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HomeMy WebLinkAbout23464-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29365 Date: 04/17/03 THIS CERTIFIES that the building ADDITION (aka 190 Old Saddle Lane) Location of Property: 1275 GOLD SPUR ST MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 95 Block 4 Lot 18.10 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 6, 1996 pursuant to which Building Permit No_ 23464-Z dated MAY 22, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to THOMAS A & DONNA A HENNESSEY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A A riz d Signature Rev. 1/81 FORK NO. 2 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) N? 23464 Z Date ......... ... 1 .. ......... 19J� ........2........... Permission is hereby granted t�o A. . ... .............. .................. ....... ...... ...........to &) .........�.. . ....... ........... .......... .. . .......... ...... ........... . ...... . .. ........... . ..... . ..... at premises located a .....X21,............. -0..... .................................................................... ......... . ....... ... ................................................................ ................................................................................................................................................................. County. Tax Mop No. 1000 Section ............qt , .... Block ....Z/............ Lot No. . . ...... t .. . .... pursuant to application dated .............. . ................. 195.6P, and approved by the Building Inspector. Fee $..25. .......... .. ................................................... .............. Building Inspector Rev. 6/30/80 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,gin 765-1802 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: 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 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 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. f JSl Q3 New Construction: Old or Pre-existing Building: (check one) Location of Property: jqD 1�V e /1 , jfy' House No. Street Hamlet Owner or Owners of Property: I Suffolk County Tax Map No 1000, Section "f Block !q Lot O /D Subdivision Filed Map. Lot: Permit No. c Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 4,2 S-©G� chi t> /A 3(P 5 Applicant Signature a�d����• _ � - -� ..�+—�+v-,r..�.. ' �i { .w _.-u _ .wu -��'7"�2•l -`-.:d»sa+euroala»s". a..+"!r'.>:O;.rnmc�mw�.wy • f !' f !d ?^'�''ir.� x'"""nm.:' h .' _ `...�ar!w�� ��'-^•'r .e .�`•mav�4gY�y.b �o,'sl{ ,. fS �Y - - __,�. - . ; "'7{pa-•F �' � - +, Ley f�F .. ,.' - -...�+�` �6�,y f� � , MAY 61996 kU • . . ��' .' � .I' sf_rrm ;" �" ~� a.7 0.k♦,�.5"*�p��,�c g�''� _ � .. 5y'��,�,�e„d. It T65-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ? INSPECTOR ,,lr,� ...... �jl M I III IATI()I I ................... 1)AT 10 11 ............. ROUGH FIIAIIV ----------------------------- III.'Illl.A'1'1011 ,It cong .e:................ F I IIAL ---------- ADDI IMIAL ............... .......... . .................. ................. —---------- ............ ......... ............ BOARD OF IIF.AI.'I'll . . . . . . . . . . . . . . . 1'OR11 NO. I /:I ,II:'I',i OF II.AN.i BETS ' ` . . . . . . . . . . . . . TOWN OF SOUTHOLD /SHRVKY . . . . . . . . . . . . . . . . . . . . . . . . II111I,1)I NC, DEPAR'1111QUY / VIIE :R . