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Home My WebLink About22128-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23068 Date JUNE 24, 1994 THIS CERTIFIES that the building Location of Property 200 BAYER ROAD House No. County Tax Map No. 1000 Section 139 Subdivision ACCESSORY MATTITUCK, NY Block 3 Filed Map No. Lot NO. Street Hamlet Lot 24 oonforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 27, 1994 ~ursuant to which Building Permit No. 22128-Z dated JUNE 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 FOR AN "AS BUILT" ACCEBSORY SHEDASAPPLIED FOB. The certificate is issued to BAYMOND D eVE~/~A (owner, lessee or tenant} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED //~ildlng Inspector Rev. 1/81 FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (TH~S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Date ....... ~....../..~..': ...................... N~- 22128 Z Permission Is hereby granted to:~,~ .~ ~/~ . .......--, ~-'~~....~,~.~ ....... ,~.~ .......... .............. ~ ..~....~.~.,L/.~: ................................ / ,/2 ~ /~',,'2_ ,¢-~. :,~J~', / ,_ ~---~' .......... ~. ................... (.........~...~.~._..~ .................................... ~ ............................... CountyTaxMapNo. 1000 Section.....,/,,...~.,,~., ........ Block ...... ,~. ............... LotNo...,~,..,~,.. ................. pursuant to application dated....~.~...~.....~.~.. ......................... Building Inspector. Fee $..~...,.~.. ....... Rev, 6/30/80 and approved by the /~ Building Inspector" 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(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 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 Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwe±ling $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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building .... ~ ...... Location of Property .... %q9 ............................................................. . Bayer Road Mattituck . .. House No. Street Hamlet ~.M~PD~ J' DeVerna and q~i4%~ ~eVeyA~ ....... % 0nwer or Owners of Property ................................. County Tax Map No I000, Section.~OP ...... Block .... Q$~O~ ...... Lot .... Q~,D. QQ .......... Amended map of Mattituck Heights, ...... ProDertv of Gustav Bayer ~.. .Lot.. ~ .9~ .~. ~uoalvlslon...,-J;.~ ............. ~; ............. Filed Map ............ Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ........................ . : Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~ ....... Fee Submitted: $.2.5.:.0.0 ...................... ... ......... OUNDATIO~! (2nd) ,OUGH FRAME & .PLUMBING H;SULATION ?ER N. Y. STATE E~;ERGY CODE Fi;;AL ADDITIO~L COMMENTS: /- BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~NAL BL~. D~P1: Approved ..... ~/~.~., 19 .~./~ermit No..~...[ ...... Disapproved a/c ..................................... · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Received ........... ,19... Date., .i~.ay..2..6 .......... 19 .9.4. ~,~,,2[q~f£L~L..,~? )Z!~! (~?!.j?.,~ INSTRUCTIONS a. T~s 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 build~gs on premises, relationship to adjoining premises or pubic streets or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this appli- cation. ' ' c. The work covo~ed by this application may not be commenced before issuance of Bulldog Permit. d. Upon approval of this application, the Building Inspector MIl issued a Building Pemit to the applicant. Such pemit shall be kept on the pr~mises available for inspection throughout the work. e. No building sh~ll be occupied or used in whole or in p~t for any purpose whatever until a Certificate of Occup~cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dep~tment for the issu~ce of a B~lding Pemit pumuant to the Building Zone Ordinanc~ of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or Regulations, for the construction of build~gs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all app~cable laws, ordinances, buffding code, housed code, and regulations, and to admit authorized inspeetom on premises and in bulldog for necessaw inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises..R, gy.mg.n.d'...G....D.e..V.e.r.n.a...a.n.d...G.e.r..a..1 .d.i.n.e...D.e.V.e.r..n.a .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of dnly authorized officer, ............................................... FEE: _.'