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HomeMy WebLinkAbout18414-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19620 Date DEC. 31, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 415 RACHELS ROAD MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 108 Block 04. Lot 7.2 Subdivision Filed Map No. Lot No. 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 1989 Pursuant to which Building Permit No. 18414Z dated AUG. 28, 1989 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 ONE FAMILY DWELLING WITH WOOD DECK AND STEPS. The certificate is issued to TOWN OF SOUTHOLD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-32 DEC. 26, 1990 UNDERWRITERS CERTIFICATE NO. N148514 SEPT. 12, 1990 PLUMBERS CERTIFICATION DATED HARDY PLUMBING & HEATING 11/19/90 /�ui ding Inspector Rev. 1/81 FORM 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) N2 18414 Z Date ..................... 19A-'.'er Permission is hereby granted to, 0 ��...... - .... . .. .... ... 00' ... .... .. . . ....... . ...Zoe—�- - ... .. ... . to ....... ...... ..... . .. . ..... ..... . .. ... ........ .. .. ..... ................................................................................................. ........7....................... . .................... W.4 JA.. ............If at premises located at ......... ...... ... .............. .......................................................... . . .......................................................... .................................................................. .....w.... .. ..... .. .......................................................... County Tax Map No. 1000 Section J..'07.9......... Block ..... /..... Lot No. 7, ..'"...��. e-7 pursuant to application dated ........./..'X.................... 194Rg.I., and approved by the Building Inspector. Fee $ Building Inspec or Rev. 6/30/80 fy THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000968 BUREAU OF ELECTRICITY B5 JOHN STREET, NEW YORK, NEW YORK 10038 Date SEPTE.NBER 1.990 Application No.on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of -f 1),0 Ir I T'qO BEARS 13 S RACJ U; RD. , j,0T94!, ' J1.ATTtTUf.7' fq.y. OUT 1)8 �)4 P'l 07 in the following locaA[?!ll ,n Basement El istn El 2nd Fl. 1 k yj�S A.1 1 1.19 9 P Section Bloc Lot was examined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT 1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. .1 5 4 1.2 1.4 DRYERS' FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS - AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. SYSTEMS TRANS. AMT.I H.P. NO.OF FEET AMT. WATTS 3 F SERVICE DISCONNECT NO.OF S E R V I C E METER OF NEUTRAL XL TYPE EQUIP 1.0 2W I 3W 303W 304W 140.OF CC.COND. A.W.G. NO.OF HI-LEG NO.OF NEUTRALS A. .G. AMT. AMP QUI PER AY OF CC. G. OF HIAEG 1 1.011 C B 1. 1. 4 OTHER APPARATUS: SWNF. 3?ETECTOR:-2 16 N11JUTAT11 T-STOCK 11889E !2SO S1,11'.[TITTOWN AVEU(TE B0H1i,'1TfA, RY, 13.71.6 GENERAL MANAGER 1J 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. 76+-1802_ •��, TOWN OF SOUMDEDI << = OFFICE OF BUIII.D+II K_ WSsP-1_L-" DR. P.O...B.a TOIY.N „OUTHb.L,D,N:.X. k 11971. 41 C E R T I F I G A T I. O: N. Date NOVEMBER 19, 1990 Building Permit No. 18414 Z Owner TWO BEARS/NORKLIN (please print) Plumb-e-r-HARDY PLUMBING & HEATING NORTH, INC. (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 fne this day of 192LVotary Pub c Nota_: P0-" ic, ( Coun:.y . eA'HEA11VC-A HAY Public,Star® Nor Yap Quarfl�,49sssSS r'Ir:LD Ii:S:'LC i l0N DA- TL E COMMENT -o� H� FOUNDATION ( 1st) �y cn FOUNDATION ( 2nd ) _ c�O 2 . ROUGH FRAME & -PLUMBING En .3 c� • H I14SULATION PER N . Y. ` STATE ENERGY v u CODE c v 4 . y G�1 FINAL ADDITIONAL COMMENTS : JL - - xo A 4" {.., BOARD OF /41EALTH . . . . . . . . . FORM NO. 1 3 SETS e PLANS . . . . . . . . . . . . SURVEY . . . . . . . . . . . . . . . . . . . TOWN OFSOUTHOLD CHECK . