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Home My WebLink About22477-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. No Z-24202 Date MARCH 8, 1996 THIS CERTIFIES that the building ACCESSORY Location of Property 405 MAYFLOWER ROAD Rouse No. Street County Tax Map No. 1000 Section 107 Block 8 Subdivision Filed Map No. MATTIT~CK, N.Y. Hamlet Lot 21 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 7, 1994 pursuant to which Building Permit No. 22477-Z dated NOVEMBER 17, 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 ACCESSORY STORAGE SHED IN '£~ REAR YARD AS APPLIED FOR. The certificate is issued to DIANE LESSARD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. pLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 FORM TOWN OF SOUTHOLD BUIt. DING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) z .......... ............................ CountyTax Map No. 1000 Section ., /~..2 ........... BIock,,...~..~... .......... Lot No ........ .~...,~.. ............ pursuant to application dated ................... .~.../'/2 ....................... 19....~...~....., and approved bythe Building Inspector, Fee s..~..~. ......... ~'~ '~g~ector Rev. 6/30/80 Form No. 6 ', ~,t ', ~':' ..... TOWN OF SOUTHOLD ""%,, g/IR - 8 1996 BUILDING DEPARTMENT ',' TOWN HALL ! .................. 765-1802 i~ LDP a,'~\-i-4t~r 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 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. 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 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 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 Buiidine - $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 $i5.00 Date ...... .~/.~l~ ~. ........................ New Construction ..... .' ..... Old Or Pre-existing~ ft,c~ Building~ ....... .' ........ .~..~ ~ .~. Location of Property...~0..~. ....... ~....i .... ......... llouse No.~ Street Hamlet Onwer or Owners of Property.~.l..~...~.. L~(R~J / QZ. County Tax Map No I000, Section .... ~ ........ Block ............ Lot .................. Subdivision .................................... Fi led Map ............ Lot ...................... Permit No.~.~.~.'~'.~.Date Of Permit ~/~/~.~...Applicunt...~.~.~'....~..~..'J~.~..(~..~-..~ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approw~l ........................ Request for: Temporary Certificate ........... Final Certlcate .......... Fee Submitted: $ .... ~'~'~ '~' '~'~? .............. ~ z~,~ ~~ .... ........... .... .~.0 ~ ~ a O~ APPLICANT Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 14, 1995 Ms. Diane Lessard 405 Mayflower Road Mattituck, NY 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 22477-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. SH FRAME &.. :.. .-. , ~ CODE FI;;AL '. /~DDIT~OH~'[, CO!-T~IENTS: TOWh 3F~OUT~o! D 765-t802 BUILDING DEPT. INSPECTION INSPECTOR ,~, NOV - Y 1994 BLDG. DEPT. TOWN OF SOUTHO~ · i~.,~ NOV - ? 199/1 i' '~ : BLDG. DEPT. ~TTOWN OF SOUTHOLD ~ Approved... fl//..7.. ....... , ~it No..~.~Z Z ~ Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . (~,il~ng Itlspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... SEPTIC FORH .............. CALL ........ MAIL TO: Date ................ INSTRUCTIONS ' a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se~s 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 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 tiffs application may not be commenced before issuance of Building Permik d. Upon approval of this application, the Building I~nspector 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 what, ever until a Certificate of Occppancy 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 regu~tions, and to admit authorized inspectors on premises and in building for necessary inspe ' s. - -' (SignatureN:lf applicant, or name, if ~/~orporation) ....... ' ZiMailing a~dress of applicant) (Name and title of corporate officer0ccUPANCY OR Builder's Lioense No ................ USE' 'IS'UNLAWFUL Plumber's License NO ........ : ...... WITHOUT CERTIFICATE Electrician's License No .............. 0F'0CCUPANCY State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn,,,plumber:or, bmlder. If applicant is a corporation, signature of duly authorized officer. NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... /.~. '. 7 ....... Block ~ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existiug us~ and occupancy ...... .~..~.~..~5~...~'."~-~ ..................... ;~. ,.~ .,..: .... ~ ... b. Intended use and occupancy ................... .... ................ 3. Nature of work (check which ' appl,cable): New Building ....... Addition .......... Alteration .......... Repair Re oval D molition Othe, r Wgrl~ . ~ · (Des ripti n) 4. Estimated Cost ............. ....................... Fee ....................... ............. _ (to be paid on filing this application) 5. If dwelling, number of dwelling[units ..... .Y?/?. ..... Number Of dwelling units on each floor ..... .~c~/,~. ..... If garage, number of cars ' . .2~.Z'..~. ~ ., 6, ~f business~ c~mmercia~ ~r mixed ~ccupancy ~ specify nature and extent ~f each type ~f use . . . .~(/. ~ ............. 7 Dimensions of existing structures if any' Front Rear Depth Height ............... Nunlber of Stories .............................................. Dimensions of same structure with alterations or additions: Front ' Rear Depth ................... !.. Height .................... ·.-. Number of Stories ..................... 8. Dimensions of entire new const etlon:Front..:..,.~ .~O.. Rear ..... ' / Depth Height ................ Nun)bbs of Stories ...~ ......... ,~,... ~. ....................................... 9. Size of lot: Front ....... ~,~?~_. .......... Rear ........ ~. ........... Depth .... 10. Date of Purchase ~ ?qc?3 ' I~ ff'e:ff, w~,,~ ........ , ......... , ........ Name of Former Owner ....................... 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate'any zoning law, ordinance or regulation: ..~d~. .... 13. Will lot be regraded ........ ~ ................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~J~E.. ,IgT.~,~... Address . .ff~. ~.,~t*.~/~.~.~.. ~ Phone No.e~.~: .~"Ft~./ .... Name of Architect .......... I ................. Address ................... Phone No ................ Name of Contractor ......... I .................. Address ................... Pho~No ................ 15. Is this property within $00 feet of a tidal wetland? *Yes ........ No..*..~ ..... *If yes, Southold Town Trustees Permit may be required. ! PLOT DIAGRAM . i Locate Clearly and distinctly alll buildings, whether existing.or proposed, and. indicate all set-back dimensions from dumber or description according to deed, and show street names and indicate whether property lines. Give street and block interior or corner lot. STATE OFNEVf-YORKF! ! ~ (Name of individual signing contract) above named. He is the ................... ~. ............................. . .................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly~ authorized to perform or have perfomled the said work and to m~e ~d file this application; that all statements contaihed ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner get forth in the application filed therewith. Sworn to before me th~. Note, Public, . ...... ~~ .~~C°unty ' N~W ~bllo, State of N~l~r~ ,..' , - No. 4879505 ~ml.~n E~ee D~m~ ~, 19~ (Signature of applicant)