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HomeMy WebLinkAbout23358-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24429 Date DUNE 14, 1996 THIS CERTIFIES that the building ADDITIONS Location of Property 475 WILLIS CREEK DRIVE MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 17 Lot 17.15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 2, 1996 pursuant to which Building Permit No. 23358-Z dated APRIL 9, 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 AN ADDITION OVER AN EXISTING FIRST FLOOR AND A RAISED DECK ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SAL TUSA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. 12248 DUNE 1, 1996 PLUMBERS CERTIFICATION DATED N/A Bui ding 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....... „ .......... ...... ...........,.......,. 19.. NP 23358 Z Permission Is hereby granted to: _ ..... f. .. ��V.................................... /,... . .�. ...,, :...................I............ � S '.. ... .. . . .. . . .. .. ... .... .......... .... ................ ... ................. ..Y.... .....Ll/' .. . ..... ...4Z ....... ............✓,:!-................ ............U... . ....Gn .......... ............................................................................................. V10......-...........-......... at premises located at.......... . ..........�+� . .............................................................w.... ... ............................... . ....... County Tax Map No. 1000 Section ......../1.. Block Lot No. / pursuant to application dated ............... �/),...,. ..... 19...1. ..., and approved by the Building Inspector. Fee$... .,.......... - Building Ins e r Rev. 6/30/80 ee Form No. 6 ! 0 U GTOWN OF SOUTHOLD JUN BUILDING DEPARTKENT TOWN HALL 765-1802 LD .TOWN OF SODUTHOLD APPLICATION FOR.CERTIFICATE OF OCCUPANCY A. This application must be 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 17 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. s 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. C. 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 Buildins - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. ;Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . • . ~ . . . • • . Vew Construction. . . .. . . 0 d Or Pre-existing Building. . . . . . . . . . . . . . . . ` �,ocation of Property. � /�: :� � �(/1C1Y�. . . . . . . . . . . . .. I.,r...7v �;.. _.... ..... . . House No.. Street Hamlet Jnwer or Owners of Property. . . . f_.W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .'ounty. Tax Map No 1000, Section. ./J,... . . . . .Block. . . .,.1.7... . . . . . .Lot. . /p . . .,[.�i. /f. . . . . . Subdivision! f�d�4� :�.A1�1_.V<A,Filed Map. . .� '.Lot. . . . . . . . . .. . . . . . . ... . . . ?ermit No. 0? . .. . .Date Of Permit.L/_.,.I.6�. . . . .Applicant. .- ?ii!sG. . r 4':'T!'�. . . . . . . . . . . . . 3ealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . ?lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . lee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . sib . . . . . . . . . . . . . . . . . . . . . . . . . l c�Ej AP . I CANT ELECMCAL INSPECTIQI�SERVICE INC. . 375 DUNTONAVEINrUE EAST PATCHOGUE,NEW YORK 11772 (516)286 6642 z 12248 APPMATIONNo.ONFILE DATE: 611196 a vltc�lcE AVTTITUCK VOWN. SO&THOLD ADDRESS; unrri ml,FK1)RII -InT#1R ISSUED TO SAL TUSA gip: r- - --. — - - .