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HomeMy WebLinkAbout21080-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24217 Date MARCH 15, 1996 THIS CERTIFIES that the building Location of Property 720 BUNGALOW LANE House No. County Tax Map No. 1000 Section 123 Subdivision ADDITION FA~TTI~CK, NEW YOI~K Street Hamlet Block 2 Lot Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated O~TOBER 30, 1992 .pursuant to which Building Permit No. 21080-Z dated NOVEMBER 13, 1992 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 DEC~ ~)DITION TO DWELLING & P(~)L (SURROUND) AS ~PPLIED FOR. The certificate is issued to GENE DOROEKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPART~NT OF HEALTH APPROV~L N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A · ~ / ~l~d~hg Inspector Rev. 1/81 lvO~ NO. Il TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERi'IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-oN? 21080 Z Dote ..... ~.~ ..................................... , $9.~....~-. Permission is hereby granted to: .... z~.~.....~~~..~.~ ..... . ..~~~,. ............. : ........ ,~ ,~ ,o ~~r.~....~~~.~~....~ ...... ...~~z,.~~.~.;.~ .......................................... at premises located at ....~.~....~......,~....~~....:..~.~:2~'. ................................................. County Tax Map No. I000 Section ...... ,~..~,,,..~,. .... Block ......... .,.~,,.,,~,,,,.. Lot No .......... ../~.,,~,,, ....... pursuant to application dated ....... /..~../.a.~...~. ............................. , 19~ and approved by the Building Inspector. / S~lng Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD ,BUILDINC DEPARTMENT TOWN I~LL 765-1802 A~PLICATION 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 buiidings 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 ~roperly 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 O. ccupancy - New dwelling $25.00, ions to dwelling Alterations to owelling $25.00, Swimming pool $2~Ac~e~g $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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15·00 Date ... ~. :/.~.':.g52 ..... ew Construct~on.....~.. .... Old Or Pre-existing Building ................ .7~..o. ........... ~.. ' Location of Property .... · ~2.~.~4/~7q_f.....~j~...~ ........ '' ·/Y,~.,~:,~../.~ .~.~.~ :-¢ .... House No.' ~/ Street Hamlet Onwer or Owners of Property .... . .... { .. County Tax Map No 1000, Section.../~..~ ..... Block ..... ~.~_~ ..... Lot ..... l~. .............. Bubdivision.).. .... ;'~ ......................... Fi~ed ~ap ............ ~ot ...... Permit No : /..~.~.~.C_; ~' ......... : ..... .... ~.~. ....... Date Of Permit ..... L Applicant...~C/.~.~..p.~..D.~../ ..... Health Dept. Approval ........................ Underwriters · ' Approval Planning Board Approval ...................... Request for: Temporary Certificate ........... Final Certicate..~ .... TOU~DA~ION (1st) -'OUNDATIO|~ (2nd) ~OUGH FRAME & -PLUMBING ~IISULATION PER N. STATE ENERGY CODE FI$~AL ADDIT!ONA'L COMMENTS: Town Hall, 53095 Main Road P. O. Box 1179 Southold, New YoM 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD February 6, 1996 Mr. Gene Doroski 720 Bungalow Lane Mattituck, NY 11952 Re: Building Permit #21077-Z & 21080-Z Premises: 720 Bungalow Lane, Mattituck Suff. Co. Tax Map #1000-123-2-11 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 Southold, 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. FORM NO. 1 TOWN OF SOUTHOLD ~' ~I'~ ~' ' ~ ' '' BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 '.~./7"'"' TEL.: 765-1802 Examined ../ ., 19~.? A,,pro ,,d .... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ......... o CHECK .......... 9EPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: Date .... k .Q[/.~. ....... , 19 .~.~. 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 streets 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 Southol_d, 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 ta admit authorized inspectors' on .premises and in building for necessary inspections.~ ~x , (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ~r2 t~ ~ (~ O~5.&.. ( .r_.&~. ............... (as on the tax roll or latest deed) If applicant is a CO~l~orat'ion, sign~ gt~r'e pf duly authorized officer. · · '~. ~'1. ,',"~. , , ~ : ~ (Name and title of corpo£~it~ officer) - ALL CONTRACTOR'S 14UST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which propose, d work will be done .................................................. . ........... . ..................... House Number Street Hamlet County Tax Map No. 1000 Section .../. ~...~. .......... Block .... 0.~. .......... Lot../.~. .............. Subdivision ..................................... 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 .... · 'l' A' ' '~tt~'~! ~ ~3'~ ' ~ "~" ,.,,'I~ .......................... b. Intended use and occupancy ... 5.{. '~'t '/~'~ .... ~' ~ '~.Jlff'~;~E~d~'J:: ',;. '~': t*~ ~('~ ....................... 3. Nature of work (check which applicable): New Building .......... Addition .... *. ......AlteratiQn, .......... Repair .............. Rerooval .............. Demolition ............ Other Work ............. 4. Estimated Cost~. 4~)Z)I:Q" "i -- -- Fee ............. ,I *' (to be paid on filing this application) 5. If dwelling, number of dwellin~ 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 structules, if any: Front.. ...... Rear Depth ...... He'ght Nu~nber of Sto' Dimensions'of same structure with alterations or additions: Front ........... ...... Rear .................. Depth ................... i. · · Height ...................... Number of Stories ...................... '~-8. Dimensions of entire new construction: Front ...~ff~. .... , ..... Rear ...~'(~ ......... Depth . :~.~. ......... Height ............... Number of Stories .......... , .¢,. .......................................... 9. Sizeoflot: Front .~..q i Jr4~ Rear. ~' ~(o Bt-nth &~d')., 10. Date of Purchase .......... ~ ................... Name of Former Owner ............................. 1 I. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction viglate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ..... /4.0.~ .................. Will excess fill be removed from premises: Yes No Nane of Architect .......... .................. Address .'~..~..f~.i~.o..r,,. {C/ ....... Phone No ............... Name of Contractor ...O~B~,..~.ud.rl. :.x, ........ Address .... : .............. Phone No ................. 15. Is th-ia property loeatedl within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trcstees Permit maybe required. ~ i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc]: number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW '/OP~K~, COUNTY S.S (Name of individual signing contract) above named. AP, P'ROVED AS NOTED N~i:IFY ~UrLOI~G DEPART~T AT 765-1802 ~ AM TO ~ PM ~OR THE FOLLOWING INSPECTIONS: 1. FOLINDATION TWO REQUIRED' FOR POURED CONCRETE 2, ROUGH * FRAMING & PLUMBING 3. INSULATION FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENT8 OF THE N,Y. STATE CONSTRU~ON & ENERGY CODES. N~ ~8~NSISL~ FOR DESIGN OR CONS~U~ON E~ORS being duly sworn, deposes and says that he is the applicant He is the ........ .(~)..f'~.. ~..~..~. ! .................................................................... i (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 filed therewith. Sworn to before me this ........... C7~..A~./ ....... day of,/~Jd.'~,~'~ ~ ..... ,19~.'.~ ota~,Rublie, Stat® of ~ ~ .......................................... Ouallft~ In 8uffetk CeenW _~q (Signature of applicant) Commim~lon /?//'