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Home My WebLink About22635-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24973 Date APRIL 10, 1997 THIS CERTIFIES that the buildin~ ADDITION Location of Propert~ 680 DONNA DRIVE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 15 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 7, 1995 pursuant to which Building Permit No. 22635-Z dated MARCH 17, 1995 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 (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JOHN & JANET M. JEROM~ N/A N/A Rev. 1/81 FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ............ ........... N.o 22635 Z at premises located at ................................... r .................................... ........................ ~ ................................ ~.~..~...~..~.~.c,~_ ........ ~.~,..~ ............. CounlyTaxMapNo. 1000 Section ....... .~../.~,. Block ....... ~..,~ ...... Lot No. .,,..~.....~... ............... pursuant to application dated ................. .~,..~.~....Z, 1 9....~.,.~and approved bythe Building inspector, Rev, 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 simiiar 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. 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 Buildinm - $100.00 3. Copy of Certificate of Occupancy - ~ .25~. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 / Date ....... p .... ¢ .................... New Constructio.n~. ......... Old Or Pre-existing Building ................. Location of Property .... ~-O.~L.. ~.~.-,- ~ j ....... House No. Street Hamlet Onwer or Owllers of Property...~.O~O. /5 County Tax Map No 1000, Section...~-.'. ...... Block ................ Lot ...................... .... . .oJ.e....C.V .............. iled ............................ Permit No.~...' ......... Date Of Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate..~.. ...... 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~SULATION [ ] FRAMING [~/FINAL ~~ [ ] FIREPLACE & CHIMNEY R£MARKS: ,~ ~:~/~ ~ ~* ~, DATE INSPEcToR 765-~802 BUILDING DEPT. INSPECTION [-F~OUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL ..,INSPECTOR //~//'~ BLDG. DEP'L 'rOVtt~l OF 8QUTHOLD E amined FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 g0^~O oF ~£^LT~ ........ ~3 SITS OF ~L~nS ........ ~SURV~Y ................. /C~luc~ . . HAIL Disapproved a/c ' / / ( ui,di Inspeetor) " · AP~LI.,,.,,.,gtATION FOR BUILDING PERMIT Date ...... Mare. h :... ..iNSTRUCTIONS a. T~s application must be completely filled in by ~pewfiter or in ink and submitted to the Bulldog Inspector, with sets of plans, accurate plot plan to scale. Fee acco~ing to schedule. b. Plot pl~ ~ow~g location of lot and of bulldogs on premises, relationship to adjoining premises or pubic street: or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this appli- cation. c. The work covered by t~s application may not be commenced before issuance of Building Pemit. d. Upon approval of this application, the Building Inspector will issued a Bufld~g Pemit to the app~cant. Such pe~it sh~l bg kept on the premises available for ~spection throughout the work. e.: No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ceaificate of Occup~cy shall h3ve been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bulldog Depmment for the issuance of a B~lding Pemit pursuant to thc Building Zone Ordnance of the Town of Southold, Suffolk Count, New York, ~d other appEcable Mws, Ord~ces or Regulations, for the construction of bu~d~gs, additions or alterations, or for removal or demolition, as here~ deschbed. The a~Ecant agrees to comply ~ith all app~cable laws, ordinances, bufld~g code, housing code, and regulations, and to admit authorized ~spectom on premises and ~ build~g for necessa~ inspections~ ff ~ . . (Signature of applicant, or name, if a corporation) 680 Do~a Drive, ~ttituck, ~ 11952 (Marling address of applicant) ;tare whether applicant is owner, lessee, agent, architect, en~neer, generai 'contractor, electrician, plumber or builder. ~ers Name of owner of premises .. Jo~ & J~et Jerome .-,-,. ~ ~ ....... ~ ' ' (as o~ ":t~ ~ o[1':' ~ ' ~ ',or, t~s~ d - ................ If applicant is a co~oration, signature of duly authorized o.fficer~, ~-~ V".' 5 J ~'~ ''~ ~ ~ ~'~ * ~? 7 ~ ' ................ ~ff~. · ~ ,~ ~,~ ~x ~: ~ ,.. ,~ .... ~ (Name and title of co~orate officer) } ~ ~ ~ ~ ~'"~"~ ~' Builder's License No .......................... PI tuber s Lmense No ....... . ........ : Electrician's License No ....................... Other Trade s License No ...................... Location of rand on which proposed work will be done ........................ - 680 Dorma Drive Mattituck House Number Strcet Hamlet ....................... County Tax Map No. 1000 Section ...~.5. ............ Block 15 ..... :... Lot 20 Subdivision Deed Hole Creek Estates , 4256 27 .... :- · .. ............... · .............. Filed Map No ............... Lot ............... (Name) State existiug Use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy single family residence ' b. Intended use and occupancy deek 'with ramps ,'. Deck 'X · 3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration ...... Repair .............. Removal Demolition . Other Work '.. ~. ~)(~(...) ..... __~. ,'" . (Dcscriptio 4. Estimated Cost .~. · ..... . · ..................... Fee .................................. (to be paid on filing this application) 5. If dwelling, number of dwelling ypjts ....i.i.N./.A ......... Number of d~velling units on each floor ........... If garage number of cars : }y/v. .' . .. 6. If business, commercial or mixed occupancy, specify nature and extent of chch type of use .... ixJ/..~ ........... 7. Dimensions of existing structures, if any: Front...~¢[ ......... Rear .............. Det~th . .3.7.-+/ ....... lleight .. Number of Stories ~ ' ' Dimensions of shine structu're with alterations or additions: Front . 62' Rear · 4-! ' Depth .... .5.7. ................ ! leight ....... : ........ ,.. Number of Stories ...1 .... 8 Dimensions of entire new construction: Front 3P' Rear Depth .2.0.' ~eight ........ ....i ~_~3 Number of Stories ......... ................ ~,. Sizeoflot:bront . ' ,.,'. · '" ' ' D pti "~ .... Rear ............... e I ..... 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: ...ixJ~ ........................ 13. Will lot be regraded ..... ,N.9'. .................... Will excess fill be removed from premises: Yes ~' .. 14. Na~ne of Owner of premisesl .JP.Bn. & Janet Jqrqm. e. Address .S.a¢..e..a.s. 9.n. fVOrtt~... I'hone No..2.9.8Z.1.0.1.~. Name of Architect ' · ' Address ' Phone No Name of Contractor *.see. .b.~lp.w Address ' Phone No 1.5.' T.s this property within 300 feet of a tidal wet:land? *Yes ........ No ......... ~Zf yes, Southold Town Trustees Permit may be required. PLOT DIAG IUkM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dbnensions fl property hnes. Give street and block number or description according to deed, and show street names and indicate whe~ interior or corner lot. , See attached stmvey *owners will be b~ilding deck themselves STATE OF NEW YORK, COUNTY ....... OCCUPANCY OR USE! IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY S.S APPR'OVEI1 , "NOTED · NOTIFY BUILDING DE~ 765~,1802 9 AM TO 4 ~ FOR TH[~ FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE /2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O, AL[: CONSTRUCTION SHALE MEET THE REQUIREMENT~ OF THE N.Y, STATE CONSTRUCTION 8[ ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Jbhn Jerome being duly sworn, deposes and says that he is thc applic (Name of individual signing contract) above named. Owner/.applicant Ile is the ......................................................................... .. (Contractor, agent, corporate officer, etc.) ~f said owuer or owners, and is duly attthorized to perform or have performed the said work and to make and file u>plication; that all statements co'ntaincd in this application are true to the best of his kn.owlcdge and belief; and that .york wDI be performed in the manner set forth in the application filed therewith. ~wom to before me this State of ~ew York~ 8uffol~ Counex ..... ........... Commission Expires Sept. 30, 1996 ' JohWJerome~' ' '~Sign~[dk'ofapplica No..4675642 N 02" 40~40''' E 110.00' ?OST 110.00' ,,~- S 02' 40' 40" W 616.09' I~~- DONNADRIVE N 0~.' 40'40' E 110.00' I~~- DONNA DRIVE 616.09'