HomeMy WebLinkAbout13922-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCuumANCY
No Z-23575 Date MARCH 29, 1995
THIS CERTIFIES that the building. ADDITION
Location of Property 3940 WESTPHALIA ROAD MATTITUCK NY
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 MAY 2, 1985 pursuant to which
Building Permit No. 13922-Z dated MAY 8, 1985
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 DECK AROUND AR EXISTING INGROUND SWL%9~ING POOL AS APPLIED
FOR.
The certificate is issued to
~%RO~.~ & ~AR~{A JOWES
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
Rev. 1/81
~OE.I~ NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERA41T
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 13922 Z
Date
County Tax Map No. 1000 Section ....... L./..~ ........ Block .......~ ........... Lot No....;~........~... ........
pursuant to application dated ........ ~ .................. , ~'~
Building Inspector.
Fee $. ,~,,.. ..............
Rev. 6/30/80
Form No. 6
TOWN OF SOUTtlOLD
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
inspector with the following: 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.
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 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.
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 Buildine - $i00.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00~, Commercial $15.00
pate .J.a. 0 ............................
Construction ........... Old Or Pre-existing Building...w~.. ............
ation of Property.. ~.q~ .............. ~.~.~i~ ~ .J~i ~.~/~
House No. Street Hamlet
mr or Owners of Property ..... I~fO~-~ .~.'.~. )(.]~[f~O. J~: ~JO~ ............................
~ty Tax Map No 1000, Section...ll~ ........ Block...% ........... not../~ ..................
tivision .................................... Filed Map ............ Lot ......................
,it No ................ Date Of Permit ................ Applicant ............................
.th Dept. Approval .......................... Underwriters Approval .........................
ming Board Approval ........................
est for: Temporary Certificat~ ........... Fiual Certicate...,o~. ......
Submitted: * Z ?.'.OP ......................
APPLOMCANT .
FIE~tD
~SPECTION
FOUNDATION
FOUNDATION
2.
ROUGH FRAME &
PLUMBING
(1st)
(2nd)
ADDITIONAL COMMENTS:
INSULATION PER N. Y.
STATE ENERGY
~ODE
FINAL
COMMENTS
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
DATE ///~ ~/,~
/ /
'NSPEL'~TOR~_~.//~
/
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FFIAMING ~ ] FINAL
DATE
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved
9isapproved a/c .....................................
................................ .......
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
BLDG.
TOWN ?~:
Received ........... ,19...
t filled in in ink and submitted to the Building Inspector, with 3
a.
application
must
be
completely
by
typewriter
or
ets 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation. .
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
hail 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
hall 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
luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
[egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described·
?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
~dmit authorized inspectors on premises and in btlllding for necessary/~spections.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engdneer, general contractor, electrician, plumber or builder.
4amc of owner of premises. ·...~.~d .~..?:.'. ................................................
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade s License No ......................
· Location of land on which proposed work will be done ..................................................
· .qq. ............................... , ................ /. .........................
House Number Street Hamlet
County Tax Map NO. 1000 Section .../.4.7 .......... Block .... ? ............ ..... .Z. ...........
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 ...... ~.£.~. )..d~/~..rid'..~. ~.. ....................... . ........................
b. Intended use and occupancy ..... /~7 ~/ff. ff. ~ ..~../~.~../~..ff..~....~/~-.~,~..~...~o~..4d~.~' :~e.~,g.d..i: ./; ...,. ,.¥. :.: :<~,,~ .....
3. Naiure of work (check which ,applicable): New Building ..... ' .....'Addition .... · .]'/'~. ·.. Alteration ..........
pal . '~ .~ ~ Removal Demolition ..... Other Work .
Re r .... ~ ,~ ..... . .... , .............
~ ~ ~ ,,,~ (Description)
4. Estimated Cost ...... /..~.~ .~..-'~. · .................. Fee ...............................
· " (to be paid on filing this application)
5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................
If garage number of cars ~
6. If business, ommerclal or maxed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height Nu'mber of Stories
Dimensions of same structure With alterations or additions: Front Rear .....
Depth .................. i.. · Height ............ ; ......... Number of Stories ..............
8. Dimensions of entire new con~'truction: Front ..... ../.~. ....... Rear .... ~ ......... Depth .... ~5"t2 .......
Height ............... Nuinber of Stories ........................................................
9 Size of lot: Front Rear Depth
10 Date of Purchase ' Name of Former Owner
11. Zone or use district in which premises are situated ......................................................
12 Does proposed construction" ' ordinance or regulation:
· wolate any zomng law .................................
13. Will lot be regraded ....... i .................... Will excess fill be removed from premises: Yes No
fp ~
14. Name of Owner o remises . ~ .................. Address ................... Phone No ................
Name of Architect ........ i .................. Address ................... Phone No ................
Name fC tor : Add Phone No ~.7~--5~/37
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines· Give street and bloc ~ number or description according to deed, and show street names and indicate whether
interior or coruer lot.
STATE OF NEW Y~OR ~K,~
COUNTY OF. ~... S.S
(Name of individual sign. inn contract)
above named.
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 conlained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the man,er set forth in the application filed therewith.
Sworn to before me this
/,/(Signature of applicant)
No. 4822568, Suffolk C~l~r~l.'.ff..~ ,
Term ?xpires March 30:"~9
· 'FEE: ,
BUILI ~EPARTMENT A-T
9 AM 4 PM FOR THE
IN~
FOR POUR[
2. ROUGH-
3. INSULAT!c
4. FINAL -
BE
ALL
THE REO~ I
STATE CC
CODES.
DESIGN
TVVO REQUIRED
2, PLU,M~ING
-;" :"vnN J t~AUST '
)N ?, ~NERGY
RESPoN?BL~ FOR
/CONSTRUCTION ERRORS.
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