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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. ,~c~z /~z' .5'0 ' =/"