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HomeMy WebLinkAbout23456-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25109 Date JULY 1, 1997 THIS CERTIFIES that the building ALTERATION & ADDITION Location of Property MONTAUK AVENUE FISHERS ISLAND, NY House No. Street Hamlet County Tax Map No. 1000 Section 10 Block 7 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 25, 1996 pursuant to which Building Permit No. 23456-Z dated MAY 17, 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 ALTERATIONS & ADDITIONS TO EXISTING ONE FAMILY DWELLING `AS APPLIED FOR. The certificate is issued to MARY JEAN PEHLAM (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-051994 - SEPTEMBER 25, 1996 PLUMBERS CERTIFICATION DATED MAY 21, 1997-DAVID DOROSHEVICH //uil ng 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) NE? 23456 Z Date ... ..17.......................................... 19.�... Permission Is hereby granted to; n ......: ............................................ ......... .. .:a:......... f........... .... o to .. t . . .Gd. t ....... .. ... . .... .. . it .... . ..� .......... ......... ......... -- .................................................................................................................................................................. .................................................................................................................................................................. ...................................................................... at premises located at..... . .. n.-61'.... ....................... .... . ... . ��............... ..... ..................................... .. ...... County Tax Map No. 1000 Section ........A.......... Block............7......... Lot No. ................. pursuant to application dated .... . ....... .... 19lK........ and approved by the Building/Inspector. Fee$l r ........... �. .......?�� ........... f .................... % .Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD ;l BUILDING DEPARTMENT %. TOWN HALL 765-1802 : - .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 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 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. .0., Fees 1 . Certificate of Occupancy .= New dwelling. $25.00, Additions to dwelling $25.00, i _--:�'Alter.ations 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 - -254�. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of.Occupancy - Residential $15.00,JCommercial $15.00 Date .`N.r 7?'�Xl�. . . . . . . . . . . .. . . . . • New Construction. . . . . . !. . . . Old Or Pre-existing B ilding. . . . . . . . . . . Location of Property... . . .. .... . .��!pp�� ��.� ?�. . .. . . . . .. . I./.��? � � . l!/.•. .�Lr2��� House No. f� Street Hamlet Onwer or Owners of Property.. '4l . . . . . . C hj%�w . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . (( © . . . . .Block. . . . . .7 . . . . . . . .Lot. . . . _;IV . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . ... . . . . . .. . . . . . . . . .. ...Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . -� • . . . . Permit No . . .Date Of Permit.^..:�. . . 5� . .Applicant:/: .� ll�. • - • L: Health Dept. Approval. . . .. . . .. . . ... . . . . . . . . . .. . ..Underwriters Approval�l . S.��f•���� • Planning Board Approval. . . .. . . . . .. . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate.°. . . . . . . . . Fee Submitted: $. � .`�.`. � . . . . . . . . . . . . . . . . . . �� . . -. . . . . . . . . . . . . . .. . . . OV&C-,S3O f .APPLICANT vm cz Town Hall, 53095 Main Road - Fax (516) 765-1823 P. O. Box 1179 Q Telephone (516) 765 1802 Southold, New York 11971 � �' ,�� �zzzr:r� 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 . Owner: /4yu (ple se print) Plumber: Ulqvto Dlok- (please- print) I certify that the solder used in the water supply system . contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this day of 19- ` Notary Public w County EIrLEEN G. WALL NOTARY PUBLIC, NEW YORK STATE NO. 01 W A9509185 QUALIFIED IN SUFFOLK :OUNTY c TERM EXPIRES O^��?