HomeMy WebLinkAbout23656-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25019 Date MAY 6, 1997
THIS CERTIFIES that the building ACCESSORY
Location of Property 790 WILLIS CREEK ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 115 Block 17 Lot 17.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 21, 1996 pursuant to which
Building Permit No. 23656-Z dated SEPTEMBER 3, 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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE ENCLOSURE TO
CODE AS APPLIED FOR.
The certificate is issued to NANCY L. FOOTE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE DATED DECEMBER 4, 1996- #14297
PLUMBERS CERTIFICATION DATED N/A
W / Z.
i�Z4� ,�/7
Bu' ding In ector
Rev. 1/81
70Bat NO.
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° 23656Z Date ............./ ............................... 19.f.�
,
Permission is herebyam ted to:
.....'�.�.7.... �..=. .� �.................. . ...............
to .��1'::-sf. �i . .......... '.`.�.......:'�`.��' ....... .`..!l.?>!'.?:.i/ " 7�`�
........ .. ...... . . - .. ... . . . .........................................
at premises located at ......��. V.....�(�.1�?:.....�.... .s::.................................................
..................................................... . .�1 �.� ,........................................................................
........................................................................................................./..77......................................................
County Tax Mop No. 1000 Section ......&, ....... Block ..../,C........... Lot No. 47.1 ........
pursuant to application dated ............ ....... ............... 19J�r., and approved by the
Building Inspector.
Fee $...•.!`Si�..
... ........... ........................
Ing"nspector
Rev. 6/30/80
Form No. 6
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 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 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.
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
Iq
/ Date . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . .. .. /fQ/. Old Or Pre-existing Buil ing. . . . . . . . . . . . . .
jtkLocation of Property.. .C ,1.4!. . .�:Y.�.�(./.S `�. .. . . . . . . . . . . . . . . f:1 .::'.`. . . . . . .
House No. Street• Hamlet
Onweror Owners of Property.. . . . . . . . ... ./.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. .. 1.t5��.. . . .Block. . /. 1. . . . . . . . . . .Lot. . . . �.r7 . . • • • .• - • -
Subdivision. . .//. . . .JJ. . . . .. .. .. ... . ... .. . . ... .. .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No Date Of Permit�/� /.�� . . . .Applicant. /Aq y
. . . . . . . . . . . . .
.
1
Health Dept. Approval. . . .. . . .. . . . . . . .. . .. . .Underwriters Approval. . . �. . _ • • • •
Planning Board Approval. . . . . . . . . ... . . . . . .. . . . .. /
Request for: Temporary Certificate. .. . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . . . . . .. . . . . . . . . . . . . . . . . .. . . .
s
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suauiNa DE".
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ VeFolNAL���� 1
[ ] FIREPLACE & CFIIMNEY
REMARKS:
DATE 511 -INSPECTOR _��G�
I'11,I,U 1 USlu:'1 I UN Io,vowl- DATE. 'OMMI,N'1'S �
------------
FOUNDATION
-- --- ---FOUNDATION ( 1!;,[,) w
OUNUA I ION (2N1)) �
1 �
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Roll( II FRAME h '
I{
ITIIMIt I NG
I'
INSULATION ('I:R N. Y .
STATE.. F.NFMCY
..... . ... ....
conF.
- al
I
F1NAI. {
ADDITIONAL (OFIMI?N•I.,:
tt
9
9
C*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 CALL
' TEL.: 765-1802 " " " " " " "
MAIL TO :
Examined . . . .
Approved . . . . . •�� . . . . ., 1 Permit No,,) i� w.
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
or)
. . . .^. l' ' . . . . . . }OVWiV &�FfJ 6'{+.- -,4,,L ,.......,
(�ng spect
APPLICATION FOR BUILDING PERMIT
qDate . . . I
./. . ., 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 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 of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York and ptbar("lioW - s, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or deinblitiQQ as herein described.
The applicant agrees to comply witlIJOWM$Fl�l�inances, building code, hodsing cbde;`anZ regulations, and to,
admit authorized inspectors on premises and lbflig for necessary inspections. I_
. . . .�c (rye_). .VA V<ZX21 S.. . . . . . . . . . . . . . .
(Signature of applica , or name,if a corporation)
A-.moo. . ppig .�Y.1 . . . . . .76
.
AQ Y�NA9UU
(Mailing addr of applicant)
State whether applicant is ownerjummohnawieer, general contractor, electrician, plumber or builder.
cam. . . . . . . . . . 3T1�?I�ITA�I .TUQHT ': . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises
Xe.U�.✓2Y, g1� `
(as on the tax roll or latest deed)
If applicant is a oration, signature f duly authorized officer.
