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Home My WebLink About19849-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19919 Date MAY 20, 1991 THIS CERTIFIES that the building. ADDITION TO ACCESSORY Location of Property 1130 OLE JULE LANE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 122 Block 4 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 7, 1991 pursuant to which Building Permit No. 19849-Z dated MAY 10~ 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 ACCESSORY INGROUND SWIMMING POOL The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 WILLIAM & BERTHA STARS B~ilding Inspector ltrORM NO. t TOW~ OF SOU'DIOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~_ 19849 Z Permission is hereby granted to: ..... ::"~'"~"~ ........................................ L~ ...~.. ~.~.~...~....;..~.~... ~ ~ .~.....~..~......~/~ ...... ~..~ ........................................... ~,~,.~., .... .a~:~.. ~//~~~ ................... ...................................... ~j.~....~..~~~...:. .......... .:...~ .................. ~..~......~ ........ ~.'/. c~.~ To~ ~ No. ~000 ~,~t,o. .... ~...~ ~,~k ........ ~ ...... ~o, No ......... ~.. ~,,~a~ to ~,,~,o~ ~,~ ..... a.~/~ .................................. , ,,..~, ~,~ ~ov~ ~ t~, Building Inspector. ................... Rev. 6/30/80 Form No. 6 TOWN OF SOUTt~LD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. 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. 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. 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 - $100.00 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, Connnercial $15.00 New Construction ........... Old Or Pre-existing Building ................. ,ocation of Property ........... ~.~..~ ..... i. : ..................... House No. Street Hamlet )nwer Owners of Property :ounty Tax Map No 1000, Section...~ ....... Block .... ~ ......... Lot...~ ................ ubdivision .................... ·- · ............... ~ ~ ............ Lot ................ 'ealth Dept Approval ~nderwrSters Approval lann~ng Board ApprovaZ ....................... . eques~ for: Temporary ~errSf~cate ........... FSnal Cert~cate..~.. .... ae Submitted: $ ................... FOUNDATION FOUNDATION ( 2nd ) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTIt ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK ............... TO: Date .................. , 19... INSTRUCTIONS -. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plarl 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 ,l' 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 cbmmenced 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 :eguiations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspcg~ons. //,~ --' (Signature of applicfi'nt, or name, if a corporation) ......................... ,.. (Mailing address of applicant) ;tale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .by..o4.2o . lameofownerofpremises LOl~-~..t~,'~l ~ 7B~,'~T'14.q- 'i-7, ~T.q~<~ (as on the trr:t roll or latest deed) r applicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) Builder's License No..'.~..k~... ~).,~.{..~..~.~..S.L~.... PI mber s L~cense No ......................... Electrician's License No ....................... et er Trade s L~cense No ...................... Location of land on which proposed work will be done .................................................. House Nmnber Street Hamlet County Tax Map No. 1000 Section /~ Block ~ 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 .......................... W3,D ~ ~ %r~ . b. Intended use and occupancy . . .'~ ~b ~ ~ 80(}i'~.,'~ .................................... ~'~O~ 7~u{e .~, b ,~iCf~O .......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ,q~l~,. 4. EstimatedCost... ?. ~.) v.ggdli !' / tDesc~'p't on) (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ............... Number of dwelling Units on each floor If garage number ofc~s ................ 6. If business, commercial or mixed ~occupancy specify nature and extent of each t ~ of us Dimensions of existing structures if any Front , ~ff~ e ......... 7. q~. ,~ i ......... Height ............... Numb~er of Stories t ......................... Depth .......... Z~ ~P~q. ~8~ ~O~D~ensions .... '' of same st~cture with alterations or additions: Front . .~.~ .... &~ ; ........ Rear..~.( .... Depth .... t .... ~. Height ...................... Number of Stories. ~ ........... 8. Dimensions of entire new constmgtion. Front R .............. ear ............... Depth ....... Height ............... Number of Stories ~ ~o~ Po ~ ~ w~w ~ ........ 9. Sizeoflot: Front .... ~ .............. ~ .................... 0.~. I0. Date of Purchase ! .................... ~epm ........... ''' ........ ............................. Name of Former Owner 11. Zone or use district in which premises are situated ..... ' ............................ 12. Does proposed construction violafe any zonin, law ordi ..... ' ..... "'." ......... ~7~' ....................... W~I 1 t be . _ ,z_ · a , ,anc~ or regulanon: .. ~ ..... . 13. o regraaea ~ · . . Wi ......... ..... : ;,~: .... > ...... 11 excess fill be removed from premises: Yes o Nme of Owner of premises ~(.t~4~ t~O~Adaressll30 P~O~ I4. ...... · ............ : .... q hone dfirgk. ..... Nme of Architect ........... ~ ............... Address ................... Phone No ........... ; .... Nme of Contractor .......... ~ ........... 15. Is thSs property w~thSn 30p feat of a .... Address ................... Phone No ....... ~Sdal wetland? ~Yes ........ No .~.. ' ........ ~I~ yes, Souehold To~n Trustees Permit may be required. ' .... PLOT DIAG~ Locate clearly ~d d~st~nctly ~I b~ild~gs, whether ~xisting or proposed, ~d. indicate fll set-back d~ensions from prope~y ~nes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whether interior or comer lot, APPROVED AS NO'I ED NOTIFY BUII2[~ING DEPA~ff2..~4JT A3' 765-J802 O AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR ALL CONSTBUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NEWdf~,OR~O l [/ S S' 'OUNTY OF..~ .~.. J.O.. · (Name of individual signing ~ontract) )eve named. e is the ......................... , ....................................................... i (Contractor agent corporate officer etc) ......... ' said owner or owners, ,'md is duly authorized to perform or have performed the said work and to make and file this 'plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ark will be performed in the manner setlforth in application filed therewith. yom to before me this . .............. Qualified In Surfak ~eufll,/ ~ ~ ~'-"~ (Signature of applicant) ....... being duly sworn, deposes and says that he is the applicant