~_ " (Name and title of corporate officer) ' NOTIFy BUILDING 785-1802 9 AM TO 4~I~'M FOR THE Builder's License No .......................... FOLLOWING INSPECTIONS: ,. t, FOUNDATION . TWO REQUIRED Plumber's License No ......................... FOR POURED CONCRETE 2, ROUGH . FRAMING & PLUMBING 3. INSULATION Electrician's License No ....................... 4. FINAL CONSTRUCTION MUST gE COMPLETE FOR C.O. Other Trade's License Nu ...................... ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF..T~IE N..Y: ...... 1. Location of land on which proposed work will be done .............. STATE CON'S'I'~'U'I~'I:I~)j~ & ENERGY 200 Bayer Road .~D~u4~DT RfiS?.O.N.S,I,~ FOR ... .......................................................... E..O.S House Number Street County Tax Map No. 1000Section . .1.3.9....0.0. ......... Block ...q3.:9.0 .......... Lot....0.2.4.:.0.0~0. ..... Amended maD_ of Mattituck Heights, Subdivision .P.r.o.p~...rt.y..o.~..G.u.s.t.a.v..B. ay.e.r. ............ Filed Map No .... %.1.8.4. ...... Lot 6.5...aD.cl.".66 .... (Nmne) 2. State existing nsc and occupancy of premises aud intended use and occupancy of proposed construction: a. Existing use and occupancy ...&c. qe.s..sP.r.Y..B.u.&l.d.~-.nst ............................................. b. Intended use and occupancy . .A.c. qe..s.s.o.r.y..B.U.~3:..d.i.n.q : ' 3. Nature of work (check which appligable): New Building ..... ' ..... Addition .......... Alteration- ~' .T~ ...... Repair .............. Removal .............. Demolition .............. Other Work 4. Estimated Cost ............... i ....................... Fee ... $3.5...Q0 ........... ~...: ~. ~ ;i:j~ ...... ! ' (to be paid on filing this appli~atidn) 5. If dwelling, number of dwelling unRs. ............... Number of dwelling units on each floor ................ If garage, nmn bet of cars ....... i ................................................ . ................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front. 8 ' Rear 8 ' Depth 10. '. Height ~ ' Numbe} of Stories Dimensions of stone structure with 3Iterations or additions: Front ................. Rear .................. Depth ...................... !Iteight ...................... Number of Stories ...................... Dimensions f ntire new construction Front Rear Depth Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...$05...24.~.. ......... Rear ..... ],%,1,.2.Q .......... Depth . ,%¢.0...6.4...&. 10. Date of Purchase . .Aqlq~l. at. ~LJ..~..$9B.3. ........ Name of Former Owner C. elz;1..g,...8.1q<~ie.q .~ .Sbls..aq .J.;,~.Sk,,r. eze( 11. Zone or use district in which premises are mtuated ....... 1~.-.4.0 ...................................... 12. Does proposed construct,on wolatelany zon,ng law, ordinance or regulation: .... o. ........................ 13. Will lot be regraded ...iN.q ..... h~l ....lXtV~i'-fiA'&' .Willex£(~(~s~.llberemo~ed from premises: N/A Yes No 14. Name of Owner of premises ~e'~L~r~:De~Ve~... Address L(l~tT.~c[,l~.~$952. Phone No.(5.1.6.)..2.9.8.-:5.3.9.5... Name of Architect ............ ! .............. Address: .................. Phone No ................ Name of Contractor ' Address Phone No 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~... *If yes, Southold Town Trust~ms Permit maybe required. PLO7 D~AGRAM ildings, whether existing or proposed, and. indicate all set-back dimensions from :~ber or description according to deed, and show street names and indicate whether See atta{lhed survey of Roderick Van Tuyl, P.e. dated Audi. 5, 1983. Locate clearly and distinctly all by property lines. Give street and block nm interior or corner lot. ¢TATE OF NEW YORK, 20UNTY OF..S.U.F.F.Q.L.K. ....... S.S ........ .R%Y..MQ.N.D...J,..D.~V~RN.%.: (Name of individual signing tbove named. ................. being duly sworn~ deposes and says that he is the applicant :ontract) te is the ....... .O.w.n.e..r ............................................................................ (Contractor, agent, corporate officer, etc.) ff said owner or owners, and is duly a~tthorized to perform or have performed the said work and to make and file this pplication; that all statements containet in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this ...... 2. §.th ............ day of.. !...M~Y ............. 19.9..4 Notary pUblic