HomeMy WebLinkAbout29202-Z FORM 11O. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29307 Date: 03/11/03
THIS CERTIFIES that the building ACCESSORY
Location of Property: 3985 SOUND AVE MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 121 Block 1 Lot 2
Subdivision Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 11, 2003 pursuant to which
Building Permit No. 29202-Z dated MARCH 11, 2003
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 AGRICULTURAL BUILDING AS APPLIED FOR.
The certificate is issued to ANTHONY & MELISSA PERULLO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ PENDING 02/10/03
PLUMBERS CERTIFICATION DATED N/A
—"'L ),
X-�
ut `rize Signature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 29202 Z Date MARCH 11 , 2003
Permission is hereby granted to :
ANTHONY & MELISSA PERULLO
3985 SOUND AVENUE
MATTITUCK,NY 11952
for
CONSTRUCTION OF AN ACCESSORY AGRICULTURAL BUILDING AS APPLIED FOR.
THIS PERMIT REPLACES BP#26455 .
at premises located at 3985 SOUND AVE MATTITUCK
County Tax Map No. 473889 Section 121 Block 0001 Lot No. 002
pursuant to application dated MARCH 11 , 2003 and approved by the
Building Inspector to expire on SEPTEMBER 11, 2004 .
Fee $ 150 . 00
ho ized ignature
ORIGINAL
Rev. 5/8/02
FORM NO. 3
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)
PERMIT NO. 26455 Z Date APRIL 19 , 2000
Permission is hereby granted to:
ANTHONY PERULLO
134 CHURCH STREET
KINGS PARK,NY 11754
for
CONSTRUCTION OF AN ACCESSORY AGRICULTURAL BUILDING AS APPLIED FOR.
at premises located at 3985 SOUND AVE MATTITUCK
County Tax Map No. 473889 Section 121 Block 0001 Lot No. 002
pursuant to application dated MARCH 31, 2000 and approved by the
Building Inspector.
Fee $ 50 . 00
Authorikpjd Signature
COPY
Rev. 2/19/98
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
•� '7n^'I
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:
I. 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. J
New Construction: _V_ Old or Pre-existing Building: (check one)
Location of Property:
House No. f Street Hamlet
Owner or Owners of Property: Pe rl_-_ I Iy
Suffolk County Tax Map No 1000, Section a Block 00 C) ' Lot C Z
Subdivision �� V Filed Map. Lot:
Permit No. D a Date of Permit. V Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Si tature
SCALE ti 4} :;ft• DATE 3/4i?y t
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T3I7ILDING PERMIT REVIEW �LIFCK LIST
Applicant/ , n p r n Date
Owners Name: {�t� Of��l \ ego Reviewed:
Architect/ - — Date
Engineer: Submitted:
SCTM #:
District: 1000 Section: i�-I Block: _L Lot:
Project \ Subdivision
Location. D
Name:
Single&separate Required
certification: (Yes/No)
Req. Req.
Zoning District [Lot size Actual. I (Lot coverage Proposed. ]
Req. Req. Req.
[front Yard Proposed.--J [Side Yard Proposed: 1 [Rear Yard Proposed: J
Project Description:
AGENCY PERMITS Permit
REQUIRED FOR REVIEW N.A.. NO YES Number
Suffolk County Health Dept.
New York State D. E. C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
9-7
FIELD INSPECTION REPORT DATE .. . . i _ COMMENTS —C
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ADDITIONAL COMMENTS:
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FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY tt. . . . . . . . . — . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK Ga. 4? :.4'.s'. . . . . . . . . . . . . . .
TOWN HALL RE2219111e! . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971 �
TEL: 765-1802 NOTIFY*
-
CALLY
�2npPP�
Examined...f1.............. 20.... _ MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved..i .(�........... 1,0A . Permit No.
Disapproved a/c .................................. ...................................
....................................... .. ..........
.......... .. ..............
(Buildirg ctor)
APPLICATION FOR BUILDING PERMIT
MAR 3 1 Date. .Amr-y h . . 31. . . , 20.Cyp.
INSTRUCTIONS
a.' 'Ihig application must) letely filled in by typewriter or in ink and submitted to the Building Inspector wi
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan stowing 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 rwst be drawn on the diagram which is part of
this application.
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
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 BEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Tone 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
regula[i°` r . �l adipi.0 authorized inspectors on premises and in building for..necessary r tions.
,. N,
rgna a of appli , or name, if a corporation)
%v, rw E1W 89L°B �a:r`.4t 3`1J )a... �. .....Iw...l .cl�.. ..(�t1�L
�Doi"
L : (Mailing address of applicant)
Q31l11Ip311 OwT,�
Sta±yyle,p����whet�tyr�, � �essee, agent, architect, engineer, general contractor, electrician, plumber or builder
it+rv2,,,�y7 iWY}C�..Y.....................
Idm t Won .. .. .. !?"Ir,
Nae o a+re 1d°`: ..." . niTL�ON I.....p.
