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Home My WebLink About23358-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24429 Date JUNE 14, 1996 THIS CERTIFIES that the buildin~ ADDITIONS Location of Propert~ 475 WILLIS CREEK DRIVE MATTITUCK NY House Ho. Street Hamlet County Tax Map No. 1000 Section 115 Block 17 Lot 17.15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 2, 1996 pursuant to which Building Permit No. 23358-Z dated APRIL 9, 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 AN ADDITION OVER AN EXISTING FIRST FLOOR AND A RAISED DECK ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SAL TUSA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. 12248 PLUMBERS CERTIFICATION DATED N/A JUNE 1, 1996 N/A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT 'TOWN I~d.L $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ...... ~.E ..................... ,9.~ N~ 23358 Z Permission Is hereby granted to: ~ ../... ~~ .......... ....... ~../,,,,,,.,~~.,.,,~.,.,,.: ................................ at promises located at ............ ..~...~...'~.....~-~~.. .,', ......................... coun~Ta, .ap No. ,000 sect, on ........ /~ B,oo~ ...... ../...?. ........... LotNo.../...~...../..~ pursuant to application dated ............... ~i~.~....~....., 19,,. ,~..~..., and approved bythe ..................... g g p Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMEBFf TOWiq E~LL 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/I0 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 pian requirements. B. ' For existing buildings (prior to April 9, 1957~ ~on-conforming uses, or buildings and Vpre-existing" land uses: '4 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. 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20200 4. Updated Certificate of Occupancy - $50.00 5. ~Temporary Certificate of Occupancy - Residential $15.00, Co~ercial $15.00 ~ Date ......................................... New Construction O~d Or Pre-existing Building Location of Property..~..7..~.~..~. ~..~.~f~.~.~/~/~*~.... .~.~.~'~. t/-~..~'~. .......... House No. Street Hamlet 3nwer or Owners of Property .... .~.~.. ~.M~. ............................................. ounty T= No 1000, ...... Block .... ........ .... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ....... lequest for: Temporary Certificate ........... Final Certicate..~. ....... eesu, mi.ed: ............................. /I.//? . . .......... ELECTRJCAL INSPECTIOJ~ SERVICE INC. s7s outrro2g a rg~u~ EAST PA TCttOGUE, NE~V YORK 11772 (516) 286-6642! '~J~tOa: MATTITUCK tOWN: $OUTHOLD 12248 .4~PLI~ TION No. ON'FILE .4DDF, E~$: ~'H'.l'.ll.q (TR ~ii~J DR tU'~. - LOT# 1,~ Issr~so to: ,gAL TU, gA LICNo: I610-E , , INraODUCED IlZ' g. C. ELE~C ..... ' wa~tn~don ~.~1.96 a~f~ndmb~l. ~mp~anc~thth~Na~onalEl~C~ LO~TION: Ba~. ~ 1~ 2nd ,~ D~ Garag~ Hot ~b , Po ·OIItER $ O UT£ET~, I SWlTCH, I SMOKE DETECTOR, l LIGHT FO~ A 1 ROOMEXTENSION B UILDINO PEPal~T No. i BLUE ORIOINAL YI3LLOW COPY PINK C, )FY OFFICE Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 5, 1996 Mr. Sal Tusa 11 Regal Ct. St. James, NY 11780 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file.j xx The check is not on file. $25.00 . No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 23358-Z Please contact our office on this cooperation. matter. Thank you for SOUTHOLD TOWN BUILDING DEPT. lEI.Il Itl~WEt;(I. DII IU~l'Oitl U~II~ CUtlilI';,III.~ F~LIIII)NI' I {)Il (21t?)) COI~Ir, F I II^l. ^111) 1'1'1011^h COIIIII~.II I'S ~ ,, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]//~I~NDATION 2ND [ ]INSULATION [~]' FRAMING [~ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ~LATION [ ] FRAMING [~'] FINAL [ ] FIREPLACE & CHIMNEY REMARKS.. ~ DATE f/~/~, /~ INSPECTOR OPE R CY ESCAPE AS BY PART. 714 OF Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ..., SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 1 .~Permit No ......... Disapproved a/c ........ ' ~LICATION FO; BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTII 3 SETS OF PLANS ~SURVEY ................... '--ClIECK ..................... SEPTIC.FORH .............. FLAIL TO: a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 %ets 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 sti'eets ,or areas, and giving a detailed description of layout of property must be drawn on the diagram which i,s 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 Pe~Tait to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No butRlm'~-§llttl[/l~e~ ,o,g~t~?