HomeMy WebLinkAbout17990-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19089 Date MAY 31, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 115 WALNUT STREET MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 142 Block O1 Lot 013
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 29, 1989 pursuant to which
Building Permit No. 17990-Z dated APRIL 4, 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 APFLIED FOR
The certificate is issued to THOMAS ANSHUTZ, JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. PENDING - 5/31/90
PLUMBERS CERTIFICATION DATED MAY 24, 1990-THOMAS ANSHUTZ
Building Inspector
Rev. 1/81
FORM NO.f
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)
No 017990 Z Date ~ 19.$.~
Permission is hereby grunted to:
.......~~.5..3`~....~.~:..~,~~:...~.r.......
to ...~:5.~'..4r.~?...~~"^"~'^!~....J;.A...a!r.!~t.....;~:A~!-hGR....~A..~tf^`~5,{...
.j
ct premises located at ....~.~~......4r.4~a:Q:!^;u~..............~.f~
County Tox Map No. 1000 Section ....~.~.a........ Block .....Q.J......~.t. Lot No....~.I..~.........
pursuant to applicotion doted .....~.~5.1!/....~.~ 19.k.9.., and approved by the
building Inspector.
i i
Fee S..a71.:.SS..
Bu ding Inspector
Rev. 6/30/80
_
Form No. 6 r ) L'~ ~
TOWN OF SOUTHOLD ~7f1Y e, 4 ~'9
BUILDING DEPARTMENT G ~ i
TOWN HALL j~~.~~
765-1802 BLDG DEPT. ~
TOWN OF SOUTHOLD
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 foam},
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.
B. 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 o£ Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.OD,
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
S. Temporary Certificate of Occupancy - Residential $15/. 00, Commercial $15.00
Date r! .2: y~.~~."
New Construction........... Old Or Pre-existing Building...,Y ~s..........
• ~ 9 ~ N .'~U .-1C
Location of Property.. li 5'~....... ? T S ....................„.9:~.................
House No. .Street Hamlet
Onwer or Owners of Property.
~f~;~9J /a/, q-rvJH ~ R
County Tax Map No 1000, Section...~`.~.?`......Block.... ..°.!.........Lot....~~ ~
Subdivision ....................................Filed Map............Lot................_.....
Permit NoO~7.~9~......Date Of Permit. !9p:2:~..~.~S.Applicant
Health Dept. Approval ..........................Underwriters Approval................_..__....
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate..,YG
Fee Submitted: $
~C.3QGlj.
Co ~ ~9oSy
Oc~~EFOLKCOG
VICTOR LESSARD ~ Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR ~ P.O. Box 1179
(516) 765-1802 ~ ~ Southold, New York 11971
FAX (516) 765-1823 e.
~,yol ~ yao
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
May 4, 1990
Mr. Thomas N. Anshultz, Jr.
P.O. Box 1108
Mattituck, N.Y. 11952
Re: Building Permit #17990-z
Premises: 115 Walnut St., Mattituck, N.Y.
Suffolk County Tax Map #1000-142-1-13
Dear Mr. Anshultz:
In order to amend your permit to include a deck addition
to your dwelling, we need the location on your plot plan (survey)
of the proposed deck.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
~C ~
Thomas F' er,
Building D artment
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~pS~FF~C/~ ~Ol~, TO~JN OF SO~TTHObD
. , ~c OFFICE OF BUILDIPIG INSPECTOR S
o RU. BOX 728 D
~E~~ TO~VNHALL
"O/~ ~ ~ SOUTHULD, N.Y. 11971 ~i
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TOWN
OF SOUT}lpip ,
C E R T I F I C A T I O N
Date s'/~ y/~ o
Suildirg Permit No. ~ y`~
Owner ~.f~ A ~ ~s~..rH.. r,_
(please printl
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of l~ lead. -
" ~ um - ate`-'-~,~!
Sworn to before me this
day of ~'Yj~-!--{__.'
19~. ~ ~ paw ya-~
Notary Public
t7otary Public, County
HELEN K OE YOE
M111fI1RL' PUBLIC. Shy d Na/ ~
K ~ ~ Na.4707878, yUlblk Ca~MY
TKw Expires iArch 30,19L~-
t10(gC4 PUBLIC. State of Neer ~
No. 4707878,SeHclkCowdY
Sarin Expires March 30.19
I~~~~
765-iS02
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST (s~ ROUGH PLBG.
[ ] FO DATION 2ND ~ ] INSULATION
[ FRAMfNG [ ]FINAL
REMARKS:
~ p .r
DATE ~ ~ INSPECTOR f
765-1802
BUILDING DEPT.
tNSPE~TtON
[ FOUNDATION 1ST ~ ~ ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ~ FRAMING [ ]FINAL
REMA~~R//KS: ~
C.~C~
_.~~Z3_
DATE ~ INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOU ATION 1ST ( ] ROUGH PLBG.
~7`
[ ] FOUNDATI N 2ND [ ]INSULATION
[ ]FRAMING ( ]FINAL f
REMARKS: ~ `r% ~2~'7 ~r
~
DATE ' INSPECTO v ~ ~
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765-1802
BUILDING DEPT.
.INSPECTION
[ ]FOUNDATION 1ST [ ROUGH PLBG.