. . . . . . . . . . . . .
ame and le of corporate officer)
ALL CO TRACTO ' S M STZ�BE SFOLK COUNTY LICENSED
Builder's License No. o J 414- P1. . . . . . . . . .
Plumber's License No. . . . . NIA. . . . . . . . . . . . . . .
Electrician's License No. R(o.-75.E. . . . . . . . . .
Other Trade's License No. . . .�M. . . . . . . . . . . .
1. Location of l`aAnld ofn which proposed
�/work
Qwill be
done. . . I /
�a.� . . .VU 1 l .S. . .�! . . .!. . . • ,I. !`. . . . . . . . . . . ^!1�..*: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
House Number 1I11 Street Hamlet
County Tax Map No. 1000 Section . . . . .![. . . . . . . . . . Block . . �. . . . . . . . . . . . . Lot .�.�'.13 . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises
and intended use and occ�uppaan/cly/of proposed
construction:
a. Existing use and o cuprancy . 1✓1 l s✓ � 1'• �:"t-�!1. . w�(,�, . .0
s
9 b ntended use and occupancy . . . . • • • • '
3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration
Repair . . . . . . . . . . . . . . Removal . . . . . I . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . Lam?I . . . . . . . .
n (Description)
4. Estimated Cost . . . . . 7.QR� 040. . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . (Description)
. . . . .
( (to be paid on filing this application)
S. If dwelling,number of dwelling units�� �� �!�-� Number of dwelling units on each floor . . . . . . . . . . . . . . . .
Ifgarage,number of cars . . . . 'Ca. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
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 of Stories . . . . . . . .
9. Size of lot: Front . . . . . . . . . . Rear . . . Q". . . . . . . . . . . Depth . . . . . . . . . . .
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated 'P.4.0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded . Will excess fill be5emoved from premises: "Q Yes No
�i
14. Name of Owner of premisesK. . . .�. . . . . . . . . Address?gO.�L {.S U: k�.P one No. `
Name of Architect �� , Adc e,�
Name of Contracto�� :PQ .a
�` e�• r�'",SWtmK�r10Ad��reesss''471 1 P elNo 7 - .11 . . . .
15. Is this property located within 300 feet of a tiidal�� wetland? *Yes . . . . . No �. .
*If yes, Southold Town Trustees Permit LOy_ ed.
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 whether`
interior or corner lot.
APPROVED AS NOT�E�D� -
DATE: �,if 3 9 B.P. -23&5& ��R$
FEE: �'�' BY:
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION • TWO REDUIRED
FOR POURED CONCRETE OCCUPANCY OR
2. ROUGH • FRAMING & PLUMBING
3. INSULATION USE IS UNLAWFUL
4. FINAL - CONSTRUCTION MUST
COMPLETE FOR
ALLB CO STRUCTIONC SHALL MEET WITHOUT CERTIFICATE
THE REOUAREMENTS OF THE N.Y.
Si ATE CONSTRUCTION & ENERGY OF
I nr(�OCCUPANCY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW OIj�K, S.S
COUNTY OF . . 6I.K_ . .
• • • • • • • • • • • • r1 T-.'- p4�. -� �. . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heis the . . . . . . . is I A�.�!\ . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(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
. . . . . . . . . . . . . . . . . .day of. . . . . . . . . .. 19 9 So
Notary Public, . . . . . . . . .K6yHAGER
WFei:uyNo.5,State cf,3 .
CueaMd in SuftoUi3 . . . . . . . . . . . .
Ccmntis Wm y � 7 ignature of applicant)
FROM RANDY T. RODECKER -- PHONE NO. 516 474 0921 w Nov. 06 1996.02:37PM P2
G
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t=
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I I I i l I i l i
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�i r Orr POOLsaooTM• .oN sate TTrt• s�a►ta = � t•
RANDY T. 8009= R• INC.
' Tt OtS}CShL S"LL K Ltwtp To Ow•t WS twin KING PC=
tai i :Z' f t t 1 22 I e I e i Q I • ) 4 , SR Isom em"1 1e UoT LOCAL SC 6YL TI a Ns•
rn� torr. :Sw
• NOUS! ,. '
. pR•N1.O
�a�.•n.e Nx,.n.l LOT COVERAGE:
IML.•Io.4 5�.•Y.4
UPLAND AREA =36500 S.F.
