HomeMy WebLinkAbout20076-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPART~{ENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20554 Date FEBRUARY 27~ 1992
THIS CERTIFIES that the buildinG ALTERATION
Location of Property i945 ELIJAHS LANE MATTtTUCK~ NY
House No. Street Hamlet
County Tax Map No. 1000 Section 108 Block 4 Lot 7.11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 5, 1991 pursuant to which
Building Permit No. 20076-Z dated AUGUST 9~ 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 isENCLOSE PORCH ADDITION TO AN EXISTING ONE-F~MIL¥ DWELLING
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
JOHN MCDERMOTT & WIFE
N/A
N 221909 JANUARY 27~ 1992
N/A
Rev. 1/81
~ORlt~ NO. O
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 20076 Z
Permission is hereby granted to:
.../.~ ../..~.~../~.../'~. ..................
...... ~~..,..~
.~..~......~~:: ........ ~ ....................................................................
~,~-,~ o, ...~~~.... ~~....~. ..............................................
County Tax Map No. 1000 Section ........ .~...~....~...... Block ....... ~ ....... Lot No ....... ..~.<../.../.. ....
pursuant to application dated ...... ~5~..~.~.?.../.. .......................... , 19 ......... and approved by the
Building Inspector.
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANC]
l[II FEB 2 6 1992
TOWN O' ~,'~ '"
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 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 Building - $i00.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5, Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
/
Date .... ....................... ....
New Construction ........... Old Or Pre-ex~stin uilding ........
L, ......... ..
Location of Property .............. ~. ......... .~..z.~ ......
House No. Street Hamlet
Onwer or Owners of Property ...... ~..~...¢.. Z..."?7~..'~.~.'~ .... · ././.~.+.~..~/. ,-~.e..'~-~. ................
County Tax Map No 1000, Section .... /.~. ~.'. .... Block ...... ~. ........ Lot ..... Z%li ............
Subdivision .................................... Filed Map .........., . Lot ................ . .. ...
Permit No. a ~. ~..~.. ~.~.~ate O f Permit....~. l¢./.~. / ..... Applicant...~.~.~ .~..~..~. (~.~ .~t?..~ .-~.
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ..................
Request for: Temporary Certificate .......... . Final Certicate ....... . .. .
Fee Submitted: $ ~.~ .......................
..............
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Buikling Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
JOHN MC DEP~OTT
1945 ELIJAItS LANE
MATTITUCK, NY 11952
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
OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOL]
J~NUARY 17, 1992 .
To Whom This May Concern:
We are unable to complete your Certif
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
XXX 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 ~. 20076-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
,¥,A~',Jll,<'I~'V .~7. I")~, JOHN STREET, NEW YORK..F~.Tp~ ]ep~s, ,~ ~'~
i
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY IdANNER.
1.
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONA'L COMMENTS:
NOTIFY
765-/802 9 'AM
FOLLOWINt
1. FOUNDATIOA{
2. ROOGH
3. JNSUL.ATION !
4, FINAL -, CON
BE COl
ALL CONSTRUi
THE
STATE
CC, DF~.S. NOT
765-1802
BUILDING DEPT.
INSPECTION
/
[~FOUNDATION 15T [ ] ROUGH PLBG.
FOUNDATION 2ND ~ ~ INSULATION
FRAMING ~ ] FINAL
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[~~DATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
FINAL
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
~ J FOU~)ATION 2ND [ ] INSULATION
~ t,~'FI~MING ~ J FINAL
DATE ~//3 ~/~/INSPECTOR ~
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [~NAL
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [~SULATION
[ ] FRAMING
[ ] FINAL
REMARKS:
TITLE
T
'%.
REVISIONS YOUNG & YOUNG
JUNE//,1974~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
dl// Y
1974
ALDEN W. YOUNG HOWARD W. YOUNg
SURVEY FOR:
INLAND HOklES, /NC. ~ ~
LO7 NO. 8, "ELIdAH'S LANE ES~
MATTITUCK oo,,e :',~ONO, L~ I ,
s~o~ co., ~,~:
J"r'~ ~ ~. ,-...
-mmm, TOWNHALL
IIIHI ~ - ~1 , ~ ~i 8OUTHOLD, N.Y. 11971
lU U~: ............ ~J ~,:) TEL: 765-1802
~ppro
..... , 19~r Permit No.
