HomeMy WebLinkAbout16330-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z-17024 Date June 23, 1988
THIS CERTIFIES that the building AD D I T I O N
' Location of Property .... ..... Mattituck, N.Y.
House No. Street Ham/et
County Tax Map No. 1000 Section . . . ! .0.0 ...... Block . . .0. ! .......... Lot 3 2
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... .~.u.g..u.s.~..7..,..1.9.8..7 pursuant to which Building Permit No. 16330 Z
dated ..... .~.u.g .u.slr.. ! .2:.. 1. 9..8.7 ...... was issued, and conforms to atl of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
DECK AI~DITION TO EXISTING ONE FAMILY DWELLING AS APPLIE'D FOR
The certificate is issued to MICHAEL & ROSE WENGRYN
..................... ......................
of the aforesaid building.
Suffolk County Department of Health Approvai N/A
UNDERWRITERS CERTIFICATE NO ............. IxJ../.A .................... j .............
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Roy. 1/81
i~O~ NO. B
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST DE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WOP, I( AUTHORIZED)
16 S ~ 0 Z Da,e ...~.~..~....../..~....., 19..~.7
Permission is hereby granted to:
~.~....~.~...-.~..~.t~ .......
....~.~....~....~.~....! .............
~.~:...~...~..,....I.1..I~ .........
....... : ....... .......................
County Tax ~op No. lO00 Section~...J..~ ........ Block ...... ...~..J ........ Lot No .....~..~:.~.~.~
pursuant to a~plication dated .... ~~..~......g.: ............. , 19.~..]..., and approved by the
Building InspeCtor.
Fee :~ ............... ..........
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
CATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic featu res.
2.Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3,Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5.Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming u§e~, or buildings and "pre-existing"
land uses:
I. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
2.Sworn statement of owner or pre¥ious owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
Fees: Additions $25.00 POOLS 825.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory !$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.. 00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00 ~__/ ~ J ~.
5.Updated C.O. $ 50.00 Date .........................
New C OhS %ruc t i on ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property..~['..0.0...$'.~..~...~,~i ?r. ~.~. .......... W~ .¥,/ ~..~ .-~..7-.[i'.'~..~..~. I~'.~,../.~..~.'.. (/..~. ~'~,
House No, / Street Ham/et
Owner or Owners of Property { .~.~..~.'~%.?. ~. .............
County. Tax Map No. 1000 Section .... 1..~. ~ ..... Block .... .~..(i ....... Lot.. ~
Subdivision .......... ~ ..................... Filed Map No..~...Lot No. -- '
Permit No. ].~.' .~..' .~..~.. ~Date of Permit ¥'.~J..~-.~...~.Applicant. J~.{.~l.~......~..~..~[..~.~.~. ~ ....
Health Dept. Approval .... ';; : Labor Dept Approval ~
Underwriters Approval ---------~ d App
....................... Planning Boar royal .... ~ . .
R q st fo T mpo aryCertificate %..--~... FinaIC tiff ~
e ue r e r ............... er cate .................
Construction on above described building and permit meets alkapplicable codes and regulations
Aoplicant .... . ...........
Rev. 10-10-78
eo%
TOWN OF SOUTLIOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN IIALL
sou'mo r>, N.Y.
TO Whom This May Concern,
TEL. 765-1802
lqe are unable to complete your Certificate
of Occupancy because .of the following reasons.
/
/_~/ An opplication ~or Certificate of Occupancy
is not on fil~..
/--/~// Ne Underwriters Certificate on file.
/~ The chock is(outdated/_not On ,?,~.) ~5-.OO-3
/_-/ No Health Dept. Approval on file.
/_--_/ No final in~.;pection has been made.
Please contact our office on this matter.
Thank you for your cooperation.'
Building Permit tl ,,,] _/~ ~ ~ {[~k. Z
Buildin[f Dept.
***/-/ Ilo Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
7GS-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION ZST [ ] ROUGH PLBG.
[ ] FOUNDATION ZND [ ] INSULATION
[ ] FRAMING /~/J~FINAL
REMARKS.' ,~/(/-~/.~
DATE ~ '-~///2--//.,~.//~ I NSPEC. rOR ,~~ ~ ~-~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [r~ NAA
REMARKS:
DATE
// s /
UNDATION (1st)
UNDATION (2nd)
UGH FRAME &
PLUMBING
SULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONA'L COMMENTS:
O~
~0~
jorio ..~~
formerly
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
m'~ TEL.: 765-180:~
Exa . .O~..~'../..X..., 19.8.7.
ApproX..¢~ .?..~..~.., 19~.. ?. eerrait No.)..~..~..~..~..~..
BOARD OF HEALTH ·
3 SETS OF .~ANS ~'-~-~ ·
SURVEY ·
SEPTIC FORM ............. :
NOTifY
CALL ........
MAIL TO:
Disapproved a/c .....................................
..........................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date .................. ,19,,,
a. Tlfis ~pplication 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 properW 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 approvai 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_______inspectioas.
(Signature of appliMnt(dor name, if a corporation)
· ' (Mailing address/of'applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...... ..............................................................................
Name of owner of premises .,.,, e_a .~ ~.¥. t.q.~..1_., t .¢. a, .,. ,F_ .L,. ....
(as on the tax roll or latest deed)
II' applicant is a corporation, signature of duly authorized officer.
(Name and title of co.orate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done] .................................................
..:, ,~ ,, ¢~ ii. ~..*~, .,,, ...................
