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HomeMy WebLinkAbout16941-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18243 Date AUGUST 4, 1989 THIS CERTIFIES that the building ADDITION Location of Property 200 LEGION AVE. MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 142 Block 2 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18 1988 pursuant to which Building Permit No. 16941-Z dated MAY 6 1988 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 HANDICAPPED RAMP & TOILET ROOM AS APPLIED FOR. The certificate is issued to ADVENT LUTHERAN CHURCH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-062156 - MARCH 10 1989 PLUMBERS CERTIFICATION DATED JUNE 26, 1989 -JOHN E. WALTERS PLUMBING Building Inspector Rev. 1/81 I FOUX NO. a 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) NO- 16941 Z Date ......................................... 19.Q. p Permission is here-by gr nted to: � � ... aW ............. .` 5..... ..::....... ..........Lale................ ....... °. ........%��y.. � ..:-�.... , ... ....�- to ......... . I ........ . . ....................................:......................................................................... of premises located at ......ram ® ...... . ..... . .. ... .......��`t` ........................................................ ........................................... . , .��' .................................................. ...............................................................................................................................................I................ County Tax Map No. 1000 Section ....ll�..Z^...... Block ..............:;?=. Lot No. ........ �� .. pursuant to application doted .... ....��. ��.................................. 19..$;i.0 and approved by the Building Inspector. O� Fee $.. ✓.... .t:. ulI i nspector Rev. 6130180 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE J��:7 �? . . !9rA NEW CONSTRUCTION . . . . . . .OLD OR PRE-EXISTING BUILDING.V/. . .VACANT LAND. . . . . . . . U�610 n( V k � 1 Location of Property. . . - ATT(TUC - - - - - - - - - - - - - - - - - - - HOUSE NO. " " ' • • ��^^-}} STREET � / HAMLET Owner or Owners of Property. f. .ty1eNI . . . .LU ,.�n���_N . - -C/�U2c" . . . . . . . . County Tax Map No. i000 Section Block off, Lot Subdivision . . . .aa. . . Filed Map Lot . . . . . . . Permit ao . I �j. l =l �-Date of Permit . . . . . . - • - .Applicant . . . . . Health Dept . Approval . . . . . . . . . . . . , • • , , , Underwriters Approval . . . . . . . Planning Board Approval . . . . . . . . . . . . . . . . Request for Temporary Certificate V HRJ'C� Final Certificate . . . . . . . . . . 'Fee SubmiCted : APPLICANT. . . . ADVENTLUTHERAN CHURCH 1100 Bayer Road Mattbek, N.Y. 11952 rev- 10/ 14/88 �ae•3�g01 C0 43 FORM NO. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALT, 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings 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 of 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 solder used in system contains less than 2/10 of 1% lead., 5. Commercial buildings,' industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the 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, buildings and unusual natural or topographic features. 2. A .properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separ to ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of,the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25,00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3.1 Copy of Certificate of Occupancy - $5,00 - over 5 years - $10.00 4. ' Vacant Land Certificate of Occupancy - $20.00 5.', Updated Certificate of Occupancy - $50.00 6.' Temporary Certifigate of Occupancy - $25.00 Residential $50.60 Commercial �1a4'�rJ,f TEL. 765-1802 TOWN OF SOUTf OLD zoo �i C r7i �� OFFICE OF BUILDING INSPECTOR P.O. BOX 1 17 9 TOWN HALL SOUTHOLD, N.Y. 11971 June 23, 1989 RICHARD MENARD, 645 WAVECREST LA. MATTITUCK, N.Y. 11952 RE : ADVENT LUTHERAN CHURCH To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons . / ✓/ An application for Certificate of Occupancy is not on file . QWWY � I No linderwritcrs Certificate on file . J✓/ '['he check .is W#44harl/nut on file . ) 12 0'0 No Health Dept. Approval on file . No final inspection has been made . Please contact our office on this matter. Thank you for your cooperation. Building Pcrmi.t'. 