HomeMy WebLinkAbout18096-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18740 Date January 25, 1990
THIS CERTIFIES that the building ACCESSORY
Location of Property 390 ALOIS LANE MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 06 Lot 4.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 2, 1989 pursuant to which
Building Permit No. 18096-Z dated MAY 5, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate 1s
issued is ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to CHRISTOPHER & ADRIENNE REHM
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
B ldang Inspector
Rev. 1/81
msx xa s
TOWN OF SOUTHOLD
6UILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
6UILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Na 1~U~U Z Date ........A./...l..~Gr~,....e~ 19.g~
Permission is hereby grouted to: U
...-1',ao~..3 b
to ,-r~^:i~:
~'....9.4,.....slcs.:.....~..ll~: c-~,!-w.14Y......f!r°...
. .
at premises located at ...r~.`~.~....J.. ~..~f~'?:.`.:°..... ..~'':!:°r........9rtsS:k~:l.P.f.S .
County Tox Map No. 1000 Section~~ a^~i .3........ Block ......p.lR.......gLot No. ...T..!.~.....
pursuant to application doted ....J..Y..1..A4:S.q 19.~ ! and approved by the
Building Inspector. 1 (Vl
Fee 5.~~~
Bu Iding Inspector
Rev 6/30/80
1
TONN OP SOUTDOLD y~
BUILDING DCPART;tCtiT ~~SJ ~
D TOUN HALL
~ SOUTIIOLD, NEH YORK 13971
~ --""""'"1 7 6 5 - 18 0 2
TOW
N ~
F SrU~„H Ol.p
APPLICATION FOR C1:ItTIFICATE OF OCCIIPANCY G/,/
DATE ~ L
NEH CONSTRUCTION ..OLD OR PRE-E%ISTItiG IIUILDINC...._.DACAtiT LAN/D_./...._..
Location of Property. ~ ~C........::~~"r ~.S_._~G`_._.__ ~~L~l~~lit_.....
UOUSE NO. STACEY HAHLCT ~
/ L,. / ,/r
Ovner or Ovncrs of Property ~~~Y-l^:/..~srnt'. ~ f/r_~.f/.'~h'!' :.t:/..fl.` ~~1~'~-.
County Tax Hap No. 1000 Sectioa 1.~~. Block Lot
r
Subdivision Filed Maap/5S.......Lot_/_r~.~~....
Pcrait No. !U.G~~.Datc of PcrmiC ~/~~~/.Applicant ~1~F,LI:r~:._.......
Health DepC. Approval Un do rvriCCrs Appraval._._.__....
P lanaing Board Approval
Request For Temporary Certificate Final Certificate .l-_.__..__..
$ -
Pee Submitted:
..a
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f,r ~ ?
'k~
rcv• 10/14/68
~e~.3gq~~
"
FORM N0. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN i1ALL ; a,{: , ,
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
i
A. This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the following; for nev buildings or nev 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 Dcalth Dept. of eater supply and seweragr_-di°sposal(S-9 form).
3. Approval o£ electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that solder used in system contains less'
than 2/IO of 1Z 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 existing buildings (Prior [o April 4, 1957 non-conforming uses, or buildings
and "pre-existing" land uses:
1. Accurate survey of property shoving all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
shoe single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent infoxmatioa required to prepare a certificate.
C_ For Vacant Land Certificate of Occupancy:
1. An application for vacant land Certificate of Occupancy shall be suhmitted,
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, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - Nev Duelling $25.00, Additions Co Dwelling $25_00,
Alteration to Ihrelling $25_00, Swimming Pool, $25.00_ Accessory building $25_00
Addition Co Accessory buildings, $25.00 - Businesses $50.00_
•
2. Certificate of Occupancy on pre-existing dwelling - $100_00_
3. Copy of Certificate of Occupancy - $5.00 - aver 5 years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
5. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $15.00 Residential
Commercial
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ev. IOJ I4/S8 1
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cOUNDATIO;I ( 1st) '
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ROUCH FRAME & -
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PLUMBING
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I1dSULATI0P1 PER N. Y. ~
STATE ENERGY
CODE _
/ 71' 9~I ~ ~ `
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FIiIAL
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ADDITIOPIAL COMMEPlTS: m
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C/~~.i1// BUILDING DEPT.
SPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ~ FOUNDATION 2ND [ ] iNSULATI
[ ]FRAMING _ NAL
~a
REMARKS: O
~ ~C,4
DATE ~ ~ INSPECTOR
} i ~ C) ~ 765-1802
{ BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T t ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]~ULATION
[ ]FRAMING [ FINAL
REMARKS:
0
DATE ~ Yy O INSPECTO ~
BOe1RD OF HEALTH
3 SETS OF PL.YsYS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC CORM
' TOWN HALL
EOUTHOLD. N Y. 11971 NOTIFY ~7rI ` ~J/~
TEL.. 7651802 CALL
MAIL T0:
EXamuud . 19 gq
\pprovcd ..1: 1". 1 ~ . , 1989. Permit No J. ~?ZZ. ~ ; ' i F = ,
Disapproved a/c
y~p~~
/1 U
d4.G[/. TOWN OF
OU~Th~IOLD
..C .M
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date I5 . .