Disapproved a/c
BOARD OF HEAL'I'll .........
'1 SETS OF PLANS ..........
SURVEY ...................
CIIECg .................
SEPTIC FORH ........... ~'
r"& J...
"~:f-~ TO:
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
:t~ 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
r'areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
c. The work covered by this application may not be c'~)mmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
hall 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
~all 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
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to
Jmit authorized inspectors on premises and. in building for necessary inspection~.~ . /~
(Signature o~ applicant, or name, if a corporation)
· .... .................
(Mailing address of applicant)
tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
lame of owner of premises .......
(as on the t.a¢ roll or latest deed)
:' applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
~ Builder's License No.
Plumber s L No ...........
Other Trade's License No ~;/
,Location of land on which proposed work will be done .....................
County Tax Map No. 1000 Section...~'/.0..~/Block .....~..9. ........ Lot ..... ~..-77../.l.
Subdivision ............ (Name) Filed Map No. · · ' Lot
State existing use and occupancy of premisT, l and i,ntended use and occupancy of proposed conslructio~n%l'
l 32 (Description)
4. Estimated Cost-... · .... Fee ... , ..... · ~
i (to be prod on fi}!~lt~[sa I ation)
5. If dwelling, number of dwelling units . ~ ...... Number of dwelling units on each floor
· If garage, number of cars ..... ! .....i[ .t .... [ "' ..........
6. I..f. bus~n.ess, co.mm, erc~al or mlxe4 occupancy, specifK..nature and extent of each tv,e ,~e t,~,, (~LC--.~Ogrf_ia ' ' '
7. la~mensto~ns of cresting stmcture~ if any. Front '~lt.~ l#t~ D -'l,~r"J.ff~,~ .... ~. ..... x'il,'~/ffl~,it ......
~ensmns~fsame structure w~th alterations or additions: Front ~'1 1 ~' ~.~. ~;'~ '[P" .......
Dimo--: ..... ~' g ' ~ '~ ............ Number of Stones ..~ .
8 ....... n~lons~I entire new construction. Front .~ ~ ~ ' ~'' _' ' '~-Y2.~X .......
Height .~ x~ ~ ~'~ '. ~, ~ ....... ar...~,~ ...... ~ept~ ..~...
lO. DateofPurchase ~ .......... ~ear..:/~:U ..... Z ..... Depth ..~ ................
Zone or use district in which pre$ises are situated ..............
12. Does proposed constructiCn violable any zonin, la~ .... ~: .... ' '.' [. ' ' ' a'[~ .........................
Will lot be reor de~ ~/~ ~ ~ --, ,~umance or regmauon: ...~ .
13... ~ . . ~[~ .... a.'p/ .... t~ · · Will excess fill~ re~0v~d, from premmes: Yes
14. m~e oI Owner of premises . ~h[...[~~Address .. ~.. ~'1~ . Phone No ................
Nme of Architect ...... ~ ............ Address ~ .... Phone No. ~...
N~e of Contractor ..~. "" ' ' ..... ~ ....
............ Address. [~l'~ . Pho NO ........
15. Is this property within 300 feet of a tidal wetland? *Yes ........ ' ~ .......
· If yes, Southold Tdwn Trustees Permit may be required. No .........
PLOT DIAG~
Locate clearly and distinctly ~1 ~uild~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from
prope~y Hnes. Give street ~d block n~er~ d~sgfiptio' accord~ to deed a · ·
~ntenor or comer lot. * g , nd show street n~es and ~nd~cate whether
,TATE ~F NETWORK ibe -1
:ou y oF.. s.s
........... ~ B..~ .~.e~0.~ ........ ,.. ing duly sworn, deposes and says that he is the applicant
>ore named(Name of individual signing ~ontract)
e is the ....................... ~ .................................. .~ ............................
~ (Contractor, agent, corporate officer, etc.)
said owner or owners, ~d is duly a~tborized to perfom or have perforated the said work and to m~e and file this
~plication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
ork will be perfomed in the m~ner set~ forth in tlte ~pplication filed therewith.
yom to before me tiffs
>ta~ Public .......... County
+ :/12s30. s.,¥~ e~u,,~ i (Signatu~ of applicant)
~mm, Expffos~O, 1~O i
Nature ofw (check which applicable): New Building .......... Addition .......... Alteration
Repau' .., ,~N ........ RemOval .............. Demolition .............. Other Work .(O..t~..