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HomeMy WebLinkAbout21598-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22610 Date SEPTEMBER 23, 1993 THIS CERTIFIES that the buildin~ ADDITION Location of Property 2035 THERESA DR. MATTITUCK, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Sectio~ 115 Block 16 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 3, 1993 pursuant to which Building Permit No. 21598-Z dated AUGUST 17, 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 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 N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A RICHARD H. & LYNNIS M. BAKER Rev. 1/81 / '//~6i~ding Inspector FORM NO.3 TOV/N OF BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21598 Z Date' "l'/"2 .............................................. CountyTox Mop No. 1000 Section ...././..~.. ........... Block ........ ,~.~. ........... Lot No...../.~ ............... pursuant to application dated ........~/~ .......................................... 19..~..~.~.. ........ and approved bythe Building Inspector, Fee ~..../.~./......~.)~... ~.~l~ Building Inspector Rev. 6/30/80 Form No. 6 >~? .... TOWN OF SOUTtlOLD BUILDINGTowNDEPARTMENTHALL 'Z~ ·~ ? ~65-1g02 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 requirement.~. ~. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and L'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 Inspec{or 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 o~ Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ............... New Construction .... ~ .... Old Or Pre-existing Building ................. Lncation of Property ...................... ~ ........ ~ ................ House No. Street Hamlet Onwer or Owners of Property.~.?~.~.~....~. ~.~/~/~.~..~...~.~. ~. ...................... County Tax Map No 1000, Section..~Z~~ ...... Block ~ ~ Permit No.~.~.Date Of Permit ................................ .... Applicant ......... Health Dept. Approval ....................... · · . Underwriters Approval ................. Planning Board. Approval ................ .. . ~ . ... Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. FOUNDATION {1st) FOUMDATION 2. (2nd) ROUGH FRAME & .PLUMBING' INSULATION PER N. STATE ENERGY CODE FIliAL ADDITIONA'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [L/]~INAL DATE INSPECTOR /I I ,.~O0 - I I:~,00-/ (,,,00 - dl~", 000 LOl~ $9 Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 g0ARD OF HEALTH ......... SETS OF PLANS U RV.E. Y ... ~ . ~.<~ ~d~.Z ..... HAIL TO: INSTRUCTIONS 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 briildings on premises, relationship to adjoining premises or public sti-eets {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 I?y 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 describbd. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necess~~~ f~c~gA_~ -- (Signature of applicant, or name, if a corporation) ?.o.*..fl .~..?m P~ :~.~//.,..~..~k ~.,.Y..//~.z.~........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. .©..~../<e. t%. ...................................................................................... N~me of owner of premises./~./.C..iT.//:..~. ¢/. ¢~... ¢..~. '.~'A</. ,C. J~.... j~/~/~.C J~ ......... (as on the tax roll or latest deed) If applicant is a corporationl signature of duly authori:/ed officer. (Name and title of corporate officer) Builder's License No..q.~..//(.~. ~ .............. Plumber's License No ........................ : Electrician's License No ....................... Other Trade's License No ...................... t. Location of land on which proposed work will be done ................. : .................. ' ..... ............. ltouse Number Street Hamlet cotmty Tax Map No. 1000 Section ... :/.~'.~.,. ......... Block .... /..~. ' Lot.../..~. ............ St,bdivision .~. ?..~fl...~. (.~-..('/~.,q .~/.4....O.g..f'~tj~ ..ff./.... Filed Map No...97...~..(>. .... 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 ............. . ........... : ..................... k ( ' h ~ppl' ) Additi ' ..~... Nature of wot check wh]c mable: New Building .......... on ..... Alteration :).' ' Re r .............. Removal .............. . Demolition ..... : ......... Other Work ~ ' . (Description) 4. Estimated Cost ...... ,~..o. i ~ (to be paid on filing this application) 5. Ii' dwelling, number of dwellin~ units .... , .......... Nmhber of dwelling units on each floor ................ It' garage m bet of cars ' 6 If business commercial or mixed occupancy specify nature and ........................................ · ' , extent of each type of use 7 Dimensions if any: Front Rear ' ' ' ' '~ ................. · ot ex]rang structures Depth Height Nuin~er of Stories .... r ............. . ........... , ............... D~menmons of same structure With alterations or additions: Front I ' . ................ Rear. [ ................. Depth .... ~ .................. Height ........... '..~ ...... ; ·. Number of Stories . . ' ' 8. Dimensions of entire new cons!ruction: Front ........ ~ Rear .. 2 .cf.: .. Dep't~ '.. g ..... Height ............... Number of Stories . "' ' ' ' >. Size of lot: bront .......... J .......... 2.. Rear .. Depth .................. 10. Date of Purchase ~.: .~.~i .................... ' "' · · - . ..... ' ........ '. Name ofFormer Owner ,/,/f,~.~e..~O lj~.~./.~ 1 1. Zone or use d~stnct ~n wtnc emmes are situated ..................... i ...... 12. Does proposed construction vi01ate any zoning law, ordinar~ce or regulation: ............... i ................ 13. Will lot be regraded ' · ·" i' . Will excess fill be removed from premise3: Yes 14. Name of Owner of premises .. 1 .... ~ ...... Address ................... Phone N~ ...... ' ..... ;... Name of Architect ......... i.. ............. Address ................... Phone N~ ....... Name of Contractor . · ' ...... Address ................... Phone Nq ....... "' ':' ' ' 15. I~ thzs property within 300 feet of a tidal wetland? *Yes ........ No ..... '1''' '''"'' · If yes, Southold i~own Trustees Permit may, be required. ~. , PLOT DIAGRAM Locate clearly and distinctly ali buildings, Whether existing or proposed, and. indicate all set-b~ck dimensions from~ property lines. Give street and blockinumber or description according to deed, and show street names md indicate whether interior or corner lot. STATE OF NEW YORK, $.S COUNTY OF .................. · .. .... 3 .. (Name ofindividua! signing contract) ...... being duly sworn, depose~ and says that he is the applicant above named. He is the ' .~-'~%).. )9..'~..&. . (Contractor agent porate officer eta ) of said owner or owners, and is dulyI author zed to perform or bare performed the said work and to make and file this ~pplication; that all statements contaibed in this application are true to the best of his knowledge and belief; and that the ,york will be performed in the manner lsat forth in the application filed therewith. ~worn to before me this ........... ....... .... 7; ...... ,i9... ' qot a ry eu !lic,~'~./d~...~~. ~nty Ota~/t'ublic, State of New ¥o?K ' · ............. No. 4951364 Qualified in SuffolkCountyO ~-- (Signature of applicant) . Commission Expires Ma;y 22, 19~,