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . . . TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL James. C: , WsPhPn. . . . . Examined 19--of MAIL T 0 :. Town Hall , Main Road Approved . . ,1. . . ., ff.���Z Southold, New York 11971 190PermitNo. Disapproved a c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D L5 V L5 . . . . . . . . . JUN 2 21989 000, (Building Inspector) BLDG. Dz- � rowN of you-;_±��_r_, APPLICATION FOR BUILDING PERMIT - Date .May, A, , 1989. . , 19 . . . 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. 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 inspections. Town o.f. Southolcf - Community Develop. .(Sign'tuire•oi'applicant, or name, if a corporation) Town Hall -,- Southold., NY 11971 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises .TOWN• .OF• SOUTHOLD . . . _ . . . . . . . . . . . . . . . . •(as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. James C . McMahon, Administrator, C . D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii . . . . . . . . . ., (Name and title of corporate officer) Builder's License No. ... . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . ..34 . . . . . . . . . . . . Electrician's License No. ... . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . Location of land on which proposed work will.be done. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `.�. . . . . . . . . . . . . . . . . . . . . '� a:S. .��! � 1'. . . . . . . ./. t+mj 7 C . . . . . . . . . . . . . . .. House Number Street. Hamlet County Tax Map No. 1000 Section . . . . /®0. . . . . . . . . Block . . . . .,(. . . . . . , . . . . Lot . .l.r+� ° ... . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . (Name) .. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy, . . VACANT . . . . . . .. . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sin b. Intended u5c and occupancy , ..le� .. ... Residence . . . . . . . • . . . • . . . . . . . . . . . . . . . . . . . . . . . . } ' IL c 3. Nature of work (check which applicable): New Building . . .X.'. . . . , Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . (Description 4. Estimated Cost . . . .C.l! ,�.coo. . . . . . . . . . . . . . . . . . . . . . Fee . Elived Town . Project . • . • . . (to be paid on filing•this application) 5. If dwelling,number of dwelling units . . . . . . . . . .1 . , . . Number of dwelling units on each floor..'.. JV,%A If garae, number of cars .NIA. . . . . . . . . . . . . . y . , , , , , ' ' 6. If business, commercial or mixed occupancy, specify'nature,.and'c,ctent of each. ... . .typc use 7.' Dimensions of existing structures, if any: Front .N%AN,�A • • ' ' ' ' . Rear .N./A. . Depth . .1q/A Height . .N/A. . . . . . . . . . Number of Stories . . . • • • • • • • • ' . • • . • Dimensions of same structure with alterations or additions: Front • • NSA • • . . . • • • . • • • • • . . . . . • . . . • • • • Depth Rear . . . . . . . . . . . P .NIA. . . . . . . ... . . . . . . . : Height , , , , • Number of Stories . N/A 8. Dimensions of entire new construction: Front . ..3Q�. Rear 3ca� . Depth .a,?,a1,—,� Height °�/�'y . Number of Stories'. ;a . . . . . . . . . . . . 9. Size of lot: Front . .y.1:�Y° . . . . . Rear (��•9 ��',9,�,5� . . . . . . . .Depth 10. Date of Purchase .�JQ3jF , , , , , , , , , , , , , , , . Name of Former Owner• !4 FMLil;C©OWA Y , . . 11. Zone or use district in which premises are situated • • ' ' ' ' ' 12. Does proposed construction violate any zoning law, ordinance or regulation: N�t~ . . . . . . . . . . . • . . . . . . . 