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HomeMy WebLinkAbout23650-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of• the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25362 Date: 11/12/97 THIS CERTIFIES that the building ADDITION Location of Property: 165 SELAH LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 106 Block 9 Lot 4.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 12, 1996 pursuant to which Building Permit No. 23650-Z dated AUGUST 28, 1996 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. The certificate is issued to MICHAEL & LISA FANDREY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ilding Inspector Rev. 1/81 FORM NO f 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) N° 23650 Z Date .. ........................................ 19.1.. Permission is hereby granted to: . J .................. ..... . . ..... to ...... ...............41............ .. ....... .... .. ........... . .. . . .. ...... . .. ........... 04.� i ........ ...... ...... ........del .......li..�,0 .fi r.... atpremises located at .............. �et ..... .e6 ...., '.`. `................................................... .................................. 1.. '.7�1 .�.. ........ ..:.....�/42F :........................................ County Tax Map No. 1000 Section -100f.......... Block ......i ,97...... Lot No. . . ...... ,r,�.Y..0 pursuant to application dated ...... T.�l.✓.r.....,/ ....,.,,, 19./...,and approved by the Building Inspector. Fee 5....... .�.. ... ......... .c. ................... di �nspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENTR TOWN HALL DA 15 765-1802 NOV -- 7W APPLICATION FOR CERTIFICATE' OF OC CY OLM DEPT A. This application must be filled in by typewriter OR ink ding 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 12 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. 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 Building - $100.00 3. Copy of Certificate of Occupancy - .25C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .�. !f b ! g �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building.. .. .L. . . . . . . . . . . . . . Location of Property. . . 1(0S , . SG.IA N. . LQ:'.L . . . . . . !'.�.o l? �v,�t . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street l 1 Street Hamlet Onwer or Owners of Property. ,� I:`.!�:��`. . �:'l�n �1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . ./ -�. . . . . .Block. . . . !. . . . . . . . . . .Lot. .'Lj,Ll. . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . .Per-mit No. .Z3�S�. . . . . . .Date Of Permit. plZ /9� . . . . .Applicant. P.tdl(�.Q- q . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Finai Corticate. . . . . . . . . . . FeeSubmitted: 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . k.! /�I[�. .�? . . . . . . . . . . . . . . . . . . . . S3ca -AT PLICAi T a� BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ J ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [GINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: DATE � �/C/// �771NSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ FINAL [ J FIREPLACE & CHIMNEY REMARKS: DATE 2 �7 INSPECTOR����� BUILDING DEPT. MSPECTION [ UNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS• DATE INSPECTOR N. r I EA.I) I NSI'LCT I ON It VOit'T DATE. COMM CNTS ii d IZ- FOI INDA'1'I(1N ( I S•I•) POUNDA'T I ON (2ND) ----------------- ------- ---- uOUI.N FRAHM ITIIMII I NG ! I In I NSIII.AT I ON PI?It N. Y . E_ STATE.. 1.N1.1 (:Y CODI'. I - II - _ I F1 NAI. ADDITIONAL (OM TENTS: - r—I Vol O y rn BOARD OF HEALTH . . . . . . . . . . . . . . . fn FORM NO. 1 3 SETS OF PLANS €; TOWN OF SOUTHOLDSURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT -CHECK . . . . . . . . . . . . . . . . . . . . . . . . . AUG 12 1996 TOWN HALL. SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 1 TEL: 765-1802 NOTIFY: BLDG. DEPT. Q {y TOWN OF SQUTHQL!` — .! CALL .�J�- J V •3 . Examined... I....... 19.! MAIC. TO: . . . . . . . . . . . . . . . . . . . . Approved....0I'W ......, 19 l..O Permit No. �4�� .................................... Disapproveda/c .................................. .................................... .... S ........ (Buildi Inspector) APPLICATION FOR BULLDING PERMIT Date. . . . . . . . . . . . . . . . . 19. . . . INSTRUCTIONS a. This application mist be completely filled in by typewriter or in ink and submitted to the Building Inspector witl 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. 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 HEIM MALE 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 regulations, and to admit authorized inspectors on premises and in buildi f necessa 'nspections. ........................ (Signature of applicant• •name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general. contractorA AN�qi, r or builder. ........Q s ? :t.. ................................. ...................... .A�. &�� �p*! Y�j`Z1 .._ Name of owner of premises D:J.�.S. � :���.