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Home My WebLink About22192-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OC~PANCY No Z-24006 Date NOVEMBER 2, 1995 THIS CERTIFIES that the building Location of Propert~ 505 BUNGALOW LANE House No. County Tax Map No. 1000 Section 123 Subdivision ADDITIONS MATTITUCK, N.Y. Street Hamlet Block 3 Lot 7 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 29, 1994 ~ursuant to which Building Permit No. 22192--Z dated J~LY 18, 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 CO~ERED PORCEADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES MALONE¥ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED M/A H-047433 - O(~TOBER 19, 1995 N/A /ui~ding Inspector Rev. 1/81 N£ 22192 Z FORM TOWN OF $OUTHOLO BUILDING DEPARTMEI~' TOWN H~ ~,!~OUTHOLI~, N.Y. Permission Is hereby granted to: ~s, ~,~ .O...o...~..ol .................... i ...... .......... ...... ..~.Z~...LI ............................... ::.~ ................ , to....~,..-..~ ........ ~ .......... ~,~.~.:../....L..~~ ......... ~ ,,Z/.Z.....:.....~.. ............ ,~.~. ........... ~.~..:.,.'z~ ............... ~ ............ d .............. .~.~...Q.~./.:..~z~.:...o.~.,..~./..o?o.~..:o. ............................................................. ....................................................................... ~..d~~ ....... .. ............................................ at premises located at ......... ~..~ ~,,(4~,,,....~4~.. ................................... ...................................................................... &~ ~ ....... ..,,.~.,~ ............................ CountyTox Mop No. 1000 Section ...,Z,~,,,~. .......... Block ....... ~...~.. ........... Lot NO ......... ~.,~.., .......... pursuant to application dated ...... ~.'~..,~........,~...,~.. .......................... 19..P.../~....., and approved by the Building Inspector. ~ee ~....Z~..'~ .... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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: i. 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-existinK 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 Date . New Construction ........... Old Or Preexisting B, uilding .................. · z /- Location of Property...~.~. ......... ~ z /~'~' '~/'~'~' '/g'~' · .... ~ ........... ~.~..~.~.~. .... . House No. Street Hamlet Onwer or Owners of Property ..... ~.f~.~r~..../~..~..~.~'..~. ................ , ' .~ ............ Bloc~ ....... ~ ..... Q ...... Subdivision ................................... · Filed Map .......... . . Lot ..................... . Permit: No..~..c~..t~.7.~....2~Date Of Permit ..... Applicant ................. ttealth Dept. Approval/ ..................... .. .. Underwr±ters Approval ....................... .. Planning Board Approval ................. ...... . Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ Z2qb0 ............................................ · · - -- 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 August 29, 1994 James & Janet Maloney 505 Bungalow Lane Mattituck, NY 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file. The check is (outdated/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 # 22192-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 765-1892 ' BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~INAL REMARKS: , ~ INSPECTOR OUI~DA~ION (1st) OUNDATIO:! (2nd) ~OUGH FRAME & -PLUMBING 2I~SULAT!ON PER N. STATE E~ERGY CODE Fi;IAL ADDITIO~IA'L COMME~;TS: New York State Department of Environmental Conservation Thomas C. Jotllng -, / -~-. CommiSsioner Date: Based on the information you have submitted, the New York State Department of Environmental conservation has determined that: Therefore, zn accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary, precautJ:ons are taken to prevent any sedimentation or other alteration or disturbance to th~ ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project'. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale'berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional Permit Administrator FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL" SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined ..... ..?~.../( .....,19 ~.,~ ' Disapproved a/c ............. . ........................ · (Bu/~lding4nspector) APPLICATION FOR BUILDING'PERMIT Date ................... 19... INSTRUCTIONS 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 st?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. o. The work covered by thi~ application may not be commenced before issuance of Building Permit. 'd. Upon approval of this application, the Building Inspector will i~sued 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 Build'lng 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 necessary insp~_tions, fx~//.'. ' ' . . ' . ..... ................ i ' -- ,' · (~,fiature of applicant, or nar~, if a corporation! ..... .z?.,, ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. ..... .c2 .~..~. '..~5. .................... ' ..... '· Name of owner of premises · ~4eA .A. ~.~.'~.~.,q'.' f.~. " "' -- (a' s on" tt~e' iai(' r'o'li ~ i~t~}t'cii~c;) ....................... :' If applican~ is a corporation, signature of duly authoriied officer. (Name and title of corporate officer) Builder's License No ...... ~...r,,~...,~.. ........... Plumber's License No ..... .~...'~..~.. ............ : lectrmmn s Lmense No....O..e~.'~/..'~.. ........... Other Trade's License No... ~ .......... Location of land on which proposed work will be done .............. n ....' ................ ; ................ ltouse Number Street Hamlet Cmmty Tax Map No. lOOOSection .../~..~ ........ Block ...~.Y. ...... i... Lot .... ~.~ ......... Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) , State existing use and occupancy of premises and intended use and occupancy of proposed cons?ructi0y: a. Ex~st~ng Use and occupancy ....... ~...~{~t : .... ~. . · '"' :[' * ''~>:: '/;~ . ~ / , ./ / ....... · · · .:'. .... . ~,k,; .~;~::';-~-~'~,~4~ ...... b. Intended use and occupancy ..... ~, - .'.,. ~ c , . ' ature, o wor c cc w c a ca e ewBu ng .......... . ...?.. eration ........ R pal R n~o 1 D oliti Other '' 4. Estimated Cost . - escr t/on) (to be paid o~ ,fi)0t~hm~a~Ppli~htfon) 5 · If dwelling, number of dwellin~d units / · ; ............... Number of dwelling units on each floor ............ If garage, number of cars .... ........ t ........... ' .................................. ,. .......... ... 6.' If business, commercial or mi,x~d occupancy, specify nature and extent of,each of use .. 7. Dimensions ofexis~ti~ructurqs, if any: Front ..... d.~. ....... Rear .... ~/~ ........ Depth ..~. Height .~.7-..lt~i .... Nulnber of Stories ~ ' '" .... Dunenslons of same structure ~vith nltorat;r, ner,,- ~-~-:',' m ~ ' ' '~- ................. '/"% ......... Denth (P ...... . ................. Rear /..d ~ . :ght ... L~ .............. ,.. Number of Stones ....c> ....... ; ...... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height .... · ~ . · · .......... Num her of Stones ............ . 11. ich premises are situated ................ ; ........................... i ~... i... 12. Does proposed construction rio(ate any zoning law, ordinar~ce or regulation: ..... /t~/,,~ .............. 13. ~%leOtofb;~ng:;d:fd r;~i;;s':" 'IA/~ '~' 'd 0~ .......... Will excess fill be removed from premises: Yes 14' P · .;. · .,~.'.,d]~g~ ....... Address ........... Phone No ...... - hoif~;nrtor ......... ~.~,'-'*,-- ........ ~aaress ................... Phone No . . . · If yes, Southold ~own Trustees Permit may be required, t~o ......... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block Jumber or description according to deed, and show street names and indicate wh~th~r interior or corner lot. : STATE OF NEW XOJ?,J~,.~/ "S ................ ~'' ' ~'~/' ....... ' ........ being duly sworn, deposes ~d says that he is the applicant (Name of individual signin~contract) ~Oove named. , { th ' ' i (Contractor, agent, corporate officer, etc.) .f said owner or owners, and is duly a]utfmrized to perfom or have perfo~ed the said work and to m~e and file this pplication; that all statements contain6d M this application are true to the best of his knowledge and belief; and that the ,'ork will be perfomed in the manner se]t forth in the application filed therewith. worn to before me this ~