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Home My WebLink About22634-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF No Z-24974 Date APRIL 10, 1997 THIS CERTIFIES that the building Location of Propert~ 680 DONNA DRIVE House No. County Tax Map No. 1000 Section 115 Subdivision ACCESSORY MATTITUCK, N.Y. Street Hamlet Block 15 Lot 20 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. 22634-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 ACCESSORY STORAGE SHED IN REAR YARD 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. JEROME N/A N/A N/A ~~s~peCtor Rev. 1/81 FOBM NO,3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF '~HE WORK AUTHORIZED] Date .............................................................. 19 .......... 22634 Z Permission Is hereby granted to,'.,// ~,~L ~,~ h' ~,L..:_~~.. ............. ~ ~ ~~ ....... ~..: ........ ,¢ ............ ~....,~..~...../... ..:....~ ./...<....-.. ...... ~__._ to...,~CA_m_, ~../.,.~,.¢..:./.........~.....,/,...¢....¢.~.¢..~..~.~ ....... ~.~,~_ ~.~.,...... .x.,~,..:,,~......~...~.,~.~......~ ..~.....~......,¢~.,.~.. .....~...~./:...,..~?...~:....: ..~ ......... ~ .>..~: ....... ~~.....'.. ...................................................................... at premises Ioaated at .......... ~..~,~..~......~~'~'"...~'~'""~ ........................... County TaxMapNo. '1000 Section ...... /~ Blool( ........ .~..~ ..... LotNo; ~.,.~., ................. p,rs,~tto opp,,oot,o~ doted ............... ~..~...7...., ,,..¢.... ...~., ~-~' ~ppro, ed Building Inspector, Fee ~..."~..~ .... 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 ~nk 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-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, cO-dT~ssory building $25~00~ Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinm - $i00.00 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~i ! · .~../ ........................ New Construction....~.. ..... Old 0r Pre-existing Building ................. Location of Property.. ODD..~ .~ ~. ~.d~. D. CJ~V.~.. d..~..~.~/.Gr..~.,. ~ .~ ................... House No. Street Hamlet Onwer or Owners of Property...J~.fiO..~...¥/.0~..e~..~.,..~..~.~.~.~. ............................. County Tax Map No 1000, Section.. 775°. .... Block. /~ ....... Lot ~.O.. .... ·.. ......................... ............. Filed ap. ot. .... Permit No.~.~.~.~..~. ..~...Date Of Permit..'~/]2Z~..'"~. ..... Applicant.~'.~ .~ .~0.~..~.~-~CO PO~,~. Health Dept. Approval...................-..----Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ............ Final Certicate..~ ...... Fee Submitted: $....~.~ INSULATION PER H. Y. STATE ENER~'Y CODE It II II II FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971. TEL.: 765-1802 - B~,%KD OF HEALTH ........ /3 SETS OF PLANS ........ /suRvs¥ ................. ~,- c~ir-cK ........ NOT I PY; ................ HA I L . Disapproved a/c ' 'i'-:i:~:~i~' %i //Bui,dinglnsp¢ctor) Sl , ~. va5 ~!~ ~L~J~ A TION FOR BUILDING PERMIT ' . [ .................... j - ..... · 'BLOG. DEP[ TOWN OF SOUZ'HOU] ~ ' INSTRUCTIONS a. T~s apjlication must be completely filled in by ~pewfitcr orin ink and submitted to thc Build~8 Inspector; with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~8 location of lot and of build~gs on premises, relationship to adjoinin~ premises or pubEc street: or areas, and Eiv~8 a deified description of layout of property must be drawn on the diagram which is paa of this appli- cation. c. The work covered by t~s application may not be commenced before issuance of Bufldin8 d. Upon approval of this application, the Building Inspector will issued a Bufld~ Pe~it to the apphcant. Such sh~J be kept on the premises available for ~specfion throughout the work. ~. No buildin[ shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificatc of Occup~cy shall have been ~ranted bY the Building Inspector. ~ APPLICATION IS HEREBY'MAD~ to the Build~8 Depmmcnt for the issuance of a B~Iding P~it pursuant to the Buildin~ Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable Laws, Ordnances or Re[ulations, for the const~ction of bufld~s, additions or alterations, or for removal or demolition, as here~ described. The appEcant agrees to comply with all applicable laws, ordinances, bugd~8 code, housin~ode, and regulations, and ~ .' (Signat~of appli~t, or name, if a corporation) 680 Donna 9~ive, Ha~tl~uck, NY. ZIg52 (Mailin[ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ~eneraJ 'contractor, electrician, plumber or builder. Owners Name of owner of premises .... .. ~o~n & ~ane~ ~om~ ~ ,~ ~.~ ~ · · , ...... 'L.; ..... ' ' ~ . ' q[s~n lh~'tax 'roll"6~ l~tcst deed) If applicant is a co~oration, signature of duly authori$~ Offi66r},',,...