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Home My WebLink About16365-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall 8outhold, N.Y. CERTIFICATE OF OCGUPANCY No Z-23621 Date MAY 8, 1995 THIS CERTIFIES that the buildin~ ADDITIONS Location of Property 3940 WESTPHALIA RD. MATTITUCK, NEW YORK House No. Street Hamlet County Tax Map NO. 1000 Section 113 Block 9 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 18, 1987, pursuant to which Building Permit No. 16365-Z dated AUGUST 22, 1987 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 ADDITIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR* The certificate is issued to HAROLD D. & MARTHA A. JONES (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. M-045327 - MAY 4, 1995 PLUMBERS CERTIFICATION DATED MAY 4, 1995 -- F~%ROLD D. JONES Rev. 1/81 i/~ng Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ..... ~....~....~.~ ....... 19~.7 N~_ 16365 z Date .... Permission is hereby granted to: ....... ~..:...,..~~....~/,~ ............. ~..~..~./....~..,....~~...~ ......... ..~.~.....~.:..~.,....t.~.~.~.? ~ . County Tax Map No. 1000 Section/,~...././...,.~.. ....... Block ...... ,{~.,,~ ....... Lot No ...... pursuant to application dated ..... {~..~.?...;....J...~.. ........... , 19..~...7., and approved by the Building Inspector. Building Inspector ~ 6~0~0 Form No. 6 TOWN OF SOUTI/OLD BUrLDING DEI'hR'['IIENT ';' AP/? 2 7 1995 TOWN [IALL 765-1802 APPLICATION FOIl CERTIFICATE OP OCCUPANCY A. This applicatiou must be filled in by typewriter OR iok and submitted to the buildzng inspector with the following: for new builcling or new use: 1. Final survey of property with accurate location of all buildiogs, property lines, 2, Final Approval frmn ltehlth Dept. of water supply and sewerage-disposal(S_9 form). 3. Approval of electric,~[ installation from Board of Fire Underwriters. , 4. Sworn statement from 'plumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. C:7 1 ; ~ rig, multiple residences and similar buildings ~ ' ' ' ' de Compliance from architect or engineer respousible for the building. 6. Submit Planning Board Appr~oval of completed site plan requirements. B. For existing buildings (prior ko April 9, 1957) non-conforming uses or buildings and "pre-existing" land uses: ' l. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a 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, Swi~mning pool $25.00, Accessory buildiug $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildint - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00., Co~ercial $15.00 New Construction ...... Old Or · - Pre existing Building Location of Property....~ .... ~S~IJ~ ltouse No. Street tlamlet ........ County Tax Map No 1000, Section. ~/~ .. .Block. ~ ...... Lot..}~ ..... -ubdi · . ............................... Filed Map ............ Lot ................... Permit No. -. ........ Date Of Permit ..Applicant..~¢~ .... Ilealth Dept Approval ' ' ........................ Underwriters Approwil .................... Planning Board Approval ........................ lequest for: Temporary Certificate ..... Final Certicate..~ ...... Fee Submitted: HAROLD D JONES · , 3940 WESTPHALIA ROAD HAROLD D. JONES MATTITUCK, NY, 11952 certificate must not be altered in any manner; return to the office of the BOard if incorrect. Ins~ec;2r$:: m y by their credential,. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 27, 1995 Mr. & Mrs. Harold D. Jones 3940 Westphalia Road Mattituck, NY 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. xx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 16365-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FIELD INSPECTION ~OUNDATION (1st COMMENTS FOUNDATION (2nd 2. ROUGH FRAME &~/ PLUMBING $. INSULATION PER N. STATE ENERGY ~DE FINAL ADDITIONAL COMMENTS Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit No. !~.~&._~_ Owner: ~ LA ~ ~/~ (please print) Plumber: (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ( IS lur~bers S~ ~ Sworn to before me this ~ day o~ Notary~i~ ,~ County ~e~. mm ~ N.Y. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE , INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST I- ] ROUGH PLBG. FOUNDATION 2ND [~INSULATION FRAMING REMARKS: FINAL 765-].802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION 765-1802 BUILDING DEPT. INSPECTION [-,~/FOUNDATION 1ST [ ] ROUGH PLBG. / FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE INSPECTOR Examin 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~FTIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL BOARD OF HEALTH .. · 3 SETS OF PLANS SURVEY ~_.0..~ ...... C~]EC~: '~.I.~ Z ..... FORM ............. : . TO: Disapproved a/c ................................. (Building Inspector) APPLICATION FOR BUILDING PERIVIIT Date... ~./..