-- --• _ - - *-,';" -- _-'-- --- --- ��+„--� MMODUCEDBY R. C.ELECTRIC L1CNo: 1610 E IRE*. was examined on 5-31-96 and found to be is compliance xnth the National Electrical Code J j LOCATION: 'Base.. 3 ist 2nd `;i j - $rd ��i Attic - # ,. k fi DeG'Garage Hot Tub Poo! SWITCHES RECEPTACLES FIXTURES HEATERS I FANS GFI. AIR COND.i DISHWASHER DRXER CLO�IIES WASH. GAR.DISP , RANGE (OVEN SMOKEDETEC210R c' FURNACE DIL. GAS 'CA MOTORS BELL TRAN MWCEDISCONNECT ,¢.` - _ I MBTER AMPS PXASB >• y'., OTHER ; EQUIPMENT .3 OUTLETS,l SWITCH,'1 SMOKE,DETECTQR, 1 LIGHT FOP,A 1 ROOMEXTENSION. d 0 UGO S SU1tDl PRESIDENT BUILDINGPF.ILLIITNo. n� 'm»tnatbe� a;n�y � I � 1r>epactot�awybe>.3eatiGedb 1lteQaod�tieLs BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE � I 1 1, o�oS�FFo�,��o o� Gym co .Z Town Hall,53095 Main Road - • Fax(516)765-1823 P. O. Box 1179 Telephone (516)765-1802 Southold, New York 11971 ��j `1►a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 5, 199.6 Mr. Sal Tusa 11 Regal Ct. St. James, NY 11780 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file.."/ xx . The check is not on file. $25.00 No Health Department Approval on file. , No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23358-Z Please contact our office .on this matter,. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. �E� v ✓ 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] F�UGF1 PLBG. [ ] FOUNDATION 2ND �✓ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE !E CHIMNEY REMARKS: DATE � I�INSPECTOR 70-ieo2 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ - ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE Sl -INSPECTOR � �. 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS• �z DATE INSPECTOR . I_ll:lsltl I II'il'I;l:l I.Ull�l(I;I'(rlu, UATIi (:Ulllll�lllni 1:01111DATT Oil IUlllll)ATIUIIm��a(Zlrf))v�� --._...._ IU)IICII F Ilnrlli R o ---_:.--- I -- ---- -rInI r if(: --- ...__...... --------- - ------ -- - rI.I „-vaa.,-,,,, a/- -- .,=-.�aa-,-.-,._a-_...a.,. ---a.,ad. -- ------- I I1:;IIl.nT I t111 I'Iilt it. Y . STATE I'.I11;11(;Y CODRI } F I IIAI. C7 y rt.a,-,ewe.w,.e.e -----------,.-aaaa-m_-•. AI)U I T I OIIAI. C(llll ll?IffS: � �`4.ar.a--,—e,arem.--e,na._f9a.._ea--rl----�en,a-a MCe]zaae,• -----„ ---------,�a - _ _• ^e _..._._.___.___._._-._.__.—.____—_..—___.__._.—.__.__-_.-. - --- 4SN .. ... _..............----. 'tl BOARD OF HEALTH . . . . . . . FORM NO. 1 3 SETS OF PL.1:1S APR1-OWN OF SOUTHOLD "SURVEY . . . . . _ _ _ . . . . . . . . . . . BUILDING DEPARTMENT `"CIIGCK . . . . . . _ _ _ . . . . . . . . �---� _ . TOWN HALL SEPTIC FORt�t . . . . . . . . SOUTHOLD, N.Y. 11971 "t / " a. /// n TEL.: 765-1802 r:OT I FY 7� � CALL 1 Examined . . . MAIL TO : '.. . _ . . . . . . . . . . . Approved /�: ., 199�Permit No.�J 3 . . . . . . . . . . . . . . . . . . . . . . - - - - - . . . . . . . . . . . Disapproved,a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspecto P LICATION FOR BUILDING PERMIT Date ././,PX/.G. . . . . . ., 19�, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 rsets 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 occupiedlor 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, os' co , and regulations, and to admit authorized insnertors on n_-emises and in b iildin.P, fo neCeSS2.iy iriSpec mriS. . . . . . . . . . . .�' . . . . . . . . . . . . . . . . . (Signature'of applicant, or name, if a corporation) S� 7��. . . . . . . . . . . . (Mail2*address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. e . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises , �f� . l. .�/�✓7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . I-house Number Street • Hamlet n County Tax Map No. 1000 Section . . . ' /..