= e1 / THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE i 8060929 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 Date SEPTET IBER 25,1996 Application No.on file 1.1948296/96 H 051994 THIS CERTIFIES THAT PERMIT NO. 23456 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of MARY JEAN PELHAM, MONTAUK AVENUE, POLE#721 , FISHERS ISLAND, N.Y. in thefollowinglocation; ❑ Basement IN Ist Ft. ® 2nd Fl. ' OUT Section Block Lot was examined on SEPTEMBER -10,1996 and found to be in compliance with the National Electrical Code. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT-FLUORESCENT I OTHER AMT. I K.W. I AMT. I K.W. I AMT. K.W. AMT. K.W. AMT. H.P. 3 13 12 3 1. F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS 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 1 C E AMT. AMP. TYPE 1 A 2W 1,e'3W 3 0 3W 30 4W NO.OF CC.CO ND. A.W.G. NO. HI-LEG A.W.G. NO.OF NEUTRALS A•W G. TER PER 0 OF CC.COND. OF HIAEG OF NEUTRAL 2 100 CB 2 OTHER APPARATUS: PADDLE FANS-4 MOTORS:4—F H.P. G.F.C.I:-3 SMOKE DETECTOR:-4 MARY JEAN PELHAM I L C/O.TOt•1 DOROSHEVICH BOX 129 GENERAL MANAGER FISHERS ISL. , NY, 06390 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Insptctors may be identified by their credentials. 0-2149211:11 14 T10or L)<l.'\J1rZ Lcjyj non UNDERWRITERS CERTIFICATE REQUIRED A PROV - AS NOTED DATE- # f- FEE� BY: tj Albn " NOTIFY BUIL G DE-6��p'T & ' T 9 765-1802 APA " 1,, 996 -,'"0 4 Pr\41 FC)R THE FON'L0'-"44,R.!G MISPECTIONS: _ lot 0 .06P7. 1. FWNDATIONI - 'PAIC)REQUIR OL/ - FOR POURED CONCRETE' 2. ROUGH - FRAMING 8,, PLWIAMNG 3, INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR CA --- , -RUI Qlm! smTj HE REQUIREMENTS OF THE MY, BTATE CONSTRUCTiON 8t ENERGY or MDES- NOT RESPONSIBLE ROR DESIGN OR CONS"rRUCTION 0RrjR,13 ,SIP,kpr(� o PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OF N.Y. STATE BUILDING CODE. tq f a o HOOC ?COFS,� 0 0 0 Removes IY)�.r-o{- P��� t ron S I Yl � h � - '(�2. I�, cam, w� � K 1 b 31 ea z� d a{r-Cc,S,�_ � ins��, �� � Ioc�r� �o ;s 1�S Z X Uv �k qh ec, �r �F,n �r` � EI s-�z S ` I `` II I w�a` C. gyg� r�s�r P ►^Clo uj V n)Ae r"'S��i !'t,v 4. l I 1 n SJ G .' , U r� r 11GVS� XH rx Znj �"Cdor S�ruc:�Cv�e.. . -- Ga b)2 FN� VIeLY-) I (lum60 . Q�:, 4 0. �.� � �n c: ��cC�- s�-ruC..�-���.., � �:�`� L:� ° �=• d-'�a iL�� e..c.�,,� 1 �A coll�,� ri �- - ro vfY1 l�ed��o�riS i Z '�C►� vela 1�s }- Z jx G � RG-�-e-i'�S �I�m ber- ,e06M r(oDtab -- 035000'4i' g)Oor� rroY"^-a �OwT i/i L-L a PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OF IV-y STATE BUILDING CODE. pAJ�d/C 'IELD IN�t'ECTION REPORT DATE n n OUNDATI ON ( 1ST) II II II II II ;r I�—II I � _ODNDATION—===(2ND) ----- I� k- 1 1�—II :OIIGH FRAME & PLUMBING i J mil m NSIILATION PER N. Y. STATE ENERGY CODE u � u u I � n ;I n I FINAL II I ADDITIONAL COMMENTS: ra x y 'J Jz -- I K { { HEDGE STREETPIPE �N 1834.81 NIFW 567.83 JOHN R: FISHERS IS \39 NO ,�- N a UTILITY CO, INC.- � �X cfi \ \ r v (,�J\O rd o Ste^ 'per k W_ N 1736.25 It �/ _ S OF WAY TO W E W 666.1I / � RIGHT_ �`GCA77ON f2 OLD E gg G- �` ?� MON. � y�89 �'� \ p PROBSEE 0111 2 Pi F & A RA 2 2 AZ N 1736.85 MON. W 524.45 f 4� ` L/ ` ° Q`Q 0 � I ,�/� ao I N 1651.23 53 �° W 613.45 LD 9 L 5 aaE' MON. QH �ptJ I 1 I 5-el r• 90 ti F16 0 0 0'1' �°• 04952� O CFO� J�J GUARANTEED TO MARY JEAN PELHAM a ,C MMONWEALTH LAND TITLE INSURANCE � IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SUR- VEYS OF 'THE NEW YORK STATE LAND TITLE ASSOCIATION. TITLE NO. RH941133 .K-.4 c� I / H= STET PI E -, �N 1834.81 N/F NIF�( W 567.83 JOHN R: HELL/ER FISHERS ISLAND UTILITY CO, IhC. \ cil I Vo �� v► `` \\ \ y, ! —OF WAY_ WEST HA RBOR R G►Ff OF WAY N 1736.25 Y TO / F� RIGHT ' WIDE W 666.1 I -. �� LGCATI9 N PG 496 a1 ti OLDmoN• y' 89 `'� p PROBSEE LIBER 6 N/F z , F a ART�UR GREENLEAF NOTES w � � AZ. 1) COORDINATE DISTANCES� AR:;& GEODETIC SURVEY TRIANGUL P PROPERTY IS LOCATED IN THE e���i� / a y , N~-W I524•45 { �OF suFFOLK, DISTRICT IooO, SEC G i O - 3)TOTAL AREA = 12,980+/- S.F. = i .15 tu 1/�,� AA N 1651.23 y3-5 A6o cr° O W 613.45 9 LD 5 MON. a tit P SU RV PREPA norp rY4 3 r< ON MARY J E►+ �,11 �veh rove o� ��uS� q�� L MONTAC �° 04952� .40 /.�`� FI SHERD ISI BOARD OF HEALTH l5 . FORM NO. 1 3 SETS OF PL.IZIS . . . TOWN OF SOUTHOLD SURVEY .LK, . . CIIECK . .