HomeMy WebLinkAbout22989-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office -of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25300 Date OCTOBER 6, 1997
THIS CERTIFIES that the building ALTERATION
Location of Property 300 PACIFIC STREET MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 141 Block 4 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 21, 1995 pursuant to which
Building Permit No. 22989—Z dated SEPTEMBER 6, 1995
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 ALTERATION, FOUNDATION, AND DECK ADDITION TO EXISTING
ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to THOMAS G. & HELEN C. KOCH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H-051938—SEPTEMBER 20, 1996
PLUMBERS CERTIFICATION DATED SEPT. 24, 1997—TANDY PLUMBING & HEATING
Building Inspe or
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 22989 Z
Permission is hereby gran
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.............. ........ ... ... ? . i....�
.... . ... .... . - ........
to . .. ... .... .................. . r JI+..�.
........... .................. .. . .....
..- ° .... .. ...
at premises located at..................zz.; ..............1..... ... ... ....... .
...................... ....................................." �., ......................... . ............
County Tax Map No. 1000 Section ...... . ... Block............. ........... Lot No. ..1... ...............
pursuant to application dated ............. ;?/........... 19...1..,4 ., and approved by the
Building Inspector.
Fee $...,��... ..
.............. .. . ..........
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD 0 /ql
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OF, 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.
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 Buildinz - $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 p$15.00
Date' . . . . . . . . . . . �. .l. l 9' . . . . . . . . . . . .
New Construction. . . . . . . . . . Old Or Pre-existing Building. . . . ),... . . . . . . . .
Location of Property. DO -� � � .�T.. . . . . . . . . . . . . . . . . . . . . . .Im7.(CJ.� . . . . . . . . . . . . . ..
House No. Street Hamlet
.l m. . .�:. . . . . .I� L �l �. /mac -f. ,
Onwer or Owners of Property. U !3S , , , � , , , , , , , , , , , , , , , , , , , .
County Tax Map No 1000, Section. ..f:T.1. . . . . . .Block. . . . . . !. . . . . . . . .Lot. . . . . J1. . ... . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . ... ... ... . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No q ??U . . . .Date Of Permit. ./1./��9�. . . . .Applicant. . . �Cy � • . • . - - - • . . . .
I '
Health Dept. Approval. . . .. . . .. . . . . . . . . . . . . . .. . :Underwriters Approval.. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . .. . . .. . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .�. . . . .
Fee Submitted: $°�:�'�� . . . . . . . . . . . . . . . . . . . . .
�'��� APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS ray 1
8059418 BUREAU OF ELECTRICITY
F_ 85 JOHN STREET, NEW YORK, NY 10038
Date SEPTEMBER 20,-1996 Application No.on file 11416396f 9G H 051935
THIS CERTIFIES THAT f:'ERNIT N- 22989Z
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
THOMAS G.& F ELEN C.YOC'.H, 300 �� PRCIFIC STREET, d'�.t-�I'I'3.'191MCK, N.Y.
in the following location; ❑ Basement L�b 1st Ff. ❑ 2nd Ft. Section 141Block 4 Lot 19
was examined on SEPTEMBER 2.7►1996 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS RECEPTACLES SWITCHES INCANDESCENT I.FLUORESCENT I OTHER AMT. K.W. AMT. K.W. AMT. I K.W. AMT. K.W. AMT. H.P.
C 12 11 3 3 1 1.21
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMT. K.W. 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 I C E
AMT. AMP, TYPE METER �,4W t.B 3W 3 0 3W 30 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W.G.
EQUIP. PER AY OF CC.COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
G.F.C.I;-3
`i`Ht}AT S G. & 11BILIN C. KOCH
300 PACIFIC ST.
La 0. BOX 191 GENERAL MANAGER
IM-ITITUCK, krf, 11952 1.1
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.
TEL. 765-1802
TOWN OF SOUTHOLD
" y�c OFFICE OF BUILDING INSPECTOR
z P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date 9
Building Permit No.
