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Home My WebLink About22741-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25853 Date: 07/27/98 THIS CERTIFIES that the building ADDITION SOUTHOLD Location of Property: 3905 WELLS RD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 86 Block 2 Lot 14 Subdivision Filed Map No. __Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18, 1995 pursuant to which Building Permit No. 22741-Z dated MAY 9, 1995 was issued, and conforms to all of the requirements of the applicable provisions of the law. The o¢oupanoy for which this certificate is issued is ACCESSORY STORAGE SHED ADDITION TO EXISTING WOOD DECK AS APPLIED FOR. The certificate is issued to ROBERT E. ANNE N. MITCHELL (OWNER} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N356686 06/29/95 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the.Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25854 Date: 07/27/98 THIS CERTIFIES that the building ADDITION Location of Property: 3905 WELLS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 86 Block 2 Lot 14 Subdivision Filed Map No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18, 1995 pursuant to which Building Permit No. 22741-Z dated MAY 9, 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 WITN SWIMMING POOL AND FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to ROBERT E. ANNE N. MITCHELL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N356686 06/29/95 N/A Rev. 1/81 FORM NO.3 TOWN OF BOUTHOLD BUILDING D~:PA~TMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT ITHI$ PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Dote ,...~..~..~.. ...................................... N_o 22741 Z Court, Tax Map No. 1000 Section ......... ~ ......... Block ......... ~ ........... Lot No ...... Z~ ............. pumuan~ 1o app~lco~ion dated ................. ~ ...................................................... Building Inspector. Rev. 6/80/80 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: i. 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 co~tains 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 '!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 Buildin~ - $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 New Construction .... ~..... Old Or Pre-existing Building ................. Location of Property.. ~O~ ~.~-~.~ ~p~. /.~..-~..../%(.~. ...... House No. Street Hamlet Onwer or Owners o ~-v~j ................ _ .................................. County Tax Map No i000, Section .............. Block .............. Lot ................... Subdivision ............................ ... .. . .. Filed Map ............ Lot ..................... . Permit No .............. Date Of Permit ...... Applicant ............ Health Dept. Approval ........................ .. Underwriters Approval ......................... Planning Board Approval ..... Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $.~.~.~.f ................. /~..~...~~ ~ ~..~...~. C0 % 05 53 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A4 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: i. 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 I% 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 Upre-existing" land uses: 1. Accurate survey of property showing ali 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 - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...~..~../. New Construction ......... Old Or Pre-existing Building ................. Location of Property ................................................ . House No. S ~reet Ha~et Onwer or O~ers of Property. o County T~ ~p No 1000, Section .............. Block...~. ........... Lot. JJ. .................. Subdivision .................................. Filed Map ............ Lot ............. Permit No~~'l I ~ ~o~ L~. ~,rc~ ............... Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $.~.