HomeMy WebLinkAbout17815-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 220057 Date SULY 5, 1991
THIS CERTIFIES that the building ADDITIONS
Location of Property 1545 WOODCLIFF DRIVE MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block 06 Lot 17.4
Subdivision Filed Map No.w Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEB. 3 1989 pursuant to which
Building Permit No. 178152 dated FEB. 9, 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 ROOF OVER EXISTING DECK AND DECK ADDITION.
The certificate is issued to EDWARD SLAGA
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO.~~~ N~A
PLUMBERS CERTIFICATION DATED N(A
Bui ing Inspector
Rev. 1/81
FOBai NO. D
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)
Nfl 017815 Z Dare ..~:.~.....9 19.g.~
Permission is hereby granted to:
t0 ;c!1...... 0.-.... ~4/.i!S~r.!~(1......1.3J.....~!!.1....:
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ct premises located at ......!~Sd..tJr~?:771.... ~ ....~.~:.......~.41!l<lef.M..'1.~...........
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Caunty Tox Map No. 1000 Section ...n..~-.....7........ Block ....Q..Se......... Lot No..:7..~-~7::-~•.... ~ 7~
pursuant to application dated 19..1..., and approved by the
building Inspector.
Fee :
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.
Building Inspector
Rev. 6/30/8D
Form No. 6 ~c3y~.
D r~ r
~7R~. ! 3 ~ GILDING DEPARTMENT > /S(F~
TOWN HALL
94D(3. D%g' ~ 765-1802 ~n"
TOWN OF SOttTru, . Q~
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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-4 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 19, lead.
S. 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.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling 2~5.00~
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $~5';p0,
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. L'puated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, CommerQCpial $15.00
Y Date ~..1.\~.
::ew Construction.,: ` , Old Or.Pre-exis.i• Buildin
Location of ~-^d!~'Y,'ap y, g
Property., f,i~Y.+`iJ... ~2.
House No. .Street•••.~~ Hamlet ~
Onwer or Owners of Property.....~~.~;;~4~,,,~q,~,,,~.•.~9k
~~77
County Tax Map No 1000, Section... ~?.1......Block....... e
~.......Lot...!.~_~.
•
Subdivision ..........Filed Map........ _
....--L11ot....... ((7~
Permit No...~.~,~,Is~ ,,,,,Date Of Permit,'.a~'~.~ 3`~~,,,,,
Applicant.~r.9W~.ls°~..~je, ~p.4~:......
Flealth De _
pt. Approval .Underwriters Appro 1.
va „
Planning Board Approval
Request for: .Temporary Certificate...........
Final Certicate...~,,,
Fee Submitted: $„01,,~,.
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BUILDING DEPT.
1 NSPECTION
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REMARKS: ~ ~ - ~ -
DATE ~ ~ ~ INSPECTOR -
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BOARD OF HEALTH
FORM NO. 1 3 SETS OF PLASYSr~~:
SURVEY ` _
TOWN OF SOUTHOLD CHECK ~..'F.~, , , , , , , .
BUILDING DEPARTMENT sEPTI FORrt
TOWN HALL .
vDUTI-IDLD, N.Y. 11971 NOTIFY ~~JJ ~
' TEL.: 7G5-1802 CAL .....C.cr
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Examincd.~w~~,`~,,,,19~`~, MAIL TO:
Approved 19? Permit No. ~ .1.L', IS ~ ~,.m,.n~.7aa.:`~-.~J,.~.,n....m,-a
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Disapproved a/c ~ ~ FEB e~
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. ~n,t// .a~:t`• "~7'-:........ BLDG. DEPT.
TOWN OF SOUTHOLD
(Bui]ding Inspector)
APPLICATION FOR BUILDING PERMIT
Date Fel?, , 3.,..1989.., 15 . .