Owner "y
(please print)
Plumber�,�,�/>y (/ 4- A
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber ' s i ature)
Sworn to before e this
day of
19 Notary Pub is
Notary Public, County
PATRtMA RIC
Notary Pr ok,State of New York
No.30.4741154
Quditied in Nassau/Suffolk unt
Commission Expirca
gISFFO1,�coG
Town Hall, 53095 Main Road y Z Fax(516)765-1823
P. 0. Box 1179 -y • Telephone (516)765-1802
Southold, New York 11971
viol
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 8, 1997
Christopher M. Leaden
P.O. Box 652
Aquebogue,N.Y. 11931
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)
No Underwriters Certificate on file.
/X The check is (not on file. ) $25.00
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 22989-Z (KOCH)
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEFT.
INSPECTION
/'eFOUNDATION iST [ ] ROUGH PLBG.
UNDATIOW 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNEY
REMARKS: �
DATE �� IN8PECT0 L
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [2,}4ROUGH PLBG.
[ ] FOyNDAT10N 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE � � INSPECTOR
ass-iso2
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE �/ /� �/ INSPECTOR
765-1802
BUILDING DEFT.
INSPECTION
[ per FO NDATION iST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR /✓ ��
70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
-� "- 3 A 07
DATE�� INSPECTOR
2l(
• q
2-c/
arT--
765-1902
suauiNa DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBO.
[ ] FOUNDATION 2ND [ ] INSU TION
[ ] FRAMING [' INAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
T'
DATE f� �� INSPECTOR��
Z �'d�1�z�
765-iS02
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUG LBG.
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS-a
DATE OS INSPECTOR �
FIELD T.NSPECTION REPORT DATE COMMENTS
FOUNDATION- —( IST)
FOUNDATION (2ND)
I
1:5 z
ROUGH FRAME & rr--- -- —
PLUMBING --- —
il --
II
' II
II II H
TNSUT.ATTON PER N_ Y.
STATE ENERGY it
CODE II l
—
�� II
FINAT. JII mil ,� <J✓/�c'
c
ADDITIONAL COMMENT
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NOTED _C 0
DATE: J B•p #� � NPU
JN
LA
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FEE: BY:
NOTIFY BUILDING DEPA Ef AT UE;
765-1802 S AM TO FOR THE / \ t _
FOLLOWING INSPECTIONS: �
1. FOUNDATION TWO REQUIRED —_�_/ � -,_\
FOR POURED CONCRETE - -_- ,. \ � �
0
2- ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST f
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE_WY..Y. i � � ex c vafe GL A de— r
STATE CONSTRUCTION & `ENERGY ! i
CODES. ,NOT RESPONSIBLE' FOR
DESIGN OR CONSTRUCTION ERRORS
row tZ p� ote,�u��:� � Isr�n
PLUIVIBIN
ALL PLUMBING VIIASYE-j r`bN r 17`
&WATER LINES 9NEED>
TESTING BEFORE COVERING t
i
PLUMBER CERTIFICATION 3�to1�. .swb F'La.r
ON LEAD CONTENT BEFORE
CERT/FICATE_O_F OCCUPANCY l __
/ _
SOLDER USED-IN-WATER-.-
-SYSTEM CANNOT
EXCEED 2/10 of 1% LEAD.
If copper tubing is u
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for water distributin
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System; piping shall be L 411 y Ao r
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75 N. INDUSTRY COURT
dersen DEER PARK, N.Y.PHONE 516-667- 700 700
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s_- SURVEY FOR
GEORGE KOCH 8, ViRGINIA KOCH
MATTITUCK
�// ��• TOWN OF SOUTHOLD
_ S OF F. CO., N.Y. GUARANTEED TO=
NORTH FORK BANK G TRUST CO.
_SCALE , I" = 40' HOME TITLE DIVISION OF CHICAGO
t _ ;. TITLE INSURANCE CO.
4 �� _ OCT , 15, 1965
NOTE , 0
MONUMENT ` ��� _—
R
;i�. PROFESS[ N61N RAND
1Y�A q LAND SURVEYOR, N.Y.S.LIC.NO.12845
a RIVERHEAD, N:Y. 1
BOARD ' OF HEALTH . . . . �
FORM NO. 1 3 SETS OF PLANS . . . . . .
SURVEY
. TOWN OFSOUTHOLD . • - • • -. - - - • • • • • • • •�
BUILDING DEPARTMENT CIICCK . . . . . . _ . .