~ .......................... .3 ArrLICA r FIELD REPORT DAT~ CON~ENTS FOUNDATION (]ST) FOUNDATION ( 2ND ) ROUGH FRAME & PLUMBING II INSULATION PER N. Y. STATE ENERGY CODE II ADDITIONAL CO~NTS: ~he O£fica of Hearing. ~ith a recom~enda~i~m of THE NEW YORK BOARD OF FIRE UNDERWRITERS · 11~5077 mUREAU OF ELECTRICITY V 't. SS JOHN STREET, NEW YORK, [flEW YORK 10038 Dat~ ~ 29,1995 /IpplicatlonNo. onfile 07337795/95 N 356686 THI~ CERTIFIES THAT only the e~trica~ ~uipment ~ ~scribed be~w a~ inflated by t~ applicant ~ on t~ a~ve application nu tuber in t~ prem~es of ROBERT & A~ ~TC~, 3905 ~S RO~, PECONIC, N.Y. in the following locatlon; ~ B~ement ~ Ist FL ~ 2nd FL O~ S~tlon Bilk Lot ~s examined on ~ 26,1995 and found to be in compHance with th~ Na~onal Electdcal Code. ~T. K. W, O~L H. P, GAS H, P ~J~T, NO, A W. O, RANGES PECIAL REC'PI R TIMECLOCKS t BELL UNTHEATERS MULTI.OUTLET SYSTEMS mT, A~P$. TRANS. NO. OF FEET ¥ I C A. W, O. NO, OF HI-LEG A, W. G OF CC, CONO, OF HI-LEG EXHAUST FANS AMT. H. P DIMMERS AMT WATTS AW.G NO. OF NEUTRALS OF NEUTRAL OTHER APPARATUS: SWIMMIGN POOL- 1 TIME CLOCKS 40 AMP-I G.F.C.I.-! PANELBOARD$, 1-2 CIR. 100 *(SWI~4ING POOL) This certifica~e covers compliance at the date of ~nspection only. Because of unusual environments it is advisable to have ~reque~tt test/and or repairs <<< Continued on Page 2 >>> Gm~RAL MANA.G. ~E~ Per \. , This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTS/lENT. THIS COPY OF CERTIFICATE MU~T NOT BE ALTERED IN ANY MANNER, " THE NEW YORK BOARD OF FIRE UNDERWRITERS PA~E ~ -- --~8~.,, Bu.~^u oF ~'ECTR,C,TY 85 JOHN STREET, NEW YORK. NEW YORK 10038 O~t~ ' JU~ 29,1995 ~ppl~cation No. o,f,e e7337795/95 N 356686 ~ THIS CERTIFIES THAT o~y the electrica~ equipment ~ ~scrJbed be~ a~d intr~uced by t~ appl~ant ~med on the a~e application number in ~he prorates of in the followlng location; ~ B~ment ~ Ist FI. ~ 2nd FI. O~T Section Bilk Lot ~s examined on J~ 26,1995 and found to be in compliance ~ith the Na~onal El~ctdcal Code. FIXTURE OUTLETS EECEPTACLE$ SWITCHES FIXTURES RANGES OVENS E)ISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET E E R V I C NO, OF CC. COND, A W. O NO OF HI-lEG A. W G. NO OF NEUTRALS A W, G, PER ,e' OF CC, COND OF HI-LEG OF NEUTRAL OTHER APPARATUS: made by a qualified person. ROSLAK ELECTRIC P. O. BOX 164 CUTCHOGUE, NY, 11935 LIC. #3677-E GENER~LMAN&GEII Per This certificate must not be altered in any manner; return to the office of the Board if .incorrect Inspectprs may be identified by their credentials. ........COPY FOR BUILDING DEPARTMENT/T_.:~_~[~I~IS COPYr OF CERTIFiCAT.[{~.MUST. NOTBE ALTERED. IN ANY MANNER . TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 Bo APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewrlter OR ink and submitted to the building inspector with the following: for new building or new use: I. 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). Approval of electrical installation fro~ Board of Fire Underwriters. 4, Sworn statement from plumber certifying that the solder used in system contains less than 2/10 off 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 "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 applicatio~ 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 ~riting to the applicant. C. Fees 1, Cer=ificate of Occupancy - New dwelling $25.OO, Additions to d~elling $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-existin~ Buildin~ - $~O0.00 3. Copy of Certificate of Occupancy - .25~ 4, Updated Cer=ificate of Occupancy - ~50.00 5, Temporary Certificate of Occupancy - R~sidential $15.OO, Commercial $15.O0 New Construction.,.~,~''.'' Old Or Pre-existing Building ................. ocation of roperty.. 3 o5' . P. .......... ........ House No, $Cree= Hamlet -..' ............................. Onwer or Owners of Property .................. County Tax Map No 1000, See=ion ......... Block ..... Lot ......... Subdivision ............................. Permi~ ~o .............. Date Of Permit. Health Dept. Approval ................... ....... Filed Map ............ Lot ...................... ............... Applicant ...................... ....... Underwriters Approval ......................... Planning Board Approval ,- · Reques~ for: Temporary Certificate ..... Fee Submitted: $.?.~,~ ................ ,. . Final Ce~icate ........... APPLICANT BUILDING DEPT. INSPECTION [ ] FOUNDATION 15T [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROU/GH PLBG. / [ ]/INSULATION [ ~] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,~*~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~ULATION FRAMING [~/] FINAL [ ] FIREPlACE&CHIMNEY REMARKS DATE ~///~//~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] R~GH PLBG. [ ~U~SULATION [~/] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ~/c.