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HomeMy WebLinkAbout24428-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25347 Date OCTOBER 30, 1997 THIS CERTIFIES that the building ADDITION Location of Property 625 RILEY AVENUE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 143 Block 4 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14, 1997 pursuant to which Building Permit No. 24428-Z dated OCTOBER 24, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT" The certificate is issued to JOHN & RUTH WHELEN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A �- //v&ng 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.......24.......................... 19...97... 24428 z Permission is hereby granted to: GARY FLANNER OLSEN (WHELEN) MAIN RD PO BOX 706 ........................................................................................... CUTCHOGUE.NY 11935 ........ to ......A. DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING .............................................................................................................................................. AS BUILT AS APPLIED FOR .................................................................................................................................................................. ................................................................................................I...................... ...........•......I....................... ................... .............................................................................................................................................. ........................... ...............................................................I.......... at premises located at....................625 RILEY AVE MATT I TUCK ............................................................................................. ......................... .............................................. . . . ....................................................................... County Tax Map No. .....473889.... Section ....143 ...... Block ......0004...... 015 Lot No. pursuant to application dated ..,,,OCTOBER 14 19 97 and approved by the Building Inspector. Fee$.........75.00... ................ .. ..................... uildi Inspector Rev. 6/30/80 FORM NO.G TOWN OF SOUTHOLD Building Department BLDG.DEPT: Town Hall 's Southold, N.Y. 11971 765 — 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions z A. This application must be filled in typewriter OR ink, and submitted =somomar to the Building Inspec- tor with the following;for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings,Multiple Residences and similar buildings and Installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. Tor existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $-25A0 -- BUSINESS $50 . 00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3.Copy of certificate of occupancy $'5 "00 , over 5 'years $ 10 .00 4.Vacant Land C.O. $'20 .00 10/9/97 5.Updated C.O. $' S0 .00 Date .. . . . . . . . . . . . . .. . ... . . . X deck as built NewConstruction. . . .. . Old or Pre-existing Building Vacant Land . . . . .. . .. . .. . Location of Property . . ,575.Ri 1 ey.�kve; . :. . . .Matti tuck . . , . . . . .. . . . . . . . .. . . House No. Street Hamot Owner or Owners of Property . ,Ruth,Whet en . . . . . . .. . .. . . . . . . County Tax Map No. 1000 Section „143. . , .. . . . . , Block . . 04. . . . . . . . . . . Lot. . 015. .. . .. ... . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . Permit No. .. .. . . . . . . Date of Permit . . . . . . .. . .Applicant . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . t Health Dept.Approval . . . . . . . . . . .. . .. . .. . . . . . .Labor.Dept. Approval . . . . . . . . . . . . . .. . . . . .. . . . Underwriters Approval . . . . . .. . . . . . . . . . . . . . . . . .Planning Board A oval . . . . . . . . .. . . . . . . . . . . .. Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final ertific to . . .. . . . . . . . . .. . . . . . . . . . • Fee Submitted $ . . .25.00. .. . . . . . . . . . . . . . . . . . . . . . . . Construction on above described building and permit meets ,l ppl' egSlcs-aaagulations. Applicant . . . . . . . . . . . .° .. . . . .. . . . . .. . . . . .. . . . . .. . . . . .. . . . GARY FLANNER OLSEN,ESQ. nw.10.10 79 P.O.BOX 706 CUTCHOGUE,NY 11935 Q�• 5 3S 7 • BOARD OF HEALTH 3 SETS OF PLANS • • • • • • • FORM NO. 1 SURVEY . . . . . . . . . TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 • . . • . . . • • • • . . • . . CALL TEL.: 765-1802 MAIL T0 : Examined . : . . . . .. P6 t 4 ., 19 Y7 Approved . . . . . . ���., 19/,/ Permit No. •��,��•� D � ' Disapproveda/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OCT 4 . . ;::. . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . i uing Inspector) . APP L C TI N FOR BUILDING PERMIT Date Qctolier,9, , , , , , , ,, 1997. 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. tb. 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 must be drawn on the diagram which is part of this appli- o4ion. 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 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 whate r un it a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuan of a Bolding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, d other;applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for to , herein described. The applicant agrees to comply with all applicable laws, ordinances, building c e, 6 ',� gulations, and to admit authorized inspectors on premises and in building for necessary inspecti ' .�. .. 