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HomeMy WebLinkAbout21921-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Bouthold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23511 Date FEBRUARY 27, 1995 THIS CERTIFIES that the building Location of Property 1295 ELIJAH'S LANE House NO. County Tax Map No. 1000 Section 108 Subdivision ADDITION TO ACCESSORY Street Hamlet Block 4 Lot 7.7 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 23, 1994 pursuant to which Building Permit No. 21921-z dated FEBRUARY 25, 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 ADDITION TO AN ACCESSORY IN THE REAR yARD AS APPLIED FOR. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. H044287 PLUMBERS CERTIFICATION DATED PETER VICTORIA (owner) N/A FEBRUARY 7, 1995 N/A Rev. 1/81 /Bui/ldingi~spector FOgM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N©_ BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED] ............... ............................ 21921 Z Permission Is hereby grantec~Lto: ...~ ........ ~.,~ ................................... ...~.~.~ ....... &~.~ .......... ~,,~ ........... ~ ..... ~~.~. .......... ~.~...., ........................... to..~,~.,~-:,~.~:: ...... ~.....~..~;~..~.~,~....C...~ ....... ,,~..{.....~.~.~ .... · .~../.~ ............ ~ ............ ~ ........ ~,~_.~. ............. ~z ....... ~... at premises located a -. ....................................... County Tax Mop No. lO00 Section .... ,/..'~.d~i .......... Block ......,.~..,~,~, ........... Lof No ...... r?',../~,. ............. pursuant to application dated ...... ,,~,~,.-/~'......~.~.. .......................... l g.,, .~.,..,,~,..., and approved by the Building inspector. Fee $.,~,~. ..... Building Inspector Rev, 6/30/80 ' - ..... "- Form No. 6 TOWN OF SOLm.tOLD __ APPLICATION FOR CERTIFICATE OF OCCUPAECY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 A. 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). 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 insta!la~ions, 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 applicantr 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, Commercial $15.00 Date ...................................... New Construction ........... Old Or Pre-existing Building .... ~ ........... Location of Property.. .f.~. ~. ...... ........ . .. ~. · (~.~.r~ . A~ ............. a'~./J~7J~- ~'/~-~. · . .. House N~% Street ,~..~. ~ Hamlet Onwer or Owners of Property....~.~J~.....~...~?.~.~. ~.4 .~....~..-....~J! .... ~. ..................... COunty Tax Map No 1000, Section .... ~?. D. .... Block....~. .......... Lot ..... 7% [7. ............ Subdivision..~.~.ffl~...~-...%.~ ....... ~ Piled Map ............ Lot....~. ................ Permit No. .e~. / ~-/ ~--.Date Of Permit .... Applicant. Health Dept. Approval ..................... Underwriters Approval ............. Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Ccrticate..'~. ....... Fee Submitted:~c'~ q~l~t $''~'~: ..................... ' .~.~.~J- /~'/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY aB JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIE$ THAT DRYERS FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS taCAN DE ~<: ENT t F [U(~E~CENT~ i OTHER TIME CLO~KS SYSTEMS NO. OF R~ET E OTHER AI~ARATUS: P~LBO,~E:)S = 1 -q <TIP. C..F.C. I= -2 E R V I C NO. OF CC. COND. PER ~' OF CC. COND 1295 ELIJAH LANE MATTITUCK, NY, 11952 ~ MAHAGll This certificate must not be altered in any man~er; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER, Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax {516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD November 23, 1994 Mr. Peter Victoria 1295 Elijah Lane P.O. Box 1130 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) ~ xx No Underwriters Certificate on file.~ xx The check is not on file. $25.00 ~_. No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21921-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. COM~IT$ FOUNDATION (lstl FOUI~DATIO~! { 2nd ) 2. ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COM~IEI;TS: BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] ~LATION FRAMING [ ~F'INAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 ',[,proved ...'.~..,~. .... 19 ¢¢ec~it No.~Z~/~ t ~iszpp~ovcd a/c ..................................... BOARD OF H£ALT}I ......... 3 SETS OF PLA~tS ......... SURVEY ................... CIICCK .................... SEPTIC FORH .............. CALL ...... .... HAIL TO: ...... ~'~ingqnspector) FEB 23 I- ~'~ APPLICATION FOR BUILDING PERMIT ;' . .:'.'; :- . ~,,,T..?