HomeMy WebLinkAbout18240-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20794 Date JUNE 16, 1992
THIS CERTIFIES that the building ACCESSORY
Location of Property 605 SALTAIRE WAY MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 100 Block 1 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 19, 1989 pursuant to which
Building Permit No. 18240-Z dated JUNE 21, 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 ACCESSORY STORAGE SHED AS APPLIED FOR.
The certificate is issued to THOMAS & DEBRA FLADER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1%81
V
vosax xo. s
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)
N 8 2 4 ~ Z Date a: ~ 19. g..l
Permission is hereby granted n
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to ..~%C?:LruX1.t.~A,l;.~.....~..~......G.4i:F~........~......Si~ZJ.,t:.Y.~::4:..........
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at premises located at ..~P.S?.,!..... S%l.A... ~~.......~.`.'l!!:!:4:!^~lrri
County Tax Map No. 1000 Section Block .......d..J......... Lot Na.......~:..l.
pursuant to application doted ......~..k:.'!:!A.....J..9 19.~~.., and approved by the
Building Inspector.
i
Fee $.a?S
wilding Inspector
Rev. 6/30/80
_ a9g-~~y7
Form No. 6
M TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION POR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OP, 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 17 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 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,
Al[erations 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. Co~~y 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
•
.l.5...... Date ~5....V ~:`P:..ll??:...........
ew Construction. Old Or Pre-existing Building,. .
ocation of Property...G'c~5-............~~s-.~~~;. ;e ~~~.......~`;!gTl.'.~?a~
fIouse No. / Street Hamlet
ewer or Owners of Property.; 7. .y o~.•J'...{~.::......~/~~;v
>unty Tax Map No 1000, Section..,(,~`~,,,,,,Block.. .0/...
~ J > ......Lot.. ~
:bdivision.~~ ~~;t;;~...,C,%s.7~,7c:....//.....Filed Map..f~,~c~;?.....Lot...~.~
rmit No.~~,z `(,v„z~'`,,.,Date Of'Permit.,6:z~,~Q~,,,,,Applica nt. AC:a, ~µ,~q S', ~~~2/
alth Dept. Approval ..........................Underwriters Approval.........................
anning Board Approval
quest for: Temporary Certificate........... Final Cer icate.........
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BOAP.D OF HE.\LTH
3 SETS OF PL.1NS . , , , , , , .
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORPI .
TOWN HALL
SOUTHOLD, N.Y. 11J71 NOTIFY ~i 9fj~,> 7
' TEL.:7G5~1802 CAL
Examined..?-.~. 199 MAIL T0:
roved /-t~t~R.. I . , a O'~.
PP , 19~q. Permit No. I $ 7 - CCU ~ f-+
Disapproved a/c ( ~ ~ ~+r~
~ JUN 19x.989
;j
BLDG
0arwl>r:
. h~o-~:. TOW(VOF50d1THOLb
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 18. .~IUDe.........., 15$g.
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 is part of this appli-
~ation.
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 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
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 the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors an premises and in building for necessary inspec
(Signature of applicant, or name, if a corporatton)
605 Saltaire Way, Mattituck, NY 11952
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Owner
NameoCownerofpremises ,Thomas A. & Debra N. Flader
(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. (~1.:(!^;2,v:' :
Plumber's Liccnsc No . .
Electrician's License No . .
Other Trade's License No .
1, Location of land on which proposed work will be done. '
....645..Sal-t.aire. Way... Mattituck
House Number Street. Hamlet ~ ~ ~ ~ ~ ~ "
County Tax ~A9ap No. 1000 $CCIIO? ..100 Block Ql , , , , , , . , . , , .
Lot.?~
Subdivision ...Ss~.l.taire..Estat.es Filed t`tap No. ..4,682........ Lot . 22........... ,
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Esisnng use and occupancy S.~,rl9]-e..F:amily..&es.idenca , , ,
b. Intended use and occupancy ,Storage, Shed, ,(La\vn, E uipment , etc . )
.Q
3. Nature of wort. checl. which al
` ' ( pPlicable): New E3uildin
S Addition rUtcratiog
Repair Removal ..X........... Demolition Other 1Vork .S.h~-.°~
"~3000~ 0~0 (Description)
4. Estimated Cost.... :...il Fee.....................................
" S (to be paid on Cling this application)
5, If aarallennumber of carswellin units Number of dwelling units on each floor............... .
„
6. If business, commercial or mixc ~ ~ ~ • • ~ ~ ~ ~ ~ ~ ~ ' ' ' ' ' ' ' ' ' ' ' '
l d occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Front . 4b...3 ! , , , , , ; , , Rcar , slb,„3 ! Depth 29:.7: ,
Haight Number of Stories ..2. , , , , ,
Dimensions of same structure with alterations or additions: Front Rcar .
Depth : Height . . Number of Stories . .
8, Dimensions of entire new construction: Front . ~ 6, Rear .16, . Depth 10
Hcigltt Nuttiber of Stories .1 • • .
.
9. Size of lot: Front 1QQ Rcar ,100.. .,;.,'...,,,.....Depth 225,...,...,."""'
10. Date of Purchase 7,/,??($9 i Name ofFotmcrOwner Stanley _&~Rite~Wowak~"'
1 I. Zone or use district in which premises are situated ~ : ,~~,Q , ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ • • ~ ' ' ' ' ' ' '
no
12. Does proposed construction violate any zoning law, ordinance or regulation: .
3. Nill lot be regradedp , , , , , , , , , , , , , , , , , , , ,Will excess fill be removed from premises: Ycs Nib
14. Name of Owner of remisesT., J&..L1» .F1ad,er... ,Address 605. Saltaaxe .Way. Phone No. 29.8 :97F1.7..... ,
Name of Architect , , , , , , , , , , , , , , , ,Address .Phone No. .
Name of Contractor .........I... • .Address . .Phone No. .
IS.Is this property located within 300 feet of a tidal wetland? *YES.. .NO.X.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM ~
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property Lines. Give street and block ~tumber or description according to deed, and show street names and indicate whether
interior or comer lot.
SAc..7Art~c wAY
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27$ FRAME uovSF 25,9
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GocAT/ON>
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STATE OF NE1V YORK, I
COU;
lTY OF SI S
i ..lo contract)
(1\antc of individual si~nili ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
above named.
~ ,
flcisthe
(Contractor, agent, corporate officer, etc.) ~ ~ ~ ~ ~ ~ ~ ~ ~ " " "
~f said owner or owners, and is duly'~autltorizcd to perform or have performed the said work and to make and file this
=Pplication; that all statements contaiticd in this application arc true to the best of his knowledge and belief; and that the
•~ork will be performed in the manner $et forth in the application filed therewith.
sworn to boforc me this
.y .......day of 19~l.
rotary Public, .~`~Q~il-; , , , , , , v~; , County
NOTARY PUB IL
GKShOtEe~of
~w YarM
No. 4707878, SuPfalkCou~ty,,.~ (Signature of applicant)
Tam Ellpires Nierch 30,19..,.ZL
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