HomeMy WebLinkAbout24476-z FORM NO. 4
TOWN OF SbUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25980 Date: 09/22/98
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1995 RUTH RD MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 106 Block 7 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 30, 1997 pursuant to which
Building Permit No. 24476-Z dated NOVEMBER 12, 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 ACCESSORY STORAGE SHED IN REAR YARD AS APPLIED FOR.
The certificate is issued to ROMAN BAJLAK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
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i ing Inspector
Rev. 1/81
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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.... NOVEMBER.....12........................... 19.37....
24476
Permission is hereby granted to:
ROMAN & WF BAJLAK
......................................................................I..............
PO BOX 945
....... ... ... ....................................... ..................
MATT I TUCK,.....NY,,,11952
to....,CONSTRUCT..AN. ACCESSORY. SHED AS APPLIED FOR I N REAR YARD
.......................:..........................................................................................................................................
... ..................................................................................................... , ......................
..................................................................................................................................................................
I.......... ......................................................................................................................................................
at premise$located at................1995 RUTH RD MATT I TUCK
.........
.......... ................................................
.................................. ..... ......................
.................................................................................................................................................................
County Tax Map No. .,,473889..,... Section ,,,106............. Block ,.,,0007,_,.,.,., Lot No. 00.7................
pursuant to appiicotion doted ...SEPTEMBER 30,,,,,,,,,,,,,,,,,,,,,,,,, 19.....97....., and approved by the
Building Inspector.
Fee$.......35.00.....
........................................ . . ...... .......... ......................
Btu ing Inspect
Rey. 6/30/80
Form 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 buil(
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lir
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 for
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contain
less than 2/10 of 1X lead.
5. Commercial building, industrial building, multiple residences and similar buil
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
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 applic<
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 - .251q..
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction.44 Old Or.gre-_existing Bu di.
• ••. .. . . . .. •• • • • •• •• • • . • • • . •• • • •
Location of Property.. .. ...... .. ... . ... : .-...2:� �:. . . . . . 7iG/ ccC !. . . . . . .
House No. Street Hamlet
Onwer or Owners of Property.. . ;..
County Tax Map No 1000, Section. ../ 6. .. . . ..Block. .. .7 . . . . . . . . . .Lot. . . . 7 . . . . . . . . .
Subdivisionsn. . . . . . . . . . . . . . . .. . . . . . .. .. . . . . . .. . ..Filed Map.. . . . . . . . . . .Lot. . . . . . . .
. . . . .
Permit No. . .? . .Date Of Permit. �27 . . . .ApplicantO?7�CL,�;L.
Health Dept. Approval. . . . . . . .. .. . . . . .. . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . .. . . . . . . .. . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate... . . . . . . .
Fee Submitted: $. . . . -,. :.O� . . . . . . . . . . . . . .
�CGGQ,GG �CL
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . APPLI'A.'T. . . . . . .
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BOARD OF HEALTH . . . . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK • . . . . . . . . . . . . . . . . . . . .
E=� 3 �` � TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
= TEL: 765-1802 NOTIFY:
"_ . CALL
Examined. ...... ., 19. ! MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved. 19 .. Permit No. ................ ....................................
Disapproveda/c .................................. ....................................
......................................................
.... Vinsp;--o
..... . ..
(Building tr)
APPLICATION FOR BUILDING PERMIT
Date.`,
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 not be drawn on the diagram which is part of
this application.
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 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.
APPLICATION IS UMW MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zane 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 herein
described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and
refulations, and to admit authorized inspectors on premises and in bulldlM for necessary inspecti S.
4 (Signature of applicant r name, if a corporation)
................................ ........•-- -...
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer,.general contract 'c r or builder.
OTM
,41:7PZ/CANT FoR NIS f ?� ./T,rs•0WNES? ..... .
..... ........ ...... ................
1P ASN
• DATE 7B.R0• 7 -
Name of owner of premises .. � � j.� { ��
.1. �cf.............................. BYi ... .
(as on the tax roll or latest deed) NOTIFY SURMOi DEW NT T
If applicant is a corporation, signature of duly authorized officer. 785-1N2 9 AM TO 4 PA FOR THE
FOLL+OWM ME W-1101ri:
t 1pOr IN •
TM HOMED
.................................................
