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HomeMy WebLinkAbout29181-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-29310 Date: 03/14/03 THIS CERTIFIES that the building ALTERATION Location of Property: 4055 WESTPHALIA RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 113 Block 13 Lot 18 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 3, 2003 pursuant to which Building Permit No. 29181-Z dated MARCH 3, 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 "AS BUILT" PORCH ENCLOSURE ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BARBARA RAACKE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1116453 02/24/03 PLUMBERS CERTIFICATION DATED N/A //ur ized ignature 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. 29181 Z Date MARCH 3 , 2003 Permission is hereby granted to : BARBARA RAACKE PO BOX 816 MATTITUCK,NY 11952 for PORCH ENCLOSURE TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT" at premises located at 4055 WESTPHALIA RD MATTITUCK County Tax Map No. 473889 Section 113 Block 0013 Lot No. 018 pursuant to application dated MARCH 3 , 2003 and approved by the Building Inspector to expire on SEPTEMBER 3 , 2004 . Fee $ 300 . 00 Authorized Signature COPY Rev. 5/8/02 Form No.6 TOWN OF SOUTHOLD 11 BUILDING DEPARTMENT -- - TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY �r^� 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$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 $15.00 /Date. 3 - I �— C New Construction: Old or Pre-existing Building: ✓ (check one) Location of Property: f&55_ Wa- T F"ALI R X V (}=- House No. Street Hamlet Owner or Owners of Property: ,uujme 4RA OZAACKE Suffolk County Tax Map No 1000, Secy 01" 113j Block 0013 Lot 019 Subdivision Filed Map. Lot: Permit No. 29 I$ Z Date of Permit. 3 - :1 0 3 Applicant: Health Dept. Approval: Underwriters Approval: I Il.ey5A Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 'Zb PP /�� p 3 o /&4'1f_ �A4a Q��� Applicant Signature ❑= RIC.IUPRIUMPRI@.l@.IER I i I i I i I@I@.I i I i I i fC fC fC fC l@l@I@P[ i: i:l@Iiii.I@.I@I@I@fC I i@Ii.i:; [P[P[J1:11:1 1:f11 1: 1: nC-IPrJ[Pr C rL3ffij-r3 P[I@PLfCn ❑� 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY 5 �j 40 FULTON STREET — NEW YORK, NY 10038 55 5 CERTIFIES THAT S 5 Upon the application of upon premises owned by 5 5 ROBERT RAACKE BARBARA RAACKE 5 5 O64055 L MATTITUCK N.Y 11952 MATTITUCK, NY 11952 L5� Located at 4055 W ESTPHALIA MATTITUCK, NY 11952 CS Application Number: 1116453 Certificate Number: 1116453 j] S�C�C�CS Section: Block: Lot: Building Permit: BDC: NS11 7C7C7C5 Described as a Residential occupancy, wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 First Floor,Outside, 5 5 5 c5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5 found to be in compliance therewith on the 24th Day of February, 2003. 5 5 Name OTY Rate Ratine Circuit Type 5 5 Miscellaneous 5 5 FINAL 02-21-03 MR RICHERT 5 5 5 Wiring and Devices 5 Outlet 1 Fixture 5 Receptacle 4 General Purpose 5 5 Switch 2 General Purpose 5 Fixture 1 Incandescent 5 Paddle Fan 1 'F' S 5 5 5 5 5 5 seal 5 5 5 5 1 of 1 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 o �������gapL�LPs��LPs��LJsLPr-PdE T-ULLDII � ' �«#1 - I" F�� Applicant/ nn Date. Owners Nan Reviewed: Architect/ Date Engineer: —IX-g-nv Cdr Submitted, 33 SCTM N: District: 1000 Section: _ mock. _13 ixt: M Project / ' Subdivision Location. 5 5 k✓ .TT�-ems_. Name:— -- Simla & separate Required cetitfcation: (Yes/No) /-,//� Req. Rcq, /oning Disnice—R.SP— fit,,sim: Acetal: �l i� �(� [Lot coverage 0 Propoacd Req. Req. /J Req. 11 tons Yard Proposed. 04- [Side Yard Proposed: �. ) [Rear Yard SCJ ProposcQ°yiF_ 11 ri Project Description: P AGENCNRER_MITS / Permit REQUIRED FOR REVIEW , NO YES Numbei 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: e • M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [,, INAL [ ] FIREPLACE & CHIMNEY 1 _ REMARKS: DATE �� INSPECTOR f J. FIELD INSPECTION REPORT DATE COA M UM FOUNDATION(1ST) --------------- FOUNDATION(2ND) - p O r ROUGH FRAMING& :7 PLUMBING INSULATION PER N.Y. j STATE ENERGY CODE C FINAL ADDITIONAL COMMENTS O c C x t7 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DERA RTM>ENT R —'3 �r 4 Do you have or need the following,before applying? TOWN HALL 'i Board of Health SOUTHOLD, NY 11971] 3 sets of Building Plans TEL: (631) 765-1802• _. - - Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. 