��. a��• •jr APR 2 9 {� BUILDING DEPARTMENT . . . . . . . . TOWN HALL SEPTIC. FOR21 _ _ _ . . . . . . . . . . . BLDG.DEPT SOUTHOLD, N-Y. 11971 9 TOWN OF Examined SOUTHOLD ,_.I TEL.: 765 1802 2:OT I FY . 19 - . . . . " " " ' MAIL T r/ ^ Approved /�. . . . . . 19 . . . Permit No. � Disapproved a/c . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . �� /U� . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . � APPLICATION FOR BUILDING PERMIT Date . . . . .a 19 g� INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 admi'c authorized inspectors on premises and in building for necessary inspections .(Signa� 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises (as on the tax roll or latest deed If applicant is a corpo ration,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�o/f land on which proposed work will �be done>.�, , , , , , , , , , . . . . !. .!c !7 a✓1� . . . .1 �,/.6 v.�. . ffv, . :C 0 House Number Street J ' Hamlet County Tax Map No. 1000 Section . . ��� . . . ... . . . . . . . Block . . . . . . :7. . . . . . . . . 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, :.i . . . . . . b. Intended use and occupancy . . . . . . . . . . � %[ . r 1\ \1 ,e of work (check which applicable): New Building . . . . . . . . . . . . . . + , , g� • Addition r Removal Demolition . . . . . . . . . . . Other Work--. . J o9 (Description) 4. Esfimated Cost . . k.Ol, aDD . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . (to be paid on filing this-apprlicatiori) 5. If dwelling,number of dwelling units . 1t / . . Number of.dwelling units on each floor. . .. . . . . . . . . . . . . . Ifgarage, number of cars . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 If business, commercial or mixed occupancy, specify n to a and extent of each t e.of use . . . . . . . . . 7.! Dimensions of xisting structures,if any: Front �. . . . . . . . . Rear . . ... . . �.. . . . . Depth . . . . . . . . Height T . . . . . . . . . Number of Stories . . . .4 . . . . . . . . . . . . . . . . . . , , , , Dimensions of`ame structure with alterations or add�t}ons: Front . . . . .64dll l. . . . . . Rear : . . �.�p�, , , , , , .ea Depth . . .���. . . . . : . . . . . . . . . . Height . . . . . . .�,. . . . . .'. . Number of fSto es . . . . . . .' .�. .. . : . . . . 8. - Dimensions of ntire new construction: Front . . . . . . .. Rear . . . . (��. . . . . : Depth . . . ; Height . . . . . 1. . . Number of Stories . . . A . . . . . . . . .? :. . . . . : .? . . . . . . . . . . . . . 9. Size of lot: Front I Z. a,a. . . . Rear �.►. :, , , , , , , , , , , , AI)epth 10 7 Gi0. Date of Purchase4�t1/� �Y .� 7.��.�. . . . NameofFormer Owner ,. c. 11. Zone or use district in which premises are situated . . . . . . . . . . . . .&. . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... . . . . . . . . . . . . . . . . . �t �J . . . . . . . . . Will excess fill be removed from premises: �'es . 13. Will lot be regraded . No 14. Name of Owner of premise� U1C t�A'�dres � fi42�.1��:-. . Phone Name of Architect j�. (/. . . . . . . . . . . . . . Ad �� ZZ¢�,r Lt,Dh�.P . Phone No. . F. o?.- , .'v Name of Contractor . . . �.. . . . . . . . . . Address . -:-.-�.�.- . . . . .. Phone o. . . . . . . . + 15. Is this property withinA00 feet of a tidal wetland? *Yes. . 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 scrip 'on according to deed, and show street names and indicate whether interior or corner lot. , STATE OF K, S.S �OUNTY OF . .70 L1/Ya - . , , . . , . . . , �� "�. . : �2Gz ., . . . . being duly sworn, deposes and says that,lis the applicant (Name Win'dividual signing contract) above named. Sieisthe . `: . . . �f...1U�! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . (Contractor, agent; corporate officer, etc.) f said owner or own—ors, and is duly authorized to perform or have 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- iork will be performed in the manner set forth in the application filed therewith., worn to.before me.-this " . . . . . . . . .C�. . . . : .day of . . . +, ,�/ �. . . . . 19 R. � 1 otary Public, . . . . a:: . . . • . Counfy '�' ABS1B L. B1A NOTARY PUBLIC . . ... . . . . . . . . . MyCoMMISSiON EXPIRES SEP 30,1998 (Signature of applicant)