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HomeMy WebLinkAbout22143-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~RTIFICATE OF OCCUPANCY No Z-23058 Date JUNE 22, 1994 THIS CERTIFIES that the building ADDITION Location of Propert~ 3430 WIo~AMAVENUE MATTIT~K, NY House No. Street Hamlet County Tax Map No. 1000 Section 107 Block 9 Lot 16.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16, 1994 pursuant to which Building Permit No. 22143-Z dated ~ 22, 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 DE~KADDITION "AS BUILT" TO A SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) N/A N/A Rev. 1/81 /~Building Inspector FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. N-~ 22143 ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Permission Is hereby granted to: ............. ~.~...~.. ........ ...~./...~.~ ........... ~.. ........ ~¥~ .......... ~....:...~ .......... ~...~.~ ............... ~.5 ............ ~./....-~ ..~ ............... ~z~(~ ........... ~, .................................... '..5... ................................. ......................................................................... ,~...¢...~...zT..~ .................................................. Counh/Tax Map No. 1000 Section ./.~...~... ........... Block ....... ..~.., .~',. .......... Lot No..,./~'..:....~.. ........ pursuant to application dated .......'~,..~...,,.,,..,.t.~.'. ................... 1 9....~.yc~,(~,,.., and approved byfhe Building inspector. Fee $ ...... .'.?, .~.. ,¢~,. ..... ~" Bulld~nglnspector , Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING 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(Si9 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. Be For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 Oc6upancy 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 Buildin~ - $100.00 3.Copy of Certificate of Occupancy - $20.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Qertificate of Occupancy - Residential $15.00, Commercial $15.00 ~ 22, ]994 Date ......................................... New Construction ...... x Old ildi ..... Or Pre-existing Bu ng ................. 3430 WICK~AMAVENU~ MATTIT~CK Location of Property ........................ ~ ................................................ House No. Street Hamlet Onwer or Owners of Property ..... ~.As'~..L~..B...~..~ ................................................ County Tax Map No 1000, Section .... IQ~ ....... Block .... ~ ........... Lot ....... L~% ........... Subdivision .................................... Filed Map ............ Lot ...................... No 22143Z Permit ................ Date Of Permit..~ A~lica~ PAMELA BARNEY Health Dept. Approval.' ......................... Underwriters Approval ..................... .. . . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate... X Fee Submitted: 25 O0 APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1't971 TEL.: 765-1803 Examined ............... , 19 Disapproved a/c ..................................... . (Bu~d~fig Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF ItEALTIt 3 SETS OF PLAI~S SURVEY CIIEcK ............... ;; i, ' SEPTIC R CALL .................. HAlL TO: INSTRUCTIONS a. Tiffs 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 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 tlzis 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 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, - APPLIC,~TION 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, stiffolk County, New York, and other applicablo 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, buitdi¢g3code, housing code, and regulations, and to admit authorizedinspectorSonpremisesandinbuildingfornecessaryiy~s.. ..... .'7..~ ~ ~ -- io~~~.~ ....... ~'/ ....... (Si°nature of applicant, or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plurhber or builder. N fo ofp emis ameo wner r es ...'... . ........ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~[~ ...... ' ' (Name and title of corporate officer) I~E, NOTIFY BUILDING DEPARTMENT AT .Builder's License No. 765-1802 9 AM TO 4 !