AREA OF HOUSE DECK PORCH,
I t l BRICK PAVERS S PObL a 3850 S.F.
LNa.all e'lal .. LR�d4 o YO MIuL ASPHALT DRIVEWAY = 1400 S.F.
D9N1T, W' ►A {irfl[ TK►IK Ga�b►eei:'
TOTAL PERCENT OF
UPLAND COVERAGE * 19.8gfo
•' igig-rte_fL 1.4
P'ROPbStD SANIT/gCY SYSY�M
uss (3) MOL, wtva
1
N 'Is ° SC 'A L (p
OV ED AS PEA Of CppO1 9Qz ,�a '
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Is
OCCUPANCY OR
,,,,yEv o 4
o e4op ,,1'�+ o A °` -re-jr E USE IS UNLAWFUL
kM �QO° DAlfa-1*-&-94
TIMt 1 1 oo in vA.
WITHOUT CERTIFICATE.
eL.•�.s o.o'
OF OCCUPANCY
LOAM
9.0
� SAND
NOT NIL.• 1.4 7 e' 6lreut lv WAY0It
MEM"M� WArst lIJ
I.S NDINGS SHOWN THUS '!
l •2) ARE SnwO
REFERENCED TO MEAN LOW WATER
2.ELEVATIO NS SHOWN HEREON ARE FROM ACTUAL SURVEY UNDERWRITERS CERTIFICATE
AND ARE REFERENCED TO N.G V.D.( MSL 1929). REQUIRED
3.FIRM ZONE"A 4"BASE EL.=8.0 CONTIGUOUS WITH 8 CONTOUR. «
4.AREA= 45 744 S.F
5. •111=NUMBERED LATH SET
SURVEY FOR MAY 29,199
FEB. 28,1995
NANCY L. FOOTS JAN. 18, 1995
OCT. 1 I I1
LOT NO.139"HARBOR VIEW AT MATTITUCK11 NOV. 1994
,1994
AT MATTITUCK DATE: JUNE 10,1994
TOWN OF SOUTHOLD SCALE: I 50'
2 I r SUFFOLK COUNTY, NEW YM 140. 94•0305
M UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY 4 A VIOLATION OF SECTION 7209 Of THE
i
NEW YORK STATE EDUCATION LAW
u *COPIES Of THIS SURVEY NOT KARNi THE LAND
SURVEYOR'S INKED SEAL OR EMBOSSED UAL SMALL
MOT BE CONSIDERED TO K A VALID TRUE COPY
F
NOUARANTEES INDICATED HEREON SMALL RUN ONLY 10
TO CONSTRUCT
HEALTH DEPARTMENT-DATA FOR APPRO% t.
THE PERSON FOR THE SURVEY li PREPARED �
AND ON MY BEHALFLF TT O THE TITLE COMPANY,GOVERN-
N NEAIKST W GAIN MI.! III OF WATERT PRIVATE.�P IC_ MENTAL AKHCY AND LENDING INSTITUTION LISTED
M Swr C0. TA11 MAP i T-I&MCTION JIB.-BLACK-17 LOT 1�Ib HEREON,AND TO THE AffIGN ES Of THE LENDING O
*THEME ARE NO OW[LLMMS WITINN 100 FEET Of THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
OTHER THAN THOSE SHOWN HEREON. OWNERS
H THE+MATER SUPPLY AND$EMU DISPDBAL SYSTEM POR THIS MCA IDIEM #DISTAIICES SHOWN HEREON FROM PROPERTY LINES
WILL COMP AM TO THE STAMDAROB Of THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC
OF HEALTH SERVICES. PURPOSE ANO ARE NOT TO K USED TO ESTABLISH
APPLICANT& PROPERTY LIMES OR FOR THE ERECTION OF FENCE!
AIMESSAVENUE
TEL. YOUNG & YOUNG 400 9NW YORK
NOTE: •=STAKE FOUND 6= STAKE SET ALDEN W.YOUNG,PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED W THE OFFICE OF THE CLERK OF AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
SUFFOLK COUNTY ON AUGUST 21,1987 AS FILE NO.8377. HOWARD W.YOUNG, LAND SURVEYOR
111 IM LOCATKIOF WSLL(WI66UWnC"WASTiG Ctswao *v)M fHolrN
RE Hage" N.Y.S.LICENSE 00.45893
APROffnM FIELD aseMTIMS AM OR DATA O�TMMED FI R f
Ls.
9RAHDIs A some IMO.