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Home My WebLink About22813-zFOP/~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Offioe of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23701 Date JUNE 13, 1995 THIS CERTIFIES that the buildin~ ADDITION Location of Propert~ 2140 DEEP HOLE DRIVE MATTITUCK NY House NO. Street Hamlet County Tax Map No. 1000 Section 123 Block 4 Lot 4.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 25, 1995 pursuant to which Building Permit No. 22813-Z dated JUNE 8, 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 ALE/tN TO ADDITION TO ANEXISTING OWE FAMILY DWELLING "AS BUILT" AS APPLIED FOR. The certificate is issued to THOMAS A. PALMER of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) N/A Rev. 1/81 /~ ~u{1/din~linspector FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN SOUTHOLD, N.Y. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22813 Z Date Counh/TaxMap No. 1000 Section .....~...~ ....... Block....../~... ............... ,. Lot No ..... ~.... ............ pursuant to application dated ........ ~ .......................... 19..~..~., and approved bythe Building Inspector. Fee Rev. 6/30/80 |:ora No. 6 TOWN OF SOUTIIOLD BUILDING I)EP/~R'fHENT TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to tbs building inspector with the following: for ,ew building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topograp|lic features. 2. Final Approval from |l.ehlt~ Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrics| iestallation from Board of Fire Underwriters. 4.' Sworn statement fromlplember certifying that the solder used in system contairs less than 2/10 of 1% lead· 5. Commercial building, Industrial building, multiple residences a ' ' · · aud installations,t'a certificate of C~d~ ~ ~' ~ nd s~mzlar bu~ldzngs respoosxbie for the building. 6. Submit Planning Board Approval of completed site plan requirements. 'B. F~r existing buildings (prior to April 9, 1957) non-coeforming uses, or buildings and "pre-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 tbs applicant. C. Fees 1. Certificate of Occupaucy - 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 Temporary ertmflcate of Occupancy - Residential $15.00., Commercial $15.00' Date ew Coustructmon ........... Old Or Pre-existing Buildfng .............. Location of Property ..... !l,. ..... }louse IX/O, ' - · .... S tree~m Hamlet Onwer or Owners ,.,f Property .... . .... Couaty Tax Map No 1000, Section..l~d ...... Bluck...(~...~.. ....... Lot..~..~..,.~.. ......... oubdivms~on .................................... Fi}ed Map ............ Lot ....... Permit No ...... D~te Of Permit .......... ' ............... Applicant ......................... !lealth Dept Approval · ' ......................... Underwriters Approval .... ... "lanning Board AiProval ~equest for: Temporary Certificate ........... Fiual Certicate....~.. ..... ....... ~ee Submi.t t ed3~ $ ...................... FORM NO. 1 TOWN OF SOUTHOLD TOWN HALL SOUTIIOLD, N,Y. 1197:1 Approved ........... Disal)proved a/c ' Ohdid il o(~rln spect or) ~ ' ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS B~AR0 OF ItEALTll ......... 3 SE'~S OF PLANS .......... SURVEY ................... ClIE£R ..................... SEPTIC FORH .............. CALL : ............... FLAIL TO: MAY 5 1995 a. ,~Tbis application must be completely filled in by typewriter or iii ink and submitted to tile Building Inspector, with 3 sets bf plans, accurate plot plan to scale. Fee according to scbednle. b. ¢ Plot plan showiug 19cation of lot and of buildings on premises, relationslfip to adjoining premises or public streets or are'as, and giving a detailed description of layout 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 Pemit. d. Upon approval of this application, the Building Inspector will i~sued a Building Pe~it 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 iu part for any purpose whatever until a Certificate'of Occupancy shall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for tbe issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South~ld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulafions, for the construction of buiklings, additions or alterations, or for removal ~[ demolition~as herein described. The applicant agrees to comply with all applicable law~, ordinances, buildi~ code, honsing code,~r~ations, and to admit authorized inspect6rs on prernises and in bulldog for necessa~ insp~i~ns. ~ ~ ..... ........ -- (S~gnatur9 of applicant, or name, f a corporat on) (Mailing address of app~ant) State whether applicant i l~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll orlatest deed) If applicant is a corporatioq, signahu'e of duly aufimri~ed officer.' Builder s License No .... . .~>.~ . .' ......... Plumber's License No ..... ~.~ ............ Eec ri" ' ' I clansLmenseNo..~...~ ............. Other Trade's License No... .................... Location of land on whicb proposed wm,-k will be'done ................................. 2 ................ ............................................. :: K ...... .......... ' llouse Number Street ltamle~ .......... ....... :... ..... Subdivisiou ........ . ............................ '. Filed Map No ............... Lot ............... (Name) , Slate existing use and occupgncy of premises and iutended use and o~m~pancy of proposed construction: a. Existing use and occupancy . -] -'/~J,.~ ~ '~ ...,7.~...~../~.. :2.4..~. b. lutended use'and occupancy,.. ~/~..~.',..).~: :~.....,~.~',/~.,.. ~.?~ ............................... ' Repair ........... Renl0vaI .............. . Demolition Estimated Cost. , ...... ]y' ..................... Fee 5. If dwelling, number of dwelling umts ...... ., robber ofdwe hng t mis on eacl floor ....... If garage number of cars 6 Ir busin.ess conm]ercial or mixell occupancy .......... ' ................................. ' .... · , , , specify nature and extent of.each type ct~ use 7 D]mensmns of' existing structures ifary Front ~ Rear .................... ........ Depth Height ............... Nuniber of Stories ' ..... . Dmmnsrons ~f same struotur, e w!th alterations or additions: Front .. ........ Rear ...... ' ' Dept 1 ...... IToh h~* ' ., , ' ..... · ...... ,--. ' . ,- , ' ..... [ ...... ~ .......... ;4 '~ ....... : , l~UinDer of Stones . . . ' 8. L, nnenslons or 9nhre new constiuction Fro it . . . .'7.. :. . ; R,'-,' o¢ / ' ~( ' ~i .~' '/',,~' ?;~ .... ..mgnt .. d. ............ Number of Stories .. , /.. . 9. Sizeofl6t: Front .... ~./ '. I . ,,,o,. '~c:'/' ....... ' ....~,' ..... -:y.:"y).5'.~ ........... T'~-,~ c.- , /9.<~--)'~'.,'~;"'~ .......... ~ .... ca,,~ ..... ; ......... U._9la. tll ,s~'a._~. ............. 10. =,,,~ o,,,rc,~ase..~, r.../.cc..~ ./.¢/.... ....... '..J~a,ge of Former Owner .(.dO/Y,¢.4... ~7..~'.ff.d,].~. . 11. z~one or use oistnct Ill whic r prer uses are muated ~ O ' , ' ' 12. Does proposed construchon vrol,ate any zoning law, ordinance or regulation M~.~. . .......... '13. Wi 16t be re faded "'" ' ' ....... t~qo~ g ' ' . .... :,'~ .........rT', ....... Wall exces~;,fill b_eremoved from prmmses: Ye~ 14. Name of Owner of premises 7"ff'/b.,qq~_f,~../~(,o'7~.,~Add-ess~.~.,/~.9 .Y'.q7 ./~. .... Plto~ e No~..~.-~r,~ ~, .~. ' Name of Arc tect . ^.~.~ .... Co?~ i2,,,. .... ~,,o.. ,. Name of Contractor ...... Add.es. d~' ~,. , ' ' ' '.'" 1.5.' l.s tbJ_s property wtth±n 300 feet of a tidal wetland? ¢~¥es ........ No ......... all yes~ Soutbold Town Trustees Perm±t may. PLOT DIAGRAM Locate clearly and distinctly all]buildings, Wheth&r existing or proposed, and. indicate all set-back dimensiows from Addition .~ ..... Alteration .. .:. . · .,: ......... Other Worked ' (Description) (to be paid on fi ' ' ' ling tins appbcatmn) property lines. Give street and block interior or corner lot, ~umber or descriptioa according to deed, and show street names and indicate whether' [I STATE OF NEW YORK, COUNTY OF ................ (Name of individual signii~g contract) above ilalned. being doly sworn, depose? and says that he is tire applicant I (Contractor, agent, corporate officer, etc.) of said owner or owners, arrd is du 5t antborized to perform or have perfommd tire said work and 1o make and file this a >rhcahon; that all statements contained ii1 tlr s apphcahon are tree tO the best of his knowledge and bebef, and that the work will Ire performed in the mannerlset forth in tile application filed tlmrewifll. Sworn to before me this JOYCE t//I. WILl{lNg ................. Notary Public State of NowYork No. ¢952246, Suffolk County ,_:_ (Signature of applicant) Term Expires June 12, 19.-~"- ' ' ' I /,/ o4 FEE: ~~ BY: NOT~FY BUI~G OEPART~ AT 768-~802 9 AM TO 4 PM FOR THE FOLLOWING INSPECT¢Of~S: '~. FOUNDATION '~O REQ~JIREB FOR POURED CONCRE'T~ 2, ROUGH - FRAMING A Pt.UMB~NG 3. ~NSLILATfO~ BE COMPLETE FOR ALL CONSTRUCTION SHALL TNE REQUIREMENTS OF THE STATE CONSTRUCTION A ENERGY CODE:S. NC RESPONSIBLE OCCUP^NCYGR ~ITHOUTCE~T~FICATE OF OCCUPANC~