~ ~//~//~ INSPECTOR~//~/ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~ULATION FRAMING [~/] FINAL FIREPLACE & CHIMNEY DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Disapproved a/c ..................................... ~ APPLICATION FOR BUILDING PERMIT BOARD OF HEAl. TH .......... 3 SETS OF PLANS ......... SURVEY ................... CIIECK .................... SEFTIC FORM .............. NO?IPY ~ ..... MAIL TO: Date .... .t//.(~. ......... '19 ?.~ INSTRUCTIONS a. Tiffs 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 las/out 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. -i" 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 other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit, authorized inspectors on premises and in building for necessary inspections. .... ...... -- (Signature of applicant, or name, if a corporation) . .g: .o:. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ ~. &~..~.~..~.......co~rrc..,~...~.~x .......................................... Name of owner of premises ....... ~..O.f~.~.~..~ .... .~....~..~..~. ..... .~../.T'..~¢L.¢ .......................... (as on the tax roll or latest deed) If appli~xt~ a cor~,~mti~/~,/sd~atu~ of duly authorized officer. ! (Name and t~tle or' co/~rate officer) Builder's License No .... ~./.¢. ~.~. %..../f~.~-. ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ..... ~..g~.C..~ .... .~../~P...'7..~.0.~7--~..C. ~ .......... · ......... ......... .... .............................. House Nmnber Street Hamlet County Tax Map No. 1000 Section ....... ~.~. ....... Block ...... ~ ......... Lot ...... ~../7(. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occupancy ............ "ff~' '~'/' ~'~' '/'~-f' '~' 'ffi/~YgOgg ;tT/~3~,~ff)$ ........................ Existing use and b. Intended use and occupancy ............. ~f. ~~ · · $~.9 ~~,~,mD ~ ' ................ 3. Nature of work (check which ap~plicable): New Building .......... Addition .......... Alteration-. ......... Repair .............. Rem6val, .............. Demolition .............. Other Work... ~ ........ (Description) 4. Estimated Cost .e ~.O.o.O. ,.*--~ .. Fee '~ (to be paid on filing this application) 5. If dwelling, number of dwelhng cmts ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth .............. Height Numiber of Stories ' Dhnensions of same structure wi,th alterations or additions: Front ................. Rear ................. Depth : Height Number of Stories 8. Dimensions of entire new construchon:. Front ............... Rear ............... Depth .............. Height ............... Number of Stories ............................................. -.' ......... 9 Size of lot: Front . Rear Depth 10. Date of Purchase ........... I ......... ' ......... Name of Former Owner ............................ 11. Zone or use district in which premises are situated ......... 12. Do s proposed construction wol~te any zoning law, ordinance or regulation: ......................... ' ..... . 13. Will lot be regraded ......... ~ ............... Will excess fill be removed from premises: No 14. Name of Owner of premises ..../~..t.~09r..L..a~. ..... Address . ..J'~??.t./?~..q~'~ ..... Phone No ................ Name of Architect ..... i ............. Address ................... Phone No. Name of Contractor ~..-. ~"/~./-..~7'. ~. ~.~. ~' ...... Address... ~2~. ! ~. Phone No. ii ~ i~i~.~.~. i 15. Is this property within 300 feet of a tidal wetland? *Yes.. ~.... No ......... *If yes, Southold ~own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whdther 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 whethetr interior or corner lot. STATE OF NEW YORK, S S COUNTY OF...~r~ ~.--~..5~.Lr.~.... :. ....... /.~..~7~.r~.. ~..,~.. ~.... ~/~.t.~.'....~..~.., ..... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .............................. ~ ................................................. ? .(Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl authorized to perform or have l~erformed 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 manor Set forth in the application filed therewith. Sworn to before me this //~ .......... ...... ..... ....... Nota. P blic, ...... County · ' ., ....... ...... Ne. 4721 189. Suffolk COo~y Term E;, irel~ May 31.19..~ TEL ~4-1~ ~ 0g:44 M~TCH~LL New York State Department of Environmental Conservation ¢,mmi~,loner s~de of the hoqoe to m~et ~he required 75' ~atbaok, Plao~men~ of