HomeMy WebLinkAbout43566-Z r
��o`pguFFn4�oG Town of Southold 6/25/2019
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P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40466 Date: 6/25/2019
THIS CERTIFUS that the building AS BUILT DECK
Location of Property: 4690 Bergen Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 113.-7-2.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/11/2019 pursuant to which Building Permit No. 43566 dated 3/18/2019
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:
"AS BUILT"DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Lindsay Jr,William
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
tho ed Signature
�guF�ot,r�oTOWN OF SOUTHOLD
moo BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
coy • o� SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 43566 Date: 3/18/2019
Permission is hereby granted to:
Lindsay Jr, William
2695 Cox Neck Rd
Mattituck, NY 11952
To: legalize "as built" deck addition to existing single-family dwelling as applied for.
Additional certification may be required.
At premises located at:
4690 Bergen Ave, Mattituck
SCTM #473889
Sec/Block/Lot# 111-7-2.5
Pursuant to application dated 3/11/2019 and approved by the Building Inspector.
To expire on 9/16/2020.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $464.00
CO -ADDITION TO DWELLING $50.00
Total: $514.00
Bui pector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,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. �/, //, /7
New Construction: Old or Pre-eexisting Building: (check one)
Location of Property: �� /6 f -ems e�J � �� <�— e,/
House No. `�' �,/ Street I amlet
Owner or Owners of Property: VV I L I/,*A 4
Suffolk County Tax Map No 1000, Section - Block 7 , 5 Lot
Subdivision [� Filed Map. Lot:
Permit No. -I Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporaryy Certificate Final Certificate: (check one)
Fee Submitted: $ (r-N
Applicant SiMature
* # TOWN OF SOUTHOLD BUILDING DEPT.
coo765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I14SULATION
[ ] FRAMING /STRAPPING [ FINAL A 06W( f
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
IL
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DATE INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION (1ST)
y
....................................
'FOUNDATION(ZND)
�-O
ROUGH FRAMING& j
PLUMBING y
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INSULATION PER N.Y-, y
STATE ENERGY CODE
S i W( lllk✓ ,�/
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FINAL S
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ALDITIONA.L COMMENTS
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building'Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 ` Survey
Southoldtownny.gov PERMIT NO. ��(� Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 Single&Separate
v
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved 20 Mail to: A&( kzadk all
Disapproved a/c
Phone:
Expiration 12
®
C
�TVR Buildi ector
AF ATION FOR BUILDING PERMIT
MAR 1 1 2019 Date , 20
INSTRUCTIONS
BUH.DDI&P-
a.This gXVAVM® =UMletely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy. .
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
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.
(Signature of appli ant or nam 'cif'a corporation)
(Mailing,address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of ownerao,f3premises , ,,, �/� i'N,i 411c/1,-
(As 6n the tax roll or latest deed)
If Ipplicant is,aTeq, oat�gn.,-sigxiature of duly authorized officer
prv4pi
` (Name and title of corporate,e icer)
Builders
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land o which pro osed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section 113 Block -7 �' Sr Lot
i
Subdivision Filed Map No. Lot j
f
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 occupmne3__1
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
i
(Description)
4. Estimated Cost 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 Depth
Height Number of Stories j
I
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories-
8. Dimensions of entire new construction: Front Rear s , 'Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
I
11. Zone or use district in which,premises are situated
I
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
i
13. Will lot be re-graded? YES NO Will excess fill'be removed from premises?YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, mustprovide topographical data on survey. j
18. Are there any covenants and restrictions with respect to this property? * YES NO
I
* IF YES, PROVIDE A COPY.
I
STATE OF NEW YORK)
SS:
COUNTY OF`�A ')
c being duly sworn, deposes M IS$A R DEBOER
(Name of individual signing contract) above named, 6jA f0ttA M&mow YORK
SUFFOLK COUNTY
(S)He is the LIC.#01 DE 349893
(Contractor,Agent, Corporate Officer, etc.) COMM.
I
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.
i
Sworn to before me this
1 l day of m aC Cy1 201�C- _
Notary Public Sig re o�Apoca�l
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1
SURVEY FOR
i s WILLIAM -LINDSAY, JR.
