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Home My WebLink About21419-zFORM NO. 4 TOW/q OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-22461 Date: 07/22/93 THIS CERTIFIES that the building A~DDITION Location of Property: 2433 CAMp MINEOLA RD. MATTITUCK, (HOUSE NO.) (STREET) (}IAMLET) County Tax Map No. 473889 Section 123 Block 6 Lot 7.1 Subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAy 14~ 1993 pursuant to which Building Permit No. 21419-Z dated NAy 19~ 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. l~ne certificate is issued to CATHERINE D. BURNS (OWNER) of the aforesaid building. S~/FFOLK COUNZ~Y DEPART~ENT OF H]~ALTH APPROVAL ELEC~rRICAL CERTIFICATH NO. PLUMBERS CERTIFICATION D~l'~u3 N/A N/A N/A Rev. 1/81 I~ON, M NO. ~ TOWN O~ SOfT'OLD 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~T.° 21~1J Z Permission to: is hereby granted the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 365-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~his 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-~isposal(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, Accessor~ building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 ?. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .~..~ .~. ) / ~. ~.~ New Construction ....... · .... Old Or Pre-existing Building ................. Location of Property. ~.~.~..~..~..~.~...~..7.~..~.4..~. ~?.~. ....... .~.~. ~.~.f..~.a..~.. ,~.~. .... ~. ~.~.l .~ ..... House No. Street Hamlet On'w~r or Owners of Property ............................................. . County Tax Map No 1000, Section..../.~.~. ...... Block .... .$. ......... Lot .... ~.~./. .............. Subdivision .................................... Filed Map ............ Lot ...................... Permit No...~/. ~..~ .~..Date Of Permit..~..~..~../.~../.~.~.~Applicant...~.~..~.gJ~. ~...~..,. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ...................... .. Reqeest for: Temporary Certificate ........... Final Certicate ........... ,, , ............... APPLICANT INSPECTORS Vict~rr ~ss~rd Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building l~spector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 23, 1993 C~rlII~RINE D. BURNS 2433 CAMP MINEOLA ROAD MATTITUCK, NY 11952 RE: PREMISES @ 210 ALOIS LANE, MATTITOCK 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 is not on file. (Enclosed) No Underwriters Certificate on file. The check is ~w~m~not on file.)$25.00 No Health Department Approval on file. No final inspectio~ has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~. 21419-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. INSPECTORS Victor Lessard Pvinzipa[ Building Inspector ' Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southoid, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 23, 1993 CATlilfglNg D. BURNS 2433 CAMP MIIqgOLA ROAD MATTITIJCK, NY 11952 RE: PREMISES @ 210 .M. OIS LANE, NATTITUCK 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 is not on file. (Enclosed) No Underwriters Certificate on file. The cheek is ~xw~not on file.)$25.00 No Health Department Approval on file. No final inspectio~ has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ 21419-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. :°z::::'°* ~DU~DA~ION (1st) 'OUNDATIO:I (2nd) ~UGH FRAME & .PLUMBING II ADDITIONA'L COMMENTS: FI;~AL .~:SULATION PER N. Y. STATE E~IERGY CODE II ,,, -., ,:WITHOUT :GERTEJCATE . OGCUP~tNGY,~ FOR POURED CONCRETE 2- ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST ~E COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET ,:THE REQUIREMENTS OF THE N.Y. 'STATE CONSTRUCTION & ENERGY : CODES, NOT RESPONSIBLE FOR ~"' ' ', DESIGN OR CONSTRUCTION ERRORS,. 1. ~OUNOAT~ON - FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No. Disapproved ~.....~C...i: ................ (Budding Inspector~ APPLICATION FOR BUILD. lNG PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedule. b. Plat 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 ofproperty must be drawn on the diagram which is part of this application. 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 issue 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, buildings for necessa~ i~.~sl~ections. (Signature of applican,~, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .~...~......~.. ....... .Y......~'...~.'f.r ............. : ................ .~....~. ................................................. If applicant is a corporate, 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 ............................................... Location of land on which proposed work will be, done. Mop No.: ........................................ Lot No ......................... Street and Number ..~.~,,,,~.....~'.~...4'..~. ...... .~ ............................................ ' ............... ~/~.' .~.C..~..~./.C ...................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. .~.¢..~.'~."~?"~ .............. ., ............................................................................. b. Intended use and occupancy ............. /~.~..~i.o ...... .9 ........... ~..~.... ............................................ t .............................. / 10. 11. 12. 13. 14. property lines. Give street and whether interior or corner lot. Nature of work (check which iapplicoble): New Building.. ................. Addition .................. Alteration ................ //,~ ..,,. J (Description) ! (to be paid on filing this application) If dwelling, number of dweJlihg units ............................ Number of dwelling units on each floor If garage, number of cars ..... ~ ....................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structuies, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .................................................................................................................. Dimensions of same structure] with alterations or additions: Front .................................... Rear ............................ Depth ................................ I~eight ............................ Number of Stories ................................ Dimensions of entire new con[struction' Front .................................... /'~ · Rear ....... ./.~ ................ · Depth ..Z'..~. ................. · Height ....... ~ .......... Number: of Stories ............... ..-7.. .................................................................................................... Size of lot: Front ....... ~.,,....J ...................................... Rear ......................................................................... Zone or use district in which )remises are situated ..................................................................................................... Does proposed construction vi )late any zoning law, ordinance or regulation: ..~?.. ................................................. Will lot be regraded . .......... ~ ......... ;. Will excess fill be removed from premises: ( ) Yes ( ~ No Name of Architect ............................................................. Address ..)) ..................... ;7~. Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indica}e all set-back dimensions from :k number or description according to deed, and show street names and indicate STATE OF NEW v,,~p,j<~ /' 4 S COUNTY 0/-~...,...'r~.~.....~......,~..... f'~' ................ ~.~...~...er~..~.....~..' ........ ~..~.~].'~ .................................... being duly sworn, deposes end says that he is the applicam (Name of individual sighting contract) above named, j He is the ............ ~.~.: ............ ~ ....................................................................................................................................... J (Contractor, agent, corporate officer, etc.) 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: 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 fil~rewith. Sworn to before me this j (Signature of appl. i~nt) Approved ..... '.?/f ., Disapproved. a/c ...................... · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 B~ARD OF HEALTH ......... 3 sETs OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. HAIL TO: . ~,?,.u' o nspector) APPLICATION FOR BUILDING PERMIT 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. e. 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 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, ~ou~ng code, and regulations, and to admit authorized inspectors on premises and in building for necessa, r!~nspections. .( '~ , ,/] , --' (Signature of applicant, or name, if a cordv~ation) . c k~L_~ -.(Mai_h'ng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N;meofownerofpremises ..C~t..ff~.. r;,xe "h, ..~..~.~..~.~. ............................ '... (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....~.~.E.( .'T..~..~. ........ Plumber's License No ......................... Electrician's License No ....................... Other T ade s License No. 1. Location of land on which proposed work will be done .................................................. · ' ! .<. .................. ' ............... Itouse Nmnber Street Hamlet County Tax Map No. 1000 Section ... t a ~ .......... Block ...6. ' Lot..~..'/ .............. Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: s .h...r. a. Existing use and occupancy . ._.t.~.]. b. Intended use and occupancy Vt.c,,) ........ ..'v~.[ ~ ' · '" ' · 3. Nature of work (check which ~pplicable): New Building . ~.. . ,~.ddition ........ Alteration ....... ' .. Repair .............. Removal~-.~.~,~ ~Demolitig~ ' . , " Other Work ......... ~. ~,000 0.0 ' · · (Description) 4. Estimated Cost ' '. ................... Fee (to be paid on filing this application) If dwelling number of dwelling units Number of dwelling units on each floor 5. If garage n'umberofcars ................ . ................ 6 If business commercial or mixed occupancy ................. ty e oi ;e specify nature and exte~lt'of ......................... .... 7' Dimension's of existing struct'u3es ' ,each ................... · if any: Front Rear Depth Height Num" bet of Stories .............................. Dimensions of shme structure ~bith alterations or additions: Front · Rear Depth .................... '... Height .......... i" ........ ;.. Number of Stories ........ ' ' · , . . · . I zk ........ 8. Dimensions of entire new consSructmn: Front .. . ~.7_~ ....... ~ Rear .... [. ~. Depth Height . .. ...... ....... Number of Stories... .......................... 9. Sizeoflot. Front iii.~...2.1~'5" ...:.. Rear ..... .~.~../...; .... i... Depth ..i .................. i-.' .............. 10. Date of Purchase ~ .... ' ........ Name of Former Owner . ~ .~.aS..o.$... :~bP. )~.... 11. Zone or use district in which p~emises are situated .... ': ....... g I ...................... 12. Does proposed construction v ate any zonin aw, ordina ce or regulation' . 13. Will lot beregraded . ; 1~.~ ..... ~ ....... ' ' '',~ ' .................... .... .,n ..... [ ....... Will excess Inl De removen Irom premises: Yes 14. Nmne of Owner of premises . .~! .~.E .~..~¢.~.~lkddress , .~q..'YW. l'rgcg.~ .M. :7.' Phone No. ~r-'-~ ~.' ?..7.o/.. Name of Architect .. i ^~,~ ...... ,I ~. ............. ~,umuss ..... , .......... Phone No ..... ~ ........ *' . · Name of Contractor .iSl. t~r.~)x.*.~e..(~.0'~.'~-[-q~.R. ~.~.4Address . .~ ~iT~. [T~...(q.,.. iii. Phone No. ~.'] ~. 15. I.s this property within 300 feet of a tidal wetland?' ',~'e's'.'.' .... No...~. ..... · ''' ,if yes, Southold ~own 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 lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY .OF ................. ....... ~..~.- ~ ........ being duly sworn, deposes and says that he is the applicant (Name of individt/al signing contract) ' above named. , He is the . .-.... ......... (Contractor. agent, cori~orate officer, etc.) 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 md in ,this'application are/rue to the best of his knowledge and belief and that the work will be performed in the manner :et forth in the appl'ication filed therewith. Sworn to before me this . .T ........... '4otary Public ...... ' .... ~ ,JO¥Cl~ M. WII.XIN$ !. · ... · ·. ..... .... cou .. . .......... ~ot(~ Publio, State of ~ow YOrk (Signature of applic~t) ~o, 4~82240, Su~ol~ Count~