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Home My WebLink About21628-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF O~UPANCY No Z-22985 Date MAY 4, 1994 THIS CERTIFIES that the building Location of Property 290 VILLAGE LANE House No. County Tax Map No. 1000 Section 115 Subdivision ADDITION MATTITUCK, NEW YORK Street Hamlet Block i Lot 1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1993 ~ursuant to which Building Permit No. 21628-Z dated AUGUST 30, 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 (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED RICHARD R. NEMSCHICK N/A N/A N/A Rev. 1/81 FORM NO.3, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ ~1628 ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Coun~fTaxMapNo. 1000 Seoflon....../../....~.... ...... BIook.... ,/~. ................ LolNo...~ .................... pu[s~nt to appiloatl~ dated ...... ~ ....................................... 19.. ~ ...... and approved by the Buildl~ insets, ~ S.....~.~.. / ~ldlng Inspector Rev. 6/30J80 TOWN ~ OU~OLO Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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: I. Final survey of.property with acculturate location o~-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 '!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 Buildin~ - $i00.00 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 ........................................ . blew Construction ........... Old Or Pre-existing Building., ~. ............. Location of Property .................................... : .... ....... ,.. ...,. ,..... House No. Street Hamlet Onwer or Owners of Property ....... ~ ....................................... County Tax Map No i000, Section .... //.~.. ..... Block.../. ............ Lot .... ./ ................. Subdivision .... _~ L~ ~ ~ /0 -~ ~..~L .~..~ ~ ............................... Filed Map .......... ot. ................ Permit No..~. ] ?..~..~..~....Date Of Permit...~.~..~.~. [. ?.~...Applicant...~. [~.d~..~.~;...~.~...~.~.'~..~.C~f .~.... Health Dept. Approval..JJ~. .......... Underwriters Approval Planning Board Approval ...................... .. Request for: Temporary Certificate ........... Final Certicate.?~. ........ Fee Submitted: Co -2_ a2 ~.S 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 April 25, 1994 Mr. Richard R. Nemschick 290 Village Lane Mattituck, NY 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy not on file. (Enclosed) No Underwriters Certificate on file. The check is not on file. ($25.00) Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on File. (All permits involving plumbing being issued after April 1, 1984.) BUILDING PERMIT # __BP# 21628Z Please contact our office on this matter. your cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. {{DATE FOUNDA'TION FOUNDATION {1st) (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 76S-1802 BUILDING DEPT. INSPECTION ]~FO~UNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION AND [ ] INSULATION [ ~RAMING [ ] FINAL INSPECTO~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . . ........ Disapproved. a/c ..................................... · (B~din~ ~fspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... SET:; OF PL,i~t$ . . . tJRVEY ........... . Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 s~ts 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 st?eets c,r 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 tEis application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will igsued 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectfipn~,?//.//~//~//.l//~/Q ' f~ 'ltl · ....... --. (Sign/~ture ot appticant, Or name, ~[ a o p .~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· (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 .... ~(~..~.~..~. t ........... Plumber s Lmense No ......................... ' Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proil.o, sed work will be done .................................................. · . .............. · H'ouse Nu~ bet~ . Street Hamlet CountyTaxMapNo. ,000Section ...:.//.~.. ...... Block ........ (. ' Lot..~..l ........ Subdivision ..... .[/i ~ .c.p..¢-.~.../~p.~.o.~: ...............Filed Map No.~Lot~ ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ./. --~.'.*t.t iC..~. '~ ..,.D~ ~-c~ C'. .. b. lntended use and occupancy ..~_.~.,.QC.~. /~ ..~- .-~.~.. ,~'.: .~.b~.< ~' .-~..?~.C · 3. Nature of work (check which applicable): New Building Addition ... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... · $'/fo~ ~ .-... ' . (Description) 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, commercial or mixed occupancy, specify nature and extent of.each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .... ] .................. Height ........... ' ........... Number of Stories ...................... 8. Dimensions of entire new construction: Front .............. : Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ......... : ......... ~.. Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ..................... : ....... 11, Zone or use district in which premises are situated ..................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... '. .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ............ ;... ' Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No .............. ... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.~ ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property tines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. AP~PRO~ED AS NOTED ' /~,-~ BY' 765-'i802 9'AM TO 4 PM FOR THE FOLLOVVIMG iNSPECTIONS: 1. FOiINDATION TtIVC, REQUIRED FOR POtJRED CONCRETE 2: ROUGH - FRAMING & PLUMBING 3 ~N~qLll_ATION ~.. Fi~ i~d. CONSTRUCTION BE COMPLETE FOR C.O~ ALL CONSTRU~ION SHALL ME~ %ME REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIBLE FOR . DESIGN OR CONSTRUCTION ERRORS STATE OF NEXiV~rO'RK,/X~ COUNTY OF,,-, .~'~L~.[--~- a'~/KI r ......... ~..i ~,.~.f'. ~....~, o~.,..~....~., l..~., being duly sworn, deposes and says that he is the applicant '~ame of individual signin~ contract) above named. He is the . - ....... ' ............................... ' .............. (Contractor, agent, cor'porate officer, etc.) of said owner or owne~, ~d is duly antho~ed to perfo~ or have perfumed the said work and to m~e ~d file this application; that all statements contained ~ this'apptication are ~rue to the best of his ~owledge and belief; and that the work will be perfumed in the re=net set forth M the application filed therewith. Sworn to before me th~ .... ............ .... ..... ~o'ta~ Publi~-f~.'-. County ~ ~/[~~ t~[~~' ~_~ · . · .. ..... ....... :...,:...,: ~ ~.~~ ~ (Signature o[ appJ~c~t~ · I000 - I1~'.00 -01,00~0OI.000 MAP OI= PFKOP~I-~TY .51TUAT~, AT MAT'I'ITUCK TOWN OF" $OUTHOLD- C. our~Ty of:- SUFF-OL~4. DONALD L. I~ALM LI¢,I~IO , 31207 ?~.. ,3HAW AVE'~ 1.5LIP I'~