INSTRUCTIONS
a Tttis apphcatwn must be completely filled m by typewriter or m ink and submitted to the Budding Inspector, with
amts of plans, accurate plot plan to scale Fee according to schedule
b. Plat plan showing location of lot and of buildin3s on premises, relationship to adlommg premises or public stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
canon.
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 vvdl issued a Building Permit to the applicant. Such perm
shall be kept on the premises available For inspection throughout the work.
e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupant
shall have been granted by the Buildmg Inspector
APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Building Permit pursuant to th
Buildmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances r
Re~ulaitons, for the construction of buildings, additions or,a[fer'ahbns~ pr for removal or demolition, as herein descnbe~
The applicant agrees to comply with all applicable ]aws. ordinances, buildrt3g code, housing code, and rem tto and t
admit authorized inspector; on premises and in buildin~`f6r'fSe>;e~s 'asp i(ions: - A~~
(Signature applicant, or name, if a corporauon)
(Mading address of agphcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde,
f. ",,7
.
Name of owner ofPremses l~d~kf.S.Y~~~~?-=r.s~,. ;R ..`f"~i`.!t:'.~. ..~l~r,~'?.........
vt R~i.1(a~rit.the{ tax roll or latest deed)
~+.~p
if applicant is iSl3t'pordiip7' e of duly auth~~ ~ `m
~ ~ ~~iA 1 t~ ~,u~ .
.
ark, ~t4€~o~p{~~3f~officer)
Builder's Licensc No
Plumber's Liccnse No
Electrician's License No. .
Ot}ier Trade's License No . . .
I Location of land on which proposed work will be one .
house Numbcr Strcet Hamlet
County Tat ,,\fap No 1000 Sccuon Block , , . , , , , , Lot .
Subdivision Filedl\fap No Lot...............
(Name)
State c~cisung use and occupancy of premises and intended use and occupancy of proposed construction
a. Existing use and occupancy
......~~G`a f
b.lntended use and occupancy ~
3. Narure of work (check which apphcahie) New Bu~iii ~ Addtuon rUteratton .
Repazr Removal , . pemolitwn Other 1Vork .
~r5 C C , c o (Description)
4 Estimated Cost Fee....................................
(to be paid on filing [his applicaUOn)
5. If dwelling, number of dwelling units Number of dwelling ands on each door .
Ifgara;c,numbcrofcars
6. If business, commercial or mixed occupancy, specify nature and extent of each tyke of use .
7. Dimensions of existing structures, if any Front f.~... Rear .l Depth !s%.: , , .
Hciglit ......t? Number of Stones .
Dimensions of same structure with alterations or additions Front - .Rear .
Depth ...zy..r licight Number of Stones .
8. Dimensions of entire new construction Front Rear . Depth . , , , .
Height Number of Stones . . .
9. Stze of lot: Front ~.7..r7.t. ,?,9i Rear . ~.2.G: I~e pth l,~G. .
10. Date of Purchase `i r . !.7 P`' , .Name of Former Owner ,Cltr.~~. ~xSS.h.:4s-, - .
11. "Lone or use distract m which premises are situated . . . . .
12. Does proposed construction violatgg__any zoning law, ordinance or regulation•
l3. ~ViII lot be regraded ..........t°t . , - . 1VIIl excess fill be removed from premises: Yes 1`
14. Name of Owner of premises ,Address ..Phone No............. .
Name of Architect Address ....Phone No.
. . . .
Name of Contractor 7. ............Address .Phone No. ~.q~~~".~~+{' ~r
15.Is this property located with in 300 feet of a tidal wetland? *YES....NO.•:~.
*If yes, Southold Town Trustees Permit may be required,
_ PLOT DIAGRAM
Locate clearly and distinctly all buddmgs, whether existing or proposed, and. indicate all set-back dunensions fro,
property fines. Give street and block number or descnption according to deed, and show street names and indicate wheth.
intenor or corner lot.
APPR0IFED AS NOTEU
GATE: ~l--i"""B,P. # 1.~=
+f. Ci.L.
FEE '~-~-5 ' -I----_ BY
NC7TIFY BUiLLNNG DEPARTMENT AT
- t R.,~ q ~,tv5 PC A PM FOR TFfE
st; , ri~vttvG ih ;PECTI~p REOUSRED
t ft)tJNUAl ION -
FOR POURED CONCRETE
y ROUGH FRAMING & PIUNIBiNG
3 iNSi1LATION
4 FINAL - CONSTRUCTION MUST
13F C.OPJIF'LETE FORGO.
