HomeMy WebLinkAbout21332-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
~ERTIFICATE OF OCC~/PANCY
No Z-23970
Date OCTOBER 19, 1995
THIS CERTIFIES that the buildin~ RENOVATION
Location of Propert~ 3005 OLE J~LE LANE MATTITUCK, N.Y.
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 APRIL 9, 1993 ~ursuant to which
Building Permit No. 21332-Z dated APRIL 9, 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 RENOVATE EXISTING ONE FAMILY DWELLING DAMAGED BY STO~,
The certificate is issued to KEITH & BARBA~ARADICH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-292062 - OCTOBER 12, 1993
PLUMBERS CERTIFICATION DATED OCTOBER 18, 1995-PECONIC PLUMBING & HEAT.
Rev. 1/81
lrOR~ NO. 9
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~N? 2133aZ
Permission is hereby granted to:
~.~..}? ~..~.~.:~..~ ........
.... .~...o.~.~..;....~.....~....~ ........
~.~.....~.:.~.,.....~./..~..~.~ .....
,o ......
at premises located at ..~.,......~ ........ ~......~iii~ .......... ~...'.'"~ .............
County Tax Map No. 1000 Sectio~:~...~...~.....'~.. ....... Block ........ ..~...~'. ..... Lot No...)...~ .................
pursuant to application dated(') -- ..~..~.......~.-- ......................... , 19.~,.~:~, and approved by the
~J
Building Inspector.
Fee $...~...~./.?..~ ...
...... '~""*'''l~ilding Insl>ector
Rev. 6/30/80
BLDG. D., ~'.
TOWN OF SO~ rD.lOl D
A.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPI, ICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in hy typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final snrvey 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
].ess thaa 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, I957) non-conforming uses, or buildings and
"pre-existing" land uses:
I. Accurate snrvey of property showing all property lines, streets, bnilding and
unssual 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
I. 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 Buiidin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
~. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
ate ...'.o. 1. ......................
New Construction .... .~. ..... Old Or Pre-existing Building .................
Location of Property...3.~. S ................ 0.\ -~...~'k~X .~. L~ ...... · .~...~,~ ~.~. ?.~.~ ·
ttouse No. Street Hamlet
Onwer or Owners of Property ....... ?.. .~.. ..........................
County Tax Map No IOO0, Section. ,[~.,(,~. .... Block.(~5*(~{~ ....... Lot..(~.~3 .~ .~.(~.(~ ......
Subdivision .................................... Filed Map ............ Lot ......................
Permit No..a./.5.~..r~-.Z.Date Of Permit ..... .~.lg.~. ...../.~.3 Applicant..~[~...~.....~a~.~..~...
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval .........................
/
Request for: Temporary Certificate ........... Final Certicate...~ ......
~ \ APPLICANT
Co 73 7D
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
C E R T
I F I C A T I O N
/ / -
Building Permit No. ~
(please print)
(please print
I certify that the
contains less than 2/10
solder used in the water supply system
of 1% lead.
· (PlUmbers S'~gnature)
Sworn to before me this
day of E3 7
Notary Public, ~..h~C
County
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[ [ 9 ~ [ 97 BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO:38
Date
THIS CERTIFIES THAT
in the followlng location; ~ Base~nt ~ Ist FL ~ 2nd Fl. O~T ~ Section Bilk Lot
~s examined on 0 ~ ¥ 0 ~ ~ (~ ~ ~ t ]. ~ 9 ~ and found to be in compliance ~ith the Na~onal Elect~cal Code.
FIXTURE
OUTLETS SWITCHES
FIXTURES RANGES OVENS EXHAUST FANS
DRYERS
SYSTEMS
NO. OF FEET
E
OTHER APPARATUS:
E R V I C
OF CC, COND.
NO. OF HI-LEG
A. W. G, NO OF NEUTRALS
OF HI-lEG OF NEUTRAL
81%8A~
11957
G~NERAL MANAGER
~ L~
This certificote must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONdL COMMENTS:
76S-1802 ~, C.~,~_~ J
I H S PE(::'rlC) N-----__~
I ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND ~[ ] INSU.L~AT~N
[ ] -FIZAMING
[ ] FIREPLACE & CHIMNEY
."MARKS:
DATE
FOI~M N0. 11
TOWN OF SOUTHOLD
BUILDING DEPARTM~2{T
TOWN H~LL
SOUTHOLD, NY
DEVELO PMET~T PERMIT
:~o .. /~,f ~ Date_ //~F~zl ~ __. 19.~
Pe:~-~l~slon 1~ h~reby grantod to:
,. %~ ~ ~
Cou,,~y Tax M~p No. !000 Seo~lo~ .J:~_Blo~k ~ Lo~..~] ......
pu~uoa~ to a~pltoa~ion da~ed ~ ~ __~ 19~., ~nd appx'oved
b~ the Bullding Inspe~op.