AT MATTITUCK DATE FEB 23, 1990'
i -
TOWN OF SOUTHOLD SCALE I"= 100'
SUFFOLK COUNTY, NEW YORK NO, 90-0132
I
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED T0:
SURVEY 6 A VIOLATION OF SECTION 7204 OF THE
NEW YORK STATE EDUCATION LAW WILLIAM L MID,6RIVE{y
*COPIES OF THIS SURVEY NOT BEARING THE LAND NORTH F Kes ST PANY
i SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL �lkfiO W r P�
NOT BL CONSIDERED TO BE A VALID TRUE COPY
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO O
HEALTH DEPARTMENT-DATA FOR APPROVI41 THE PERSON FOR WHOM THE SURVEY IS PREPARED TO CONSTRUCT AND ON HIS BEHALF TO THE TITLE COMPANY, GOVEIIN- p
M NEAREST WATER •AIN_MI ! *SOURCE OF WATER PRIMTE_PUBLIC— MENTAL AGENCY AMC) LENDING INSTITUTION LISTED
i M BUFF CO TAX MAP DIST 1000 SECTION IIS BLOCK 7 LOT z•!a P/b2 3 HEREON,AMD TO THE ASSIGNEES OF rHE LENDING
*TNERE ARE ND DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
OTHER THAN THOSE SHOWN HEREON OWNERS
I N THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE *01S
SHOWN HEREON FROM PROPERTY LINES
WILL
CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT
i TOEKISTING STRUCTURES ARE FOR A SPECIFIC -
i OF WEALTH SERVICES- PURPOSE AND ARE NOT TO BE USED TO ESTABLISH 0 •�O
APPLICANT, PROPERTY LINES OR FOR THE ERECTION OF FENCES SURE
ADME SS !
j 'EL YOUNG YOUNG R400
ERHEAD, NEW YOROSTRANDER K
NOTE■ = MONUMENT ALDEN W YOUNG,PROFESSIONAL ENGINEER
RE LOT I , MINOR SUBDIVISION CATHEI�If�E LINDSAY
HINTERLITER a WILLIAM LINDSAY, JR 4N0 LAND SURVEYOR N YS.UCENSE N0.12845
HOWARD W.YOUNG, LAND SURVEYOR
m *TME LOCATION Of WELL(W),SEPTIC TAMK(ST)SCESSPOOLS(CF)SMOWM HEREON N.Y.S.LICENSE NO.45893
a ARE FROM FIELD OBSEF MTIONS AND OR DATA OBTAINED FII'OM OTHERS
BRANDIS 3 SONS INC. y
i
APPROVED AS NOTED / // JIM DEERKOSKI, PE
DATE: 5/0/;� B.P.# 35&le
i phone: (631) 298-7116
FEE: 6 D BY: COMPLY WITH ALL CODES OF OCCUPANCY
Y
NOTIFY BUILDING DEPARTMENT AT UPAV�C V ®N�
As EQUIIREDRK TATE &AND CONDITIONS CODES E I UNLAWFUL
765-1802 8 AM TO 4 PM FOR THE USE
FOLLOWING INSPECTIONS: NDITIONS ®F
1. FOUNDATION - TWOCONCRETE
REQUIRED eEa�g WITHOUT CERTIFICATE
FOR POURED CONCRETE
2: ROUGH - FRAMING & PLUMBING
3. INSULATION -� TOm" gpAR® OF OCCUPANCY
4. FINAL - CONSTRUCTION MUST Bf�RES
BE COMPLETE FOR C.O. _-Id. . . Additional
ALL CONSTRUCTION SHALL MEET THE V
REQUIREMENTS OF THE CODES OF NEW Certification LnN
YORK STATE. NOT RESPONSIBLE FOR �� Required-
MAILING
DESIGN OR CONSTRUCTION ERRORS. may
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CONC.FTG I I
SECTION I - - - - - ' DRAWN BY: JD
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SCALE: 1/4" = 1'-0" 10'-011 3/10/2019
FOUNDATION P NEW SCALE: SEE PLAN
SCALE. 1/4 - 1'-0" �P �• DEfR Y�'A
SHEET NO:
n .t d LU
100 °- 072 0�vZ
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