Att. CONSTAUCT50N S ~MEEf'
TtiE RECtUtREMENTS Oi
STATE CONSTRUCT101'~ 3 ~~*Y ~CiCi~Q'A`~r+YWQR1`
r;ODES NOT RESPOi'1518~ fOR US~ ~S Y~~B~uL
DES1G» oR OO}tsTRUC~K~~S ~~v~RR,~tBFf~pV
tE
Nti
OF ~~Rp
STATE OF NLw YORK, S S
COUNTY OF ..r¢
. . - being duly sworn, deposes and says that he is the applicai
(A'amc of mdrvidual signuig contract)
above named.
He uthe
(Contractor, agent, corporate officer, etc )
of said owner or owners, and is duly authonzed to perform or }cave performed the said wort. and to make and file th
apphcanon, [hat all statements contained m this application arc true to the best of lus knowledge and belief; and that tt
work will be performed m the manner set forth m the apphcaUOn facd therewith
Sworn to bcfom me this
......G~?na'. .day of ~-r-m 19 .~1'
`otaryPublic, .......~~~~:<.-C:6.r! County
13NDA3 CDOPER (Signarure of applican
Notary Public, State of Newt
No gg22b63. Suf~l!
~Ca 78
SUFFOLK CO. HEALTH DEPT. APPROVAL
H. S. NO. 85'SP'25 j
\
35' IoZ ~ AL:~iS ` F9~lVA1 Ei: i~L.J ~AN~~ K.6
- - 5.85°313 JO' E . ~ 27.,229
l-__s--------E- -
bs 85 O t r STATEMENT OF INTENT
- _ _ _ I~•g4 Z \ tq THE WATER SUPPLY AND SEWAfif DISPOSAL
PovLS -p ~ SYSTEMS FOR THIS RESIDENCE WILL
~ ~ `S-+ CONFORM TO THE STANDARDS OF THE
Q ( ~f ~ SUFFOLK CO. DEPT. OF HEALTH SERVICES.
\ „ ~ ~ Y ~ L: (CANT
\ _ ~ ~ ~ SUFFOLK COUNTY DEPT. OF HEALTH
\ ~ Imo` u ~ ~ IA SERVICES -FOR APPROVAL OF
n S i - - SO - ~ CONSTRUCt10N ONLY
\ Z• I i3 v~ DATE:
\ ~ v
H. S. REF. NO.: ~5'Sp• ZS
Q
hC 75 t t0 t V+ APPROVED:
~~,.F.I ~ ~ d SUFFOLK CO. TAX MAP DESIGNATION:
6'..:++~'-'~F- riAf ~:%V(`CNGE`.`N'r:iL) ~ 1 t ~ ~:~n DIST. SECT. BLOCK PCL.
1 r- ~1~ _ - - - --'~1 l9G'J t23 6 4.r
- _ _ i
'-1 360.0 i*j.8;~~~51~++.N ~ 222.:7(; OWNERS ADDRESS:
~
~F ~
DEED: L.2999 P. 2~5 `2~F"~
r'~ I•__:__..1 r',{~.~ { C ! EST H t A
SU2~/EVE.G r-0~..
' r - ~
i ~ q f'--, f I - h t? r--' a
_J ' / A ' . _ 4 ~ Lr: In ~u.i-ras 1 r. ties cr edfNion
- ^ 1CP5gi L m s m=y is a Nolatien of
._J.__~- - ' $.,tion 720P pr the NOe.•YOrY S1Dt0
_..-.r 12
F.dccaiicn la!v.
' A Yr a^5Ah1 iJ Y copies of mis survey mep not b00A~
MArTI r V,-. t / m- Iant surveYO'o imcsd asst x
1 +c.. ~A~ amfpzsM seal shaD rwt De conebefW
~'r~ `-1--/-y cam`-pay-~ /'t- ~ ~ ~ / ~ fo Oe :valid Kue eopR -
'yWt\ ./F JV~!~"T~I.~V ~`i.`i - 2' searanteB9iMlCalaC haroOfl ~hlN N11
on1Y to the paTSOn for `mhan V+e survey
I ~r3A~1~ is preparatl, end On hb behalf t0 the
i i _ tale compem. 9owrnmental ed0npy end
I landing institution listed hereon end
MAi-' AM Ft3DE~-MAY 21,(986 totheassigneesdfhslendinQlnetl-
- tuiion. Guarantees ere not trenderebM
~ SCAa.E--~0 ° I n,r,n~,~
I
rvor ~
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AN~~9t
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` RRtt'JE YAN TUYL, P.C. ~A 20 ry~ ~
I ~V/.~s...-T......s~ tis csza~~~
LICENSED LAND SURVEYORS 14. f~LAND`'
GREENPORT NEW YORK
/EtEDYNf AST N~1635
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