02 / Check Septic Form N.Y.S.D.E.C. Trustees Examined,_, 20 03 Contact: ZIP Approved 3�3 ,20_0aMail to: �© 1.' 1D/V Disapproved a/c AU-Fr 1 1 N� LC-10 �/ Phone: ZW ' gtd67 Expiration .3 ,20�T t Building Inspector APPLICATION FOR BUILDING PERMIT Date 41JAW4 3 20(x__ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of glans, accurate plot plan to scale. Fee according to schedule. .b. Plot plan showing location of lot laid 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 propdrty 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 pem-rit 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. 7 (Signature of applicant or name, if a corporation) �v P-M 9 4(2 MATT If ocy, �1_Y 1IgOS (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder C) VI/QEFP, Name of owner of premises (As on the tax roll or latest deed) 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. Location of land on whichroposed worlwwill be done: 14D�5'5 'E'E X '->t'I AKUX PD0kV /1! ITS2- House Number Street Hamlet 738I County Tax Map No. 100 Section ► 1 Block 13 Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of roposed construction: a. Existing use and occupancy 2. C�ic"�RGC3Nl� (Zl�1 (�C b. Intended use and occupancy IE N CLL se PQRclir4 P-S BU 11.-T 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 00 (Description) 4. Estimated Cost 50� 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 1 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. i 1 / 7. Dimensions of existing structures, if any: Front q a_ Rear 34 Depth 3 Height AVID Ltd Number of Stories I i Dimensions of same structure with alterations or additions: Front `( Z Rear 34 Depth 3 3' Height PcPP —1-0 Number of Stories 1 i �} Dimensions of entire new construction: Front *4-k Rear Depth — Height ,T 2 n Number of Stories --4-- 9. Size of lot: Front / Rear Z3 + 33 Depth � d 10. Date of Purchase 1 q 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? YES NO 13. Will lot be re-graded? YES N IpNO Will excess fill be removed from premises? YES -�O 14. Names of Owner of premises�,kUWkdress zA5S \A2AW#4LlAA Phone No. .2,49 9(6'7 Name of Architect a1Ay1r_— Address Noj CEW00431TO [ one No 1!99 --X50q� 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__�K,_ * 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. STATE OF NEW YORK) SS: COUNTY OFSU rr,U 3 � a � ' 1 R&,- being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (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 p day of 1�I�1�/)n 20� )� y1V � - �l C Notary Public Signature of Applicant MELANIE V. NdW Ptble,BUdo of Naw Yak No.41911111112 Oidlod In&4*00FA* comms r*ft0a 7S l�f2VC`�' 4r FOQ. WESTANALIA AVENUE r y2 MATT M%4C V1 -- �4Rcd4C3"E. �ss.sc�49 CJW,,4 OF OU HOLD ply 4 51ClCtYtu , it nQ s r i 4 � 4 d o� j t AREA ` ! `"6 AC_ i �s 0, PIPE ;4�. 1 to •` ' • r S ��U � r a + J � MAf2. i. �5i;l�VEYI`.0 -- t0 t t E f/per• s'•. , ♦� ,t ((,/�.}/� � // ~� c��Sf.t 1, tf it F'/ �t e�•`'I I t,�ry 2tS_ + 1✓' i t? i.tc,L t o ut��/ x#� FdC�EJL T P tt.� WES'TF'Nl.LIA AVENUE: I Z�Z84lc � vouC'lEHUNG 40 E. 158.80 �3r 4-T OD 4oRCH r ti LAJ11JG Q< S ' l LIVINl.I n1G I51� Y'.FC�E.tJCN W Dy�V` cT� FA 1po a SQ f., r_, u ti C_Or•JG2E7E FL-001i TL : 1wHc¢ FLOOR -v I I ZB4�, `ruGwr 2646 r • 4m'�J �1 T � —_ RtCJk.EDGE '` 1 - 3 uj tom,, �. �h•� -- _1 S o� \{\7OKEN KI'TC4lkfa /JQRTN )VM-TK N CYRT E{ 5 0° 4 -------------- �/ S OTED S` OCCUPANCY OR o v USE IS UNLAWFUL I' .J n°v s,Jl .�lr,'G DEPARS ." T I p '. S-7602 B •4'.'d TO 4 PM 3H IJE ..� WITHOUT CERTIFICATE 1 )II '."7, 11 -ECTIONS: � OF OCCUPANCY 0 ,i - TWO I - �I'ar)CONCRETE 1� IuH - FRAMING & HL.,.u181 G T., UNDERWdITERSCERTIFICATE a. udsuLA71oN — LU, fes' e ' Fki I CX, REQUIRED 4. FINAL • CONSTRUCTION MU T — t,g �IrnntEiBE COMPLETE FOR C.O. �e, ? ASPNF L7 ALL CONSTRUCTION SHALL ME T� THE REQUIREMENTS OF THE N Y. /- 5W OGLL STATE CONSTRUCTION & ENER YLL r2 CODES. NOT RESPONSIBLE FI R O - - S ION ERRO S RaPH ALT SNINGLE DESIGN OR CONSTRUCTION c„'y1 ' VINYL Stp11JG _._ .- R.-lq FV9E'RzI.ASS ) Al,4 YhIA1U W. 6UY76A.,`. -" 41 Vwo56 -- _ aGJELEO-CEC!PY- - bOU.C3LE-RU0G ArJOEvs�u 51vtOG - Z %; u In_RaPWy - 'f WI:-NIR .)r�RUS _ x 'ZuvXt✓S101AIEi - -:- 'li'QLV u�mo 5llEAYIiING,.ISu .AGiWkL2,xG.S (alis oC.... - .- .. ._._. 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