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Home My WebLink About23089-zFORM NO,3 TOY/N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 23089 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 Z24563 Date August 8, 1996 THIS CERTIFIES that the building, addition Location of Property 2422 Westphalia Road, Mattituck House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 7 Lot 10.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 19, 1995 pursuant to which Building Permit No. 23089Z dated October 27, 1996 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 an existing one family dwelling as applied for The certificate is issued to Louis and Elizabeth Formica (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A 7ild£ ng Inspector 70W~ OF SOUTHOLD BUILDING DEP:~_R%23.Elfr TO~ ~ALL 765-!802 This applicanion muse be fmiisd in by c]~ewricer OR ink and submitued to mba building inspector w~h the following: for uaw building or'~e~# usa: Final su~zey of proper~y ~ich accurate locazion of ail buildings, propar=y lines, snree~s, and unusual ua~ura! or ~opographic features. 2. Final Approval from Eea!~h Depu. of ~-auer supply and sewerage-disposal(S-9 3. Approval of e!ec~ricai ~uscallauiou from Board of Fire Underwriters. Sworn suanamen~ from plumber certifying ~ha[ %he solder used in syst=-m con~ains !ass ~han 2/10 of i% lead. 5~ Commercial building, ~ldusgrial bui!ding~ mui~ipla residences and .similar buildings and installations, a cern!floats of Code Compiiamce fro~ arokiaect or engineer rasponsibia for the bufZlding. For e~Lsc~ug buildings (prior ~o April 9, i957) non-conforming uses, Or buildings and "pre-existing" !and uses: [. Accurate survey of proper~ shoal_ag ali property lines, s~ree~s, bui&ding and unusual nature! or ~opographic 2. A proper!? compleued app!icauion and a consenu ~o inspect si~ned by ~he applicant. If a Car~iflca~a of Occupancy is denied, ~he Building ~nspec~or shall ~a~e reasons akere~or in ~ri~ing ~o the applicant. !. Caruificaus of Occupancy - New dwelling 225.00, Additions co dwe!!f_ug $25.00, ~taran£ons ~o dwelling S25.00~ Sw~ing pool ~25.00~ Accessory bu~d~ ~dditious ~o accesso~z budding S25.00. Businesses S50.00. 2. Certificate of 0ccup~cy on Pre-exis~in~ B~i!~ - Si00.00 3. Copy of Cerzifica~s of 0cc-dpancy - ~ .25¢ 4. Update4 Certificate of Occupanc~ - $50.00 .~' . ua_~___caz_ - 5. Temporary ~ ~ ~n = of Occupancy Residential S~5.00, Co--sro%a_ ~o¢~o:o~ ~o~=~ .... ~ .............~[¢.~ ......... Eouse Yo. S ~eec ,02wer or 0~mers of Properuy ...... ~f~.* · t~ .. f~l~ ...... ~'. ................. S ab4ivision ......................... ~ .......... FiXed Mao ............ Loc ...................... - ........ ......... ................ . .. ~aquesu for: Temporary Car~%flca~a ........... Finai Car~%cata ........... i{cpair .............. Removal .............. Demolition . ~ , .: .......... Other Wo~ .......... ~ .... ' ~ '"" ' (De~ripti~0 d. Estimated Cost .,.--.~.~. Fee ...................... (to be paid on ~ling th's a >pltcatio,) 5. If dwelling, number of dwelling units ..... ~.; ]~ .... , Nmhber of dwelling units on each floor.. ~ ......... If garage numbe~ of cars :~ ~ ' 6. If business, commercial or mixed ocm pa my, specify nature and extent ofeach type o~use .... ~ ............ 7. ' ' ' 'ex tings tures,~ ~ Front ~;.;~ .... Rear Dunensmusol is tmc 'fan : Depth lleight Numbe of Storms ' ' Di mnsmns of shine structure with alterations or additions: Front · " Rear ?th ......... ....... ........... orAto , ..= .:...,L: r ........ 8. ummnsmns of eafiie new constructioo: Front .. ,~ Rear ~ D~nH~ 16 ' e~g tt ...... ~ ........ Number of Stones ................. I O. Date of Purchase ...... ~,1J ~ ] ~,~ .... ' ....... ~a ne of Former Ow,,~r ~' ' ' 11. Zone or use districtin which l'~re.hi'sgsare s?ated,. ,~..¢0 ~ ['~' ] ................. 12. Does proposed constmcfion xiolate any zomng aW ordinm~ce or re~t at o(' ~ ' '" ....................... 14. Name of Owner of premises ~ q I ~.~. &J~ .