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HomeMy WebLinkAbout24419-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25449 Date: 12/22/97 THIS CERTIFIES that the building ADDITION Location of Property: 2175 DEEP HOLE DR MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 115 Block 14 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 11, 1997 pursuant to which Building Permit No. 24419-Z dated OCTOBER 21, 1997 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 ONE CAR GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PETER M. & SANDRA B. COLEMAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Buildin Inspector 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) Date......OCTOBER.......21.......................... 19...97.. 24419 z Permission Is hereby granted to: JOE AMBROSE JR. (COLEMAN) .......................................................................................... BOX 1276 ............... .......................................................................... MATTITUCK,NY 11952 ...........................................................I.............................. to......CONSTRUCT A ONE CAR GARAGE ADDITION TO AN EXISTING SINGLE FAMILY ........................................................................................................................................... DWELLING AS APPLIED FOR .................................................................................................................................................................. .................................................................................................................................................................. .........................................................................•.............................. •.....................•............................... ...................................................................................................................................... ...................... t remises located at.......... 2175 DEEP HOLE DR MATT I TUCK 4 p ......................... . ................................................................................ .......................................................................................................................................I........................ County Tax Map No. ,.; 473889 Section .,, 115.......... Block .... 0014 Lot No. 015 ........................ pursuant to application dated .....SEPTEMB. ....ER 11. .................... 1 q 97 and approved by the .. .... . .. Building Inspector, Fee$.........75.00 001, ........... .......................................... .. Building Inspector Rev. 6/30/80 rurm No. b ?�� TOWN OF SOUTHOLD �`�-��✓/ ✓ BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 Qf 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. 42. 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, 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 - $100.00 3. Copy of Certificate of Occupancy - I .25,C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 /q - ib—97 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction.4. . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property."�?.�.7 .. .. . . . . . .DeeP -I�- oLe ,okty� . . . . . . . . . . . . . . /'Y!: M- v(;.)e . . - - - . . . . . House No. Street Hamlet Onwer or Owners of Property. . M•. , /! ,Sf{+�►nR!}, d,- - ,C'c?. . r+-.AnJ. . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . .1IS . . . . . . . .Block. . . . . . .Lot. . . . �j� . . . . . . . . . . . . . Subdivision.. . .. . . . .. . .. . . .... .. .. . .. . . . . . . . . . .. .Filed Map. . . . .. . . . . .Lot. . . . . . .. . . . . . . . . . . . . . . Permit No.�:�:ll9:-. . . . . . .Date Of Permit'a 1?!1q.7. . . . . .ApplicantM . . . . . . . . . . Health Dept. Approval. . . . .. . .... . . . . . . . . . . . . . . .Underwriters Approval. . . . ... . . . . . . . . . . . . . . . . . . Planning Board Approval. .. .. . . . . .. . . . . . . . . . . . . . ��//' Request for: Temporary Certificate. . . . . . . . . . . Final Certic te. . . !\ . . . . . Fee Submitted: $. .� : U�.. . . . . . . . . . . . . . . . . . . �� - S 3��� . . . . . . . . . . . . .APPLICANT.� . M. .� . . . . . . 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]�ISULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 0f c- U• DATE �y �� � 7 INSPECTOR M-1102 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ( ] INSULATION [ ] FRAMING [ NAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE �Z � f 7 INSPECTOR suaniNc DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FNDATION 2ND [ ] INSULATION [ FRAMING [ j FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: _ zc_ .nuc � kE DATE _INSPECTOR T65-1802 BUI NQ DEPT. SPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE � � INSPECTOR 1 T3:l.IJ 111_i l'Ia:1 I UI1 lthl'UR'1' ,1J�Tl: r. TI '^ 0,7 c� FUUNHA'('(UI1 (1111)) Itt)11t:11 ------ FRAM'. d (y^ ►•1.111111 1 ll(: _\ r ---ww www--ww---ww_.._---- ------www ww--r.•www—w---w.--- -----w..wwwwww -------------------- I IN I I i.AT wwwwwwwww..www.-wwww.IINIIi.AT 1 Of PKH If. Y r. (,1111'. _ ..,....._... ---www........---- w.. .... w----...-----..w.. . � _w_w....w ,w. ww--- t ©� ko� C. a Ir 1 Ilnl. .Ol . _ .. ._w_-..-ww.._w-w-w_w.w-.iR ^-__w_-w_..___.._..w_ww _ Atli)l'('IOIIAI. (;Olillgtl'1'..i .w._..-ww_wwwwwwww-www___w 1 t ■w!Twr�R f e f— • t • Q `X f . n v 1'1 BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . -97 TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: p 2 CAL6�f Y Examined..... a ..., 19. . 