1k Z Building Dept. MkkJ��No Plumber Solder Certificate on file . ( all permits involving plumbing being issued after April 1 , 1984 ) 1125065 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE I BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 Bate MARCH l0, 1989 Application No.on file 60114389189 N 062156 THIS CERTIFIES THAT only the electrical agriprwant as described helve and Introdlced by the s plicant named on the aboes application number in the promises of DVENT LUTHERAN CHURCH, LEGION AVE, /POLEYLILS, MATTITUCK. N.Y. in thefd/ominR q A V 27, 19 827,7 8t E] IAt Fl. ❑ Ynd FLOUT Section Black Lot was examined aKU9 andfound to be in compliance with the requirements of this Board. mxnm ACLU SMTCM MIXTURES RANGES COOKNO DICKS DISH W EXHAUST FANS OUTLET{ M RUOeORNT OTHER I "T. I K.W. AMT. K.W. I WT. K.W. I AMT. I K.W. AMT. N.P. 22 2 22 1 1 F DINERS FJOtAO 110101016 RRIIY AFIt1AHCR ItlDNS WMAL DEC" 111VA CLOCKS qtL UM HSATSRS MUIit.OUTIST GNOMES "I. K.W. OIL 0.r. GAS X.P. AMT. W. A.W.G. AMT. AMr. AMT. AAU'S. TRAtMi. AMT. X.r. M,a MET M1T. WRITE =vIC@ am NBCT HOOF S E R Y t C E G. AMT. AAa. Trrt 1 X M 1.I SLT t/SW t X KW NO.OF R;COND. OF CG.Ca NO.OF MUG 01�L& NO.Of NEUTMl6 OF NEUTeAL OTHIR AHNMATUS: EXIT-t BATTERY PACK-1 FEERERSil-3 E 6 BASEMENT TO 1ST FLOOR PANELROARDSt1-8 CIR. 60 G.F a;. It-3 SMOKE DETECTOR2 -1 LAKE ELECTRIC LIC.81843 E ' 17 FOREST TRAIL RIDGE, NY, j1961 Per 1 This caMfkyN vet be ahered in any manner; return to the office of the Board if incorrect. Impactors may be i_______bl�Mwir..tradlKdiydt.. FOR MLOM T 119 ALT=9P IN ANY MAWN7GREERESIN TEL. 765-1802 �pS�FF� �pG TOWN OF SOUTHOLD y� OFFICE OF BUILDING INSPECTOR AnP.O. BOX 728 �' Z;F TOWN HALL SOUTHOLD,N.Y. 11971 ''�n711 C E R T I F I C A T I O N Date ���e �(�, qeq Building Permit No. Owner Ab0?&r Lkyry� cl�j2C� (please i print) Plumber lki OE. wkle, 5 C"Luuiogr 14EP tiw (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this a(o�day of _u , � ® or)1997 Public Notary Public, 5urtoL/G County JANET p, STEVVgr2T NOTARY PUBUC,'St of N0. 62-4663485 ¢ Y�oFk Q61*;on 7n "otk County eesnm(asion Expires Nov. 30, 199V - AW OUNDATION ( 1st ) - DUNDATION ( 2nd ) n d DUGH FRAME & v/ PLUMBING !2 d x co H x m ISULATION PER N . y STATE ENERGY CODE I FI14AL ADDITIONAL COMMENTS : --------------------- h a 'b H x a H O ' T m a r m �n H 70.1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ J ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: 1 DATE 1111411 INSPECTOR �/ 1 j f 765-1802 BUILDING DEPT. INSPECTION l [ ] F UNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ) INSULATION [ ] FRAMING [ ] FINAL REMARKS: -454�� DATE I7 0 ,���,INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL REMARKS: 1 DATE ( � I � INSPECTOR 70-1802 BUILDING DE". INSPECTION [ ] FOUNDATION 1ST OUCH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: lee 2 1 DATE c3a �'� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. [ FOUNDATION 2ND [ INSULATION [ ] FRAMING If. ] FINAL REMARKS: 611- "O�� � DATE d d INSPECTOR :A.40,� ADVENT LUTHERAN CHURCH p 7 0 ` Legion Avenue + , Mattituck, N Y BLOC.OSFT TOWN OF.SOUTAOCD DETAIL OF ROOF GIRDER SUPPORT IN NORTH WALL Addition to plans requested , by Town of Southold; Building Department: 1/2/89 r , 1 ' I I li li I ..r_ , `r ��X ',If 1 F� --l-7 �. _ y r FO1.II"I1DA7I hy ��• D . I L ii BOARD OF HEALTH . . . . . . 3 SETS OF PLANS . . . . . . . t6 J( FORM NO. t SURVEY . . . . . . . . . . I• ' 51988 TOWN OF SOUTHOLD CHECK - • • • - • • • • - BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . .. TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 e. CALL _. . . TEL.: 765-1802 MAIL T0 : Examined .