�O,y 71as on the tax roll or latest deed)
T33M JJA" "Off ml1AY29105
I
ft ly. %TVAVbU & Jgsi$patrre of duly authorized officer.
t Mfl1i7UNT8bb0l 3Ti4r:
PQ4 /#1al4 r4R. T"a ti..83,:�1,.....................
CNalf�`� i 'trothl�e"�°o�ir)
Builders License No. .........................
Plumbers License No. ..........................
Electricians License No. .....................
Other Trade's License No. ....................
1. Iocati n of land on which proposed work will be done..............................................................
...._...-7.lA.s�....��.QUnK!...!�r4.....................................J". fd-uck..................................
House Number Street "Hamlet
Canty Tax Map No. 1000 Section ....J).J....... Block .....1.......... lot ...�...........
Subdivision ...................................... Filed Map No. ............... Lot ...............
(Name)
2. State existing use and occupancy oS prises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ... Q Si 4wC r...........................°.,......,...........................
occupancy Aee QLI ��� . UJ�� *VAYvef."ti W ... .!
b. Intended use and Deco ........�!.....JCJ. ... ....... ................
Nature of work (check which applicable): New Building .......... Addition ........... Alteration ..........
Repair ............ Removal ............. Demolition ............ Other Work ....lIC-y.........................
(Description)
Estimated Cost fee ..............................................
(to be paid on filing this application)
IE dwelling, number of dwelling units ............ Nmber of dwelling units on each floor ................
Ifgarage, number of cars ......................................
If business, commercial or mixed occupancy, specify nature and extent of each type of use......................
Dimensions of existing structures, if any: Front................ Rear ............... Depth .................
Height ......................... Number of Stories ......................
Dimensions of same structure with alterations or additions: Front ............... Rear ...............
Depth .................... Height .................... Number of Stories ...............
Dimensions of entire new construction: Front ................ Rear ............... Depth ..............
height ......................... Nmber of Stories .....................
Size of lot: Front .................... Rear .................... Depth ....................
0. Date of Purchase ..................... Name of Former Owner ........................................
I. Tube or use district in which premises are situated ....................................:?fir}y,.......................
2. Does proposed construction violate any zoning law, ordinance or regulation: ........................
3. Will lot be regraded .................... Will excess fill be removed from premises: YES NO
4. Names of Amer of premises ........................... Address .............................. Phone No. ..............
Name of Architect .................................... Address .............................. Phone No. ..............
Name of Contractor ................................... Address ...............................Phone No. ..............
5. is this property within 300 feet of a tidal wetland? * YES .......... NO ..........
*IF YES, SOtNlICFD IM TMISIMS, PM4FT MAY BE W9QNIRED.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
Tam property lines. Give street and block number or description according to deed, and show street names and indicate
+nether interior or corner lot.
AP,PD 11S NOTED
OCCUPANCY OR
i�cE 10" UNLAWFUL FES
WITHOUT CERTIFICATE Non" mum
76b,Eoa ! AM m 4 M roR TME
OF OCCUPANCY I
z. mm . VAM arum
3.
�4. � um
THE Itswitman
OF In N.x
STM a
rrclr•, or Nw Y` C>( n ff SS Oen"OR 001119111111111191141110 wwopw
......A!`! p0.n�....Fii.4�L�Q.............................being duly sworn, deposes aml says that he is the applicant
(Name of individual signing contract)
rbove named,
leis the ..... �nG V�.J4. .................................................................
(Contractor, agent, corporate officer, etc.)
3f said owner or owners, and is (July authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are troe to the best of his knowledge and belief; and
that the work will be performed in time manner set forth in the application filed therewith.
9wom to before me this
.�............da of
Notary Public lI_—
..m� --
.. ... p�....................
(Si re of A licanC)
LYNDA M.BOHN
NOTARY PUBLIC,State of Now York
No.01806020932
Term aExpires Suffolk
8,20(Zy
fC
1.i''N1. mm.
SURYEY OF PROPERTY 2"" �'°` — — — —sss'se'4o•EFE
Fr STOCKADE/EyyCE 208.96
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AT MATTITUCK 0.,'w - x b — — °°"
TOWN OF SOUTHOLD61 � � x xI FE
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SUFFOLK. COUNTY, N. Y. i n °2 ° x x X
1000-121-01-02 r
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FEBRUARY 4, 2003 2 I
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AREA=1.0000 ACRES �UN� ��087' ��ti y09
—X—X—X—=POST & WIRE FENCE
Y. LC. NO. 49618
ECO PC,S S.
ANY ALTERA77ON OR ADDITION TO THIS SURVEY 15 A OOLA77ON (631) 1) 765-1797
OF SEC17ON 7209 OF THE NEW YORK STATE EDUCATION LAW. P.0.
EXCEPT AS PER SECTION 7209-SUBOMSION 2. ALL CER77FICATIONS 1230 TRA ET
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SOUTHOLD, N. Y. 11971 03-118
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WHOSE SIGNATURE APPEARS HEREON.
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