TOWN HALL SEPTIC FORK _ . _ . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL.: 765 1802 t:aT I FY \ 1
Examined 19 CALL — �
t1AIL TO. . . . . . . . . . . . . . . . .
Approved . . �?. . . ., 19 . . . Permit No.po��./. <! .
Disapproved.a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . .
(Building Inspector)
' ICATION FOR BUILDING PERMIT
s' Date . . . . f. / . . . . . . ., 19 Q�
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 stieets
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 i spe ions.
�. . . . . . . . . . . . . . . . .
(Signature of applicant, or name, if a corporation)
�?$off' Gsa .¢Q•cea6 V.Y. /I93 J. . . . . . . . . .
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, lectrician, plumber or builder.
Name of owner of premises . . . . . 1 h . . . . . . . ... . /7;2%�1. . . . . . . f?,
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorised officer.
. . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
Builder's License No. . . . . 1': . . . .. . . . . . r (_ 1
--_
Plumber's License No. rAUG
2 + ►sue
Electrician's License No. =—T_
Other Trade's License No. . . . . . -- -
1. Location of land on which proposed work will be done. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . .
t)�. . . . . . . . . . . . . . . . . . . .�`:C�-G I!' t C. . .`�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . .
House Number Street c Hamlet
County Tax Map No. 1000 Section . . . ? : / . . : i. . . . Block . . . . . .r/. . . . . . . : . . . Lot . . . 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 /\es/Ge n C . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . a rH�,, . .' . . . ` .``." . [��'. . .�o c���. . . . . . . . . . . . . . . . . . . . .
•3. Nature of work (check which applicable): New Building . . . . . . . . . .. Addition Y. . . . . . Alteration . . .
Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Description)
4. Estimated Cost : . . . . . . /-?�.'o o. . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of.each type of use . . . . . . . .
7. Dimensions of existing structures,if any: Front . . . . �`�`. . . . . . Rear. . . a. Depth . . ��7.�
Height . . . . . . . . .
g ��? . . . . . . Number of Stories . . . . . . .a . . . . . . . . .
Dimensions of same structure with alterations or additions: Front a f.� Rear S�
Depth . . . . . . . . . . Height . . . . , .,6 . . . . . . . . : . . Number of Stories . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . .
.Height . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . . . . . .. . . . . ... . . .... . . Rear . . . . . . . . .. . . . . D pth. . . . . . . . . . . . . . . . . . . . . . .
10,,'<•Date of Purchase . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner 11Nc%f
I,XZone or use district in which premises are situated . . . . . . . . . . . . •'r;'`'. ° r
'2. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . ... . . . . . . . .. . . . . . . .
:3. Will lot be regraded . . . . . . . •. . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No
�4. Name of Owner of premises . . . . . . . . . . . . . . . . Address . . .. . . . ... ... . . . . . . . . . Phone No. . . . . . . . . . . . .
Name of Architect . . . . . . . . . . . . . . Address Phone No.
Name of ContractorL� sl'"� ff'e G����! . Address�'a S®xbss "ebor . . . Phone No. .-Ps-9
5. Is this property within 300 feet of a tidal •wetland? *Yes.. . . . .
*If yes,- Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
)roperty lines. Give street and.block number or description according to deed, and show street names and indicate whether
nterior or corner lot.
TATE OF NEW YURK, . S.S
OUNTY OF . . . . . . .
• • • • • • • • • . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
)ove named.
eisthe . . . . ... .. . . . . . . . . . . . . . . . . . . . . . . . . ... .. . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contracto , agent, corporate officer, etc.)
F said owner or owners, and is duly au ed erform or have performed the said work and to make and file this
)plication; that all statements contained in this-application ate true to the best of his knowledge and belief;and that the
ork will be performed-in the manner set forth in the application filed therewith.
worn to before me this
.'. . .day of. . . . . . ! . . . . . . ., 19�
otary Public, County
ELI�B H ANN NEVILLE . y .. (Signature of applicant)
Notarryy Pub ic,State of Kzw York
No.52-8126850,Suffolk Cou ty
Term Expires October 31, 1 S2
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