Building Po::nlt
Building InspoctoP
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 12, 1995
Mr. Keith Radich
3005 Ole Jule Lane
Mattituck, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of
because of the following reasons:
xx An application for Certificate
Occupancy
of Occupancy is
not on file. (Enclosed)
xx 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.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 21332-Z
Please contact our office on this matter. Thank you
cooperation.
for
$OUTHOLD TOWN BUILDING DEPT.
Town Hall, 53095 Main Road
P, O. Box 1179
Southold, NewYork 11971
Fax (516) 765-1923
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
September 27, 1995
Mr. & Mrs. Keith Radich
3005 Ole Jule Lane
Mattituck, NY 11952
Re: Building Permit %21332-Z
Premises: 3005 Ole Jule Lane, Mattituck
Suff. Co. Tax Map ~1000-122-5-17
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued.
According to the Code of the Town of $outhold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of Occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Thomas J. Fisher
Senior Building Inspector
IA....
pplzcatlon Received'
Disapproval Issued
19
FORM NO. 10
P~it #
APPLICATION FOR DEVELOPMENT PERMIT IN THE TOWN OF SOUTHOLD
19
1. Type or DeveLopment Proposed: New Structure %lnc'' Iud'~lng storage tanks
Addition and/or Alteration__ Fled Proof Below Base Flood Elevation__--
2. Elevation Data ~n relation to' a~ove main sea love1 ~f:
(a) Lowest floor elevation, including basement feet inches
(b) In a V Zone, bottom of lowest structural member ~eet inches
3. FIRM--Flood Insurance Rate Map, Zone designations
4. Owner of Premises .~.~,~ ~ ~m,~_. ~~
5. Location of Property:
House # ' Street ' ~ Hamlet
County Tax Map No., Dist. 1000, Section /2Z1~ Block
Subdivision Filed Map#
6. Permission to be granted: ~ Owner as above ~ New Owner
:. Under Contract .. Lessee __ Contractor __ Phone
Name if not given above Mailing address
Lot(s) / 7
Lot (s)
7. Approval from other(s) before Permit is issued:
e
DEC Wetlands (Town Board)
Health Services
ZBA
Building Permit ~ ~ ~ Planning Board
· t~ant~, m the Owner __, Co-Owner
I,
I__, New Owner , Under Contract , Lessee __, Agent , Contractor ,
and agree to comply with all applicable sections of the Code of the Town
of Southold; County, and State and to admit authorized inspectors to
premises authorized to perform or have performed the said work and to
make and file this application, that all statements contained in this
application are true to the,best of my knowledge and belief and that the
work will be performed in the manner set forth in the application filed
therewith.
STATE OF NEW YORK ', %, '2?
COUNTY OF SS
Signature
SWORN TO THIS DAY ~F 19
~otary Public
ApPlicant.s mailing
address and phone #
if not given above
11/85
FORM ~0. 10
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
(516) 765-1802
P.O. Box 728
Southold, N.Y.
Town Hall
Main Road
Southold,N.Y.
11/85
11971
ApPI.¥C~TA~ ~ n~V~T.ODM~N~ DEpMiT
Instructions: The application to the Building Inspector includes (each
In ,~~) 1. Fork No. 10 filled out in ink or typewritten, 2. Sur-
Vey of premises with!elevations above mean sea level, 3. Drawings of pro-
posed work. The application must give complete information to show that
the proposed can comply to the Local Law No. 1-1980, Chapter 46 of the
Code of the Town of Southold known as "Flood Damage Prevention Law" of the
Town of Southold. The applicant must submit approvals that any other
agency requires. ~ .~,
General Standards as irequired in Section 46-17 of the law to minimize flood
~amage:
A. Anchoring of!structures, including tanks and mobile homes
B. Use of construction material and methods
C. Design and location of utilities
D. Subdivision ~roposal with drainage, public utilities design and
base.flood, e~evations
~pecific Standards as. required in Section 46-18:
A. Residential clonstruction
Non-residents:al construction
C. Mobile homes i
The applicant must submit plans and specifications as well as any other~
information requestedi by the Building Inspector to substantiate the facts
that the structure ha:s or will have the lowest floor, including basement/
cellar, elevated abov~ the base flood elevation or; if permitted by the
Federal Regulation, that: 1. such structure is flood proofed in such
manner that below thelbase flood level the structure is water tight with
walls substantially and impermeable to the passage of water, 2. that
structural componentsi are capable to resisting, hydrostatic and hydrodynamic
loads and effects of buoyancy, 3. applicant must submit certification by
a registered professional engineer or architect that the standards set
forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied.
