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Home My WebLink About24455-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25365 Date: 11/12/97 THIS CERTIFIES that the building ADDITION Location of Property: 580 LUPTON PT RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 115 Block 11 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 23, 1997 pursuant to which Building Permit No. 24455-Z dated OCTOBER 31, 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 PORCH ADDITION TO REAR OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT" The certificate is issued to PHILIP PHOEL, JR. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A � k Za- Bui ding Inspecor Rev. 1/81 i 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 31 ............ 19...97... 24455 ............................ Permission Is hereby granted to: GARY OLSEN ATTY.PHILIP PHOEL .......................................................................................... PO BOX 706 .................................................................................. CUTCHOGUE�NY 11935 ..... ....................................... to CONSTUCT. A PORCH ADDITION ON THE. REAR,.OF A,_,S I NGLE„FAMILY.,.,,, . DWELLING AS APPLIED FOR AND (AS BUILT) ...................................................................................................................................................... ............................. ..}...................................................I............................... ............................................. .................................................................................................................................................................. ............................................ . .................................................................................................................. at premise$located at....................580 LUPTON PT RD MATTITUCK ........................................................................................................... ......................................................................... . .............. . ............................................. ................... County Tax Map No. .... 473889.... Section ....115........... Block , ,.,,0011...,,., Lot No. „019.............. pursuant to appilcaflon dated ..,,,SEPTEMBER 23 , 19.......97..., and approved by the Building Inspector. Fee$........:75.00 ...........:... ..1...... Building Inspec Rev. 6/30/80 I FORM NO.6 TOWN OF SOUTHOLD ' . Building Dapartmont Town Hall Southold, N.Y. 11971 765 — 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ee armeeer 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 Doard approval of completed site plan rC9uirements where applicable. B. -For 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 $.25 :00 -- BUSINESS $50 .00 2. Certificate of occupancy on pre-existing dwelling $ 5o 00 3.Copy of certificate of occupancy $'5 :00 , over 5 'years $ 10 .0 0 4 .Vacant Land C.O. $'20 .00 Sept. 23, 1997 5.Updated C.O. $' 50 .00 Date .. . . . . . . . . . . . . . . . . *Porch as built .• NewCons true tion, , , , . . Old or Pre-existing Building Vacant Land . . . . .. . .. . .. . 580 Lupton Point Rd. Mattituck Location of Property . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . .. . . . . . . .. . . . . .. . . . House No. Street Hamlet Owner or Owners of Property . . .? 1 lR J.Y•. . . . .. . . . . . . . . . . . . . .. .. . . . . . ... . . . . a . . . . . . County Tax Map No. 1000 Section . .7.7.E . . . .. . . . . . Block . . . .1.1. . . . . . . . . . Lot. . . . )9.. . .. ... . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . Permit No. .. . . . . . . . . Date of Permit .. . . . . . . . .Applicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . Health Dept. Approval . . . . . . . . . . . . . .. . . . . . . . . .Labor.Dept. Approval . . . . . . . . . . . . . .. . . . . .. . . . Underwriters Approval . . . . . .. . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . .. . . . . . . . . . . .. Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Fi rtificate . . :. . . . . . . . . . . . . . . . . . . . Fee Submitted $ . . ..25.QQ.. . . . . . . . . . . . . . . . . . . . Construction on above described building and permit m I abl�nd regulations. �i. Applicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . Rev.10.10.70 GARY FLANNER OLSEN,ESDI. P.O.BOX 706 CUTCHOGUE,NY 11935 2- C'0�.2 3 S I ass-zsoi BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ON [ ] FRAMING [ A41NAL [ ] FIREPLAC CHIMNEY REMARKS. � 4.,r�- ,a,2 gLe�' / DATE ` �� INSPECTOR 1 111.11 11�;'f 1'Ia;I�lil{ IU'I'l1H'I' Ili Il•: �J`\ �1 1'11111111n'I'1 1111 ( I!i'1') N l 1'UUIMAT 1011 v _.z 1111111:11 111.1111111 N11 I� III:i111.A'I'lllll I'1!Il 11, Y (�I '� STA'1'1! 11.111?IIIIY (:11111! • 7(17m L-- . ' t l92 a 6. "I 0 -- - 6 1.. It • - 1 BOARD OF HEALTH . . 3 SETS OF PLANS - - - - - - - FORM NO. 1 SURVEY . . . . . . . . . . TOWN OFSOUTHOLD CHECK - • • • • • - • - - BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL - - • - • • - • - • • - • • • - MAIL TO : Examined ./��/! • . . ., 19 . . . Approved . �� . ./F. ., 19 . . Permit N6'�2wt. . . . . Disapproved a/c . . . . . . . . . . . . . . . . .;LIGA-I . . . . . . . . . . . . . (Building Inspect r) ION FOR BUILDING PERMIT Date S?pt:. M . . .... 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. 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 must be drawn on the diagram which is part of this appli- cation. 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance o B ' ding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and ther plicable Laws,Ordinances or Regulations, for the construction of buildings, additions or alterations, or for rem a or emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building co o code, d regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Sigfrature of plicant, or name, if a corporation) . Gary F1 anner 01 sen, as attorney for Philip Phoel, Jr. ?•.0, B00M M Ni o.Rd., .Cutchogue,. NY.11935 . . . . . . . . . . (Mailing address of applicant) State whether applicant is,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Attorney for owner I ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . Phi]i p.Pboel , Ar.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR'S 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. .580 Lupton .Point Rd. , Matti tuck, NY . . . . . . .. Nouse Number . . . . . . . . . . . . . . . . . . . . .Street . . . . . . . . . . . . . . . . . . . .Hamlet County Tax Map No. 1000 Section . 115. . . . . . . . . . . . Block . . 1 . . . . . . . . . . . . . . Lot . . .19 . . . .. . . . . . . . . . . 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 . . . . . . Porch, as, Built. . . . . . . . . . . . . . . . . . . . . . . . . . Porch as Built b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . tcheck which applicable): New Building . . . . . . . . . . Addition , , Porch, , , Alteration . . . . . . . . . . . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . .�. . . . . . . . . . . r (Description) 4. Estimated Cost . . .$1.,000.,00 . . . . . . . . . . . . . . . . . . . . . . . . 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, commercial or mixed occupancy,specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions,of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . .Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Nameof Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . 15. Is this property located within 300 feet of a nidal wetland? *Yes . . . . . No . : . . . *If yes, Southold Town Trustees Permit Lma b O DIAGRAMrequired. Locate clearly and distinctly all buildings, whether existing 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 whether interior or corner lot. STATE OF NEW YORK, LK S.S COUNTY OF . . . . . . . . . . . . . . . . . Gary F1. . . . . . . sen , , . , , , . , being duly sworn, deposes and says that he is the applican (Name of individual signing contract) above named. Heis the . . . . . AttornP_y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said k and to make and file th application; that all statements contained in this application are true to the best of his nowle ge and belief;and that t work will be performed in the manner set forth in the application filed therewith. J Sworn to before me this . . . . . . . . . . 23. . . . . . . . . . . .day of. . . We PTW. . . . . . . . .. 19 . 97 Notary Public, . . . .51, . . SU.ffCounty Public,State at NewVbtR . . . • . . . . . . . . . . . . . . . . . . . . . . No.4828378 (Signature of applica' Qualified in Suffolk County Commission Expires Nov.90.1W-7 � <s•734 �..�C•86 33� X0268 PIR ee< Q a0 ` Unauthorized alteration or addition to IMS survey is a violation of seetbn?m of 1M Now York b is ' ,- Educdontiw. 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