7 (Si i rftWift Mptsration) Gary 1 ani eysUr.,�Ruth W41 er .P. .0. Box , .Qu A4� State whether applicant is-owner, lessee, agent, architect, engineer, genera 0-1 r`or builder. Attorney TIKIM N01lOt1A►�Mb� JA#A'a . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . Atl1'>l�dl rl'lt�lt�ittt:�` ? . • . . . . . . . . Name of owner of premises . . • .Ruth AQ1 Qn . . . . . . . . . . ... . . . . . . . M JAN N011'9tM11AS (as on the tax roll1=41i1 -11-1 A 3`• �NOEt a I If applicant is a corporation,signature of duly authorized officer. *A / 4y�� Wo40 •jI'�y�` ' • • • • • • • a • • . . . • • . . . . . . . • • . . • . . . . . . . . . . . . . • . . . (Name and title of corporate officer) - ALL CONTRACTORS MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. Electrician's License No. . . . . . . . . . . . . . . . . . . + . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . 575. . . . . . . . . . . . . . . . . . . .Ri1Qy .AYQ: . . . . . . • . , . . . . . . . . . .Matti.tuck . . . . . . . . . . . . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section 143 , , , , , , , . . Block . . .04. . . . . . . . . . . . . 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 . . . dBCk. as.bui 1 t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . b. Intended use and occupancy • . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . deck as built ' 3, Nature of work (check which applicable): New Building` . , , , . , . . . . Addition . , . , . . , . , Alteration . . , . . . , . . . Repair . . . . . . . . . . . . . . Removal , , , , . . , • , , Demolition . . . . . . . . . . . . Other Work . , , , ,., , , , , . .•• (Descriplion) 4. Estimated Cost 300;00 � , , . . . , . , . , . „ � . . , , „ ., � t ,� Fee , ` (to be paid on filing this application) '5, If dwelling,number of dwelling units , . . . . , .. . . , . , . . . Number of dwelling units on each floor , , , , , , , , Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . , , , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , , , , 6, If business,,co�mtaercial t mi ed4ee ancy,specify nature and extent of each type of use , , , , , , , , , , , , , , , , , 7, Dimensions of existing structures,if any;;Front , . . . . . . • , . • , , , Rear , , , , , , , , , , , , , Depth Height Number­�(Sti ries . . . , , , , . , , • . , , • , , . , , . . , , , • , , , , , , , Dimension f0 in ctuFe with al o 4tions or additions: Front , , , , , , , , , , , , , , Rear . . , , , , , , , , , , , , . , . , Depth , , , • . , .11 . , . , . . . . . . . . . . . . . . . . t , , , , , NumberofStories . , , . , , • , . , , . , f , ► , , , , . -8, Dimension of a ont . , . . . . . , . , Rear . . Depth , , ,,, , , , , , , , , Height , . ,..:, f$t ries . . . . . . , • . . , . . . . . . . . . . . . . . . . . . . . . . . . . . ... , , , . , . 9, Size of lot: . . . . . . . . Rear , . . , , , , t , , , ► , , . , . . . Depth . . . . . . . . . . . . . . . , . . . , . , 10, Date of Purchase , . , . • , , , . . , , . Name of Former Owner . . . , , , . „ • , , Il, Zone or use district in which premises are situated „ , , , , , , , , , , , . , , , . , . , , , . , , , , • • • , , , . . . . . . . . . . . . . . 12, Does proposed construction violate any zoning law, ordinance or regulation; , , , , , , , , , , , , , , • , , , • , • • , , • , _ • • • t 13, Will lot be regraded . , , , , , , . , • , . , , , • , • , • • . • . . . , Will excess fill be removed from premises: Yes No 14, Name of Owner of premises . , , . . , , . , . . . . . . . , , . , Address , , . , . . . . . . . . . . . . . . .PhoneNo. . , . , , , , , , . . . . . . Nameof Architect , ­ , , . , , , . , , , Address .Phone No. Name of Contractor . , . , , , , , . , , , . . Address , , , , ' , , . . , , . . . . Phone No, , . . . . , . , . , , . 15, Is Xhis 'ppopertylocated within 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trustees Permit may be required, _ PLOT DIAGRAIVI M Locate clearly and distinctly all buildings, whether existing 1 or proposed, and,indicate all set-back dimensions from property lines, Give street and block number or description according to deed, and show street names and indicate whet�sr interior or corner lot. See attached survey OCCUPAN CY OR USE IS U (LAWFUL AFPJM As NML WITHOUT CERTIFICATE �. �� OF OCCUPANCY FFA' .Y: d- 46 NOTIFY 9t11Ld 8 766-190 t AM To t ru "NIM, FOLlrtMM W 1 F01 • V” hmp1 2. If� . 3. MOULOM 4. FINAL - COMA____ K cowun ALL C01111M_IOIrOIM *MILT THIS 11RIMUIIM11'i M MM M.I: STATI 91100 • 8� CODIO. NO, ; !� DUM an co-Willue 011 STATE OF NEW YORK, S.S COUNTY OF . .SOFFOL-i . . . . . . . . , , . , . , , . , .Gary .F1anner. .01sen . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . .attorney . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . , . . . . . . . . . . , . . . . t". . . . (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. Sworn to before me this 9 day of. October • • 19 .97 . . . . . . . Notary Public, . , , S.f of k• • County LOR ` . . . . a „ r r • , , . . r . . . . , . . . . . . . . . . . , . . . . NOWY PUMP,SWOof Now Yat (Signature of applicant) No.4828373 Qusi83ed in Suffolk(burly Commission Expires Nov.30,1NX7 SURVEYED FOR:- •Jpyv J y�` ,euThi 8. `✓,'.'EL EN LOCATED AT MAT7i TUC. , AI of.SouTHOL.o, SUFFOLK Cou,v7Y, N.Y LOT MAP OF o,PoPc,2Ty 7F !�//�C/•4M 7' cE` Q4N/EG T .2/oE'Y Co.CLK Na. /Blo F/LEO ,t/v v. 2 7 /928 i SCALE 1"=20" `E/ W SCIFFoc K COUNTY 7;4X MAP p<7TA .D�ST.•�oo0 ..3E�-/43 81 . 4 DoT••/S O� C�ypoD ax � '� IV.. P/LEY A VE. v gr ox n - y 7 a � L4 6.0 I — - - - -- - N 2o.p rn oO w 112. 7 23A AVEN%AE F/.PST .4ME,Tc/CAN Ti iL E - //C/Sc_/RANL E COnilPAA,Y DF NEw f'0,2.� 70;,. / V1 _oti�v7.e/' s7.FA�r; LTA. SURVEYED 14.,1o;< /�, 19�p5 BY 7/ WILLIAM R. SIMMONS-/R. P.o.6ox _577 JIJMESrieT L.I., N.Y. FILE NO./a oi2 PAGE -- 3 GRID J�% DRAWN BY /7