :P.✓r
..ocation of Property. . ll . �. ?. . . . E9 c c v:... . . . . . . . . . .�'�
House No.
�S/treet / Hamlet
)nwer or Owners of Property. .<w�.Vr !.:fk . /'��-. . !1.� -5.� /./�� p:�. . . . . . . . . . . . . . . .
:ounty Tax Map No 1000, Section. ./ �/. . . . . . . .Block. . 2. . . . . . . . . .Lot. . 141AZ !.2. . . . . . . . . . . .
,ubdivision. . . /. . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . N M. . . .Lot. . . IY`..l . . . . . . . . . . . . .
-'ermit No.-?.'3—_ �. 7 . .Date Of Permit. .`'.`'. . 'FV?j . . .Applicant nlvr ; rlS�lDcrS;ny Jed"ki �"G�
lealth Dept. Approval. .�M7 . . . . . . . . . . . . . . . . .Underwriters Approval. .Y'!E 5. . . . . . . . . . . . . . . . . .
'lanning Board Approval. �//�. . . . . . . . . . . . . . . .
request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .Vl�. . . .
,ee Submitted: $. . . . . . . . . . . . . . . . . . . . .
������ �� � nFrr,lcnN•r
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAS; 1
1085085 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NY 10038
Date OCTO BER 29,1996 Application No.on file 11758096/96 N 39593.9
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
IdO.FORIC HOUSING ALLIANCE, 11600 OLD SOUIT) Pxmlim, 1,MTTITjCx, N,Y.
in the following location; M Basement ® 1st Fl. 0 2nd Ft. OUT Section Block Lot
was examined on .AUGUST 29,1996 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES 1COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS RECEPTACLES SWITCHES INCANDESCENT.FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
11 29 1E 11 1 7.6
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. A,A7, H P CS.OF FEET NO FE AMT. WATTS
1 F
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP. TYPE METER R�,4W 3W 3 JB'3W 3,0'4W NO.OF CC.C.OND. A.W.G. NO.OF HI-LEG A.W G. NO.OF NEUTRALS A.W.G.
EQUIP. PER.6 OF CC,COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
SMOKE DETECTOR:-4
FiLIATi IiLTBB�'L'�D, ELECTRICIAN ��TC.� 2P5 F L ��'L
R. 0. BOX 2241
AQtE.BOGU-E, NY, 11931 GENERAL MANAGER
11
a5 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.
-)'—..7-
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1035085 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NY 10038
Date SEPTEILBEP 03.1996 Application No.on file 11751QO+96/96 N 3959'.9
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
NO.EORK HOUSING .FIANCE, 11600 OZ1Z SQUMD? Al INT1110, HAT ITUCK, N.Y.
in the following location; IS Basement 0 lst FL 0 2nd Fl. OTJT Seetion Block Lot
etas examined on AUGUST.' 29,1 oa6 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
11 29 18 1.?. 7.6
DRYERS FURNACE MOTORS' FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL
Yy H..tP. GAS H.P. AMT.. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. I H.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S * E R V I C E
AMT. AMP. TYPE METER ��9 7W 1.03W 3 0 3W 3,0•4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A•W E0 NO.OF NEUTRALS A.W.G.
EQUIP. PER B OF CC.COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS: IIKt[�Q�I
C.7.P�.C.I:-61 I�
SHONE DEM ECTOR:--4 NNCC]]
AIAN p UBBARD, EI I-0,CTRICIAN LIC.;;MM5—F
P. O. BOY, 22,1
AQUEBOGUZ, NY, 11931 GENERAL MANAGER
11
xl Per Ka
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials11-1
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
�4®SgFw����
Town Hall, 53095 Main Road � I Fax (516)765-1823
P. O. Box 1179 � Telephone (516)765-1802
Southold, New York 11971 �i�q® uy,,,•% ,�'�1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:
Building Permit No. �Z J J 7
Owner: olOi—fl F r'*- AAO"-s:r� /���itrv,c It--.
(please print)
Plumber: 4.1 Ct
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers Signa ur )
Sworn to before m this
day of 19 �0
Notary Public, / rl Count
CLAIRE L.GLJEW
Notary Public,State of Now York
lNo.4.S79505
Qualified in Suffolk County q
Commission Expires December%19®�
'65.1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FO DATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: G
DATE � � INSPECTOR
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ RO H PLBG.
