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HomeMy WebLinkAbout21546-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24028 Date NOVEMBER 16, 1995 THIS CERTIFIES that the building ADDITION Location of Property 3005 OLE JULE LANE MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 122 Block 5 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 8, 1993 pursuant to which Building Permit No. 21546-Z dated JULY 20, 1993 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 SCREENED RAISED PATIO ADDITION, A DECK ADDITION AND ADD FOUR FEET IN HEIGHT TO AN EXISTING FOUNDATION TO ~ EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N290062 PLUMBERS CERTIFICATION DATED KEITH & BARBAP~ RA~ICH (owner's) N/A OCTOBER 12, 1993 N/A Rev. 1/81 /B~lding ~Inspector FOi~M NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ ~1546 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ................. y,¢~... ................. ~ .............. Permission Is hereby granted to: .... ...k~..~./.......~:.~ ............................................ ...... ~.~(..T~.C/..~ ....... ~.~.::. ........ ./.../...¢~ ..... to...~~r........~ ........ ~.~,:~-~.~ ......... ~:Z-.~..,...~..A.~..:.-...~.~;,.......A... ...... at premises located at ~00 ~- 0~-'~'-- ~'~L~ ~. CountyTax Map NO. 1000 Section ...... ./...?..~.. ......... Block ....~ ........... Lot NO ..... ~ ............. pursuant to application dated ............. ~ .................................. 19...~ ....... and approved bythe Building Inspector. ~ $...J~:~ ...... // Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD ~-- 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. Submit Planning Board Approval of completed site plan requirements. 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. ~For 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 Certificate of Occupancy - Residential $15.00, Commercial $15.00 ............................. New Construction .... ..~..... Old Or Pre-existing Building ................. Location of Property ..... ~] .......... ~ ........................... House No. Street. Hamlet Onwer or Owners of Property... ~..~. ~ g~.~.~ .... ~'~ ..................... County T= Rap No 000, Section. L ,QQ...Bloc .O. 6,.©O- .... Subdivision .................................... Filed, Map ............ Lot ...................... . .&.' Permit. '~'l~'l '~ '~''' Applicant..~ ~%~..~ ~,~ -~. ..... ermit Of Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate..~.. ...... C~'~ ~q 0~' % ' 'APPLICANT Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 31, 1995 Mr. Keith Radich 3005 Ole Jule Lane Mattttuck, N.Y. 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 # 21546-Z Thank you for Please contact our office on this matter. cooperation. SOUTHOLD TOWN BUILDING DEPT. (2nd) rOUGH FRAME & -PLUMBING ~I~SULATIO?I PER N. STATE ENERGY CODE FI;IAL ADDITIONA'L COMME~TS: § FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . (~irding Inspector) APPLICATION FOR BUILDING'PERMIT BOARD OF HEALTH ......... ~ SETS OF PLANS .......... SURVEY ................... CIIEC~ .... CALL .................... HAIL TO: Date ................... 19... · iNSTRUCTiONS· a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sots of plans, accurate plfit plan to scale. Fee according to gchedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti'eets dr 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 i~sued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. .e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificat~ 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 South01d, 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 describhd. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ing~. ;~ns& ,nj. ~, i~'''t''~'-''~{~''~'~t;'~ .. . -- (Si~natur.e oftapplicant76r name, if a corporation) o.b.e. kock (Mailing address o f tpplicant) State whether applicant is owner, lessee, 'agent, architect, en~neer, generaJ 'contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorii~d officer.· (Name and title of corporate officer) ' Plumber's License No ....... · .................. Electrician's License No. Other Trade's License No... .................... Location of land on which proposed work will be ·done .......... : . .... .qeo. S. · ' ' ... House Number Street Hamlet Couhty Tax Map No. fo00 Section . .~-~.~. ,, .(~.0. ...... Block .0. S ,.C~.~. · Lot .0.'~ .~....(~'. .... Subdivision ........ . ....................... ' Filer! Map No ............... Lot ............... (Name) Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: '3. Nature of work (check which applicable): New Building ' · ·; .4.ddition ...g ..... Repair .............. Removal ............... Demolition ...... ; Other · (to be paid on filing this applicafl6n) 5. If dwelling, number of dwellin: units ..... i~ ......... ~ Number Of dwelling units on each floor... · If garage, number of cars ................................. . ................................ . 6. If busin.ess, co.mmercial or mix ed occupancy, specify nature and extent of.each tyoe of use .................. 7. Dime~mons of exi~ing struct'u :es, if any: Fronf .~), Rear Dnnenmons of same structure with alterations or nam~;~,,o. ~.,..., . ~ ~ -- ~ o. ~nm~nmons ox entire new construction: Front ...;. ~ ~ ,. . n~. z .'~ ~ ' '.;' ' ~ ;~' '" ........ I1. &one or use district in which piemises are situated .... .~s~r~:,,,/ .... ~ ......... .'": ....... 12. Does proposed constructmn violate any zoning, law ^--=-' ......... ;.- ,'~ ...... · 13. ~m lot ~o~regraoe~d .... .' [~':d{'' '~'' LC-' 'c ..... Will excess fill be rellkaved from premises: Yes ~/~o Nme of Architect ......... I .................. Address ........ .... Phone No. . .. Name of Contractor. ...................... ·, ....... ; .................. Address . Pho~.No.... ..... 15 Is this property within i300 feet of a tidal wetland? *Yes ........ No ..... ' ' rustees '~' · *If yes,' Southold iTown T Pertait may..be required , i ' PLOT DIAGRAM Locate clearly and distinctly ali buildings, ~heth&r existing .or Proposed, and. indicate all set-back dimensions from property lines. Give street and blockinumber or descriptio]i according to deed, and show street names and indicate whether interior or corner lot. I . , cou .x nF..=x4_.t..w. ¢. rs .... (Name of ifidividual signi ..... : ·.......... being duly sworn, deposes and says that he is the applicant ~g contract) above named· , ....idi nir' cidr' or Ja't;ofiicer,"e'tc ) ................. ' ......... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and ~file this application; that all statements contel ned Jn t~is'application are irue t0 the best of his knowledge and belief; and that the work will' be perform/ed in the manner!set forih in the application filed therewith. Sworn to before me.~. i ~ ' · unty /9 ~ 7) /9 -- ( l