��
(Kane and titleofcorporate officer) �
x. 1101 o - IMAM •RUMM4
�. EWNJM
4. bFINU.• MUST
Builders License No. ......................... W COMRm fMCA
Plcmbers License No. ......................... All OWIW rIWJN �L MEET
••............. THE Nummm OP THE M.Y.
Electricians License No. ..................... :TATE Ci'IINT�11it1Dili
NEW
COOEi. FOA
Other Trade's License No. ....................
A-M to
1. lunation of land on which proposed work will be done.M.P . Dow aS07
...i9 5.................... �r�j. oA ......H14T?117.Uc ......A/:/..1.1.6 ;2r ...................
House Number Street Hamlet
Canty Tax Map,161�ISection A�� ... Block ................ 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 L ING
b. Intended use and occupmxy -SHED........ ...................
..... ................
IN
3. N•jture of work (check which applicable): New Building .......... Addition ... Alteration ......
Repair ............ Removal ............. Demolition ............ Other Work -5r-ORAGE..5#947.............
(ITcscri ption)
4. Estimated Cost ...Y:.....49 �� :. ......... fee ..............................................
................
(to be paid on filing this application)
5. If (kaelling, number of dwelling units .......... ilthmber of dwelling shits 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..... .7 1 ..
Rear ...��.'.�/.... Depth ..2.7,......
lleiglht ...8.................... Nu»lher of Stories ............ .........
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 ........................ Nxd)er of Stories ...-.... ..........
9. Size of lot: Front .. .!0®'....... Rear ....//®•.a�.'..... Depth .....100:Ash/.....
10. Date of Purchase :TA/�.�� �.... . Name of Former Owner :61I.AlS.E7 KA'(VZZS DE'1.!ELDP;C99RA
11. Zane or use district in whichremises are situated !!TLGlC
p ...... .................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..!��..................
13. Will lot be regraded .......11(9........ Will excess fill the removed from premises: YES
14. Names of Owner of premises f Q/Y!!�!1/ .:$AJC AI. gess$9,.. :!?vrH RO.M4;rr17 Vie%, Phone �,�s/4)2got-qi`6
Name of Architect .................................... Address .............................. Phone No. ..............
Nameof Contractor ................................... Address ...............................Plhone No. ..............
15. Is this property within 300 feet of a tidal wetland? * YES .......... �...v...
*IF YES, SOUl1M 113A 9HI1SIMS PERMIT MAY IE MQRRli.
PI.OT DIAGRAM
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
wlhether interior or corner lot. -
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y� �1�ii�•isTAT�. .being duly sworn, deposes and says that he is the applicant
_ (Nene 141tjowtv
above WV
Ileis the .Q).NX................................................................ .....................
(Contractor, agent, corporate officer, etc.)
of: said owner or owners, and is tkhly 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
Lhat Lhe work will be performed in the manner set forth in the application filed therewith.
Sworn toI>Qfore me this
......5Q .......day of —:54.7 ........19.9 7...
Notary Rhblic ..
JANF;T V. STLWART ......•.. (Sign t re (.Applicant •'. .'•.
NOTARY PUBLIC, State of New York
11o. 6Y -4f,63,"
Qualified in Suffolk County
Commission Expires Nov. 30, 19 gd
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Owner's Manual & Assembly Instructions
Model No. C0108-A ❑ HY108-A ❑ LB) 08-A ❑
LX108-A VS108-A ❑ NW108-A ❑
697.68729-A ❑ 697.68747-A 11T108-A 11
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I
ARROW
World's Leading Maker
of Storage Buildings•
y CAUTION:.SOME PARTS HAVE SHARP EDGES.CARE
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SAFETY SAKE,PLEASE READ
j 709040397 I SAFETY INFORMATION PROVIDED IN THIS MANUAL
BEFORE BEGINNING CONSTRUCTION.WEAR GLOVES
BUILDING DIMENSIONS •Size rounded off to the nearest foot • WHEN HANDLING METAL PARTS.
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Exterior Dimensions Interior Dimensions Door
•Approx. Foundation Storage Area (Roof Edge to.Roof Edge) (Wall to Wall) Opening
Size Size Sq. Ft. Cu.Ft. Width Depth Height Width Depth Height Width Height
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10'x 8' 121"x 92.3/4" 74 487 123 1/4" 95 1/4" 87 7/8" 118 1/4" 90" 86 5/8" 55 1/2" 60"