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HomeMy WebLinkAbout22191-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-23284 Date OCTOBER 14, 1994 T~IS CERTIFIES that the buildin~ Location of Property 100 SUNSET DRIVE House No. County Tax Map NO. 1000 Section 106 Subdivision ADDITION Street Block 7 Lot Filed Map No. Lot No. MATTITUCK, NY Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 16, 1994 .pursuant to which Building Permit No. 22191-E dated JULY 15, 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 A DECK ADDITION TO AN EXISTING CEE FAMILY DWELLING AB APPLIED FOR. The certificate is issued to of the aforesaid building. PEC~Y PERTSINIDES (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A uil~i~g fnspector/ FORM NO.3 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22191 Z Date ............. ~,,g~,/.]~., ......... ./~ ...... ~9.~...~... ............... i ................................. ~..~.~....~.~..c.A: ............. ~:..~.., ................... Coun~yTaxMapNo, 1000 Seotlon.....Z.~)....,~.. ...... Block..,,,,,~,, ................ Lot No. ....L ..................... pursuant to application dated ........ z~.~,..~y ........ .~..~ .......... ] g'"'~'"F" and approved bythe Building Inspector, Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILD%NG DEPARTMENT TOWN HALL 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 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 amd 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 Buildinm - $i00.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, CommercSal $15.00 Date .......... .~. ~.~./. New Construction ........... Old Or Pre-existing Building ................. Location of Property ........ J.~.~ ....... House No. /~} treet Hamlet Onwer or Owners of Property ....................................................... County Tax Map No 1000, Section · . Block Lot ............. Subdivision .................................... Filed Map ............ Lot ..................... . Permit No ................ Date Of Permit ................ Applicant....~.: ......... ~.: .......... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval .............. Request for: Temporary Certificate ........... Final Certicate...>~.. ...... Fee Submitted: $ z'~~'~-'~ ....... i ................. 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ZST [ ! ROUGH PLBG. DATE Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 ~,-,Fa~(51(q,, .,.~ 6) 765-16) 823 765-1802 OFFICE OF THE BUILDING INSPECTOR~?:~;?~ September Ms. Peggy Pertsinides 100 Sunset Drive 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 net 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 # 22191-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. COM~ITS :; ', -. .' CODE Y® ~DDITIONAL COM~IENTS~ : .t ¢3 ~ ~'~-' N OSI~[IHSO(T $ArM~t · ~ ,,Ocj,gc~z~ N '~OYBYD ~' (av~) ,~'~ 3 ,,o~z~z~ ~ Z >r-*O ~:C~ o 3. Nature of work (~check which applicable): New Building .......... Addition .......... Alt Repair .............. Removal .............. Demolition .............. Other Work~l,~,a .~¢.. 4. Estimated Cost ................ Fee (to be paid on filing ~t,hi,~I~.~-~.~ 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 natu~re ~and extent of each type of use /9~. ,'~- ....... 7. Dimensions of existing structures if any' Front / ~. ' Rear 'i~;2t'h' .... ~.z~,; ........ Height ..... ~...~ ....... Number of Stories ................................... , .................... Dimensions of sam~q/structure with alterations or additions'. Front ..... .a~{ ~...~7 .... Rear .... ~. .......... Depth ...... ~.. ............ Height ...... .~...~. ....... Number of Stories .............. ~ ....... 8. Dimensions of entire new construction: Front ..... ~qP~t~. ...... Rear ............... Depth .. /~.. Height ...... ~..'%. ..... Number of Stories ........ , ..... - · · .............................. 7. ......... 9. Sizeoflot: Front " Rear ............... Depth 10. Date of Purchase ..................... ........ Name of Former Owner ............................. 11. Zone or use district in which premises 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 . ~:f~.~.. 7. · ~./'.~,-c£4~.~. Address ~/.~.~...~'.o-.o~..*.. p.r'4..... Phone No. ~.~.ff. 7.~.~./..~ ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes'. ....... No.....~.... · If yes, Southold Town Trustees Permit may be requi~ed. PLOT DIAG ,P,~MM 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. STATE OF NE~Y~R~, v ' COUNTY OF. ~ ek./.o. ~q~... (Name of individual si~ing contract) above named. He.'s the ......... (('~C5o~tractor, ag ent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform Or have performed the said work and to make and file this application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in thezglml,ner set forth in the application filed therewith. Sworn to before me this~ l,h./7 ~. 47_2508~'~o~ ~11~/, (Signature of applicant) , mrm Ex~ires I'Ja,y 31, 19 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Disapproved a/c ................. ! .................... "'/./(Building Inspector) ~' AP T ON ED. BU.D NG PE"M T V INSTRUCTIONS , a. This application must be compl sets of plans, accurate plot plan to scale b. Plot plan showing location of BOARD OF HEALTH ......... ~3 SETS OF PLANS . -./-SURVEY ......... Date ................. 19... · .tely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 Fee according to schedule. )t and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed descript on of layout of property nqust be'drawn on the diagram which is part of this appli- cation. c. The work covered by this applidation 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 ~or 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 Buitding 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authmJzed inspectors on premise ~ and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contraftor, electrician, plumber or builder. Name of owner of premises .......... ' ...................................... (as on the tax roll or latest deed) If applicant is a corporation, signature )f duly authorized officer. APPROV. ED Ag II IED (Name and title of co~orat~ officer) FEE: ~ o~ ~ ~ NOTI~ BUILDING DE Builder's License No ...... J. 766-1802 9 AM ~ 4~M FOR THE ................... FOLLOWING INSPECTIONS: ~, ~OUNDATION ~O REQUIRED Plumber's License No ........................ FOR POURED CONCRETE ~, ROUGH FRAMING & PLUMBING Electrician's License No ........................ 3, INSUt Other Trade's License No ...... ~ ................ $~ ~qP[ET~! FOR 1. Location of land on which propose' work will be'done. ./~ ~~NS~¥~/~.~ House Number Street County Tax Map No. 1000 Sectionl . [~.~... Block ............... Lot ........... Subdivision .......... ~.~ ...... Filed Map No ......... Lot ............... (Nome) 2. State existing use and occupancy o~ premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ,~ ............. · Intended use an occupancy ....... , .......