[ j F UNDATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMARKS: ~~i~.~d'~__
~
DATE INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS Parrx 1
1185077 EUREAU OF ELECTRICti'Y
88 DOWN STREET. NEW YORK. NEW; YORK 10038
Bate NOY$NB$R 16, I yFS9 63211285189 N l o.t4',7
.tpplicetion No. on file
THIS CERTIFIES THAT
awfy eke deetrlw! s~tpment v described blew and iwtrorAucvd 6y ~he gppNcent wa!ltsot an the abase epp/icatiow number in the premises of
TNONAS AN&HUtZ, 115 NAI,NUT S'1'RiS$T, POL$ 4, MATTITUGR, N.Y.
in ekefdbtetnl{ /acstton; ®Basemewt ? /st fl. ? Ynd Fl. (7[JT Section Block Lot
uw eramtwed ale NOY$NA$R 02,1985 end found to be in compliance utith eke requirements of thL Board.
OUIIlff Aq6 lYINTCMRS RARIOK ORCieS OVMi4 DI:iN T NINf
NCMIRFSCRM llapttQMT OTNRR AMT. K. W. AMT. K. W. AMT. R.W. AMi. R. W. AMT. N. 1.
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*NOT$: This is a partial, nr>t x
corpl.ttte certificate.
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PATCHOtiO$, NY, 11535 YrE~AI ,
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BOARD OF HEALTH
n r 3 SETS OF PLt S ~:~a :~1°~;'~~.~;-
U ~ fORMN0.1 SURVEY .Q~~.
TOWN OF SOUTHOLD CHECK -3!Y .
MAR 29i~;89 BUILDINGDEPARTMENT SEPTIC FORM
TOWN HALL
BI.UG. GEPT, SDUTHOLD, N.Y. 17971 NOTIFY
:NUf//SCUTF1dL[7 TEL.:765.1802 CALL ...°?9~..7~J y~.......
Examined . C....7, 19~y q q MAIL T 0
,~pproved~ .......I....., 19QR. Permit No.?~.i.l~ ~ .
Disapproved a/c
y}...........
r~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .:3. z. ~ 15
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wit
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings an premises, relationship to adjoining premises or pubfic stre
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of ibis application, the Building Inspector will issued a Building Permit to the applicant. Such peri
shall 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 Occupai
shall have been granted by the Buildin; Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to
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 app rcant, or name, if a corporation)
• a ijar iia/' ...~.i
ii uzr r7~
ter... r.•~........ .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build;
O (?.?G2 iii F.?eane ~ i.+SZq~7e Z .~Le~. T.¢•e. .y /~/?.-..qw,
......................../..J...................................................................
Name of owner of premises J'-2 , . , .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ....0?-r:'??S!~! .
Plumber's License No. .
Electrician's License No. .~!~RN .
Otfter Trade's License No . .
I. Location of land on// which proposed work will be done . .
House Number Street. ~ Hamlet
1
County Tax t,fap No. 1000 Section Block .47.x•. . , , , , , , , . Lot . V.~ ~ •..d.° .
Subdivision Filed Atap No. Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....:S!."'9~`~ • F~.'•": /y ,~wm//, .?f
.
b. Intended use and occupancy ....:~f? $1~'. C~,; r~ . . . .
~a,r,,,,~ , a a•... , ..r~r .
c~Y,)pkz'i^~~ -
3. Nature of work (check which applicable): New Building Addition • Alteration
Re air Removal Demolition Ot~cr_ Work
p
(Descriptic
4. EsIimated Cost Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling unitsa.... ~ Number of dwelling units on each tloor .
If garage. number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each typpe of use .
7. Dimensions of existing structures, if any: Front Rear ~ 7.....:.. Depth .
Heigftt .....~`C Number of Stories L
Dimensions of same structure with alterations or additions: Front 1f".......... Rear .:.3.y, , , , , , , , ,
Depth IIcight ~ /
................Number of Stories L
8. Dimensions of entire new construction: Front Rear Depth , , , , , ,
Height ...............Number (Stories....~.........::....................................._
9, Size of lot: Front . . 7~....... Rear Depth ~.y .
]0. Date of Purchase ~ ~O.'.°.. Name of Former Owner ~
°?.~.'.':`•`.'e..... , .
.ra: ~r ~ r, q
I I. Zone or use district rn which premrses are srtuated .
12. Does proposed construction violate any zoning law, ordinance or regulation: . N. e?• .
13. Will lot be regraded /Y.~? ..................1Vi11 excess fill be removed from premises: Yes
14. Name of Owner of premisesT!'?^.'t'.', ^,'f^':','?; Address F°:?'*!r°r? ^»rr~q.e, , p}lone No. ?3:t':... 96, . ,
Name of Architect ......E'~'.^::' :L. ,Address ...................Phone No............ .
Name of Contractor r3,w.r+E~..s~ .......Address ...................Phone No. .
IS.Is this property located with in~00 feet of a tidal wetland? *YES....NO.,?X.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions f,
property lines. Give street and block number or description according to deed, and show street names and indicate whet
interior or corner lot.
STATE OF NEW1Ql~j:,,k S.S
COUNTY OF . .
~~ov~as {J, r°c •,s<.~-,~.j'z. T, . , bein dul sworn, de ores and sa s that he is the a he
...........f....~........... g y P Y PP•
(Name of individual signing contract)
above named.
He istfte
(Contractor, agent, corporate officer, etc.)
of-said• owner or wuaess: and is duly authorized to perfc fm or have performed the said work and to make and file
application; that atl statements contained in this application are true to the best of his knowledge and belief; and that
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
-n. ,
......~t.~~
...............day of I„I ~'c.l............, 19
Notary Public, .~...R.1'.~ic~. • • •S-?'^• • ••°•t~• • County
JDt1N f. R~OBt ^ .
Nally sur a NMIYWR
Nw (tuna of applic:
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