HomeMy WebLinkAbout19901-zFORM
TOWN OF SOUTBOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No E-23997
Date NOVEMBER 1, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 1780 MAHRATOOKARD.
House No. Street
County Tax Map No. 1000 Section 123 Block
Subdivision Filed Map No.
MATTITUCK, N.Y.
Hamlet
Lot 4
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 20, 1991 ~ursuant to which
Building Permit No. 19901-Z dated MAY 29, 1991
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
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
FBANK &MARIE MEYER
N/A
N/A
Rev. 1/81
Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERAAIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WOP. K ~UTHOP~IZED)
NO- 19901 Z
County Tax Map No. 1000 Section ..... ../....,~.~J~.. ..... Block....,.........,......./' Lot No ........ ~ .........
pursuant to application dat~l ........ ~...:~.. ............................... , 19~.~...., and approv~:~ by the
Building Inspector.
Fee $...~
Re~ 6/30/80
Form No. 6
TOWN OF SOUTUOLD
1995 BUnmNO DEPARTMENT
TOWN HALL
, 765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink amd 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 ~hat 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. ..
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 denled, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees I
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-existinR Buildine - $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 .........................................
W ·
ew Constructzon ........... Old Or Pre-existing B~ilding .................
ltouse No. Street tlamlet
')nwer or Owners of Property.~~/)~/~/~--
Bo ooo, .......,../ ..... ................
)ubd±vis~.on .................................... Filed Map ............ Lot ......................
Permit N0,.J,I ........... gate Of Permit ............... ApplLc~[/. ...........................
qealth Dept. Approval .......................... Underwriters Approval .........................
'lansing Board Approval ........................
~equest for: Temporary Certificate ........... Final Certicate ...........
"ee Submitted: $ ....
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 26, 1995
Mr. & Mrs. Frank Meyer
1780 Marratooka Road
Mattituck, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
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.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT % 19901-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
fi£LP - ' ';~ .... '
FOUNDATION
(1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
0
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION 2ND
FRAMING
[ ] ROUGH PLBG.
[ ] IN/~ION
[ ~INAL
[ ] FIREPLACE & CHIMNEY
REMARKS'-
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[]FRAMING []FINAL
REMARKS: ~ .~
DATE /~/.~ ~//~;~INSPECTO.
' / /'
OCCUPANCY OR
USE IS UNLAWFUL
V~THOUT CERTIFICATE
OF OCCUPANCY
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
xa ' · ?J~/'~'~ TEL.; 765-1802
· nmctl~',/..., ........... ,19
,pproved ................ 19 ~.~. Permit No ...........
qsapproved a/c .....................................
BOAKD OF HKALTII .........
3 SETS OF PLANs ..........
SURVEY ...................
ClIEcK
',:;24 ...............
,/ HAIL TO:
· (Buildijg'ffInspec~ ~ ,. -
APPLICATION FOIl BUILDING PEFtlVIlT
Date .
.............. , 19...
INSTRUCTIONS
~. ~s application must be completely filled in by Wpewfiter or in ink and submitted to the Building Inspector, with 3
s of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan show~g location of lot and of bullrings on premises, relationship to adjoining premises or public streets
areas, and givNg a det~led description of layout of property must be drawn on the diagram which is part of this app,-
ion.
e. The work covered by tNs application may not be c~mmenced before issuance of Building Pe~it
d. Upon approval of this application, the Building Inspector will issued a BullriNg Pe~it to the app~eant. Such pe~it
Jl be kept on the premises ava~able for inspection throughout the work.
e. No building shall be occupied or used in whole or in p~[ for any purpose whatever until a Certificate of Occup~cy
11 have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Bulldog Dep~ment for the issuance of a B~ld ~ '
[ding Zone Ordinance of the Town of Southold e-~ ........... In= Pe~t pursuant to the
;ulahons for the construction of buld~.~ ~a~i~;~.~ ~..~, .. ~ , , herapphcable ~ws Ordm~ces or
: applicant agrees, to comply with aH applicable laws, ordinances, building code, housing code, and regulations, and to
nit authorized Nspectom on premises and N build)lB for necessa~ inspections. ~
_. .....
(Signature of applicant, o~ame, if a ....
(Mailing address of applicant)
te whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·
aeofownerofpremises ~~/~ ~ ~/~ ~~-~
o. ;elf ii ii ' i) ...........
~plicant is a corporation} signature of duly authorized officer. ,'
(Name and title of co¢orate officer)
Builder's &icense No ......
