HomeMy WebLinkAbout23030-zFORM
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
N_o
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNT1L FULL
COMPLEllON OF THE WORK AUTHORIZEDI
23030 Z Dote ........ ~..~ .............
Permission Is hereby grante~~ ~~..~
at premises located at ...................... t .........................
Counly Tax Map No. 1,300 Section ....... /.,~..'~....., Block .......... ,.,~... ......... LotNo ..... /...~..... ............
p.rsuo, toapp,,ca,,o, dated ..........................
Building Inspector,
~ Z~~
Rev. 6/30/80
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 23929-Z
Date OCTOBER 5r 1995
THIS CERTIFIES that the buildin~
Location of Propert~ 1455 MARX'S
House No.
County Tax Map No. 1000 Section 139
Subdivision
ADDITION & ALTERATIONS
Street
Block 4 Lot
Filed Map No. Lot NO.
Hamlet
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 16¢ 1995 pursuant to which
Building Permit No. 23030-Z dated SEPTEMBER 28~ 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 CONBTRUCTA FIRMPLACE~ RMC~EATION ROOMS AND Ei~W_~%RGE AN
EXIBTING DECK TO A SINGLE FAMILY DWELLING AS APPLIED FOR
AND "AS BUILT".
The certificate is issued to
ROBEM~I~Y & ROBERT STEIGERWALD
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N/A
NIA
N/A
Building I nspe/or
Form Mo. 6
TOWN OF SOUTttOLD
BUILDING DEPARTMENT
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR'ink and submitted to the building
thspector 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 (p~ior 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 ox 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
i. 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Cemmercial $15.00
· , · · ~ February.13, ~995
~0 for' fire~.a~.jn liviog, rccm;,f~l~hed~ow~r I~vel. Date ...............................
aew cons~rj~zon ........... 01d Or Pre-existing Building .................
Location Property .. !4~ ~acy's ~0~dI Mattituck
............................................
House No. Street Hamlet
Rosemary Steigerwald
Onwer or Owners of Property .................................................... . . .. . .. . . . . . ..
14
County Tax Map No 1000, Se ' 139 . .
ct~on .............. Block..4
............ Lot... ...................
577
~ubdivi ion ~.o~ ~a~n. Heights Fil d Ma ............ Lot ......................
~ s ........................... e p
Permit No ................ Date Of Pe~it ................ Applicant ............................ .
Health Dept. Approval ...................... . . .. Underwriters Approval .........................
Planning Board Approval ................... ... ...
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $.... . ..........25 ~j R.Y..F~6N..NF.R. OLSEN,.. ESQ.
. % P.O. , ,0x
CUTOHOGUE, Lit N..¥,-~l.f)35
~.;~ ~ ~._q - ~PLIC~
FIEI.D INSPECTION RE[OIIT DATE COMMENTS
FOUNDAT ION (IS'F)
FOUNDATION (2ND)
ROUGII FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
LAWRENCE M. TUTHILL
PROFESSIONAL ENGINEER
P.O. BOX 162
GREENPORT. N.Y. 11944
(516) 477-1652
June 5, 1995
To whom it may concern,
On thursday, May 25, I inspected the chimney on the north side
of the residence of Rosemary Steigerwald at 1455 Mary's Road Mattituck,
NY 11952. I noted that the chimney did have a steel wrap around brace
bolted to the side at about ceiling height of the first floor. This
arrangement has proven satisfactory. I feel that the chimney meets the
requirements of the New York State Unifor~ Fire Protection and Building
Code.
Sincerely,
ce M. Tuthill
FEB : 6 1995
B~,DG. DEPT.
: ~C,~N-O-P-~OUTHOt ti .... SOUTHOLD, N.Y. 11971
} ~~. ,., TEL.: 765-180,::~
Approved 19~...~Permit No. 2 ~..~. ~.9
Disapproved a/c .....................................
BOARD OF HEALTH ......
3 SETS OF PLANS .......
'FORM NO. I SURVEY ..........
TOWN OF SOUTHOLD CHECK ..........
BUILDING DEPARTMENT SEPTIC FORM ............. ~
TOWN HALL
CALL .............
MAIL TO:
' ~,'Inspec
/ ~EICATION FOR BUILDING PERMIT
Date
·..F.e.b.r. qclr. y..1.3. .....
1,c
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, w
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 sl
or areas~ and giving a detailed description of layout of property must be drawn on the diagram which is part of this
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 p,
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 Oceup
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to tke Building Department for the issuance cf a Building Permit pursuant
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin de$cz
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, a~
admit authorized inspectors on premises and in building for necessary ~ctions.
(Mailing address of applicant)
State whether applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui
owner
Name of owner of premises . i BP.S.~.m.a.rY..S.~.e.i.g.e.q~.a.I.d ................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) ·
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY
Builder's License No ..........................
Plmnber's License No .........................
Electrician's License No .......................
LICENSED
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..............................................
1455 Mary's Road Mattituck
House Num bet Street Hamlet
County Tax Map No. 1000 Section
Subdivision .M.a.p..qr..qqr. O.e.q .H.~i.§h.~.s. ............... Filed Map No. 5.7.7. ........... Lot ...2.fi..$..2.7...
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existiw, us,~-a ............ Applican~ seeks buildin~ permits and CO for the foll_owi,og ,
a. i t em s: a s ~ ~,Fl~:.~i~i.¢,~,l h~, 6.
.... ~n large 0eCK as DUI~I:.
b. lnrenueu use anu occupancy ......................... '/¥..X ........fi,,/..1 ......; .)Xt ....
3. Nature of work (check which applicable): New Building' Addition .......... Alteration X. .......
Repair .............. Removal .............. Demolition .............. Other Work .............
See annexed ~survey showing approximate location of shed and deck (Description)
4. Estimated Cost ..'~'.,,~...~.. ............................ Fee ....................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ..............
It' garage, number of cars ......................................................................
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 of Stories ......................................................
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 ...................... Deptli ....................
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: ..............................
13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes ix
14. Name of Owner of premises .................... Address ................... Phone No ..............
Name of Architect ........................... Address ................... Phone No ..............
Name of Contractor .......................... Address .... : .............. Phone No ..............
15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .....
*If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions fro
property lines. Give street and block number or description according to deed, and show street names and indicate wheth
interior or comer lot.
See annexed survey.
STATE OF NE~'
COUNTY OF ......... S.S
..... .R.o.s.e.m.a.r.y..S.t.e.i.g.~.r.w.a.l.d ........................being duly sworn, deposes and says that he is the applica
(Name of individual signing contract)
above named.
Owner
He is the .......................................................................................
(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 tt
application; tliat all statements contained in this application are true to the best of his knowledge and belief; and that t
work Mil be performed in thp-mxanner set forth in the application filed therewith.
Sworn to before me this
............ of... .....
Notary Public, ~f:, .?~~~..~,
'< , · .........