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Home My WebLink About22420-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23321 Date OCTOBER 31, 1994 THIS CERTIFIES that the building ADDITION Location of Property 540 RO~LLE PLACE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 144 Block 5 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14, 1994 .pursuant to which Building Permit No. 22420-Z dated OCTOBER 311 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 DECK ADBITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 PHILIP M. & ELIZABETH S. FAHEY N/A N/A N/A - Building Inspector~ FORM NO.3 BUILDING DEPARTMENT TOWN HAIL $OUTHOLD, N.Y. N~ 22420 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to.'~/' ,../, , '-"// / ........................ .),. ................................. ~:; ...................... ...~.~...~ .~~.../,~,,~... ..... ..... ~.~.,.z/.~......~,~.... z .¢,... ./.,.. /~ to......(..~.~~....~.........~.~,:.~. ........ ~..~,~.~.~ ............... ......... ~.~ ......... :....~...~.~.:~..Z~......:.~.;..~ ........ .......... ..~ ......... ~p.:.,~.: ....... ~.~...,.....C~....:~..,.p. ............ CounlyTaxMap No. 1000 Section ....Z...~...~... ..... Block ......... :...~.~ ..... Lot No ...... ~ ............ o carlo dated . .~...,~ / ~ , ]~....~ Q,dapproved bythe pursuant ] appll n .............................................. Building Inspector. Fee $....7'-,{. .............. Rev. 6/30/80 iii OCT 141gg4 iL :, ~LDG. DEPT. [~,. TOWN OF SOUTHOL. _ .. A. Form No. 6 TOI~N OF SOUTIIOLD BUILDING DEPARTMENT TOWN IIALL 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: 1. Final survey of property with accurate location of all buildings, property lihes, 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 %ess 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" land uses: ,~ 1. Accurate survey of property showing all property lines, streets, building and f 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 i. 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 Building - $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 Date .z.O..//..~/. ~..6/. . New Construction...~ ........ Old Or Pre-existing Building ..... Location of Property ..... I?z,Z~,p, ...... e~,,~,]Z.,f~,~,,' t~ .... -/~./f~'~'-'f"! 7'0.~.~ .... House No Street HamI~ f County Tax Map No 1000 Sectio .7~.~. B1 ck ~ , n .......... o · · · q Lot Subdivision . ................................... Filed Map ............ Lot ...... Permit No Date Of Permit Applicant · Nealth Dept. Approval ....................... Underwriters Approval ......................... Planning Board Approval ....................... I~equest for: Temporary Certificate ........... Final Certicate ........... CODE FI;IAL BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION :)ND []INSULATION FRAMING []FINAL REMARKS: DATE ///~////~/////' INSPECT~ 7G.~-xS02 BUILDING DEPT. INSPECTION FOUNDATION lST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INS/ULATION FRAMING [,~FINAL BLDG. DEP~ Examined Approved FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~.ff .... 197/~ennit No...~.. ~...~ ~ Disapproved a/c ...... : .............................. // (B ldin nspector) / AP~,4CATION FOR BUILDING PERMIT BOARD OF HEALTH SURVEY ............ IIECK .............. EFTIC FORH ....... C^LL. ...... MAIL TO: 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 a~eas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cat~vn. 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 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 necess~/jnspectig~s, t J -" name, if a corporation) ' (Mailing address of applicant) //4~70 State whether applicant is owner, lessee, agent, architect, engineer, ge. neral contractor, electrician, plumber or builder. ......... ............................................................... ......... Name of owner of premises ....~/.a./)Q....'~. .... ?...~..L./.` .7~..~.C~.-~./:/...-3.. :...~.~..~.¢.'~. - (as on the tax roll or latest deed) If applicant is a corporation, 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 ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... /..~..~. ......... Block ..... ~ .......... Lot .... ~ .75...~/ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~ .~ {+~...~ ~.~ P.~¢.~ ................................ / . , .... b. Intended use and occupancy /c ~ /0~ ~ ~- .'~ ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RembvaI ............. Demolition .............. Other~k. ~..~.~.~. ...... I ' (Description) 4 Estimated Cost c~ ~../.~-7 ~. P. Fee i (to be paid on filing this aptilication) 5. If dweiling, number of dwellinglunits ............... Number of dwelling units on each floor ................ · If garage, number of cars ..... I .............. ',~ ..................................................... 6. If business, commercial ' ~ ' or m~xed occupancy, specify nature and extent of each type of use ..................... 7 Dimensions ' x' ' : if any: Front Rear Depth , of e ~st~ng structures ............................................ Height ............... Number of Stories ........................................................ Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth .................... i ' · Height ....................... Number of Stories ................. 8. Dimensions ofentirenewconstruction: Front ...... ' ........,Rear .............. e'p't 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 prgmises are situated ..................................................... 12. Does proposed construction viotate'any zoning law, ordinance or regulation: ..~ ............................. ....... ~ .. Will excess filI be removed from premises: ' Yes No 13. Will lot be regraded . .~... ............... 14. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect I Address Phone No Name of Contractor ' Address Phone No 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! 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. 15. STATE OF NE~/'¥ORI~,f'_//, S S COUNTY ...... · · · "(Nam} of individual sig~i~ 'co~t~ct~ .......... being duly sworn, deposes and says that he is the applicant above named. He is the .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ne~ set forth in the application ~ed therewith. Sworn to before me this [ t. ~ Notau Publ~~ ~: .~.. County .. . .......... O Coun~ ~mmissJon Expires D~ember 8, I 9 ~