¢' ' -~.. ~: :> .... (Name and title of co.orate officer) ~" < ' ,' ': ~ ¢~ ~ ' Builder% License No .......................... Pl~m,berk Lmense No ............... . ......... : Electrician s L~cense No ....................... Other Trade's License No ...................... Loc tie oil d lict d k illb d a n an onwl ~propose wor w e one ............................... " ..... 680 .. onna Drive Mattituck . Itouse Num bet Street ,. Hamlet County Tax Map No. 1000 Section ... :$.1'5'. .......... Block ..... 15 ' Lot ..... .2.0 ............ Subdivision Deep Hole Creek Estates · ' Filed Map No. 4256 Lot 27 (Name) . State existing use'and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy single family residence ' b. Intended use and occupancy Shell .......... . ................ '.. '3. Nature of work (check which applicable): New Building ' ' ' Repair Removal .......... Addition .......... Alteration ............ Demolition Other Work She'c[ ..... 4 Estimated Cost .$%,5Q.0 ' ' . (Description) 5 Ifd ' · (to be paid on fiingthisa licat ) · welling, number ofdwe in~ unit~ N/A ,; ., . . PP on Ifgara e number f c.~r~ ................. . ~'mmoer ut dwell ng units on each floor .. 6 Ifb ' ' ' ' ......................... 7 ' ' 'ex ti ........ ,~ occupancy, specuy nature eno extent of.erich type ofuse .. N/g,. · Dnnensxons ol is ng structures ..c . ~- - ~9 ~ ,., ........... · ~ront...¥~- .......... lxear .... th 3~ ' 'Y +~ ,,an ' ight ~ fSt .1 ~ De~ - lie ............... umber o Dries .... ' .............. h e ith It ..... ~ .................. Dimensions of s me structur w aerations or additions: Front ............ ear ......... pth . . ..... R 8 ~; ............ ~ .i .... Height ............... :.. Number of Stories ..... ' f 12.'. ................ · mensions o entire new construction: Front ............ Rear ............... De ~ ~ pth ............... el ~ .. .............. umber of Stor/es 5 ........ , ............. l~ear ..... 0.'. ..... Depth 1.812~ ! ' ' ''~ ..... 10. Date of Purchase ........ · ...................... · ' · ......... ' ........ .. Name of Former Owner I 1. Zone or use :str,ct m whic ~ premises are situated ........... '.. ' ................. : ....... ' g I ....... ......................... 12. Does proposed construction ~iolate any zonin aw, ordina ce or regulation . . . 13. Will lot beregraded ... No ...... . : ..... ; · . ............ ,. o ~ ~ .~ , ~ .: ............. Will excess fill be removed from premises: Yes 14. ~mne o~Uwnero~remises ..0.onn &, dan.et Jerome Address Same as on front 298-.1016 - ' ................. ' .......... Phone o ........... ;.. Name of Architect ':' · '" Add N ........................ ress ........ ' ........... Phone No ................ Name of Contractor . .. ~..~e.e.:.be.l.o.~.. · · .... Address ............ : ..... Phone NO ....... : ' 15. I.s this property within 300 fee~' ~'f' ~' tidal wetland? *Yes ....... ~ X ' ' ....... · If yes, Southold Town Trustees Permit may. be required. - . t~o ......... .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicate whethe; interior or corner lot. See, attached s.urvey *Shed is pr~built & will Be delivered by K~ufold's (see information attached) # NOTIFY BUILDING DEPAR~ 765-1802 9 AM ~ 4 P~FOR THE OCCUPANCY OR i USE IS UNLAWFUL WITHOUT CERTIFICATF_ :OF OCCUPANCY STATE OF NEW YORK, COUNTY OF .s.uF AK s.s John Jerome (Name of individual signing contract) above named. FOLLOWING ,INSPECTIONS: '1., FOUNDATION TWO'REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. IhSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FORC.O. ALL CONSTRIJCTION SHALL MEET 'THE REQUIREMENT~ OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN O.R CONSTRUlJilON ERROR8 being duly sworn, deposes and says that he is the applicant He is thc owner/applicant . : (Contractor agent officer " ' , , corporate , etc.) of said owner or owners, and is dulyl authorized to perform or have performed the said work and to make and file this ~pplication; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the ,york will be performed in the manner ~ct forth in the application filed therewith. ' 5worn to before me this .......... ,, .: ........... day of. ., .... ' ' 95 .. .......... 'otary Public .... ,r;~.: Suf£oYk' County . . - r,: .... ' ........ Margaret Dudek, Notary P~blic ... State of New York, Suffollk Countv . Conuni~ion Ex 'res Sept.. 30, 199~ , John Jer~ ' (Signature of applicant) --No. 46~642 ' 765-180;2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I/NSULATION [ ]FRAMING [~j/FINAL ~/~ [ ] FIREPLACE & CHIMNEY REMARKS: ~ ~:~/~-- ,~ ~' ~, DATE INSPECTOR~~ N 02' 40' 40" E ?I0.00' 110.00' ~,g~-S 02' 40' 40" W '~ DONNA DRIVE