~t ~'OR THE ......................... FOLLOWING INSPECTIONS: Plumber's License No ......................... 1. FOUNDATIOg o ~ NEQUIRED 2. ROUGH- PLUMBING Electrician's License No ....................... 3. INSULATION 4, FINAL - CONSTRUCTION. MUST Other Trade's License No ...................... BE COMPLETE FOR C.O. =' ALL CONSTRUCTION SHALL MEET 1. Location of land on which proposed work will be done. THE REQUIREMENTS OF. THE N.Y. ' ' ................... ~YAYE 'CONSTRrJCTI'ON '&' ENERGY.. .~.~f.~P..~../..C?P/~K'fi~ ~¢~',, .,~'AlttO~S~'~2~O~I: RESPONSIBLE FOR ................... , ............................... , House Nmn ber Street NSTRUCTION ~RROi~.. · County*ax ,ap No. lOOO Sac, o. .... ¥?.2 ..... : mock .... ............ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... z~.... '/t~.~./.~. '~. ].. ~ .~.' .~..R~I.IA'~3~M ~.!?~t%~*D ............... b. Intended use and occupancy ~}<~'~fO~ ~L ~..~,.(~' ~oaato~M~o .............................. ~ue3 ~o}t~g .~ ~,~h~*~ .............. 3. Nature of work (check which applicable): New Building .......... Addition.. ~. ..... Alteration .... Repair .............. RimovaI ........... Demolition ..... Other Work... ' ' 4 Estimated Cost i (Description) · I (to be paid on filing this application) 5. Ifdwelhng, number of dwellihr, u";~ I .................... Number of dwelling Units on each floor ............. 6. If business, commercial or mi ed occupancy, spec nature and extent of each e of use ........ 7. Dimensions of existing structfires, if any: Front typ ............ Height ... N~ ............... Rear Depth ~ · · tuber of Stones ........ ... ' ............ Dimensions al Same stmct'ure with alterations or additions: Front ........... Depth .... i ...... ~ .......... Rear ............ ight ..... .................. He Number of Stories ................. 8. Dimensions of entire new con~;truction: Front ............... Rear ............... Depth ... ' ' ' ' Height ....... ,. ....... Ndm her of Stories sd .................................. · 9. ze allot: Front ~ .... . Rear .... ~t~.~ ' '" ...... i ....... · I0. taate of Purchase . ~C~ ..... ' ......... ' Depth .i .......... ~Z ' p ....... Name of Former Owner ................ I 1. one or Use district in wliich remises are situated ....... 12. .~oes proposed construction ,,--, ........ . ........................................... -,~,~a[~ auy zomng ~aw, ordinance or regulation: ..... .~.o. 13. Will lot be regraded .... ' ........ · ........... fP is' ~.'/?.~.'~.' iP;'~.' ........... Will excess fill be removed from premises: Yes .No 14. Nmne of Owner o remis .Z~'ff~..~.~.-'t~ddress ~5'~.$.O. Name of Architect ... ~ .... Phone No. ...... ~ .................. Address ................... Phone No. .. Name of Contractor ....... I ............ :'... Address ............. Phone No.. . 15. Is this property within 300 feet o~ ~ tidal wetland? ...... ' ............ · If y ' ~ ~ *Yes ........ No ..... es, SoutholdiTown Trustees Permit may be required. '''' ... i PLOT DIAGRAM Locate. clearly and distinctly ali buildings, whether existing or proposed 'and. indi . · property lines. Give street and block number o- ~- '--' . .... , . . cate all set back dzmensions from interior or corner lot I. · uc~crlptlon accommg to aeea, ana snow street names and indicate whether ........................... .. . ........... ,~. )ff'[ t4oux .............. . ~:~ .' ,{Name~of.'mfl~dual mgmng contracO - T ~e~n~ ~my sworn, aeposes ~d says that he is the applicant '~ . · ....... ,.....:.), ........... v~ ~ .~~ · sm,~ o~ner, or. o~neTs~ ~dis d~ly .authorized to perfom or have perfomed the'said work and to m~e ' nd oplication; Ihat all statements contained ~ tliis application are true to the best of his ~owledge and Belief; and that the 'ark will be perfo~ed in the manner s~t. forth in tlie applicati6n filed therewith. worn to before me tliis ' ., · .................. dayof.? ~ ........... ,19 Noto~ Pubfio, State ~ ~ ~ ~ · · No. O1MIS01~ ...............