`�/ .. . . . . . . . .1 19 . � Approved . . . . . . . . . ., 19 . ..©Permit No. Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72a. . . . . . . . . . . . . . . c=' . . . . r (Building Spector) APPLICATION FOR BUILDING PERMIT Date . /,!(.,/,t!r.c�. . . . . ., 19 .gt� 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. e. 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 necessa sec ons }� Signature of appticant,o name, if a corporation) s: 1.1 , Lam . (Mailing address of applicant) ii/Y W r State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. �.G.�N. .%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises ./V�(�1/ +� !. . . . ! .�.I. �. 1qN. . .�if41tt'C. . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A:()Q . . . . . . . . . . . . . 0!�). . .! ! V . . . . . . . . . . . . . . . . .l :1/>` !. TV House Number / ( Street Hamlet County Tax Map No. 1000 Section . .1. 1. ;. . . . . . . . . . Block . . . . . . . . . . . . . . . Lot . .C7 _. Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and untended use and occupancy of proposed construction: a. Existing use and occupancy . . G AYE eCry (. . . . Y1'` / . . !z�3 rr. . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . /f U/'� C • . •L !. �• • r^ C•�� .Q�! ,7Z '��. . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition , .✓ . . . . . . Alteration . . . . . , . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . I(Descriptioh) O� Fee . . . . . . . . . . . . . . . . . . . . . . . . 4. Estimated Cost . . . . . . . .P. (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed'!occupancy, specify n$tyre and extent of each type of use . . . . . . . 7. Dimensions of xistin structure if an Front , . ,3.¢. . . . . . . . . ` g Y� Rear . .a�. . . . . . . . . Depth . .�.$r? . . . . . . . Height 30. . . . . . . . . . Number of Stories . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DepDepth io 8 ;t, h alterations or additions: Front . .1�a . . . . . . . . . . . Rear . .4Z1/ . . . . . . . , . . . . th .. .Oy �s. . ,c . . . wit Height . .,34. . . . . . . . . . . . . . . . . Number of Stories . / . . . . . . . , . . . . . . . . . . . S. Dimensions of eentire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . .. Number of Stories . . . . . . . . . . .r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . 9. Size of Rear .7..�. . . . . . . . . . . . . . . . . Depth . ,k, 6 i . . . . . . . . . . . . . . . 10, Date oflPur Purchase �. . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . J . . . . . . . . . . . . . . . . W'l e?�xcess fill be removed from premises: Yes No 14. Name of Owner of premises ADVf1UT.LIIThFEK✓fA/-'Ad ress o. .a2f"8. Name of Architect . . . . . . . . . . : . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . .' . . . . . . . . . . . . . I . . Address . . . . : . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . 15. Is this property located within 300 feet ofa tidal wetland? *Yes . . . . . No .✓. , , *If` yes,, Southold Town Tru§tees Permit ma be required. Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from properly lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I STATE OF YORK COUPY OFEW U� L.IG . . S.S i LC�f2 . • P!.. ./!t L C .r?yr. . . . . . . . . : . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the . . AG . .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 in 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 . . . . . . . . . . . . . . . �5^. . . . .day of. . . . . YYf -. . . . . . ., 19 fr. Notary Public, . . . . . . Qc4Pi !. kQ O�- . . . . . . County HEIEN K.OE VOE . . . . . NOTARY Pu0lIC,Stets of New Yak No.4707878,Suffolk nry�q (Signature of applicant) Tenn Expires Mirth 30,1L., a—/ ! i d bpm s- wdq O O _ W r Sosx 0 to U J C i a r,� bM +00,Y P D /ana/ If LoN�xl� 141°N qy Poo I WA J ! oM Pa„o j�"11p ',0"le/ ' 70��ppJO I / . 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