~'-~'*''' INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts. of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sliowing location of lot and of buildings on premises, relationship to adjoining premises or public streets , areas, and giving a detailed description of layout of property must be drawn ua the diagram which is part of this appli- dion. 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 ,all 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 , dl have been granted by the Building Inspector. APPLICATION 1S HEREBY blADE to the Building Department for the issuance of a Building Permit pursuant to the filding Zone Ordinance of the Town of Southold, Suffolk County, New York, gnd other applicable Laws, Ordinances or .:gulations, for thc construction of buildings, additions or alterations, or for removal or demolition, as herein described. .~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to imit at~thorized inspectors on premises and in building for necessary inspecti~,/~7. · · ~ / -- (Signature of applicant, or name, if a corporation) G{ailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) .~pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plum bet's License No ......................... Elcctrc an s License No ........................ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. llouse Number Street Hamlet C_'otmty 'fax Map No. lO00 Section .../..0.? .......... Block ..... ~. ............ Lot .... 7:.7. ......... 5;ubdivisim~. ~?(ff~.t?~....~.~....~.$.7~..4.. ~,~¢T / .... Filed Map No. Lot (Name) ;talc existint~ use anti occupancy of premises dnd intended use.and occupancy of proposed constrpction: . Existing usc .and occupancy ..... ,e~.~....~....~?..'.~.~C .~.. ' .......................... · Intended use and occup,~nc~, ...... ~.. s~'.'.'.'.'.'.'.'.~t ~ ....................................................... 3. Nature of~,ork (check which applicable): New Building .......... Addition..,~r ...... Alteration .......... Repair ............... Removal .............. Demolition .............. Other Work ............... .f~ ~..O~.? (Description) 4. Estimated Cost .......................... Fee .. ....................... (to be paid on filing this application) 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 nature and extent of each t.[ype of use ..................... 7. D nensonsofexist ngstructures if any' Front .~.e/ Rear ...~1~..,~.~/ Depth Height . ./.r./. .......... Number of Stories ....... Dimensions of_same structur,, with hlterations or additpns: Front ..... ' ...... Rear .. ...... Depth .... .,~ ............... Height ..... /.ff.. ............. Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ....... '.'-. ...... Depth ............... Height . .' ............. Number of Stories ......................... ~ ' ............................. 9. Size of lot: Front .... ~...a,~.... ,,e~'cMC. d~..e'j~... Rear ...................... Depth ......... · ............. 10. Date of Purchase ............................. Nam~of Former. Owner ............................. 11. Zone or use district in which premises are situated ....... ,~,l:~,~[:~.,/ .............. ' ........ ~ ......... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: .....,.,.,.,.,.,.,.,.A~? .......................... 13. Will tot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No.... ............. 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 required. PLOT DIAG RAil 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 tuterior or corner lot. C,\TE OF NEW~-- :r,r-' t, ~Ol~- ' S.S ,UNTY OF....~?.~5~ \ .'r'7 ..... .............. .~f. 3~.~.. N .x¢ ~ f% ................ being duly sworn, deposes ~a says that he is the applicant (Name of individual signing contract) named. : is t:t ......................... .~ .'-'?..}-2g-..~.". ...................................................... (Contractor, agent, corporate officer, etc.) said owner .'r owners, and is duly authorized to perform or have performed th, said work and to make and file this plication; that all statements contained in this application are true to tile best of his knowledge and belief; and tl~at tile ,x 1-: will be performed in the manner set forth in the application filed therewith. · om to before me this ~_, . ........ ~ .g £.~. .... 'o1~..~90~.~ ......... 19 .qfl7 . . ., . t:t~' Public ..... ',~'?ff' '~" "'"~'~-'2~- County - V/ ~ ROsEffi'l.~Or[.ffi. . (Signature of applicant) No, 4725~89, Suffolk ?e~m Expires May 31, 19""/..~-