~dlor used in whole or m part for any purpose whatever until a Certificate of Occnpancy shall have been gra ~ted 1By t}~Bulldulg 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 South01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction :6f buildings, additions or alterations, or for removal/~ demolition, as herein described. The applicant agrees to comply wilh all applicable laws, ordinances, building code, h~ds~ co~, and regulations, and to admit anther[zed inspectors op premises and in bui!dh)g for necessa,'7 inspections. .Z~',/,,/ ~ '- . ? ~ (Signatur~/applicant or name, if a corporation) · '' ......... '" State whet[[er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... d. . ,e. ...................................................... Name of owner of pr~mises ...~. ,~/--~ . .'~.~.-.JT~? ...................................................... (as on tile tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ..... ' .................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land oil which proposed work will be done .................................................. · ........ ./_/. ...... z .z ............... [-louse Number Street llamlet County Tax Map No, i O00 Section ' Z/./..~.. .... Block....~.7. · ..... :... Lot ./?'../.."~/. ........ Subdivision .~..,'~..,~,~..~,d?'.~...Jt~.~.;~'~/'~..d~/.~d~ed Map No..~..~..7/ ..... Lot. /~.: ........ (Name) . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~.~'.o~../~)..~..~.~.'. ........... ' ' b. Intended use and occupancy .... ' ............ .,. 3. Nature of work (check winch apphcable): New Building .......... Addition ..... Alteration Rep ' R ~ I D liti air ....... ,~, ..... e love .... , ........ . cmo on .. : ......... Other Work ~. ............ 4. Estimated Cos · . escr on i ! (to be paid on filing this application) 5. If dwelling, number of dwellinjt~units .... ./'i ....... Number of dwelling units on each floor... Z ......... · If garage, number of cars .. ~X ................... ' ............................ , ~ ............. 6. If. business, commercial or mi.xed occupancy, speclfy_naAure and extent of.ca ) y e of use ~X.. ,/~. 7. Dunensionso~fexis, tingstructu,es, ifany:Front...ffd.~:x~ ........ Rear ..~..P . D~'".~. .......... Height ...~tt~.. ...... Nu~nber of Stories .... '~ '' P ..... ~?' ........ . ~Dm),e. nsm~ of same structure ~ith alterations o,r4a~ld,/tions: Front . .~..,~ . ' . ' ' ' 'I~;.~' ';~"~ ............. Deprl c-~ ..... i I-Ia kd~t ,:b(/_~ ~.?' '. '~ ......... ~- .a..~ · . .....) ......... ..... ' ....... . ....... ~ ........ /...~.-~ ....... .. · mumve3..~f.,Stories -- . .o( . 8. ~mensm~ o~nhre new construction. Front .,~.q(. Re -/"d ' ;-J ' ' J' '-'%'£ ......... u · ~ · J // ~ · ' ..... >r ..... : ar .... ~. ~ ....... iJeptn ,,,~p. . ,,eign, ~,~. ~ ...... ,~ ...,, I'JUOber of Stories ....~( ..... ' ........ 9. Size of 10t' Front ~)~. ~.. ' ' Rear.'.. ' ' )~'-,) ..... ~ ....~- ...... 'O Y,~'~L' ' qa '~' ....... .... '. "yy~"~,.'l'7~. ............ ,,-. .w~ ....... Depth .,~t~.~.: ..~.~.~ . . 10. Dare Ol~'urcnase . ~ ~ ~ ........... ...... :Z,x. ..... Fo mer ow, ........... 11. z.o ~ et use restrict in wnlcll prelmses are mtuated ,~.~",d".e".~,~'.,~ ....... ~, .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~ .......................... 13. ,W. dl lot ~be..regradeod .../l~.~.~,.~b7' :--)-?;f~d:} ........ Willexq .ss, Ji.be r_em_oy a from pre,nises:___ Yes . 14. P~mneoluwnermpre~niseso)~-f.~. /.g.o..,-.r . .Address/./_._.A-l~_d'.)~._~. ~'- ,,- -, ".~// , ................ :~.. .... rnone cm/'~..- o/~,.. Name of Archit~ct ,.~., .... ~"'~.'~,,~'~'J~ ,;4/Z)' ,,, ~ · ... C//~, .. · '~c~' ' I ................ txume~ ........... /~... rnone r~o ....... Name of Contractor ,~,~+' .~./~r'~. ^ad .... 2/~'7oe"~ ,. , · ..... .... 15. Is th:rs property within ,300 feet of a tidal wetland? *Ye's ' '.' .'.' ~'Io. ff~.'. ................ , *If yes, Southold ~own Trustees Permit may be requir~' ' ~ ...... PLOT DIAGRAM Locate clearly and distinctly allI buildings, Whether existing .or proposed, and, indicate a I set-back dimensions from property lines. Give street and block inumber or description according to deed, and show street nmnes and indicate whether interior or corner lot. STATE OF NEW YORK, above named5Nam~ of individual signin} contract) UNDERWRITERS CERTIFICATE REO~UIREO · AS NOTED DATE: ~S.R #~ FEE: ~ NOT(FY BUILDING DE~ 761~802 9 AM FOLLOWING INSPE~IONS: 1, FOUNDATION . ~O REQUIRED' FOR POURED CONCRETE 2~ ROUGH . FRAMING & PLUMBING 3. IhSULATION 4. FINAL CONSTRU~ION MUST BE COMPL~E ~R C.C., ALL CONSTRUCTION 8HALL ME~ THE REQUIREME~ OF ~E N.Z STATE CONSTRU~ON CODES. N~ RESPONSffi~ FOR DESIGN QR CONS~U~ON ..... being duly sworn, depose~ and says ti)at he is the applicant ' ontractor, agent, cor ' ' ' ' ' ' ' ' ' ',/' (C ............... . porate officer, etc.) of said owner or owners, and is duly huthorized 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 anner s~t forth in the application filed therewith. Sworn to before me this I Notary Public, · " ! ........x ...... County AmRY. s. UsA NOTARY PUBLIC, Stat~ of New. York ........ (~tJalified in Sulfa k CountY,~ (S gnature of applicant)