HomeMy WebLinkAbout27383-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27784 Date: 06/29/01
THIS CERTIFIES that the building ADDITION
Location of Property: 11545 SOUND AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 141 Block 3 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 11, 2001 pursuant to which
Building Permit No. 27383-Z dated JUNE 11, 2001
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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to CAROLYN & JOHN SIDOR III
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
_ja'�� )"4-�
/,/uthorize'd Signature
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 FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 27383 Z Date JUNE 11, 2001
Permission is hereby granted to:
CAROLYN & JOHN SIDOR III
10845 SOUND AVENUE
MATTITUCK,NY 11952
for
CONSTRUCTION OF A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
at premises located at 11545 SOUND AVE MATTITUCK
County Tax Map No. 473889 Section 141 Block 0003 Lot No. 010
pursuant to application dated APRIL 11, 2001 and approved by the
Building Inspector.
Fee $ 75 . 00
Auth i ed Signature
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD ( r r'I 7Rn ,
BUILDING DEPARTMENT
_ � �
TOWN HALL
765-1802 +�
APPLICATION FOR CERTIFICATE OF OCCUP NCYBLDG.OF7j.
F C%T�;CLD
A. 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.
B. 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.
C. 1a'ees
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 Building - $100.00
3. Copy of Certificate of Occupancy - .251
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date � , � :O/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construct'or} Old
e Pre-e isting Building. . .
. . . . . . . . . . .
Location of Property.-7 /. .`:d� 1 �'�. . . . . . . . . . . . . . �/�T�T �':� . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. /V . . . . . . . . .. . . �. ,L'(,LS//�/ . . . ap • • . . . • . • . . • . • • . .
County Tax Map No 1000, Section. . l?1. . . . . . . .Block. .4 a V--3. . . . . . .Lot. O.! 2 . . . . . . . . . . . . . .
Subdivision. . . . . . A . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . ... . . . . . . .Lot. . . . . . . . . . . . . . .
Permit
�an3
No.`s: !. . .Date Of Permit. . . . .Applicant:Ptf?1 „ • Lyw!? !�,
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. .x . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . .
5� � . . . . APPLICANT. . . . . . . . . . . . . . . . . . . . . . . .
9'1
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH BG.
[ ] FOUNDATION 2ND [ ] IN TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
0
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,DATE f0 INSPECTOR '�
FIELD INFECTION REPORT DATE
COMMENTS
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BUILDING DEPARTMENT-
Do have or need the following,before applying
TOWN HALL R ..�. you
Board of Health
SOUTHOLD, NY 119714---- - s- 3 sets of Building Plans
TEL: 765-1802
..... r Survey
PERMIT NO. t?l 3 Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined , 20 Contact:.
Approved 6 Vk 20 0 Mail to:
Disapproved a/c
Phone:
Building In for
APPLICATION FOR BUILDING PERMIT
Date LlQ f-1 I o , 2001
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitt:Ld 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.'rhe work covered by this application may not be commenced before issuance of 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 the 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 a Certificate of Occupan
is issued 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 hereir. 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.
1A.C.4 46
(Si afore of applicant or name, if a corporation)
IO s�S SoyaJ Ave Hait- vaL
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Q W
Name of owner of premises'---J n + caa 1,4 6
( s on the tax roll or latest deed)
If applicant is a corporation, signature of duly authoriz6d officer
}
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
Ops �S � rid f • . ;
House Number Street amTet
County Tax Map No. 1000 Section Block �) Lot I
Subdivision Filed Map No. Lot
(Name)
-• �,u,� �,a�«ig ubc au►u vwupwwy ui premises and ' t
ended use and occupancy of proposed construction:
a. Existing use and occupancy—....S i n g 1 e 6 m 2
b. Intended use and occupancA,-
�. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
1. Estimated Cost Q00o•oo Fee_
(to be paid on filing this application)
If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories_
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories a
Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
Size of lot: Front Rear Depth
0. Date of Purchase Name of Former Owner �A&A J Lk)
1. Zone or use district in which premises are situated A 16 Ct-
2. Does proposed construction violate any zoning law, ordinance or regulation: UO
3. Will lot be re-graded M u Will excess fill be removed from premises: YES NO
4. Names of Owner of premisesCLOAl X +�h�3Kaldressj,0'%(K cb VAJ H� Phone No. qg-a 11 O
Name ot•Architect Address Phone No
Name of Contractor Address Phone No.
5. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
6. Provide survey, to scale, with accurate foundation plan and distances to property lines.
7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
TATE OF NEW YORK)
SS:
'OUNTY OF—
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1 0{ being duly sworn, deposes and says that(s)he is the applicant
(Name of i dividual signing contract) above named,
i)He is the OlJ� Nk(_
(Contractor, Agent, Corporate Officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
iat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
erformed in the manner set forth in the application filed therewith.
worn to before me this
/ day of 2 (:�r/
r
Notary Pu is Signature of Applicant
ELIZABETH A STATHIS
NOTARY PUBLIC,State of New York
No.01 ST6008173,Suffolk C�.lu�
Term Expires June 8,20
( C. R.
48 )
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4. FINAL - CONSTRUCTION MUST TO CONSTRUCTION
z x q BOTTOM RAIL BE COMPLETE FOR C.O.
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DECK
THE REOUIREMENTS OF THE N.Y.
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CODES. NOT RESPONSIBLE FOR DRAWN BY
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DESIGN Oq CONSTRUCTION ERRORS CMA
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