`)S Q�.. �0� ( . .. .. FEE BY: on the tax roll or latest deed)' 1JOVY 010161d br A ------ (as Alt' 765-1802 8 AM TO 4 PM FOR THtz If applicant is a corporation, signature of duly authorized officer. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ..........`. .-....................................... FOR POURED CONCRETE (Nam and title of corporate officer) OCCUPANCY OR 2. ROUGH - FRAMING & PLUMBING 3. INSULATION USE IS UNLAWFUL 4 BE COMPLETE FOR C.O.FINAL - CONSTRUCTION MUST Builders License No. ............ Plumbers License No. ............. '• r ( CERTIFICATE. ALL CONSTRUCTION SHALL MEET .....�0 THE REQUIREMENTS OF THE N.Y. .w OF OCCUPANCY STATE CONSTRUCTION & ENERGY Electricians License No. ......... CODES. NOT RESPONSIBLE FOR Other Trade's License No. DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done.............................................................. ......f.� ...... X1....1.tc I...... 1 ,� 1�....: .: :......................................... House Number Street Hanlet County Tax Map No. 1000 Section ..1.0�........ Block ...9............ 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 ... ......................................................... b. Intended use and occupancy ........................................... ............... . ..... 3. Mil tire of work (cl►eck ,rich ahplicahle): New ik►ilding .......... Addition ... At ration .......... Relxrir ............ Removal ............. i)m)lition ............ Other 14ork �.�.).r.'-....,,.........,.. (Description) }{ /I. ESL lllklted Dost ..�..Y.O ............. fee .............................................°. (to he paid on filing this application) 5. if owel I ing, rxniaer of dwelling units ............ timber of dwelling units con each floor ................ Ifgarage, rxrdaer of cars ...................................... 6. if 1xasiness, cxam►ercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front................ Rear ............... Depth ................. Ileigl►L ......................... Nnber of Stories ...................... Dinuensiorns of sane structure with alterations or ackliCions: Front ........... .... Rear ............... Depth .................... Ileigl►L .................... Nmirer of Stories ............... B. Dimensions of entire new construction: Front ................ Rear ............... Depth .............. lleito►t ......................... Nni►er of Stories ..................... 9. Size of lot: Front .................... Rear .................... iepth j ...``....t IO. Dale of Purchase :�.v....... N-we of Former (Mier .�J�.C��, O..1 .- .14 �l�a.7.... . It. Zone or use district in wluicl► premises are situated .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...Pl-.h................ 13. Wilt lot be regraded .................... Will excess fill be removed frau premises: YES IDU M. Nares of. Owner of prenises �... Address Ylnone No. Name of Architect ....................... Address .............................. Prime No. .............. Mmrie of Contractor ................................... Address ............ .. ............Phone No. .............. 15. is this property within M) feet of a Lidal weLland? * YES .......... NO ... *1F YES, S()<I111OD1) ium -minim-9 PERMCI' mAY RG REQfimm. PLOT DIAGRAM inc:ate clearly and distinctly all buildings, whether existing or proposed, and indicate all. set-back din►ensions from property lines. Give street and block rnlrldner or description according to deed, and s)xaa street names and indicate %Awther interior or corner lot. AO YOM MOO srMn, M. ram5,OXINI J/ r T1tI . �. �... jTA .... ..... * Kiri cdetxrses aril says lhat he is the appl icaul. (Mane of iodivid►ral_ signing contract) above lumecl, Iktis I_he ............... ........................ ......................................... (tkoaCractor, agent, corporate officer, etc.) of said owner or owners, aril is duly authorized to perforin or have laerforilled I.I►e said work arid to rmke and file Ibis Algal icatioo; that al I statements contained in this appl icalion are Lrnae to the best of his klxrwledge aril lx�l ief; mol that the work will be performed in the irrinaer set forth in Lite application filed therewith. `,Xoom to be ore me this ......� . .. .da of ........ x. 19...4. Notary [ ali ..... ...... G 11 . ... CLAIRE GLEW (Sigrkrt:ure of nppl icanl) Notary Public,State of New York No.4879505 Qualified in Suffolk County Commission Expires December 8,15 i x � r' OCCUPANCY O t USE IS UNLAWFUL. OAF OCCUPANCY 3 '© ----------- I � x r � C110�t1Qg0 :10, ,� 9661 Z ( `f lb �, v • Yah �,?y, Y.�.� �, ,..• �,,.. �✓ I= /`"'t•K.'F ♦.i r..d f+,� . Tr. .. i# G * � ^.� .� ... N••.� •. y`M q! K T• It �}V i "�3r", W�.r Y t iw All 14* l 41 51 S71 46 No Nor r:^ I �1 �y j • fit'sr1. y ' 3?`r� ate*' r !-• - - •,e lilt A. LL 7 1144 W, :Y S a z a� INOTEo� I.OTh4S:QNO 'JT2 "E:FA:►t fi2?rJP2'a�£!LEi3. ;fl! '?= CO.Cin!C'S 07F.1EAs ,� 5 GEA LEVEL t� 5 A I ..TILEDY f Mew N41329 �aoCZ n► i� �- OCCUPANCY OR USE IS UN WITHOUT CERTIFICATE -- OF OCCUPANCY I i `)i !V V NIAT -