HomeMy WebLinkAbout19033-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Soutbold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19109
Date JUNE 5, 1990
THIS CERTIFIES that the building
Location of PropertM 505 BAYER ROAD
House No.
County Tax Map No. 1000 Section 139
AMENDED SEC.
ADDITION
MATTITUCK
Street Hamlet
Block 03 Lot 13
Subdivision MATTITUCK HEIGHTS Filed Map No. Lot No. 35
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 21, 1990 pursuant to which
Building Permit No. 19033Z dated MAY 21, 1990
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 D%~ELLING.
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
CORINNE & RICHARD GARCIA
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAl3.
SOUTHOLD, N. Y.
BUILDING PER~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No- ~ 9033 z
Permission is hereby granted to:
~.....~.......~.....w......~...:. ...........................
..~..~c~...v.~_....~.~..:....!.~..~...: .....
........
at premises located at ..~.~-0.~,.......~....~..~...~...~ ..............
County Tax Map No. 1000 Section .... .L,~ ......... Block ...... ..~...~ ....... Lot No .....I...~ .............
pursuant to application dated ............ ..~.~...L.~.. ............... , 19.~..O., and approved by the
Building Inspector.
Rev. 6/30/80
BLOG. DEFT.
TOWN OF SOUTHOLD
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION 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 fnrm).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system cont~ns
~ less than 2/10 of 1% lead. ,*
5. Commercial building, indus.trial 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.
: B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
I. Accurate survey of property showing ali 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 - $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, Commercial $15.00
Date JUNE 4, 1990
XXX
New Construction ........... Old Or Pre-existing Building .................
Location of Property 5.05 BAYER RD. MATTITHCK
House No. Street Hamlet
RICHARD & CORINNE GARCIA
Onwer or Owners of Property ..................
County Tax Map No i000, t' ]39 .0.3 13
Sec zon .............. Block .............. Lot ......................
Subdivision
Filed Map Lot -
Permit No.. ]9033Z
.............. Date Of Permit. 5/21/90 ...A~-licant CORINNE GARCIA
~{ealth Dept. Approval... XX .X.X.
....................... Underwriters Approval .....................
P1 g d App 1 "
annin Boar rova ...XX
Request for: Temporary Certificate ........ Final Certicate. X.X. .....
Fee Submitted:
APPLICANT
1.4-0.0
~.~. o/mi
FOUNDATION
(1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
'~ B?ILDING DEPARTMENT
· ' TOWN HALL
~OUTItOLD. N.Y. 11071
TEL.: 705-1805
.... ....
Disapproved a/c ..........
.................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH ............
3 SETS OF PLANS
SURVEY
NOTIFY; CALL
BLDG. DEPT.
TOWN OF SOUTHOLD
INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building- lJmPeCtor' with
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 isF. ui. 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 throuv~hout the work·
· ¢. No building shall be occupied or used in whole or ~n part for a,ny purpose whatever until a Certificate of Occupancy
shall have been granted by tile Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit ~u~uant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or
Regulatimas, for the construction of buildings, additions or alterations, or for removal or demolition, as here~ described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housin= code, and regffiatinns, and to
admit authorized inspectors on premises and in building for necessary inspections.
...... .C.ORIN~E GARCIA , , ,
· , ;gnature licant, o na ffacorpprabon)
505 BAYER,ROAD, MATTIT, UCK, NY .1.i.952
(Mailing address of applicant)
State whe~ther appli~cant is ow:}er%, lessee, agent, architect, engineer, generat contractor, electrician, plumber or builder.
Nameofowneroforemises RICHARD' & CORIN
........................... Nt~. OARC IA
happacant ts a corporat on, signature of duly authorized ,.rc,~ ~ '~'f; ~ ~.
(Name and title of corporate officer) . , .,~'~ ,, ;: ).,~.~)
Builder's License No ....... O~ER
Plumber's Licqnse'~o'~ . . ,),
cscctmcsa~ ~; gscense No. . ~.., .,*. ~? ...........