[ ] F UNDATION 2ND [ INSULATION
[ RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:pll�r
.���.
DATE 7 13142 INSPECTOR
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: 1410
1,14
DATE- INSPECTORS
�3 33 7�
70-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ � FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
ti
DATE ` � INSPECTOR
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
[ ] FIREPLACE !E CHIMNEY
REMARKS:
DATE � JI / INSPECTOR ,
�x
ruurn)n r rON ------=---- e—=-.==�==o= — --------------,-
I
Il()11(:II FRAME b
------ -
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S'I'ATI: litll;it(;Y '
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._ ._.. ...._.__..._....__..._._._.....
, I
BOARD ' OF HEALTH . . . . . . . . .
FORM NO. 1 3 SETS OF PL.INS
TOWN OF SOUTHOLD SURVEY . . . . . . _ . . . . . . . . . . .
BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC r• ORN . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t'DT`FY ' David Abatelli
3 qq CALL . • . • 477 - dyo . . . . . .
Examined . . . . . �v�.l. . . . . ... 19/�. t1A I L TO
j33,� 110 South, S�;
Approved . . • . . c3��—,9 . . . . ., 19 . Permit No.
Green.Port . . 11944 .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . _
GCu in lspector) =:1 MAR 2
g
cor
APPLICATION FOR BUILDING PERMIT G. DEPT
Trti ms F Od 0!
Date .. .� ... ...
INSTRUCTIONS
a. This 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. • 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 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.
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 removal 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 inspections.
,.North, Fork, Housing, ,Alliance, Inc. ,
— (Signature of applicant, or name, if a corporation)
. 110 .Soatth .St.. ,. .Graenp.ort,. •NY. . .1194.4-. . .
(Mailing address of applicant)
State whether applicant is owner, lessee, *agent, architect, engineer, general contractor, electrician, plumber or builder.
Owner
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .
Name of owner of premises . . . . Korth. Rork. Housirn4 .All.iance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bess( ame%ndUltroffco ft961&0fX@r)Director
Builder's License No.
Plumber's License No. . . . . . . . . . . . . . . ... . . . ... . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . .
l, Location of land on which proposed work will be 'done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.600 Sound Avenue Mattituck
. . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . .
House Number Street Hamlet
County Tax Map No. 1000 Section . . . :141'. . , , , , , , , , . Block . . . 03 . . . . . . . . : . . . Lot . . . .45;2, , , , , , , ,
Subdivision . . . . . . . N./A. . . . . . . . . . . . . . . . . .'. 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,inc,Jle, ,family, residence , . , , , .
b. Intended use and occupancy , , , single family residence : . .
.3. Nature of work (check which applicable): New Building . : . . . . . . . : Addition . . . . . . . . . . Alteration . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . , , . . . . . Demolition . . . . . , . . . . . . Other Work . .X. . . . . . . . . . .
new windows (Description)
4. Estimated Cost . . . . . . . . .1 , 269 sq. '.ft; :: 1500 Fee ,$158 .80
. . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling, number of dwelling units . . 00. . . . . . . . ., Number of dwelling units on each floor . N/A:
If garage, number of cars . . . N A ,
6. If business, commercial or mixed occupancy, specify nature and extent of•each type of use esidential only
7. Dimensions of existing structures, if any: Front . . . 3.•5 . , . . . . . Rear Depth . 32.4 • ' .
Height .aPPrg4 , 22.I. • • Number of Stories . ,two • , ' ' ' ' ' ' ' ' ' ' ' ' ' • • . .
Dimensions of same structure with alterations or additions: Front , • same • Rear . .44Te. .
Depth . . . . 'same. . . . . . . . . . . . . Height . . s.atme.. . . ... . . . . . . . .. . . Number of Stories . same • • . � . . . • .
