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Home My WebLink About22185-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24639 Date SEPTEMBER 19, 1996 THIS CERTIFIES that the buildin~ ADDITION Location of Property. 855 KNOLLWOOD LANE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 107 Block 6 Lot S Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated J~/LY 14, 1994 pursuant to which Building Permit No. 22185-Z dated JULY 14, 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR 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 THOMAS & CATHERINE ANDREJACK N/A N/A v Building In~~ FO~M NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 22185 Z BUILDING PERMIT THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: .~,~,~.~:.....,~..~..~. ~'~.... ~.~ ........................... .... ~,,~- ............ ~.....~.~.. ......................................... .......~,~.~...~....~.~....../.~..~.~.~ ..... ,e,.,..~.'~..~ ........... ~,. ............. ~,., ......... ~.~ ........... ~ ................. ..~ ........ ~,~.~ ............ ~.,.'z~ ........... ~,-~.//.,..~ ........ ~ ......... ~.~...,.~. ........... ~..: ......... ..'... ............................................ Z ....................................... ........................................................................... ,~..L~.,~.. ................................................... County Tax Map No. 1000 Section.,....~.~.2 .......... Block, ....... ~ ........... LotNo ....... ~ ............ Building Inspector. ~..~ ........ ................. ~"~;i~'~;~'i;;~';~;;; ...................... Rev, 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~. ~. / TOWN HALL ........... .. ~1,~ ~, , a~PLICATION ~OR CERTIFICATE OF OCCUP "' This application must be filled in by typewriter OR ink and submitted to the bi%!ding 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 statemens from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Co~ercia! building, industrial building, mulcipte 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 r~asoRs 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - , .25¢. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15 00 Rate . . . .~..%[~ r.~ .......................... New Construction ........... Old Or Pre-existing Building...~ Location of Property.. ;f~-'/~dO~/t~/OOt~..~ .... /~4..~.~.7~.~.-- .~/.~. L/7~q-~ House No. Street Ham2 et County Tax Xo i000, Section..../.{.7 ...... Block... ........... ............... Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ........ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~. ....... ............... .................... OUI~DA'TION OUNDAT!O:! ',OUGH FRAME & (1st) .PLUMBING (2nd) HISULATION PER N. STATE E~IERGY CODE Fi:IAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ] I/N/SULATION [ ] FRAMING [~] FINAL [ ] FIREPLACE.,& CHIMNEY _ REMARKS:~ DATE~//~~//~ INSPECT~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGHPLBG. [ ] FOUNDATION 2ND [~ ] I//~ATION [ ] FRAMING [/.~ FINAL [ ] FIREPLACE & CHIMNEY OR IS UNLAWFUL CERTIFICATE: ,,.j FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... .. 7/../~.. .... 19. ?./~5 Approved ....... ~//f.~. .... 19~..~. ee rmit No..?.oJ./.o~..~..~.. ' Disapproved a/c ..................................... B~ARD OF HEALTH 3 SETS OF ?LANS SURVEY ................... CHECK ...... CALL ...... . . HAlL TO: lUU[~UN-'97 '99.~ 1¢ APPLICAIION FOR BUILDING'PERMIT ' INSTRUdTION8 a. T~s application must be completely filled in by Wpewfiter or in ink and submitted to the Build~g Inspector, with 3 s~ts of plans, accurate plot plan to scale. Fee according to schedule. ~ b. Plot plan show~g location of lot and of build~gs on premises, relationship to adjoining premises or public stkeets or areas, and giv~g a detaled description of layout of property must be drawn on the diagram which is pa~ of this appli- cation. c. The work covered by t~ application may not be commenced before issuance of Building Pemit. d. Upon approval of this application, the Building Inspector will issued a Bu~d~g Pemit to the applicant. Such pemit sh~l be kept on the premises ava~able for ~spection throughout the work. e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate' of Occup~cy shall have been granted py the Building Inspector. APPLICATION IS HEREBY MADE to the Build~g Dep~tment for the issuance of a B~lding Pemit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable ~ws, Ord~ces or Regulations, for the construction of bufld~gs, additions or alterations, or for removal or demolition, as here~ described. The app~cant agrees to comply with all app~cable laws, ordinances, bufld~g code, housing code, and regulations, and to admit authorized ~specto~ on premises and ~ bulldog for ~~ .