~. ...... INSTRUCTIONS a. This application 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 property 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 approval 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 inspections. __ ~ ..... (Signature otT'applicant, or name, if a corlJ6ration) ./~z ~.. az~ .r~t,..~...o~. ,.~,Z,.' .... (Mai{'ing address of applicant) //~',~ State whether applicant is owner, lessee, 9gent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ../7/~-~..~....Od~. · .~.~..t~.,...~ ........................ (as on the tax roi1 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) - ~ n ~ % Builder's License No ........................... ~ -- Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Lo_cation of land on which proposed work will be done .................................................. ....... ............. .................. House Number Hanilet County Tax Map No. 1000 Section ...... ./t~.~. ....... Block ....... .~. ......... Lot .... ./..~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 ....~.~~.. ~.. :~ ......................... 3. Nature ofwork.(~eck which a~plicable): New Building ..... ' ..... Addition....~'..... Alteration ....J-'~..... .Repair .... ~ ....... Remioval .............. Demolition .............. Other Work ............... f. '~"~17 .o.o. "," (Descrip~tion) 4. Estimated Cost .... .O. ................... Fee ..... g ~ ' " (to be paid on filing this application) 5. If dwelling, nufnber of dwellingI units ... ~ ...... Number of dwelling units on each floor....O')"~q~.. ........ If g umbe f arage, n r o cars , ................. 6. If business, commercial or mixed occupancy, specify nature an~t extent of each ,type of use ... ,,e'/./~. ~ ' .~ ...... 7. Dimensions of e,x,lst,,ing structures, if any: Front., .-~..~,. .... Rear . ,,,~'~,~.. (~ ...... Depth .. ~?..(~. ........ lteight ..... /.~. ....... Number of Stories ..... ~ .... ' ........................ '. · .i ....... ~ ........ Dlmensions.'of/same structure with alterations or additions: Front . .~- .c2/.~. ~,..". .... Rear .... ~;.~. f.. ~. f.t... Depth. f/(.ff...tfY)o~..~2. ~,rt~. Height ...,:,.A/~.'. · e...~,~,. .... Number of Stpriei/..~r~. .............. · · ' ' '" ~'~ ~ -' ,ff Dimensions of enhre~, new. construction: Front/~.--~,~;l · .}F'~'}~o Rear d:-ft"_'_~. .........~. ~ Depth ........... .... lteight .../..~.. ~./~_~XI · Numb. ei' of Stories'...- ~ ................. '. .... ... e,~.,e~. ·. v... raze of lot. Front ~[~.. ' .4~'..~ .... ....:. ~Rear. ~k~.ii[, ~.~,. ......... Depth,,d.'.~.~.'R.... ~'~,~'ir .... , Dateofeurchase .C~././.~. ~P.~. Name of Former Owner ,~1:.~.;?~t?~ 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction rio)ate any zoning law, ordinance or regulation: ..... ~..~. ....................... 13. Will lot be regraded ...... ~.~/r~. ................. Will excess fill be removed from premises: Yes (1~ 14. Name of 9.w~n~.r. _o..f~prerilise~.~_..~{~1...~Y-~k. ~gad/:l, ress/,~./.~'.,..~.~.~.ff.~.,*.I/.~. ~. Phone No{._,~,~'(-,)~!'I~'~ .~.~'~ Name of .~.~:4',~i.~l~l~k.~g~.r~..~t~;~'~'.~/e.ff,~.' J~'~'d'ress ~1~.~..~. ~.~.. i .~.~ ~/)~hone No...~'~'~...--. ~/,/.~... Name of Contractor .... ~ .............. Address .... : ............. '.Phone No ............... 15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... ~...... · If yes, Southold Town Trdstees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly ali property hnes. Give street and block interior or corner lot. buildings, whether existing or proposed, and. indicate all sbt-back dimensions from number or description according to deed, and show street names and indicate whetl{~r STATE OF NEW ¥i~)RK., , ~ ~ COUNTY OF .~ .... i~'~ .......' ~"' -'" 1 - -~z'~t~c~"~"k'~ ......... being duly sworn, deposes and says that he is the applicant (Name ofindivi ua signSngf-c~ntract) above named. He is th ~ .... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hike 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 ............ / ~7~ .... day ofi ....~ .... , 19~ff.. Notary Public, . ........ >_~ ....~.~!. County // BETH ANN NEVILL · * ..... · ' , N-N-~puSbl~le~, ~taNtNe oNfE~ sw yo r k //- (S,gnature of apphcant) No. 82-8125850, Suffolk Col~ltt~/. Term Expires October 31, 1 JIL I I PlAC~P. AM F--tT, CH E~ N PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE ,,~T~: '~ ~L~_.].~ B.P OCCUPANCY OR CERr, F, CaTEOFOCCUPANO' ~..-'~. - .Y. V. ~.~.. NOTIFY IBUILDING DEPARTMF~NT AT 765-1~2 g A~ TO ~ ~ ~R THE soLDER usED IN wATER FOLLOWING INSPECTIONS; USE IS UN~WFUL u~vsvsr~ c~.~or ~o.~°~'~*~'°~?° ~u,~O.o..~o ROUGH ~RAMING WITHOUT CERTIFICATE ~xc~ =/,o 0,'~ ~ao.,. 4 F~J~L Cr~STRUCT~ON MUST OF OCCUPANCY ..~,..,.,...~ ~ ~ di~butiN T~ FIE~[JIF~r,~t~I b OD THE N.Y ~ ~ing jhal[~ STATE CONSTitUtiON ~ ~ ~ C~E~ NOT ~NSI~LE __ I %EE v~T ~L ul I- I L_L~ PATUI',1 _+ ,::) l' oU I ,SOUTH IE b E V,,~"'T' I o i,,.J ~¥ ~- L~--VATIOM NEN // x/ %'x ~oUT½ ~ L F__VAT I ~ ¢ Zlp~ N, ~-,STI IIELEVATI ON ii *Z, LL/CF kitl! ~ i~1 PS~TF Ir ,_r kJALL B ~PF~ M 74" : ~'-~" ~ I¢ Z I