4 13. Will lot be regraded . . . . . . . . . . . . . . . . . . .Will excess fill be removed from premises: • • . • •Yes • • • 1 14. Name of Owner of premises T.o W cl. .a f. ,S p u t h o 1 d , Address Main 'R d S o u t h o l d Phone No.7 f�5-18 9 2 Name of Architect . ,W . . . . Address . . NSA . . • . • • •. . . . . P onq ').N/A • • • • . Name of Contractor .TW,o, .QL?Pr.! •gui�l.ders•-, •IrMaress P.O. ,QpX, 2117• •Ama9P eDo. 329.7.Q0�p• • 15.Is this property located• within 3100 feet of a tidal wetland? *YES. . . .NO.X. . .• *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 fro property lines. Give street and block number or description according to deed, and show street names and indicate wheth interior or corner lot. SEE ATTACHED SURVEY i � t STATE OF NEW YORK, COUNTY OF . . . . . . . . . . . . . . . . . S.S James C . McMahon • . • • ' . ` ' ' ' • ' ' ' ' • ' ' ' • • • • • • being duly sworn, deposes and says that he is the a (Name of individual•sisnilrg contract) pelican, above named. llcistile „ Community. Development Administrator . . (Cdntractor, agent, corporate officer, etc.) . . • • • • • • • • • • • • • ' cif 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 iti 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 . . . . . . . . . . . . tt. . . . . . . .day of. . . . . . . . . . ., 19 � Notary Public, Suffolk. . . . .�L:.��R:.0 County HELEN K.DE VOE NOTARY PUBLIC,State of New York • ' ' ' ' ' ' ' ' • • • • • . . . .'. No.4707878,Suffolk County ($i^natureofa licant) Term Expires perch 30,1 PP TEST - HOLE DATA DARK BROWN LOAM 10, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BROWN SILLTY LOAM Z,s• FOR PPR OF CONSTRUCTION ONLY PALE BROWN SANDY r - SI.T 6• DAT� HIS EF. NO. PALE BROWN APPROVED COARSE'SAND N/O/F BUOVODANTONA , AL/PERTI,' & , POP 0 S UR V E Y OF VACANT PROPERTY A T MA T TI TUCK q 31.6 TOWN OF SOUTHOLD" SUFFOL K COUNTY, N. Y. O N 51' 2r 10"-E 32652' ' 3zs ` z�9 �, cS� 1000 - 108 - 04 - P107.2 Scale 1" = 40' M c J,� �Q. /Qo 140 31.6 Oct. 13, 1988' 7 .s "rMsn o �. �n LOT 4` 4'�a , FEB R 1989 2 \ S Z8 R jgZy' yE4 E Of 2 PRO I am familiar with the m_"Mnd_:> f0r ,P ry .%nd 296 ctrE9ct;or, of SubsEma`, 0•4' PLEASE fn �in_cile Family Residenc@s end Mil amide by the o.4• RK a PNT , ®TE itions sea�.forth ther0aa 4nd Qnn the permit to _ ' PP qA . Requires septic tank a �strucL SHED \ 30.5 ,' 0lf ;� r >YJ� ° fir. jar �•^, 1 i` c a S r\r` 5' LOT T cover to grade. TES tum � ............. � a MOW- iv co 4S Aoft U 41NG AREA = 32,14 5s q.f t. L O T NUMBERS REFER TO THE MAP OFPROPERTY SHOWING PROPOSED V �, FOR THE NORTH FORK HOUSING FOR ' G. Wyly ALLIANCE. AA��„� �t�� .' .r., ~ :. Ur � l�' Pre ared In accordance with the minlmum The water sup ply and sewage disposal N .S. LIC. NO. 4966.8 NOTE P RT OF PARK .6 RECREATION AREA p s stems for thls residence. .w/ll conform MAP OF E'LIJAH'S LANE ESTA TES,SEC-I standards for 11t1e surveys as eslob/lshed to the standards of The *Suffolk County I ��URV S, P.C. by the .LA.L.S. and o�proved and adopted FILED.,FEB. 14 19,7.4 FILE NO. 6065 AT THE for L' 'such use by The Kew York Stale Land' ty. Department of Heollh ServJces. F OFFICE' OF ii4E SUFFOLK, COUNTY_ CLERK. Title Association. O� ' The locations of wells and cesspools shown hereon 'ore from geld AIN observations and or fiom data obtained from others. OUTHO , N.Y. 11971 88 .34 4 - !4`1 �6 L//q N/O!F BUOVODANTONA , ALAPERTI, & : POPKwS SURVEY OF VACANT 1 PROPERTY A T MA T T/TUCK f 31.6 TOWN OF SOUTHOLD N a1• sr w�•.E F_ SUFFOLK COUNTY, N. Y. azears .Q tS� 1000 - 108 - 04 - P/07.2 Aso Scale 1" = 40" /g gi ���� 31.6 OC t. 13, 1988 oo June 19,. 