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Home My WebLink About28983-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29632 Date: 08/11/03 THIS CERTIFIES that the building ACCESSORY Location of Property: 2595 WESTPHALIA RD MATTITUCK (HOUSE NO.) (STREET) (PLAMLET) County TaD( Map NO. 473889 Section 114 Block 10 Lot 22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 4, 2003 pursuant to which Building Permit No. 28983-Z dated DECEMBER 6, 2002 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 ACCESSORY SHED AS APPLIED FOR. The certificate is issued to JAMES R & SHARON L COX, ( OWNER ) of the aforesaid building. SR SUFFOLK COU1FI"fDEPARTMENT OF ~EALT~APPROVAL ELECIRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'I'~U N/A N/A N/A 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 COMPLETION OF THE WORK AUTHORIZED) FULL PERMIT NO. 28983 Z Date DECEMBER 6, 2002 Permission is hereby granted to: for : JAMES R SR & SHARON L COX WESTPHALIA RD MATTITUCK,NY 11952 CONSTRUCTION OF AN ACCESSORY SHED IN THE REQUIRED REAR YARD at premises located at 2595 County Tax Map No. 473889 Section 114 pursuant to application dated DECEMBER Building Inspector to expire on JUNE Fee $ 161.40 WESTPHALIA RD MATTITUCK Block 0010 Lot No. 022 4, 2003 and approved by the 6, 2004. COPY Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD 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 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 frmn Board of Fire Undervvriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commcrcial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliancc 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 buildiugs and "pre-existing" land uses: I. Accurate survey of property she eying all properly lines, streets, buildi~g and unusual natural or topographic features. 2. A properly completcd application and consent lo inspect signed by the applicant, lfa Certificate of Occupancy is denied, tile Buihling Iuspector shall stale tile reasons lberefor in writiog to tile applicant. C. Fees 1. Certificate of Occnpancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, 3. 4. 5. Ncxv Construction: ~ Old or Pre-existing Building: oeat'onofPrope.y: e6 q House~o. Street Owner or Owners of Propcrty: ~~ ~. Sufiblk County Tax Map No 1000, Section } [ q Subdivision Swinnning pool $25.00, Accessory building $25.00, Additions to aceesso~ buildiog $25.00, Businesses $50.00. Certificate of Occupancy on Pre-existing Building - $100.00 Copy of Certificate of Occupancy - $.25 Updated Certificate of Occupaucy - $50.00 Tempormy Certificate of Occupancy - Residcnlial $15.00, Commercial $I5.00 Permit No. ~..55' q ~5'3_ Health Dept. Approval: Planning Board Approvak Request for: Temporary Certificate Fee Sub~rfitted: $ ,~,..~. 0'-O , (check one) Block ] ~ Lot Filed Map. Lot: Date of ee~it._} ~] ¢ [ D ~ Applicanl: Ilamlet Underwriters Approval: Final Certificate: ~ (check one) ~Applicant Signature BUILDING PERMIT EXAMINER CHECK LIST /~ DATE REVIEWED: /2 / ~/02 · _~.~ DATE SUBMITTED:/,;2/,~/02 APPLICANT: SCTM# DISTRICT: J,000, SECTION: } I L~ , BLOCK: _[0 , LOT: ~ SINGLE & SEPARATE CERTIFICATION-REQUIRED? ,,L/r2 NOTES: LOTS 40,000SF -100-24. Lot recognition.(CREATED before June 30, 1983), UNDERSIZED loOTS FROM JAN.1997 100-25. Merger (A nonconforming at any time after 7/1/8~ ZONING DISTRICT: CONFORMING? REQ. LOTSIZE: ACT. LOTSIZ~O_~P~Q.~OTCOV. c~% ACT. LOTCOV. REQ. FRONT /~- PROP. FRONT )-,,/,REQ S/I~E >- ~4~T. SIDE REQ. REAR I~ PROP. REAR ~ v/' ~E~HEIGHT PROP. HEIGHT WATER FRONT,? .A,//_) Dt ~,ESCRiPTiON: PANEL #: /-/fi~ ] FLOOD ZONE: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES of N-~BED #): TOWN SEPTIC RECEIPT: Y oKI~ NEW YORK STATE DEC: PR~-VRCga/?S YES o/~ SOUTHOLD TOWN TRUSTEES: YES TOWN ZONING BOARD APPROVAL: YES or~ TOWN PLAN. BOARD APPROVAL: YES TOWN HISTORICAL PRE (SPLIA): YES o~___~ t,a's ENERGY: YES EGRESS (18 H min.? 4 sq total) ~ VENT (SQ. FT. x 4%) BUILDING PERMITS OPEN/EXPIRED: BP HAVE PRE CO'S: Y OR N BP NOTES: DTE: / / PERMIT #:R10- -Z / C/0 Z- -Z / C/0 Z- LIGHT (SQ. FT. x 8%9'-'- 1.( 2.( FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF TOTAL: '5 3 ~ SF SF)- %0 .SE)= SFX* 'q0=* SF)- (. .SF)= SF X $ __ =$ +$ INIT OTHER FEE FEE =$ TOTAL FEE +$ = $ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [ I mN~/~N [//]~NAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ INSPECTOR FO~A~ON (~) ROU~ ~G & STA~ ~ CODE TOWN OF SOUTHOLD BUILDi~IG DEPARTMENT TOWN HALL ~OUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined (~ I 20 Approved I L [ (a , 20 Disapproved a& Expiration (' ~,20 PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need theffollowahg, before applying? Board of Health 3 sets of Building Plans pJannin~ Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date ~ ~7..-'~ ,200~ _ [ INSTRUCTIONS ..... ~t~ This application MUST be completely filled m 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 waterways. c. The work covered by this application may not be commenced before issuance o£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 thc 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 property 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 permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicabl6 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. ~ ( 'gna fapplicant or name, ifa corporation) (Mailing address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 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. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Subdivision (Name) Section Block Filed Map No. Lot ~a Lot 2. State existing use and ocanpaney of premises and intended use and occupancy of proposed construction:' a. Existing use and occupancy ~qc, i~0,BC, q, 5. If dwelling, number of dwelling units If garage, number of cars b. Intended use and occupancy Nature of work (check which applicable): New Buildin~_A_ddition Repair Removal Demolition Other Work Estimated Cos? ~(~ Fee t Alteration (Description) (To be paid on filing this application Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height_ Number of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stodes 9. Size of lot: Front 10. Date of Purchase Dimensions of entire new construction: Front 2.~ t_ g-" Rear Height /d,'- Z3'~'" Number of Stories 0,~'~ Rear ~'Z-. ~ Depth Name of Former Owner Rear 2-~'-~-" .Depth Z q'-- ~' " 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__ NO ,/Will excess fill be removed from premises? YES__ NO ~ 14. Names of Owner ofpremises~~dress"~% ~c~,,~ Phone No. ~%- %l.~r~ Name of Architect Address Phone No 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 OF ) '~,N_ c',x'~,~__~ ~ Q,~ ~. being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~ UO~q.~' (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. Swon'~to before me this ~ ' I~otary Pubrlc 20 Signature 3f App]~ciin"i UNDA J. COOPER Notary Public, Sta~ of New Yofl[ NO. 4822563, Suffolk, County ~ ~.~ r Term E. xpir~ December .~1, ~J2-.--~c'~c/~o