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL 'il?PTIC FORM . . . . . . . . . . . . . . . . . . . .`i()11THOLD, H.Y. 1 1 9 7 1 'EL: 765-- IOO7_ NOTIFY: CALL lix;milled TO: u Algorcrvecl.. y !. 1 (:/- I'etniic rkt.�- ... .. .. . . .. ...... ........... ... .. .... ... ... .... Oiealrlrrcrvcd a/c .................. .... . ..... ...... ... .... ..... .. ... ....... . ........ ..........)(,),N . . . . .. ..... . .. . . . .. ./�! . . .. .._ APPL FOI( Illlll.l)IN(i Nla.lO11'I' Date . . . . . . . . . . . . . . . . . 19. . . . INSTRUCTIONS applical:icxl nllrrrt be cc,I>Illelely filled in by lylx:t•niter or ill ink a,xl srllmitted to the rklilditlg Inspector with 7 sets of plans, actn ate plot plait to scale. Fee nccordinf, to schedule. b. 1'lot plan SIxh411% %WtWI of lot alxl of Ixlildinfgs on prcinises, relationship to mijoininf, prenisen or lxlblic n ap or areas, mid g thin ivinp a yc detailed descriptimi of lax,t of plollerty mist Ire droeoa cm Ilse dinnranr which is Inrt of Ilti application- c- 'file rnrrk covered by 1.11is ctlldicaticrrl I'VIy clot be coImrenced before issuatx:e of Doildilig Permit. d. Illxm algori>val of thin application, the Iklildinf( Inspector trill ir,sue a Iktilding Petmil: I:o the applicant. Birch povillit: shall be Icepl: cm lire prernineil available For 'inslxecl icxl thrcxq'hcxll. the wotic. Se_ tkr Ixtilding shall be cx-,cupied or used in stole or in lultt For any Ixrrlxose sAinlever until a (:ertifienle of Oc:culratlx:y shall. have Imml (,ranted Iry Ilse Iklilding limpee.lor. 4AI'1'LICKFI(IN 1S IIF.Iugly MAI11; to the Ikrildinf, Deparlurnf for the issuance of a Iklildirtf; Permit lxtr:ntmtl: to the lWiding Zcxxe Ordinax:e of the 'I'cxm of Scxlthold, Suffolk (exnll.y, tkaa Yrnlc, alxl olher applicable Isrws, Orclioarxen e)r Regulatiorns, for the axnstnva:icxt of 1xtildingn, rxklil.icxns or alterations, or for. rEIxrval or derrnl.ilion, as herein described. 'live applicant agrees to coo,ply with all nplilirnble 1,,[3, ordinatx:es, Ircrilding axle, Ivx.19ing axle, ,ixl .egulaticxls, mKI to axlnit: authorized inspectors caI prcanises alxl in Ixlildinl, for necessary inspecticxts. l� ...... . . .. . . . .. ... . . .... ...... ..... .. .... .. ... ... . . . .. r (Signal.ure of appl icant, or nmie, i f I r:ol-p oration) (t41i I inf, axldress of ,pull icanl:) Slate whel.her applicant is c"rcer, lessee, agent, arch!tect, engilxeer, general contractor, electrich", pl"drer or, 611 Wer. .. . ' ... .. l�ccv ...Pi..YA 0Or... . . . ... . .... . . . ..... .... . ..... . . . . .. . . . . ........... . .. ...... .. . ..... .. . Na.Ie of cxnte.r of prc�nises'. INTO �r.�e/)0e5x;� .... .. �nll.�JT:.J�rtn�':`�sG�L .. .. (as cxI the lax roll or ,(est deed) If nplilicin>t: Lin"I corlxormAotl, nigrt:Ilute of duly arlt.horized officer. (N:nxt 'aixl T.-IC le ,of corlxoral a cl[f ir.er) MAY ^J619.96 WiNero, License No. PhIlllmun License No. 131-00,DEPT. TOWS SO THOLA Elecl:riciann Licence No. I Other Ti-axe's License No. ... . .. .... . .... . .. .. I. Iocaticxl of laixl cxn which pl-ppo;ed wcrtic will be dolte.. .�t Ikx;se Iinloer fit reef - Hanle L Clxmly Tax M.•tp l•kr. lOOO Seca.icxI .. . . ..��]]7�.... .. Illcxac Lot . .1j./c........ MIlxlivision . ................. . .. .°.. . . . . .... . . .. .. Filed ""Illlko. .... .... ... .... Lot .. ......... .... (N;nte) 2. Slatq existing use all uc:cAIpax:y of praanises m h 'I, etxled use',a`lxldi. cx:c;ulunxy of prolxor:ed construction: a. I?.xislinl, usce arxl cx:culuuxcy ....... 