C~oastal High Hazard. area (V Zone) 46-19. Applicant shall submit plans,
specifications including the required certifications and such other in-
formation as the Building Inspector may require in that the provisions of
46-19 are complied wi~h. Mobile homes are prohibited. The lowest portion
of the structural members of the lowest floor cannot be lower than the
base flood elevation With all space below open except breakaway walls.
Sand Dunes. If sand dunes exist on the premises and the applicant pro-
poses to alter same, plans and specification must be shown in detailed
nature of any alteration submitted.
~uilding Permit. A B6ilding Permit is als~ required for any structure.
Both a Development and a Building Permit must be issued before any work
can start in a special flood hazard zone. A written disapproval or a
permit must be issued within ten (10) working days.
During construction, the inspector shall be notified in time so he may
make the required insPections.~
Upon completion, the ~equired certification of the final elevations and
work must be submitted before the approval to use or occupy can be
approved.
(Fill o~t the form,.on the back of this sheet)
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined .., 19 .~..c~'
Approved .... 19 .~.~. Permit No..c~.. }. ~ ~ o1 ':~
Disapproved' a/c .......................... ~..~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY
ClIECK ..........
SEPTIC FOR~I .' '''''''''.''''''''"
CALL ...................
MAIL 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 buildings 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 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, buildiqg code, housing code, and regulations, and to
admit authorized inspectors on premises and in b~ilding for necessary in~
--' ~ (Sigr~atur9 of applicant, or name, if a co,rporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder.
NJme of owner of premises ........ ~'~-~.'¥..~...x~7...
(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...~..l~.../Y/?..~..~...~.~ ......
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
... ...... ' ........ 0.. .............. ..........
ltouse Number Street Hamlet
County Tax Map No. 1000Section ....'I.~..C~ .... Block ...(2).5.,.~.. ' Lot..O.l.~..~.~D'~O~ ....
Subdivision ........ . ............................ '. Filed Map No ............... Lot ...............
(Name)
2: State existing use and occupCncy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .. .
b Intended use and occupancy . .' ...... '
· 3. Nature ofw~rk~heck which applicable): New Building .......... Addition .......... Alteration .... 2..
Repair .... V ......... Removal .............. Demolition ..... : ....... Other Work ........
4. Estimated Cost. ~ "· .. ...... Fee .... ,~ ......... ...............
i (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 .... !...\ ..... ' ......
If business, commercial or mixdd occupancy, specify nature and extent of.each type of use
7 Di fexi ti th ~ if ,5'.Q .'JJ.O ............... i .....
· mensionso s ngstruc rs, any:Front .......... Rear ....... D:pt.h
'ght [.~ mb fSt [ ' ' .................. .'~..~.
He~ ............. Nu er o cries ................ ' ...' .............. .. . ..
Dimensions of shine structure with alterations or additions: Front '
Depth ' ' Height ' Number of Stories
8. Dimensions of entire new construction: Front '~ .~.Y'~ Rear ....................
..... : ............... Depth ...............
.Height ...:..' ......... iX/umber of Stories .................... - .
9. Size of lot Front .~ ~5~1~.. Rea~ ~ 3' 5~ '" .... ~, ~ .'. ' ' '~ ?3'r~ ......... '. ·
10. ateo~eurcnase . ~t'~."[ . . .. · Name of Fo ^ ''
......... :1' ......... ¢. rmer ~,~wner .................... , ......
1 1. Zone or use district in which pr~mises are situated ~'~.~G~?c~. ~x~ .......
12. Does proposed construction violate any zoning law, ordinahce or regulation: ....Y~O. ........................
13. NW, ill lot ?~regraded .....'~' .~'i ',','~' ' · ~'~ · '~' · ', ...... Will exq_ess fill be r, oglloved from premises: Yes
marne of Architect .......... ~ ................. Address ................... Phone No ................
Name of Contractor . , ,
....... ~ ................. Address ............ : ...... Phone/No ................
15.' I.s 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 lbuildings, Whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block Oumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NFz~W-YOR]I~/~ / ~ SIS
COUrirY-OF. 2 .%....
(Nam4 of individual signin~ contract)
above named.
He is the ' ~
i (Contracto~gent;}or~orate officer ere )
of said owner or owners, md is duly authorized to perfom or have perfo~ed the said work and to m~e and file this
application; that all statements contai~ed M this application are true to the best of his knowledge and belief and that the
work w~l be perfomed in the m~nerfiet forth M the application filed therewith.
Sworn to before me }his ~ .
.............. :~:'V;'...dayof,.u..~/~f,~.'., ~ / .....
~ml.~n ~piree Oeee~er 8, lg ~ , . ',,~ TShnat' [ 'g ure of applic~t) .