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Home My WebLink About22523-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23409 Date DECEF~ER 14, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 2505 CAMP MINEOLA ROAD MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 6 Lot 8.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECE~ER 2, 1994 ~ursuant to which Building Permit No. 22523-Z dated DECEMBER 8, 1994 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 ACCESSORY SHED AS APPLIED FOR. The certificate is issued to THOMAS & BARARA M. SMITH (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 FORM TOWN OF SOUTHOLD BUILDING DEPARTMENt' TOWN HAU. SOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ........ ........................ 22523 Z CountyTaxMapNo. 1000 Section ....... /...~......~_..... Block .......... ~ ........... Lot No. ... .~...,'.../ .............. pursuantto application dated ............. ~..~ ....... ~ ............... 19....~....~....., and app,oved bythe Building Inspector. Fee $ ......................... Rev. 6/30/80 Form No. 6 TOWN OF SOUTUOLD TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPAMCY [ealth Dept Approval ' · ......... Underwriters Approval o 'lanning Board Approval ..................... equest for: Temporary Certificate ........... Final Certicate..f.~' ee Submitted: $ ............................. .......... . ......... .. A. This application must be filled in by typewriter OR inR and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location o~ all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply ~nd sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board oflFire Underwriters. 4. Sworn statement from plumber certifying that the Jotder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple r.asidences 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) nonvc~nforming uses, or buildings and '.'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building arid unusual naturai 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 - $20.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Con Date . .(F.-../.-.?.~/. struction ........... Old Or Pre-existing Building ......... ocation of Property.. ...... ".' ".. House No. ' Street '' Hamlet ' ' :OUnty Tax Map No 1000, Sectioe..].~..~. ...... Block.. ~.~. ........ Lot ..... 'ermit No. ~.~.~....Date Of Permit.. Z..,.:.! .... Applicant ............ STATE EHERGy CODE FI;IAL '. II ~DDITIO~;~'L CO.~.L~iEIITS: 'FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Examined . l~../~. TEL.: 765-1~03 B~ARD OF HEALTH 3 SETg OF PLA~$ SURVEY CIICCK SEFTIC FOR~I CALL HAIL · Disapproved'a/c .... . ................ '~;' h ..... J .... ('~' "' ' -: ............ "! ....... . ........ ' .. ,._. . / / (BuildingInspecto;~":'""] - Z Iq94' /" u~u ,,- ' Y7 ;ATION FOR BUILDING PERMIT ' ' ' ', · Date .,;, L-' =,' ...... ~::'!g'-:: .... ~ ' INSTRUCTIONS , 19 a. T~~s app~icati~n must be c~mp~ete~y ~~~ed in by typewriter ~r i~ ink an~d submitted t~ the Bui~ding ~nspect~r~ 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 ~hall 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 ih building for necessarv~4~spe.ctions. (S~,,nature of app'licgnt, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'age 't, architect, engineer, generai contractor, electrician, plumber or builder. Nm fo fp / q ,fi) / k ' e o wner o remises ............................... (as on the tax roil or latest deed) If applicant is a 9orporation, signature of duly authorized officer.' (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ..... ....... ; .......... Other Trade's License No I. Location of land on which proposed work will be done ................. ; t-v. . . ,. . .-.%¥*.".~ ....... . ........................... House Number Street Hamlet ...... cotmty Tax Map No. 1000 Section ... :.]..~ ........ Block .... Subdivision ........ · ................... ' .......... Filed Map No. (Name) .............. LOt ............... ~ State existing use and occupancy of premises .... ........... occupancy of proposed construction: a. Existing use and occupancy ~r~i~O.,~, 0'1~ .~.~w~;J~ d.t.9~. ' ........... . b. Intended use and occupancy Nature of work (check which apPlicabl ......... ' . r~epatt .............. Removal ,-. .. teratlon ... ;.. {oo ..... ' .......... ' ' ' · (Description) Estimated Cost ................................... Fe~ ... I (to be paid on filing this application) $ If dwelling number of dwelling units Number If garage number of cars I ............... of dwelling units on each floor 6 ' If busine'ss .............................................. ...................... -... · , commercial or mixed occupancy specify nature and extent of 7 Dimensions of existing structures if any: FrOnt .each type of use Height Number .... : .......... Rear ............... Depth ............... o f Stories ............... Dimensions of. shme structure with ........................................................ Depth .~../. , alterations or ad~litions: Front .... !/_2 / ......... Rear./.O.f. .... 8 ........... Height ..... ~' ' ," ........ : Numberer Stories ' ' ...... Dimensions of entire new construction: Front ' ~ ' ' Height N~mber of Stories ' Depth . , ............... Rear ............... 9 Size ............... ' ........................... · of lot: Front . . · ....................... I0 Date of Purchase ......... i.' ............ Rear ....... Depth ...... ......... ~ Name of Former Owner 11 Z ' ' ' ~ ............ ' ......... 4 ' · one or use &strict in which premises are situated .............. ' ......... ' .......................... 12 Does proposed construction violate any zoning law ' ' · ' ordinance or regulation: .... ' .......................... 13 Will Iht be regraded ' ........... 14' ' ..... , .................... Will excess' fill be removed ~om premises: Y;i ..... 1~ · Name of Owner of premises .~ ...... Address Nam~ of Architect ' ' ........... Phone No Name of C6ntractor , · ............... Address Phone No Address · Phone No ....... 15.' Is this property withiff 300 feet of ' ' , , a tidal wetland? *Yes ............... · If yes Southoldi Town Trustees Permit may be requirg~ ...... No ......... ·, 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 c~rner lot. ~ OCCUPANCY OR LbE iS UNLAWFUL WITHOUT CERTIFICATE OF OCCUP, ,NCY S~TATE OF NEW~'r~RKb Z~. ..... :'.x4.' (Name of individual signing contract) ~bove named. , APP, RO]/ED AS NOTED DATE: .~.~B.P. # ~ By: 76S4802 9 AM TO 4 ~ mLLOWIN PECT O S: 1. FOIJND~rIoN TWO REQUIRED FOR POUR.ED CONCRETE '2. ROUGH ,, FRAMING & PLUMBING · ;3.INSI)£ATtON CONSTRUCTION MUST FiE COMPLETE FOR 'ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOB DESIGN OR CONSTRUCTION ERRORS being duly sworn, depose~ and says that he is the applicant ' (Contractor agent corporate officer .f s,.aid .Owner or owners, and is duly~utl?rized to perform or have performed the said work ppncatmn; that all statements contained m this a"'-lica*i ...... ' ........... and to make and file this · 1' ~-v ~ ~- ,-~ uue re [ne oest OllllS Knowle · . ,ork will be erformed in th dge and behef and that the ' P ' e manner ~et forth i9 the application filed therewith. , ' worn to before me this i No. 4879506. ~ /],'./ ' tolgnarure el appncant) Qualified in Suffolk COunty Commission Expires December 8,