11� �� . . ml.� . .(�W �: .. .. .. .. . .....`,,f b. lnlemled use alx.l cxculrnx:y ...... �a �... i vi . ..�VVfui�� .. ... .......... ........ ......... y ). Itilutt: Of Inn1( (cbi:cl( %Alidl a,h)licatlile): Ikaa Iktilcliol; . . . . . .. . . . Athlflfoti N. Ila: lip ir Ilulirvfil Ik+Ito 11l loll . . . . . . . .. . . . l)Ilier Houk �lL'X .. . . .. . . . . . . . . . . . . . ►u�u � �lo� (Ik:acfl Jill l(rl) f1 I.til iiirtlell 0)sl: ... ....I.�.Q�. . . . . . .. . . . . . flu: .. . . . .. . .. . . . . . . . . . . . .. . ... ... . . . .. . ... .. ... . (to Ix: paid on filing Ibis lippllcntio(l) :i. I f (114:11 fill;. 1AIt11xDr' ol` ck.r( I1 ill); ur111 s . . .. . . . . . . .. lialber ol` (hx>.11 1111" mill a (K1 elicit floor. . . . . . . . . . . . . . . . . If I;urul;e, ti(rllx:r of cnru . . . . . . . . . . . . .. . .. .. . .. . . . . . . . . . . .. . . . . 6 If Ixinllx:an, cn111rrclal or' ulixeal cx:cu,uuxry, cipec.ify onlore ooNl t:xteul: of each Lylx: of use... . . . . . . . . . . . . . . .. . . . ). I1111K:onloon of exifil inl; illltuaufe(i, If fifty: Frool .. . . . . . . . . . .. . . . Pilaf. .. . . . . . . . . . . .. . I'm Ill 11 . . . .. . .. . . . . . .. . . Ik:i(;111: lk►il)(:r of; 161c,t-len . . . . .. . . . . . . . . . . . . . . . . Il Iilkninions of acllle cll'rtu_lure ►a1111 alterfil.lcrin or itildit ioon: F(oul'. .. . . . . . . .. . . . . . Itenr . ... . .. . . ... . . . Ik:,1111 .... .... ...... . ..... Ik:l,)il . . . ... . .. .. ... . . . . . . Ikrtlief=of I11oricn . . . . . . . .. . . .. .. fl. 1)inr:il:tl(xla of: eol ill. Ix;a coral ltic:l icrt: I%loot . . . . . . .. . . . . . . . . Ilcnr . . . . . . . . . . . . .. . Dept11 . . . . . .. .. . . . . . Ik:11011. Iktllx:r of 181()l iell . . .. . . . . . . . . . .. . . . . . . 9. :iizo of lot.. F((xll . . .. . . . .. . . . .. . .. . . . IZ<:,1t . . . . . . . . . . . . . . . . . . . . Ik.:,i1It . . . . . . . . . . . . . .. . . . . ... ....... 10. kil e (if` l'oldin:in . .. . .. . . . . .. . . . .... . . Mail: of Folur.r Wont.. .. . . . .. . . . . .. . . .. . . . . .. . . . . . . ... .. .. .. . 11. IANx: of tine dial I !Cl in %A11c11 ,rl[]tiiae-1 a►e oilunl(A . . .. . .1.�L V�� �q.�!. . . . .. . . 12. Ikx:n lu'o,xuied cooillloct.lon violate ploy •r_crliol; I11%4, orclinpince fir I-elpil III,loo. . . . .k-0. . .... .. ... . .. .. I'). Will lot. Ix: t e,;riNk.tl . . .. . .yN . . .. . . . . . . Ili l l excefin f i l l lie I o1r7Ve(I f1 gill .'it pip 1111 if: Ill. 11;11K:11 of ().filer of 1trr�uiuen lDii1 5 ' � �Il j`AS �tuklrenn 11`lit�i-, Ikl. Ilaw of Ac(:lilt(-t:l. . . . ... .... . . . . . .. . . .. . . .. . .. . . . . . . .. Aakl1'c:nti lli(lite lk). . . . . . . . . . . th ill: of 0xil t ac.t or . ... .. . . . . . . . ... . . .. . . .... .. . . . . .. . fuklress . . . . . . . . . . . .. . . . . .. . . . . . .. . . . ..tlloflc: Ikl. . . . . . . . . . . . I:I llifu piulx:rly within 3(X) feel. of it titian tA!t:Igoxl'l 4 YI?f; II1 . . .. . . . . . . *IL Yli.f3, f'i(Allll(MJI 'IClldl 'llttllilll?li 11?ICII'I' IIAY I11? III!- Ifcl?Il. PLOT I)I AGIIAII locale (:ready alxl ditli.ilx.l.ly fill Ixtildlnl;n, %A1011er exfalin,; of laolK)secl, filltl iltillcul'e fill set--bock Illnrauliona Iltrlt Ilfopelly lilu:n. Give Millet: a1Nl block bullet or tlencripticxl ficcol(linl; to tiee(I, fi1Nl lanai street nivilea and illtlicule tdtellwa- inlei ior of- cofix9r lot:. APPROVED.AS NOTED LU. U PA N C OR FEE: BY A ��� F U L NOTIFY BUILDING DE B".