7 J Q MAIL TO: . . . . . . . . . . . . . . . . .'. Approved....�.©ltcl..... 19 Permit No. r. I /, .................................... Disapproved a/c .................................. ............................... ...................................................... .. .... .!. ......... (Buil .n. tor) APPLICATION FOR BUILDING PERMIT .Date. . . . . . . . . . . . . . . . 19. . . . 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 mist be drawn on the diagram which is part of this application. c. She work covered by this'application may not be com enced before issuance of Building Permit. d. Upon approval of this`•application, the Building Inspector will issue 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. APPLICArIGN IS IEWff MAIL 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 Taws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition,,as herein described. 11* 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. ...... e ,Avh b f".?.J.:% :...................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or _ _ilde ........................................................................................................................ Name of owner of•premises 201=7'e- P,.rl�:.. �:�d Vy.. .. Go l¢. .`........................................... (as on the tax roll or latest deed) If appy t is a corporation, signature of duly authorized officer. •(• anci• • . • •.'........•••. ..• titleofcorporate officer) Builders License No. .� :U,3., ...... Plumbers License No. Electricians License No. ..................... Other Trade's License No. it 1. bncation of land on which proposed work will.`be done. M.Y.Z.T..7:.`.`...: ....... ............................... .... --X1,7.5 ...... . . ............Al!q ,tzr�................. Ikx,se Number Street `` Hamlet County Tax Map No. 1000 Section ../,.„J�...,.... Block ..l Ll.....,.... Lot ...�.�.......... Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... �.�.... L-t--.e.�..!..`:5................................. b. Intended use and occupancy ....1 �h ....,G'°�,h`!�.:e........ ............ ... .. M N * 3. Rittire of work (check whidt applicable): New Iluilding ..........%ALJJI�.......... Alteration .......... Repair ............ Removal ............. 1lecmlition ............ Other Work .................................. 7 O u (Description) A. EsLinxrted Cost ..!. .............. fee .............................................. (to be paid on filing this application) 5, if Ajellivy,, rxa►ber of dwelling units ............ Umber of okmlling units on each floor ................ ifgarage, confer of cars ...1................................. G. If ixtshiess, co►rrr►ercial or mixed occupancy, specify��--naLurdNancl extent of each type of use...................... 7. Dimensions off existing stnictures, if any: FronL. �7 .17........ Rear ....... Depth ..79........... ileiloit ..�................... Mnber of Stories ...../.......... �r i)in►ensionsof sane structure with alter tions or aMitions: Front .�.?........ Rear ...�. �....... Depth ... .6............. ileigl►t ..3............. Ntnbuer of Stories .... ........ B. DiiiensioiriY entire new construaftin: Front .J4.f.......... Rear ..rf ........ Depth ............ lleito►t ......................... amber of Stories ..................... / 9. Size of lot: Pro nl ../ �........... Rear ...11 L/........... Depth 7./.../J.1/.. 10. iit:e of Purchase ..................... M.•me of Former Omer ........................................ H. 7ax►e or use district in uhidr premises are situated .............................................................. 12. Does proposed cot►stnuction violate any zoning law, ordinance or regulation: ........................ 11. Will lot be regraded ........... Will excess fill be removed from premises: YES to 14. Miles of. Omer of premises 7t:... ��G'!r.�!�!... Acklress o�OT. e. .... Plrone No./�gv.'v�„'� Name of. Ard►itect .................................... Acklress .............................. Hiorie No. .............. Name of ('.contrac:tor T�4. D:�1�-�5�:................... Ackiress .� �� �..M 7.7:7cc%•.••Plxxne No.►2�f:.�/. .6.... I,i. is this property within 300 feet of a tidal iaetland? * Yl.. .......... ..�...... *IF YES, 9(1U11CAD IMN 'I111 DMS PERMIT' MAY [iE RE(PI1(I:D. PI.O'P DIAGRAM ioc:ate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block n nber or description according to deed, and show street nacres arc) indicate n,A►etlwr interior or corner lot. a 4N, v (IF m;.w Y(NV,, 1 SS � r (XIINI ... ..... .. ,� 3 7 / ... ....................I)eing duly sworn, delouses and says Owl: he is Lbe al>t►Licanrl: •nn! of imlividual. signing ccmtracl :Ilx/ve ►umbel, Ike is [lie ...... .... ..... .....................................................:................... . ((:(mLracLo , ngent, corporate officer, etc.) of said uwner or ow►►ers, mxl is tlul.y, nul.hori7e1 to perforin or have performed the Bald work and to mike aux) file l.his appllcatioriq Lllal: all. statements contaitieA in this appl.icalicn► are true to the besL of his kixrwl.edge slid Ixilief; a►►d IliaL the work will. lie perfornied in the naum►er set forth in Ole apptientiot, Lited ll►erewiLlr. Slworn to be fore nr. th i s ........U.........(lay of .�e�-�+..19151... 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ALL TRUCTION THE REQUIREMENTS: OF THE N.Y... � a - ' .r - STATECONSTRUCTION a ENERGY r CODES. NOT' RESPONSIBLE ,FOR DESIGN OR CONSTRUCTION ERRORS " 1WOCCUPANCY OR ,baa -,.., ti ! x''•in t -: ,,, �, ?. �5.', '. ,,. - 1 _ y;'�_„ :�,i '*i.+�;` VMS..1, AWFUL VuITMOUT CERTIF[CATE OCCUPANCY