8. Dimensions of entire new construction: Front . . .N/A. . , , Rear . .N/A. . . . . . . . . . Depth N/A . . . •
.Height . . . N/A . . . . . . . . Number of Stories N�A • • . ' ' ' ' ' '
9. Size of lot: Front . . . .76. 1.7.1. Rear. . •95 :80,'. , • • � � � � • • •Depth�P,Q�rox.• 2] �' ' • ' ' ' ' '
0. Date of Purchase . A.ugupt, .17 ( . 1995• , , , , , , , Name of Former.Owner Mattie Simmons . . . . . . . ' ' ' •
1. Zone or use district in which premises are situated . . . . . .
2. Does proposed construction violate any zoning law, ordinance or regulation: . .OQ. ..
3. Will lot be regraded nO . Will excess fill be removed from premises: • • • Yes • No
4. Name of Owner of premisesNql;th Fork. Hous i ngAddress 119. South, St ;Gpt Phone No. 4.7.7—.1070
Name of Architect . . . . . Address . Phone No.
Na
me of Contractor •Vincent Dellasperanzo Address Clppiee Yes
Uedli *guee
5. Is this property within 300 feet of a tidal �wetla-nM * ' • • • • • Phone No. 722-80.7.E . . . . .
.. . . . . . . . No. .VI. . . . .
*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
;operty lines. Give street and block number,or description according to deed, and show street names and indicate whether
•tterior or corner lot.
'ATE OF NEW ORK, S
)UNCY OF , ffolk . . . . . •
• • • • • • • . . being duly sworn, deposes and says that he is the applicant
ame of individua g g c ntract)
ove nan d.
is tile'. . . . . . . . . . . . . .Executive. .Director. . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . .
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
flication; that all statements contained in this-application are true to the best of his knowledge and belief;and that the
rk wily be performed in the manner set forth in the application filed therewith.
om to before me this
. . . . . . .21s.t. . . . . . . . . . .day of. . . .UrPh . . . . . . . ... . ., 1996.
tary Public, . . . . . . . . County2
40
BARBARA MIDI HT SCHRI€VER• . . . . . . . . .
NOTARY P<;BLIC, State of i4evj York • • • • •
No.4817602, Suffolk County
(Signature of applicant)
Term Expires
NUE , P
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73053 30" �®
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AREA = 19,600 sq.ft.
SURVEY OF
PROPER T Y
A T MA T TI TUCK
TOWN OF SOU THOLD
SUFFOLK COUNTY, N. Y.
1000 - 141 - 03 - 45.2
Scale: 1" = 40'
Jan. 4, 1995
�0
ANY ALTER4TION OR ADDITION TO TIOS SI RVEY IS A WOLAT/0N
OF SECTION 7209 OF TIE M6W YORK STATE EDUCATION LAW,-AS PER SECTION ��o
IEREON ARE �FOR7M MAP A�COPES TThUEOF ONI!Y � N.o �4°e. NO. 49618
SAD MAP OR COPES BEAR TIE U ESSED SEAL OF TIE SUMEYOR
MOSE ISM TW APPEARS AMON PECONI SUR V sI ,``P.C.
AOWTADNALLY TO COAPLY KM SAD LAW RE TERM ALnMM BY' (516) 765 - 5020
AWT BE USD BY ANY AAD ALL SLRVEYORS UTA! M A COPY P. 0. BOX 909
OIL AM7MW SMEYMS MAP. 7MW SIAGI AS '>MEC7W AM MAIN ROAD
wow--TO-DATE'ARE MDT N COI MAKE W N Tlf LAN. SOUTHOLD? N.Y. 11971
95- 101
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i _ a f-f- OCCUPANCY OR
ISE IS UNLAWFUL
WITHOUT CERTIFICATE,
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2 ry
'F� OF OCCUPANvil
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PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
2- REQUIRED BY PART. 714 OF
N.Y. STATE BUILDING CODE.
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of cis indicated on the drawings
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8, Driuings art. not 10 be scaaid.
MOO; THESE PLANS ARE AN INSTRUMENT OF SERVICE AND
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�'OTP VGr��Ct/E • ARE THE PROPERTY OF THE ARCHITECT. INFRINGE
_ MENTS WILL BE PROSECUTED.
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Laipro)ect title.
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drawing title.
V
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date. scale.
m issue.
UN 19 1996
• t drawing no.
p } r,� ` f� ���rae ti 'iiel, 4 fEe�
F
_ To the best of ���y �a � � �o
, these Plan( a: d specification:
professional � �� Q
s..i�i.�'....t:3b `
nre in compliance wjt►; t��e e�,>r `�o k State Energy �;,: ;� j A
W
" Co
nservation bode, section ar
ref.no.
U6
_