1989 (re vision ) W ° 32 5 Sept 1, 1989(found. loc. ) LOT 4 00.0 O %. � PR 0.4' /vtRG' RE 0.4 PARK E'vPGP�T Q Q SHED \ NIDIF V LOT 3 O/c � r OfYF M. 4 4ING J �P AREA =.32,1.4 5s q.f t. L 0 T NUMBERS REFER TO THE MAP OF V PROPERTY SHOWING PROPOSED LOTS v O AFOR THE LLIANCE.NORTH FORK HOUSING A. S. LIC. NO. 49668 NOTE PART OF PARK,Q RECREATION AREA Prepared In ocaordance w!!h the minlmrm MAP OF /JAH'S LANE ESTATES SEC / slandardr for /Ills surveys or eslabprhed P S V RS, P.C. FILED`FEB. 14 /974 FILE N0. 6NS AT THE by. the L.I.A:L.S and approved and adopted 4ss OFFICE OF T1�IE SUFFOLK COUNTY CLERK. tor. such use by The New York Stale Land Tllle AssocloNon. � AIN OUTHOLD, N.Y. 11971 �, 88 - 344 - . (4) N/OAF BUO VODANTONA , ALIPERTI, & I. POPKINS SURVEY OF VACANT J �v PROPER T Y A T MA T TI TUCK ! 31.6 TO WN OF SOUTHOLD _ SUFFOLK COUNTY, N. Y. oN 51. 2Y w"•E 3265r 32. .�, S 1000 - 108 - 04 - P107.2 ze.s I 'ems 1 Scale 1 - 4 0 e •o oEgt'ps /y`.9� ..��- �� 31.s Oct. 13, 1988 I a ' cP 7 June 19,. 1989 (re viaia7 ) Z 32.5 s6 Sep t 1, 1989 (found. loc. ) Q @7 o$�, W: '? sT Feb. 16, 1990 ( final) L 0 T 4 0 �, tEP$ 5 2a� R 2 00 N 14 1990 0 ,, PREP` �, 29.6s T10 N, (/ SA: DEPT. OF - ..._ 0.4• RE HEALTH S�$2MES' H.S. # 89-S0-32 1'1�98� 0.4' WELL YU i SHM �" 30.5 y1, t4IQlF sBB. �S� LOT 3 IV CERTIFIED TO : V O/�c RO��RT KIMBERLSOUTH Y GIBBSINGS BANK SC (Dly dr U� E<<iNc J AREA = 32,I45SQ.f t. LOT NUMBERS REFER TO THE MAP OF V PROPERTY SHOWING PROPOSED LOTS r FOR THE NORTH FORK HOUSING Q ALLIANCE. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SINGLE FAMILY DWELLING ONLY N A. oA' H.S. REF. NO. .�"� The sewage disposal and water supply facilities for this location have been inspected by this Department and/or p S. LIC. NO. 4966G Prepared In accordance with the minlmum Oder a cte and found to be satisfactory. NOTE PART OF PARK d RECREATION AREA standards for Iftle surveys as established MAP OF EL-IJAH S LANE ES TA TES,SEC / by the L.I.A.L.S. and approved and adopted P P. Gj SURV �� 7S, P.C. FILED ,FEH. 14 1974 FILE NO. 6065 AT THE for such use by The New York Stale Land Chief f Bureau of Wastewat r Management IRS 4ss OFFICE OF TrIE SUFFOLK COUNTY CLERK. Title Association. l�L1AIN " SOUTHOLD, N.Y. 11971 88 - 344 - (4) occut -4 VIM USL I TT`rIQU R ,61RCATE I P XCUPANC"vol 1 i' X18"H -S cAS Sol r { � oLLY l�Ia.aM� f , � •� {` � \./ - O • - E �- I MF o.G 10, OJ. I I - �e t' e,��a PLUMBING aI LhO a� 1 O ALL PLUMBING WASTE Ion ( &WATER LINES NEED � _ _- TESTING BEFORE COVERING a - A-1 YKax .0 v' V LM r t a v y a o Wik ! 0 - 10/� i p ,/ If copper tubirt �+� x 1(olt Lp l h, �� n ,� K for waterdistributingot,I� lotlG �•�,. I System; � ����� � ` ° ' •"a'','•••• .' ' Piping shall be _. of types K oLLonfX t ;, � Ztl f's1�,,.�rl� �Cl,•�'./at-! fit;V L�'{s-rt►�U��S fW g�NG wAst� mG JAILL PLUM & NG WATER TES TIBEFORE COVERING A\ TOLERANCES REVISIONS } (EXCEPT AS NOTEDI " NO. DATE BY DECIMAL _ _ 2 FRACTIONAL 3 DRAWN R i SCALE MATERIAL t. .� �0 Z 4 i CHK<D DATE DRAWING NUMBER i ANGULAR fiq ' t, TRACED APP'D "•:< e _. 18 X 24 GPRINTED ON NO. t000N CLEARPRINT• uU /nI II I4,11 IS II ! FlL 'v"VITHOUT CERTIFICATE OP/ Ncy — CDu{i�-Ar-�r'�'p��4t+b `ice►-'te�.rl•.,^� .�Nkt„1. GK�.V g It�:�, _ _ ` _ . Q b L'�E KN�1�L� FOf� �LL� P N LliyiOV- K Nth .. ,.1 . .A U- .v�►��F411�I Ich. �rus,U. ;�t�. ,;:. �� � �►��L Cow: ta��ry t1••- �-�-+.Y �� a�.o Iu� t-g :�Au�~ Go N�fi v ae.Tl a►-� NA i,i.. i�! Gdl-1P1Y. A}.tD 4*faFOF %Vf-'j ALL, F-�,k14I+4-11p GODL"h AcHP ` OP DI h}Af1�4 a� 'J� _ FF-►3 L� / 1'�i L4c�r(,. 1 IlI, �_ IOf-!a II ! 1��FTHOP-7tu HAvl j&r J0E-1"��IG-m0� Dvtea. wfP-le- t� I Ile, tw "Pt' <L+cL . 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