HomeMy WebLinkAbout18472-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18644 Date DECEMBER 14, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 2755 OREGON ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 2 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 25, 1989 pursuant to which
Building Permit No. 18472-Z dated SEPTEMBER 12, 1989
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 ROBERT G. ROWEHL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
CY-C.~
Building Inspector
Rev. 1/81
f'OSM NO. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
ffHIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ ~047~ Z Date ...~...Y..4~r.:~.~::.....1.7::........., 19.g.~
Permission is hereby granted to:
~I~.. ~ - ..~~..a ..w:
....~X....1:s.~..A
ct premises located at ..aZ..7.,~:#....C?'?....~r.........~.K.Gitd^.:~~
Caunty Tax Map No. 1000 Section ........tf..~..... Block Lot No....Q.4
pursuant to application dated .!~t..x~......~:~ 19.4..., and approved by the
Building Inspector.
Fee
.......(t:~u`1: arc p~-...........
Bu ng Inspector
Rev. 6/30/80
,
TONN OF SOUTIIOLD ~ ~ ~
IIUILDING DEPART.SCtiT
TONN IIALL ~ t t
k' ` ~ i f
SOUTIIOLD, NCN YONK 11977`(
i ~F~ 7 6 5 - 18 0 2
~ `\'v n{.CG. DEPT.
TOF:!e UP 50UTfita i;
APPLICATION FOR CL•RZIFICATE OF OCCIIPAttCY L/j~
DATE!-~!~.~~"~.....
NEH CONSTRUCT20N .i:....OLD OR PRE-EBI{S.TI27C BUILDING......VACAtiT LANfD........
LoeaCiaa of Property.~~~~~..:__~/.~~~.(ry..~`-'__._...~ t?L~_~
LiOUSE NO_ STRf~EET UAHLET
Over or Ovncrs of Property.__~~
~ ~r~.~.l`~
~.e_h
Cou¢tp Taz Hap No. 1000 Section 81ock ~ Lot'_..~....
~ubdivisioa( Fil/red Map ......_.Lot_/1'.~...._.._/
Permit No.~t-1~~~_~6ate of Permit ~C~~~~~.Applicaat :.`~~:~1~";!::Qw~,h
Health DepC. Approval Undcrvritcrs Approval.___...__.___.
Plaaaiag Board Approval
Request Ear Temporary Certificate Fiaal Certificate
Fee Submitted:
APPLICANT`\J~~!V*-:JC~v~`^' ""'l
A'
rQV• 10!14/88
~,cc, 3g7~18'
eo ~ )gb~f~{
-
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,
~ FORM NO. 6
• TOWN OF SOUTIIOLD
IIIIILDING DEPARTMENT
TOWN ITAL.
y f 765 - 1802 ~ '
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
r
A. This application must be filed in typewriter OR ink and submitted to the Building
Inspector with [he following; for new buildings or vev use: '
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features. '
2. Final approval of IIealth Dept. of voter supply and sewerage-disposal(S-9 form).
' 3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that solder used in system contains less'
than 2/10 of IZ lead.
5. Commercial buildings, industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6_ Submit Planning Board Approval of completed site plan requirements.
B. For ezisting buildings (Prior to April 9, ]957 non-conforming uses, or buildings
and "pre-ezisting" land uses:
1. Accurate survey of property shoving alt property lines, streets, buildings and
~ unusual natural or topographic Features.
2. A properly completed application, a consent to inspect signed by the applicanC
and a certified abstract of title issued by a title company which shall
shnv single and separate ovncrship of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the IIuilding Inspector shall state [he
reasons therefor in vritivg to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
I. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of~the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, [he Building Inspector
shall state Che reasons therefor in vri[iag to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - Nev Duelling $25_00, Additions to Dwelling $25_00,
Alteration to Dwelling $25.00, Sviamning Pool, $25.00. Accessory building $25.00
Addition Co Accessory buildings, $25.00 - IIusinesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00_
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10_00
4. Vacant Land Certificate of Occupancy - $20_00
S. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy -$15.00 Residential
Commercial
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BOARD OF HEALTH
3 SETS OFiPLANS
~FORMNO.7 SURVEY
TOWN OF SOUTHOLD CHECK 1j'~ 3`i,aZB~.
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY . - ~Y~-.g~ / n
TEL.: 765-1802 CALL lnr~
MAIL T0:
~q
A rove ti 19 a!. Permit No. y ~»".2~..' ff~~ ti pp
PP D LS ~ ~ 1l ~ '•I
~s.~ . , i t
i
Disapproved a/c AUG 2 $ ~I~J
.
.
BLDG. DEPT.
. ~p„ . . . . TON/N OF SOUTHOLD,,.,,,,,j
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 . ,
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, 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 stre~
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apF
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 pent
shall be kept on the premises available for inspection throughout the work.
• e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occupan
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Depaztment for the issuance of a Building Permit pursuant to t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ~_
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary inspections.
(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 build:
........................Owne.r....................................................
Name of owner of premises , Rober. t G. Rowehl
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.
(Name and title of corporate officer)
ALL CONTRACTOR`S MUST BE SUFFOLK OUNTY LICENSED
Builder's License No . .
Plumber's License No. .
Electrician's License No . .
Outer Trade's License No . .
1. Location of land on which proposed work will be done. 2~.y'~ .Oregon. Rd..IJsi.t~ltlzck
2'75r Ore~or. Rd, Niattituck
House Number Street Hamlet
County Tax Map No. 1000 Section 7 ~0 Block .....2 Lot 5 .
Subdivision Filed Map No. Lot..............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........TJwe,],~ Tng w}t}'., ,fare;, buildings
b. Intended use and occupancy .......~fl'~1tlnTt.-.Pegk
3. Nature of work (check which applicable): New Building Addition ..X....... Alteration .
Repair Removal Demolition ..............Other 1Vork .
11D ~ (Description)
4. Estimated Cost ..o Fee .
` (to be paid on filing this application)
5. If dwelling, number of dwelling 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 structures, if any: Front Rear Depth .
Height ...............NumberofStories.......................................................
Dimensions of same structure with alterations or additions: Front . . Rear .
Depth ......•..:.n ::...........Height ......................Number of Stories .
S. Dimensions of entire new construction: Front Rear Depth .
Height ...............Number of Stories........................................................
9. Size of lot: Front Rear...................... Depth
10. Date of Purchase .............................Name of Former Owner .
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Will lot be regraded ...........110 • • .............Will excess fi31 be removed from premises: Ye Nc
14. Name of Owner of premises $ob.~ra . RpwPh~, , , ..Address Matt; }tuck , , , , , , , ,Phone No.25~' ~2~2
Name of Architect ...........................Address ...................Phony. No........ .
Name of Contractor ..........................Address ....:..............Phone No.............. .
15. Is this property located within 300 feet of a tggidal wetland? *Yes No ..X
*Zf yes, Southold Town Trustees PermitPLO~I' DIAGKAMed.
Locate cleazly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro„
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
-
L~~
STATE OF NE\V YORK, S.S
COliNTY OF .
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
(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 thi:
application; that all statements contained in this application are true to the best of his knowledge and belief; and that th<
work will be performed in the manner set forth in the application filed therewith.
S~vom to before me this
~:y^.....day of , 198.
,r}
~G~ . .
Notary Public, !~Y?-~.;Erz4. NlR-...~ County
.....:.CT-:.
K~ ~
~w ~ (Signature of applicant
Na 4707H)S, SulNlk Cou~y
Terre Expires Nkrch 30,19_...`/