-.- UN I P E T 755-1Sp2 9 AM TO 4 OR THE 10t ��� 1 01 U T R 9CATE I. FOUNDALLOWING INSPECTIONS: 1. FOUNL7ATfON - TWO REQUIRED � FOR POURED CONCRETE 2�t ram• ' . ROUGH - FRAMING & PLUMBING Or 1' UM;% Il � -Y . INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. . STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTIOn ERRORS (X' IVA) Y(MiK, (IA1111Y lR% .Q!.L. . . . . . . . . . l "� ' `���1���.`��(/�} . . . . . . . .. . . . . . . . . . . . . . . .Irvin,; duly a"mi, dolmtie:: 11Nl nayfi dial. bce ill Ibc algal icnnl ItNllvl(lunl til,;ulti,; C(,LL(tn(:1 ) itlNrve unlvvl, Ik: iti lln�. ... . . ... .. . . .. . . .. . ... . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . ... . . ... . . . .. . . . . . . . . . .. Il�cnil.ruclur'� n�;(:nl., i'.i,rlK,rnlft ufflt:el ,-eLu:)- - of nnitl (x�1x:f or (x+ix:rli, 111K1 in (holy cullloorizeil to ;K!1-1'01u1 or' 1larvc: ,x:ffolur(I Ilse nnirl ")(I( tllxl to nrti(e. 1110 fill! Ibis fi,gtlicaLioni tbul. all in 11,11, iind.ft:nliuu ore lrlx: to (lie Outfit of Ilia Iotoldedg(! IIIld Ixilief; 1110 Ibfil. lbe rn)11( ►afll Ix: ,x-rfontl(A III III(! uV1111 :r sill: follb In dke lipplicnl.ioo filed lltefcsallli. 1Xmill 10 1)(!W l! fir: drill �/ r Ikil all y 11i1)I i Cti-% ' CLa4IRE L.GLEW (;;i,-,nail tar c of Appi i dull ) Notary Public,State of New York No.4879505 Qualified in Suffolk County Commission Expires December 8,19 /'.a^'R7,A,�r--'Sr.. R. r_ •l'• r 1'.. w .. �?. _ '7.- '..'.' _`t"•. •� .. i. ,R.. ��.._,r .,}: ..q-•_. -r.I,,,y.,,..._ T_t'S?.. r w"r.G'..__....... ..x,.r..-�-__ r: SUFFICk to i _ k. ':. ' .a' - _ ��]/��y[•/y ;7 'Eta}e,F':�1.. �``� ` '' STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOS t - AL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO. THE STANDARDS OF THE �: C HEALTH SER :. SUFfOLK O.. DEFT: OF HEAL V_ S . , ' t I APP CANT �» r � N t, �, - --•y, - Y 5UFFOLK 'COUNTY DEFT. OF HEALTH _ 5 E R Y1 C.E S- P O R APPROVAL FQR� ` -S�Iy+ •+' r _ . CONSTRUCTION'ONLY r.. DATE: u FOt�C S. ONLY r- TM sERvl ..�� F ' CGUPfTYDEP�TM O H. S REF NO.: � SINGLE F LLY D APPROVED. - a 41 - ' H.S. ') SUFFOL.K CO, TAX MAP OESI:GNA now • tt � ` � 'T he eitN88 .DIST. SECT. BLOCK PCL. ter su" � Ed tMs location h on inept and/Or fobO oqE; two gear ow0 ied by tNIS ~tmc t or ottwt a9eacless ' to to 88tISf8G M- OWNERS ADDRESS: ; r J i zu A.Coate»P.E.,Ct>e# 1 t office o4 er srid Wastewater Mara ant .900 DEED:: �j• �' ^n .'rAt to ; _y :5t�./. TEST HO STAMP T Eked aneratlon or ad~ To ttds SurM is a Aa Wtion of jr, Sedion 79fiR of the New York State tr- +Q_ ,�- - ,��.r{�.-�.�._��_-•-�_T._. "�` ��p `__ .c^ru� _ Education Law. s� .4 It Copies of thk survey mad'c t+apriny'' .' ✓. .. �iF-,£- �'..-+-.+,��. _ me lend surveyofs irikc:seY Cr - _ smboaaed sad shag not tla ctn{idared �ty� Apt- .a1 a -lid r. t. K�+ l [}�.�. �,T, ID va7 coPY . -.✓/ - _/_•1A� S ' " 1 ,.�_' _ fauerar he s indicate rsof Fe rn -j I _� ., .pray person for�.:,^ 'k prepared.and onhie bch;'.`7o c» a �. _. - y ,t - „y�.a t r.» J�,. ,� w�: ` y u`- •- _t'nle comprsry•g:renc'no:+G:f agonCY9nd a . ~': - kPOihp tnstl n n I tad hereon and ssigrwes of itra tandin irtstl- - t r Guarantees era not tAndaroda ' b the a ,r ad tonal nst4Wipna or umic wrtQVAWM - . Jr Gy4 CC - 2 Y' 6Z. 83J .e. • - sowt t�ICli F /QJGK:V.9�, 1pCri; vt oTtCK. ANIW lb o f a<,i•'rro.G S 256`2' � ri a.:, LICETI5F.7 SURVEYORS Fo SVP y { 51 ) GR£ENf�QRT NEW YORK taNp � _