~ necessa~inspectio . . ~ - (Signature of~pplicant, or na rporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor,'eJeatncia~ft~th~,ber or builder· .APPROVED.AS NOTED "~(as on the tax roll or latest ~) ~ If applicant is a corporation, signature of duly authorized officer. NOTIFY BUILDING DEPARTMENT AT .765-1~2 9 AM TO 4 PM FOR THE FOLLO~NG INSPE~ON~ (Name and title of co~orate o~ficer) 1. FOU~BATIO~ - ~O REGUIR;ED ; ~R ~URED ~N~ ~:~ ' ~/~* ~.~;. ~ 2, ROUGH - ~MIN~ · PLU~mN~ Builder's License No. ........... 8. INBU~ON 4. FINAL - OONBTRU~ION er's Li Plumb cense No ......................... ' BEeOM~EFOR~.O. lkk ~O~BTR~IION 8Hlkk ~EET E ectncmn s Lmense No ....................... THE REQUIREMENT8 OF IHE N.Y. STATE ~ONBTflH~TIO~ · E~E~OY Other Trade's License No ...................... ~0DEB. NOT ' __ DESIGN OB CONBTRU~ION ERRORS I. Location of land on which proposed work will be done ...................... ~ ......................... House Num bet Street Hamlet couh v, x 0o0 ... :t ........ moc ........ · ...... .E .......... Subdivision ........ . ............................. Fried Map No ............... Lot ............... (Name) k Stat~ existing Use and occupancy of premises and intended use and occupancy o[ proposed construction: a. Existing Use and occupancy .... b. Intended use and occupancy .3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repmr .............. Rem:oval .............. Demolition .... : ....... Other Work ~iii 5ff-~ ~iO '"" (Description) 4 Estimated Cost · · ' .... Fee (to be paid on filing this application) 5.. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ............... · If garage, number of cars .... 2 ' .. . ........ . 6. Ifb ' ' ' ~ ............................ umness, commercml or m!xed occupancy, specify nature and extent of,each tvne f Se ............... O u 7. Dimensions of existing structur{s if any: Front R~ar Depth Height Numl~er of Stories .... : ............. ' .......................... Dnmensmns of same structure with alterations or additions: Front .... ................. Rear .................. Depth ' Hight I ' Numb f Stori 8 Dime ion ore ti truction Fr ...... "' ero es ................. · Heights s n re new cons : ont ........ : Rear .............. ,D~epth .. .... ' " ............... Num:ber of Stories. , ~, ,; -x ., ' ....... 9 Size of lot: Fro t i ......................................... ,~. ~,4 ..... · n ......... ,.'.... .... ~. Rear ' , .,, ' ....... ....................... Depth ........ i " I0. DateofPurchase ......... . .' .... Na~eofFormerO ...... ~Z hp~ ~¢~!~,~( wner ...........' ... I 1. one or use district in whic r mlses are situated , ...... . ..... l~te anv ~,i,,, ~,,' ~,~-a;,, " '"',' '. ................... 12. Does proposed construction rio ;L, ............... ' , ,, - ...... ~ .~--, ,,~,,ance or regulation: . . .',,.~ .......... 13. Willlot be regraded ...... p{.o ........ ~': ~ '~ "i ........... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .Z0 .... ~.~. .... Address . .~...~. ............ Phone No. :'. Name of Architect ...... i . Address .. Phone No. Name of Contractor .... ............................................ · ' ........ i ................ Address ................... Phone No ............ ' .... 15. I.s this property within 300 feet of a tidal wetland? *Yes ........ No.~ ...... · If yes, Southold T,own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all ,buildings, whether existing or proposed, and, indicate all set-back d/mensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S l ........ ~ .... , ........... ' ......... being duly sworn, deposes ~d says that he is the applicant (Name of individual ~i~ing contract) ~bove named. [ · [eisthe '~ . . '~~.~ ..... . ..................... . ........ . ~rate ....................... f (Contractor, agent, cor' officer, etc.) ,f said owner or owners, ~d is duly a~thorized to perform or have perfo~ed the said work and to m~e and file this pplication; that all statements contain{d ~ this.application are true to the best of his knowledge and belief; and that the /ork will be perfo~ed in the anner set forth in the application filed therewith. ~ ' worn to before me this ........ ~.~. ' .dayof.. .~ ..... ' ..... ,19. UO a4c0o m . ' ~rm e~ires ~t 31, 1~ January 22, 1996 Thomas Fisher Senior lluilding Inspector Town Hall Southold, NY 11971 Dear Mr. Fisher: The bnilding permit for construction of my deck expired on January 14, 1996. I respectfully request a six month extension. Sincerely, T.J~., ~~/~. Thomas Andrejaek 855 Knollwood Lane Mattituck, NY 11952