HomeMy WebLinkAbout45331-Z �o�oS�FFOtq-oy Town of Southold 6/29/2021
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P.O.Box 1179
o • 53095 Main Rd
�aod; Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42120 Date: 6/29/2021
THIS CERTIFIES that the building SHED
Location of Property: 260 Halls Creek Dr,Mattituck
SCTM#: 473889 Sec/Block/Lot: 115.-17-17.28
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/5/2020 pursuant to which Building Permit No. 45331 dated 10/15/2020
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:
accessory shed as applied for.
The certificate is issued to Hygom,Scott&Kathleen
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
ori Signature
TOWN OF SOUTHOLD
�g11FFoc,Yc BUILDING DEPARTMENT
4
N TOWN CLERK'S OFFICE
"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#: 45331 Date: 10/15/2020
Permission is hereby granted to:
Hygom, Scott
260 Halls Creek Dr
Mattituck, NY 11952
To: construct accessory shed as applied for.
At premises located at:
260 Halls Creek Dr, Mattituck
SCTM # 473889
Sec/Block/Lot# 115.-17-17.28
Pursuant to application dated 10/5/2020 and approved by the Building Inspector.
To expire on 4/16/2022.
Fees:
ACCESSORY $156.00
CO -ACCESSORY BUILDING $50.00
Total: $206.00
BuVii g n ctor
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
fig-
New Construction: rr Old or Pre-existing Building�:(� (check one)
Location of Proper . o b A�1S Q_\f Ge_"�C
House No. Street Hamlet
Owner or Owners of Prope :
Suffolk County Talc Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ \
V
Applicant Signature
�pF So
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
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INSPECTION
[ ] FOUNDATION 1ST , [ ] ROUGH PLBG.
[ -] FOUNDATION 2ND ' [ ] I SULATIOWCAULKING
[ ] FRAMING/STRAPPING [ FINAL S#t5
[ ] FIREPLACE-& CHIMNEY [ ] -FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANTPENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
Tm KS:
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DATE INSPECTORA 4V
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SOLATION
[ ] FRAMING / STRAPPING [ FINAL SAP
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
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DATE INSPECTO
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FIELD INSPECTION REFORT DATE COMMENTS
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FOUNDATION(IST) "
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.�FOUNDATION (ZND) IM
ROUGH
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PLUMBING
INSLZATIONPEA N..Y. y ,
STATE ENERGY CODE
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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) 765-9502q553)
Survey
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved ,20 Mail to:
Disapproved a/c ca
Phone: /_ 5
Expiration 20
Buil11
g Inspec r
APPLICATION FOR BUILDING PERMIT
Date lJ I , 20
DIO DI PT. INSTRUCTIONS
PZ�S i
a.NOTO licat'-t MUST be completely 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 t or name,if a corporation)
MCS �����c-3�P_ \MQ 1
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises 2Sc, - o \,r�-e CV-) CNV\
(As on the tax roll or lat d)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Lo 'on oof land op wh'c�proposed w rk ill bbee done:
\\
House Number Street Hamlet
County Tax Map No. 1000 Section �� Block V1 Lot \�
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy 0 • Q
3. Nature of work(check which applicable): New Building Addition Alterg4'on
Repair Removal Demolition Other Work S �
(Description)
4. Estimated Cost 00 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 ��C-'
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
i
8. Dimensions of entire new construction: Front Rear 1 Depth 1
Height /0 `' Number of Stories 0�L
9. Size of lot: Front - _ Rear -Z Depth a
10. Date of Purchase o� �� Name of Former Owner 08
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO
13. Will lot be re-graded?YES NO ill excess fill be removed from premises?YES NO V
14. Names of Owner of premisesec-\Q Address c\ Phone No. &L" 76
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF 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,must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY OF T�a{
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being duly sworn,deposes and says that(s)he is the applicant
(Name of individual g contract)above med,
(S)He is the (� �\ tt r ���y�� o�-
(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 y e thVe:fi0b&--
l da of 2002,O
SABRINA M BORN
ota!y ic.State of New York
Notary Public No.01 BO6397038 Signa e f Applicant
Qualified in Suffolk County
Commission Expires Dec.22,20
APPROVED AS NOTED
DATE: 1411,5k6 B.P.it
FEE: BY: OCCUPANCY OR
765:1802B81AMNTONOTIFY D4 PM DEPARTMENT
THET USE IS UNLAWFUL
FOLLOWING INSPECTIONS: WITHOUT CERTIFICATE
1. FOUNDATION- TWO REQUIRED
FOR POURED CONCRETE OF OCCUPANCY
2: ROUGH'- -FRAMING & PLUMBING
- 3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
RET
AIR STORK WATER RUNOFF
COMPLY WITH ALL CODES OF PURSUANT TO CHAPTER 236
NEW YORK STATE & TOWN CODES OF THE TOWN CODE,
AS REQUIRED AND CONDITIONS OF
JVV I f7V-5 � IPJO OARD
StdTH0M7U PWl tSTEES
JIM DEERKOSKI.PE
phone(631)298-7116
REAR ELEVATION FRONT ELEVATION
SCALE.1/4"=1'-0" SCALE.V4"=P-0"
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