Plumber's License No ........... : .............
Electrician's License No .......................
Other Trade's License No ......................
· ocation of land on which proposed work will be done ..................................................
ouse Number Street .......................................
Hanllet
otmty Tax Map No. 1000 Section .... (.~ ....... Block ~ ....
~bdivJsion ..................................... Filed Mnp No.
(Name) .............. Lot ...............
ate existing use and Occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy ~W~ o~' ~ff~
Intended Use and occupancy ~ ~0/~
3. : ature et work (check which applicab e)' New Bud ng . · Add
Repair .... n , · ...... ition .......... ,\Iteration
· ~em°iva! .............. Demo tion ... . ..... Other Work .~.. ~ .........
4. Estimated Cost .. /~-~, ~ , (Description)
....... · ' ' Fee '"-~'~ ' . ~>.
i' (to be paid on filing .....
5. If dwelling, number of dwelling this application)
· If qnits ............... Number of dwelling umts on each floor.
garage, hum ber of cars .... . ............................................
6. If bus ness commercia or mixed occt pancy, specify mture nd extent et cach~type o ...............
Dimensions of existing structures~ if any: Front ............ ' ......
7. f use .....................
Height ............... Numl}er o f Stories .............. Rear .............. Depth .....
Dimensions of same structure w/th alterations or additions: Front .............................
~D.epth., .... 5' ' '. ........ :...i. Height ......... ' ................ Rear ...............
8. uimenmons otentire new constru~tinn: Fron}'....~/,~. ..... ' Rear ../.,~.....~. ..... Depth ""' ''. ....
9. Sizeoflot: Front /.4)/', ~,-~> . D~._' ') -,'f,">".¢ ........ . ........... i"'
:0. DateofPurchase .'~.._¢7'/9~-~ ......... ~..-4 ........ ..Depth .~q~'. ~o
.......... Name of Former Owner ~.~'.~./-. ~ .,'~...~..~../D..t' ~..~..//.~. ....
1. Zone or use district in which premises are situated ..
'~ Does proposed construction violate any zonin, law ' ' ' ' '
3. Will lot be re~raded AP O i g , ordinance or regulation: .~..q: ........ ., ....
4. NNa~i~ DE .Owner of prem~ses~?.'~.' ./l/~ ~ .~.~.',~.'/.~-~ ~.'?.~.' j-.~l~dg~ls~.~.~ll~.~. ~,~.~cd~c[/om~,prem~scs:..,q~
o~Architect . ./~'..d .~.~' ' ~ ~ ,~¢- ;"r~:~' ..... rhone No.,~.F: ~.~..
Name of Contractor . .~. ~../~ .] ............. ~moress ....... ~ ....
............... Phone No ..............
- ' ' ' ' ~ ......... Address .................... Phone No ..........
~. Is this property within 300 feet ~'f'~ tidal wetland? *Yes ......... No.~... ' .....
~If yes, Southold To~n Trustees Permit may be required. ' ....
.... i PLOT DIAGRAM
Locate dearly and distlnctly all b~ildlngs, whether existing or proposed, and. indicate all set-back dimensions from
roperty lines· Give sti'eet and block nu ~nber or descriptio~ according to deed, and show street names and indicate whether
~terior or comer lot.
AP O t D AS NOTED .
DATE. d~?/,z.q/g~/.... B p, #
76,6-1802 9 AM TO 4 PM FOR 'THE
FOLLOWING INSPECTIONS:
1, FOUNDATION ~'WO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTIRUCTION SHALL MEET
THE REQUIREMENTS OF THE N·Y.
'1','STATE CONSTRUCTION & ENERGY
cODES. NOT ,~RESPONSIBLE FOR
' DESIGN OR ¢,ONSTRUCTION ERRORS
tory OF ~~.... S,S ]
'e named(.N;une ofindividual sig~g c~ntract)
· ·. being duly s~vorn, deposes and says that he is the applicant
: the .......................... i ..........
i (Contractor, agent, corporate officer, etc.) .......
id OWner or OWners, and is dtdy out lorized to perform or have performed the said ~vork and to make and file this
cation; that all statements contained iil this application are true to the best of his knoxvledge and belief; and that the
will be performed in the manner set f6rth in tim application filed therewith.
a to before ]ne this
....... · 74: ..... .........
/ / ........ ,.. · County
No- 7:~g:~?~//of New York ................
nlm,.;;-.. ,:'~-%h,.>Z3300 t (Signature of applicant)
t,r.~.~;~'!neo In .ouffplk Coun~
.........