~K~ , . .. ~p ,~ ~).4n~ ~e No Name of Architect , Address ................... Phone No ................. Nmne of Contractor .......................... Address ............. ~ ..... Phone No ............ ' 15. Is kiwis property withi.n 300 feet o[ a tidal wetland? *v~, ~ PLOT D[AGR~ Locale clearly aud d~slJncfly all bt dd~ ~gs, whe[b~r existing or proposed, m~d.h~dicate all sebback dbnensions from properly [[ues. Give s[ree[ m~d block number or descdpt'on according to deed, and show street nmaes and [udicate Wh~[her iatedor or corner Jot, ' APPAIOVED AS NOTED NotIFY-BUILDING OEP~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: :,.~,~'~,~I. FOUNDATION - TWO REQUIRED j~[~[ ~ ~ FOR POURED CONCEDE 2. ao~U FRAMING & PLUMBING 4..FINAL * CONSTRUCTION MUST BE COMP~ ~R C.O. ,~T~ CONSTRU~ION & ENERGY Fut~E~. NOT RESPONSIB~ FOR DESIGN OR ~N~U~ON ERROR8 STATE OF NEW YOP, K~/~ .t .................. ~.~$..~...~.,.C.~ ......... being duly sworn, deposes ami says that he is the applicant (Name of' d'v~dual sJglliug coutracl) d)ove named. t(C tractor, agent, cmporate officer, etc.) ' ff said owner or owners, and is duly atdhorlzed to peffom~ or have performed the sakl work aud to make a,d file this q~plicatlon; that all statemeuts contained fl~ Ods applicatiou a~e true to the best of his knowledge and belief; and that the .york will be perfmmed in the manner set fro'th in the applicafion filed therewith. ' ;worn to before me this HELENE D. HORNE ' . ~ ' ' (~lSIlature of applicmH) Not~ Publi~, 8(~le of Now Yore No. 4951364 . Otmlified in Suffolk qounty ~ ~ Commission Expk~8 Moy 22, ~ 9 .--' ~ Examined Approved Disapproved a]c. ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT: TOWN HALL SOUTHOI_D, N,Y. 1197~1 B~,\RD OF ItEAUTII 3 $'E~$ OF SURVEY CIIECK ......... ~ ........ SEPTIC FORH CALL : .... HAIL TO; Builder's License No ....... Plum her's License No. Electuc~ t~ s 1-tcense No ' Other Trade's License, No .... i' ' Locadon of hind on which proposed work will be 'done ........................................ House Number " 7 ' Cou'nty Tax Map No. 1000 Seclibn . ' ..... ~ Block .......... '.,, Lot. /O,. ' Subdivision ' ' ' ' Filed Map No Lot (~Name) State existing use and occnpgne~ of premises and intended rise and oecupanc~of )roposet~ constmc (Name and title of cm:po~ate officei) .i INSTRUCTIONS a. Fhls appl cation most be conap ete y filled in by typew~-iter or in ink en'd submitted to tim Building Inspector, with 3 sets of plans, accurate plot plan to sciale. Fee according to s¢'bednle. b. Plot plan showing looatio 1 Of lot and of I]uildings on premi.ses, relatio is i p to adjoining premises or public all-eels or areas, and giving a detailed descdptioh of layont of property mn~t be drawn on the diagram which ia part of this appli- cation. c. The work covered bY tbla application may not be c'omlne,~ced before issnance of Bnilding Permit. . d. Upon approval of this application, tile Bnilding Inspector will issued a Buildi. ng Permit to tile applicant. Sncb permit shall be kept on lite premises avallab!e fo' I lspection t wougbottt the work. e. No buihling shall be occnpleld or used in whole or in part fro:tiny pnrpose whatever nntil a Certificate' of Occupancy shall have been granted .by the Buildi?g Inspector. APPLICATION IS ttEREBY MArDE to tile Bnilding Departme,lt for the issnance of a Building Permit porsuant to the Bnikling Zone Ordinance of the Town of Sotttb~ld, Snffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bnildings, additionsor alterations, or for removal or demolition, aa lierein described. T!m .9pp!l,ca,t a,grees to. comply wit}l all ap. plicable law~, ordinances, bt tiding c~,le, housing cite, ant regt let mis, anti to atlmtt atttnorized inspec~6rs on premises aha.in bnilding for ne6essary inspection/j/ 'A ,"' / ,. ' .. . (Si~r9 o'f applicant, o,' name, if a corporation) . (Mailiqg address of applicant) State whether applicant ts owner, }essee, 'agent, architect, engineer, generM contractor, electrician, plumber or builder. Name of owner o remises , . (as on tile tax roll or latest deed) If applicant is a corporation, signature of duly antbori;/ed officer.' ~oo ~o~ L) ~n