O/hcr Trade% License No '
Location of land on which proposed work will be done:
505 BAYER ROAD · " '
[i ............................ . ........................... MATTITUCK
GUm: Hum bcr Street .................
Hamlet ....................
County Tax Map No. I000 Section ...... 1.~..: ~... ' BlOck . ...3 ..... 13 ,~/
......... Lot ................
(Name) Map ............ Lot '
State existing use and occupancy of prcm/scs and intended use and occupancy O£proposed construction: · -- ~'~
a. Existing usc an ONE FAMIly DWELLING ' '
d occupancy ..................... : ....................... ~-,.,,. ~ ..............
b. Intended Use and occupancy ..... .Q~. 2F. AMIL.Y...I]WEL~%~ W/ DECK ADDITION
2. Nature of work (check which app!icab ¢): New Building .......... Addition . ]).ZCK .... Altcratmn ...........
Repair R~mov~l Demolition .... poor
Tennis Court ' '
' A~¢essory Building Fence Other
~ ...... · ...... Work ............
4 Estimated Cost $500.00
i (to be paid on filing this application)
5. Ifdx~clling, nu'nber of dwelling uaits ' Number ofd~ ch floor '
, , ............... veiling units on ca ~ .. ..............
Ifgara-,e number of cars
6. If business, commercial or mixed Occupancy. spec 'y nature and e?tent of each tyre of nsc .... ., ...........
!if F
7. Dimensions of existing s~ructures, any: ront. .......
Hei,=,lit ............... Numbt:r of Stories ................................... .. . . ........ . . . . .. .
Dimensions 9f,,same stmgt~r~'witti a terations or additions: Front Rear
Depth i Height Number of Stones
S. Dimensions of entire new Construction: Front Rear Depth
~=1 D'A~I 7 V '~'~',' · ' um r of Stories ..... . .... %... ~ .............................
ront,....................." Rea- .............. .
I 0 D.'tte of Purchase ,
.......... .... , ................... Name of FqrmerOwner .............. ... .... .. .. ..
Z4 ~ W.13i p~emi
11. ne or Use district in ch scs are situated .... ; ...........................
D{ 6pos"e 'Const [io ~ ' ' · '"'i ..............
12. e~.~pr d rue
. n a!e any zoning law, ordinance or regulation: ........
13. Will lot be regraded ·: ........................... Will excess fill be removed from premises: Yes .... No..
I; Name of Owner of premises ~' Address Phone No
Name'of Architect i No
........... : ...... Address Phone ....
Name of Contractor No
· Address Phone '
15.Is this property loeat!ed within 100 feet of a .tidal wetland? ~ES .... HO ....
· lf yes, Southold Town iTruntees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all ~uildings. whether existing or proposed, =nd. indicate all set-back dimensions from
property lines. GNe street and block number or description according to deed, and show street name, and indicate whethe~
interior or comer lot. ,
SEE SKETCH
STATE OF NEW YORK,
COUNTY OF .................
APPROVED AS NOTED
NOTIFY BLJILOING OEPAR'FMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPEC31ONS.
1. FOUNDATION ~0 REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
8E COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENT8 OF THE N.Y.
STATE CONSTRUCTION & ENERGY
COOE~. N~ RE8~N~IBLE FOR
DESIGN OR CONSTRU~ION ERROR~
being duly sworn, deposes ~d says that he is the ~ppl[cant
Stvom to before me tJlJ$
. ~, 4707878, Su~lk
term E~pkes ~mh ~ ~/
(Signature of applic:~nt)
above named. ,
He is the '
! (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dulylauthorizcd to pe.rform or have performed the said work and to make and file this
application: that all state~nents contaii~ed in this applic0, tion are true to the best of his knowledge and belief; and that the
Work will be performed in the manner ~ct forth in thc application filed therewith.