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HomeMy WebLinkAbout22563-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. No Z-23462 CERTIFICATE oF OCCUPANCY Date JANUARY 20, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 325 CENTER STREET MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 2 Lot 7.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 6~ 1995 pursuant to which Building Permit No. 22563-Z dated JANUARY 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 AN "AB BUILT" ACCESSORY STORAGE E~ED AS APPLIED FOR. The certificate is issued to MICHAEL K. O'CONNER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEI~ON OF THE WORK AUTHORIZEDI 22563 Z Permission Is hereby gran~d to: -".,' -, , ,., / ~/... ~;~.:. ~~~ .. ~~ ..... ~.~ ~..E~ ................................ to ..,~~...~..,..~~.....~Z~'~~'': ..... /~, ' ~ -- Zz~j ~ z~ ~ ~ ~ ..~ ................................ ...... ~ ........ ~~~2....~ .......... ~ ~ ...... ............................................... ~; ~;;~,~ ;~;~ Z.'.'.'.'~.Z.....~ ................................................................................ .................................................. ~~.~.~ ........ ~.~. ......................... ~o~,~,~x~a,,o. ,~0 s~o,,o~..../~ ....... ~,o~ ........ ~ ............ ~o,,o. ~,~ ............... Rev, 6/30/80 Form No. 6 BUILDING DEPARTMENT TOWN ALL 765-1802 ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY r A. 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: 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" laud 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 th6 reasons therefor in writing to the applicant. Fees 1 Certificate of · Occupancy - New dwelling $25.00, Additions to dwelling klterations to dwelling $25.00, Swimming pool $25.00, Accessory buildin~ 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 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial~5.00 Date ......... ~.~..~..C ............... New Construction...~.. ..... Old Or Pre-existing Building ................. Location of Property ........ ~ ............ 1 ............................... House No. Street Hamlet Onwer or Owners of Property .... ~1.%~$[~....~:..~.~.~.~.~..~..~.~..~:.~.~.~.~.~.~.~.. County Tax Map No i000, Section .... /~.8 ..... Block ................ Lot ................... Subdivision .................................. Filed Map ............ Lot ................... Permit No ................ Date Of Pe~it ............. Applicant .................. Health Dept. Approval ............... Underwriters Approval Planning Board Approval ..................... Request for: Temporary Certificate .......... Final~cate ........... .... · ......... FIELD INSPECTION REPORT !~DATE !~ COMMENTS FOUNDATION (IST) ROUGH FRAME & II II II It II II I1 INSULATION PER N. Y. STATE ENERGY CODE FINAL It - '3. Nature Oft WOrK (Gnec]~ ',VIllCl~l applicable): New Budding .......... Addition .......... ~amraaon Repair Removal .............. Demolition .... : ......... Other Work ............... 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 ................ . 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............. '.. Number of Stories ........................................................ Dimensions of shine 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 Depth 10. Date of Purchase .................... · ......... Name of Former Owner ............................. z. one or use district in whic remises 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 No 14. Name of Owner of premises .................... Address ................... Phone No ................. Name of Architect ......... .¢, ................ Address ........... · ........ Phone No ............ : .... Name of Contractor ......... ~¢~ .............. Address ................... PholnigNo .............. 15.' I~ this property within 30~ feet o~f a tidal wetland? *Yes ........ No. ~{~. ,. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether 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 whether interior or corner lot. ......... ' .... ......... (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant i ! i 3. Nature ot work (cltecK wlnct~ applicable): New Building .......... Addition .......... mteratmn .......... Repair .............. Removal .............. Demolition .... : ......... Other Work ............... · ' '"" (Description) 4. Estimated Cost. Fee ........................... (to be paid on filing this application) 5. If dwelling, number o£ dwelling units ............... 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............. '.. Number of Stories ........................................................ Dimensions of shme 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 ...................... Depth ...................... 10. Date of Purchase .................... · ......... Name of Former Owner ............................. 11. Zone or use district in which prem{ses 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 No 14. Name of Owner of premises ..... :(7~ ............. Address ................... Phone No ................ Name of Architect ............. : ............. Address ................... Phone No ................. Name of Contractor ...... , .................... Address ........... : ...... Pho/nj/~q~ o..' .............. 15.' I~ this property withzn 300 feet of a tidal wetland? '*Yes ........ No.~ .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether 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 whether interior or corner lot. S'rATE OF NEWYOAg~K, ~ S.S c OUNTy .. ....... · .. ~tY~lfj~ /alt 7'7 being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· 765-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. ] IN/SULATION ~FINAL ~ REMARKS: .... ~ ',~/ ~ ~~,, ' FORM NO. 1 ii [~f["R lASt ,- C I~' TOWN OF SOUTHOLD · Jr l~/J~ 6~J~ BUILDING DEPARTM ENT ~ ' ' ~'.~"6~¢~/ SOUTHOLD, N.Y. 11971 TOWN 0~: SOGi"; , T~ 7R~ l~n~ Disapproved a/c ..................................... ......... ..... ~[ ~ ¢.~. ~ in. Ins ~. ......... ' - ~ATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLA~S ......... SURVEY CI1ECK .............. ,J Date .................. 19... INSTRUCTIONS r. a. This 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 sti'eets or areas, 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 Permit. 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 Buildihg 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 re!l~oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building.mOde, housin, g-e~, ~ind regulations, and to admit authorized inspectors on premises and in building for necessary inspectJd~,~..., ~ /.)/ ~..~. ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, ~rchitect engi~(eer, general contractor, electrician, plumber or builder. (as on thE tax roll or latest ~..._ ~,//,~/~ B.R # ~ If applicant is a corporation, signature of duly authorized officer. .FEE: ~BY: C NOTIFY BUILDING DEP___A'~. T/ ..............................................(Name and title of corporate officer) 765-1802FOLLOWING9 INSPECTIONs:AM TO 4 PM 'FOR THE} I. FOUNDATION - TWO REQUIRED~ Buil'der's License N°' ~ .... ' . FOR POURED CONCRETE 2. ROUGH o FRAMING & PLUMBING~ Plumber's License No ......................... 3,' INSULAllON · 4. FINAL - CONSTRUCTIONgMUST Electrician's License No ....................... BE COMPLETE FOR C.O. ALL CONSTRUCT'~ON SHALL MEET Other Trade's License No ................. - THE REQUIREEt~Fm~I~$ OF l'dE ltouse Nmnber Street Hainl;~ y ..................... Conhty Tax Map No. I'000 Section ....'/d3. ' Block ..... .0.,~ · Lot.. ~.'...2~.. ..... ]'... Snbdivision..; ..... . ................... . .......... Filed Map No ............... Lot ............... (Name) '~.~. Stat~ existing use and occupancy of'premises~nd intended use and occupancy of proposed' ~onstruction: a. Existing use and occupancy .... '.. ,~rtb ~'-R ...... b. Intended us n ccupancy .............. . ......... '3. Nature of work (check which applicable): New Building .......... Addltxon ..... .~'f.'.!J..~;~h .... : .... Repair .............. Rembval .............. Demolition · .... : ......... O t h ei-~ ~?b'~l~ ............... (D l . ., ~ .~. escription) 4. Estimated Cost ........... ; ........................ Fee ... (to be paid on 0[ing this application) 5. If dwelling, number of dwelling ihnits ............... Number of dwelling units on each flo6r:. '. ............. If garage, number of cars , 6. If business, commercial or mi.xed occupancy, specify nature and extent of.each type of use ..................... 7 Dimensions ' ' ' ' if any: Front Rear Depth · of existing structures ............................................ Height .......... '.. Number of Stories ' ' Dimensions of shme structure w!th alterations or additions: Front ................. Rear ................. Depth ' Height ' Number of Stories 8 Dimensions of entire new construction: Front Rear Depth Height Nun~'ber of Stories . ' 9 Size of lot: Front ' Rear Depth 10 Date of Purchase ' ' Name of Former Owner 11 Zone district in which pr~mises are situated .... : ' ' .... · or use .................................................... .12· Does proposed construction violate any zoning law, ordinar~ce or regulation: ................................ 13. Will lot be regraded ....... '. .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Address Phone No Name of Architect . Address Phone No Name of Contractor ......... . ..... . ............ Address ................... Pholac'fNo ............... i5.' I.s this property within 500 feet of a tidal wetland? *Yes ........ No.~. *If yes,'Southold ~own Trustees Permit may be required. PLOT DIAGRAM ., Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. 0 '.©COU?ANOY OE · ........ '.'.'..~4."..ff.'' '~f~{ ~.(.. ........ being duly sworn, deposes ~d says that he is the applicant (Name of individual signi0g contract) He is tge t ~,..,~.,, ". ~: - -, ., (Contractor, agent, cor'porate officer, etc.) of smd owner or owners, ~d m dulyNuthonzed to perfom or have perfo~ed tlie said work and to m~e and file this application; that all statements contaiged N this'application are true to the best of his ~owledge and belief; and that the work will be perfomed in the manner }et forth in the application filed therewith. Sworn to before me this Qualifl.d i ~0 I~ r, ' / ~ (S gnature of applic~t) .