� . . . . Block . . . 17 . . . . . : . . . Lot . . . . . . . . Subdivision /'/ ! ��.� 1.�,�,?� '/1�T/ V ed Map No. e�.71-1'ey. . . . . . Lot . ; . . . . . . . . (Name) 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 ,//S' �jQ � , . . , , • , , . , . ; , , . , .3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition Alteration Repair . . . . Removal . . . . . . Demolition . ' . . . . . . . . . . . . . . . . Other Work_: . ... . . . . . . . . . . (Description) 4. Estimated Cost . . � . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be- paid on filing this application) 5. If dwelling, number of dwellin units . . . . . . . . . . . . . . Number of dwelling units on each floor If garage, number of cars . . . ' . 6. If business, commercial or mixed occupancy, specify n�j ure and extent of•eac ype of use 7. Dimensions of existing structures if any: Front `V - : �. . . . . Rear ../r. . . . Depth .� ? . . . . Height . , , , , , , , . Number of Stories . . ; Dimensioi�s of same structure with alterations or 'tions: Front .v� . , , , , , , Rear Depth . .. . . . . . . . . . . . . . . . Height . . . . . r Numbed? Stories . . . . . . .� . . . . . . . . . 8. Dimensio of •ntire new construction: Front Rear /. . ; , Height Nu . . . . . . ... Depth�G�. . . . . . . . . . . tuber of Stories . . . +� 9. Size of lot: ront �'` Rear. Jpf, 10. Date of Purchase .��-� � �• • •.• • •. • • Depth �Y prt "' ,�o� • Name of Former Owner„�� /y� ,J �]`Q 11. Zone or use district in which remises are situated,'' .12.. Does proposed construction violate any zoning law, ordinance or regulation: �� 13. Will lot be regradedD Will excess 11 be removed from premises: Yes . 14. Naive of Owner of premises / /. t!�?�• Ad-dress�I �I�L � ., phone No.� Name of Architect J' `/ t . Address S `7s'�f9yIG' , , phone No. Name of Contractor SW,? . WX. , . Address . zra Phone No. 15. Is this property within 300 feet of a tidal wetland? No. *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. UNDERWRITERS CERTIFICATE �� REQUIRED 06 APPROMED LU S NOT ®ATE: B.P. �.�� � U''.:�� r,� �.k,• . t',� -„ �'� FEE: ,- -' := -- �i� NOTIFY BE41LIaiNt3 �E E 5-+B®2 S Aril TO 4 OR THE FOLLOWING INSPECTIONS: ' U ' T. FOONDAT'ION - -TWO REQUIRE®- FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR RESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF . . . . . . . . . . S' . . . . . . ' • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . . . . �.� . .Allis,�� � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 m 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 . . . . .d-ay of. . . . . . . . . . . ., 19 Notary Public, . . . . . . . . . County KATHRYN S. . NOTARY PUBLIC,State of New.York lt%� ' ' ' ' ' ' ' ' 'No.52-4867056 Qualified in Suffolk Coun l.. (Signature of applicant) Term Expires JIU)Y 1, �,Pes��ercc� FDA COUNTY DEPARTAID!7OF'lfAtTH SF�ViCESv, �4Y D�NELLING,ONLY REF. NOge disposal and ►eater si►ppiy facirit;e; for t,-is . I bcation itr.e ue^�t insr�ecte ti :his Oeartn�e;mand/or , I other a ies id 1' • ... _ It ♦. ,^< "R , �• I � v — z9j � ..mod- .t �G Tvs . ' 1 s-1.9.oE�oe. Tv=-, APR 2 1996 ��rre�FEasu�s.�reiyde !` ��• 336� �� i 1 fodvOi}'riac/LaTitAtlF� G�./,9 40.?f 41- N" k: 'op 44 op 00 Ao9rl'I7 1/�611 011�� � �. 1 'D �✓ ` �- � i � rr��o �� 7�� �a —yam/y� �PEOFDE OPE FOR Al x o�STi@!� E fERGENCY ESCAPE AS ; � �bA) Gf�/dwTl�iUT WEQUIRED By PART. N OF - �NY. STATE BU fir w / CC- 1 • ,�. �, a cry , rl /j Ahd go ev Iroo i f , �I f • 4t aNc /L/N� ,�j0 oZ X/©