~O.o... ~3 ~.~ .,.,..:r: ~-t t ~.~.~...':W.,.~.'~ v. J.~..&x :'~ .t:c.¢.c.. :,:.. ~. ['Ii.', ....
l{ouse Number Street Hamlet
County Tax Map No. 1000 Section ...... [ .O. ¢? ....... Block ..... [ ............ Lot..~.'~ ..............
c" P" .~:,::{ 3.(t, ! .I.., ,~,~ ....... Filed Map No. . · ~ ,lo.,-.,~ ....... Lot ...... ..........
Subdivision ..;ltaT.a.l.
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... [~--..~.}. [/> ~.~'~ ,--0 [~ .........
b. Intended use and occupancy .... ~..~.~.~. · ~ ....................................................
3. Nature of work (check which applicable): New Building ' Addition .. ~ ...... Alterati~l ~.'..': ......
Repair ............ '.. Removal .............. Demolition ............ -.. Other Work ...............
~ I ~:c~) (Description)
4. Estimated Cost ........... i ......................... 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 mixe~d occupancy, specify,nature and extent of eadh type of use ..... ................
7. Dimensions of existing structur~s, if any: Front .... .,) .......... Rear ...~ ...... ..... Depth ...............
Height Number of Stories ' ~
Dimensions'of same structure with alterations or additions: Front ................. Rear ..................
Depth ...... ~ ............. ' .. Height .............. Number of Stories ......................
~--8. D~menmons of entire new constmctmn: Front .......... ..... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front ..... 1.~.O. i .~..'g... ...... ' Rear ... 1.0..0... ?..?. ......... Depth ...~t~)....~...T. ........
10 Date of Purchase ' Name of Former Owner
11. Zone or use district in which premises are situated .....................................................
12. Does proposed constructi6'n wolate any zoning law, ordinance or regulation: ..... 1.':4 lC) ......................
13. Will lot be regraded ....... ~-,1.~ ................. Will excess fill be removed from premises: Yes No
14. Name of Owner of premises H~4al~¢ ~.~.~.,/.Ig.~.]~[~ *J~O. ~J.a.ur..t~il~l~: .~P~.I~.~. Phone NoZ.q~
N e ' ' ..... Iq~q'~oo..~' qq,¥. .......
am of Architect ........................... Address .................. Phone No ................
Name of Contractor
........ ~ ................. Address .... : .............. Phone No ...............
15. Is this property locatedlwithin 300 feet of a tidal wetland? ~Yes ..... No .~...
*If yes, Southold Town TrUstees Permit maybe required.
PLOW DIAGRAM
Locate cleariy and distinctly ali buildings, whether existing or proposed, and. indicate all s~t-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, S.S
COUNTY OF .................
4
............................ , ..................... being duly sworn, deposes and says that he is the applicant
(Name of individual sig ~ing contract)
above named.
He is the ..........................................................................................
. ~ : , (Contractor,, agent, corporate officer, etc.)
of said owner or owners, and xs d~ly authorized to pert'o~m' o~ I/ave perfol~ned 'the smd wof~' and to m~e and file this
application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfo~ed in the m~n~r set forth in the application filed therewith.
SWOrn to before me this I
............. ~ .......... day o~ff....~ ........... , 19~' ...... '
Notaw Public,..Z~.~..~~ ..... County~
E'~[STI NG HOU~F--
DOOI~
- ,c S
ALL WOOD BELOW THE DECK TO
ALL WOOD AEOVE DECK TO BE
BE C CA//SYP GRADE 1 OR ~
R
'2
~CALEi'~ = I
H/NHDWARE
PO 5T $
(WPAB
ARE /.x'TTACHE_D TO FOOq"ifqG WITH TECO WET POST
-Ur-) PD, E$%ED iNTO THE FOO]]MG TOP BFTFOP,,t:: TRF CO,,~qCRE. TE
AlEE A. qTACHED TO BEA~,1% WITH TEC0 TP,.IP-L-G~!P
RIIV~ ~OI$T
=i
,
[ TEC0 W~T.POST-
~ ~5E lCD NAIL5
"5~' TO LOT 6GL NDR.N
POST ARE..
OR~ HUT
~o~s:'r (SREm)
L
--~ENCH, '.,9
~1~
I 0 t~.~r..ID.
t' % CONCRE..TE: FOOTI BI6
&~P-.~ ~GEP. FO OT t N¢~-
~CALE = I
TO BE/~M$ WITH TWO
PT:i.~ PO%']"hUS~ Yz" GAL\/RN/~ELD WA%HER.
JOIST WITH -~ ~
\NRSHE~ Olq ktUT ~IDE.
FOOTINGS :
RAdL POSTS MRE ATTACHED -TO
CARRAF=E ~LT5 USE YE" G-ALVRNI
ALL HA(kS ARE TO ~Ei GAL_VRNFZED
DiECK TO BE NAILED TO JOisTS
pNT£ H - DECK:
DECK AREA:
DECK FLOOF( :
Z';%' -
, EN/ER¥
OC
IZ" DIA, B'DF_P'FH MINIMUM ~ COHCREiTF- MIX,
r~ . PEP. FOOT A,'C,/kY FROM HOUS£
DECK'TO
5%. FT
CARR AGE. 80L'f-/
FLOOR LEf4GIF(S T½LIS F'F'Ir"VlDli'~G ' '
GALV&NtEED
rt
UPRIGHT
C LEAl
SECTION
SCALE y~'"= I
Ai~lt~,V~D
DECK FOR WENGRYN R. EStDENCE.
~00 5ALTAIRE MATTTUCIK; N."r:.' IIDSZ~
DISTRICT SECTION. t00 BLOC~ I LOT
OCCUPANCY OR
USE IS UNLAWFUL
OCCUPANCY
?