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Home My WebLink About22086-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. No Z-23168 Date AUGUST 17~ 1994 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 1300 WESTPHALIA ROAD MATTITUCK, NY House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 7 Lot 14.3 Subdivision Filed Map Nc. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 6, 1994 ~ursuant to which Building Permit No. 22086-Z dated MAY 26, 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 ACCESSORY S~ 10' X 12' AS APPLIED FOR. The certificate is issued to SIDNEY & JOHANNA OLMSTED (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A S6[l~in~ Inspe/r FOgM NO.3 TOWN OF SOUTHOLD BUILDING DEPAETMENT TOWN HAIL $OUTHOLD, N.Y. N~ 22086 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN]IL FULL COMPLEI~ON OF THE WORK AUTHORIZED) Counh/Tax Map No. 1000 Sectlon.....~.Z.,~.,. ........ Block ...... ~ ............... LotNo, .,/..,¥./...'r~, ............ pursuant to application dated .......,~./~',,, .,/~,,,,,,,,~.. ...................... 10,,,,~,...~..,,,,, and approved by Building Inspector. .... 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(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/I0 of I% 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 "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 - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date..~.~..~.Z~.%..~..~..... ................ . . . · New Construction .~ - ......... Old Or Pre existing Building .... Location of Property 1.$.~.~. .~..~..~.~1'~ ~ i [[i][~.~.~-~. .. · House No. Street 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 .... /.~.. .... ~P~Fee Submitted: $ ' ' ' '~' '~'*' ~' '~ ~ 0 ................. ~..~ ~-~ ........................APPLICANT 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 June 10, 1994 Mr & Mrs Sidney Olmsted Box 731 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) 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 # 22086-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 765.t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] { ] FOUNDATION ZND [ ~N~ULATION / ~ FINAL [ ] FRAMING REMARKS: ~7~~ DATE INSPECTO~ OUIIDA'TIO:I ( 1 st) OUND~TION (~nd ~ OUGH FRAME & .PLUMBING [NSULATION PER N. Y. STATE ENERGY CODE Fi]!AL ADDITIONA'L COMMENTS: ~__ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Disapproved ale ..................................... , .... // (Buildin~ Insp~tor) INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY .................. '. CIIECK .................... SEPTIC FORH .............. CALL ....... HAIL TO: a. This 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 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 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.. APPLICATION 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, 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 all applicable laws, ordinances, building code, housingeqde, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti°ns]r't ~/ ........... k~_~.. ~. c~..~v:.,.: .~...~t ............. (Signature of applicant, or nan,, e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..,,~-../'.~J.?./...4..Z~ .]o.4,d,(.4//4_.....~.~/2T,2 j'.,./l~-..J ............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.~... ..................... Plumber's License No. ....~.. ................ Electrician's License No ....... ~ ........... Other Trade's License No ........... .x,, ......... 1. Location of land on which proposed work will be done .................................................. :?. ................ Th ................. t. .5, ?. ?. ................. . House Number Street Hamlet County Tax Map No. 1000 Section .... L-/-ti ........ Block ..... '.~. .......... 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 ..... b. Intended use and occupancy ...... ~/'Y'£~..~..~ ........................................................ 3. Nature of work (check which applicable): New Building ...'./.' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Othe$ Work?..~dtJ.~./.~ .... 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, comme~;i,gfl~~Upancy,:;..'~-~-~ specify nature and extent of each t~ype of use ............ , ......... 7. Dimensions ofex~prtl[~ny: Front .... '.~P{ ........ Rear . :~4.c/i ........ Depth .... ~ ./7-' .......... Height ....... ;-~~:v~ber 8f Stories ........................................................ Dimensions alterations or additions: Front ................. Rear .................. Depth ....... Height ...... . ................ Number of Stories ...................... 8. Dimensions Front ............... Rear ............... Depth ............... Height Stories 9. Size of lot: ........ ~..' ....... Rear ..................... Depth ....... 3 ......... ~. ..... 13. 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ Is this property within 300 feet of a tidal wetland? *Yes..~... No ......... L *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ 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 15. APPROVED AS NOTED ~(~l~ 8UILDINO OEP~AT 765-1802 9 AM ~ 4 PM FOR THE FOL[ O&~ING INSPECTIONS: i [-q~ ,:C:,AT~,~ ~[OUIRED ~ i. '..~' C{':~?';~t:~TtO~J MUST v C()e,(~I.E1E ~-~'~g C O ALi_ COr. JGFRi)CTiON SHALL MEET Tt-'F RFO..,~EMENTS OF THE f~ FATF: C{3~gT~LICT)ON g ENERGY CODES Nr~ RESPONSIBLE FOR r~F~;K~t'~ O~ CONSTRUCTION ERRORS STATE OF NEW,~'ORK ,,- .,- ?e7 s.s COUNTY OF..',0 ~. t., ......... ............. .~:/..~../~..~. .... 0.~..~,..~.~..C.'~.~. ........... being duly (Name of individual signing contract) above named. sworn, deposes and says tlxat he is the applicant He is the .......... D.(.L)OJ .~.. fd~ .................................................................. (Contractor, agent, corporate officer etc4 of said owner or owners, and is duly authorized to perform or have performea the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn t~ b. efore me this .......... .......... ignature of applicant)