INSTRUCTIONS
a. Tltis application must be completely filled in by tgpewriter 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 stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app:
. 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 perm
shall be kept on the premises available for inspection throughout the work.
e. No building shalt be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporatton)
565 Old Main Rd. Mattituck, N: Y:
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
„•,,,,,•_..•General Contractor
Name of owner of premises . ,Edward S logo
(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. , 12, 985-HI -
Plumber's License No .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
6
1545 Woodcliff Dr;,,,,,,,, '•n.„..,.• Ma~ti.tuck,, N,Y;,. 11952.
House Number Street\ ' '
Hamlet ~
County Tax I+lap No. 1000 Section ~-~7........... Block 6, , , , , , , , , , , . Lot , ;~"0'IT'
Subdivision Filed 1<fap No. Lot .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occu ant Res.i.den,ta.al ~ '
P Y
b.lntended use and occupancy Residential; with decks
li _
` 3. Nature of work (check which applicable): New BuildinS • • • • • Addition ..8oa.f.... Alteration .
Repair , , • • . Removal Demolition Other 1Vork ..Deck , , , , , , • ,
' (Description)
4. Estimated Cost .....$,5 i 200 J,00 Fee , .
(to Uc paid on filing this application)
- 5. If dwelling, number of dwcllingl''units Number of dwcllin units on each floor .
6 •
If garage, number of cars ~ ~ • ~ • • ~ • •
6. If business, commercial or mixed occupancy, specify nature and extent of eachype of use .
7. Dimensions of existing structures, if any: Front . 1. Z?..... Rear Depth : 36 ~ • ~ •
Height 22.x.......... Number of Stories . 1~ • • ~ ~ ~ ~ ~ • ~ • •
' Dimensions of same structure with alterations or additions: Front •$atn?............ Rear ..Sam@.... , • , , , , ,
Depth Iicight Number of Stories . .
' 8. Dimen~ionsokire~#ctv:.cbnst;ttction: Front Rear ...............Depth
Height' NutnUerofStories.
9. Size of°1rot;~Front 103' i Rear ~..h~ ~ ~i!' Depth ..2.05' .
]0. Date ~tf Pur<ehase ` ; .....AUg..' .$4 . . . . . . Name of Former Owner , Ori,gzna,l • • ~ • ~ ~ ~ • •
11.' Zonepr apse district in which premises are situated R~Sldt'T!t,3a)-......... .
12. Does ro osed construction violate any zoning law, ordinance or regulation: ~A .
ill lot be regraded yy
Will excess fill Ue removed from premises• No
14. Name of Owner of retno es Ed.l ~ . • • ~ •
P '.Sla$a. • • ........Address P.0. Box 397 Matt~,hone No~98-515
Name of Architect ~ .Address Phone No. .
Name of Contractor S.t,anley.' • ~ ~ ~ ~ ~ ~ ~ • ~ • ~ • ~ ~ " •
.~.,~'~.iss.Jr,.,,,AddressOld_Main Rdt.Mat~ptoneNo298-$7t30 ,
15.Is this property locajted with in 300 =feet of a tidal wetland? *YGS....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 fron
property lines. Give street and block ;number or description according to deed, and show street names and indicate whether
interior or corner lot. I
it .
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STATE O F \ E1V 'O ~ S
COUNTY OF o ~ , , r
' • ' ' • ' • • • • • ~ • • • • • • • • • • • • • • • Ucing duly swam, deposes and says that he is the applicant
(Nantc of individual signiltg contract)
above named. A~
He is the....~~~~7v1/
(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 Gle this
application; that all statements contajncd in this application arc true to the Uest of his knowledge and belief; and that the
work will be performed in the mannerjsct forth in [he application tiled therewith.
Sworn to Ucfore r~ this„ i
. day of , ~ . 19
Notary Public, County ~ ,
JUDITH T. TERRY',
NONfY RubUc, State of NeW York .
No. 62.0344963 i .
~~a~I1N~
i~n8eeMeyg~nty~ (5ignatureofapplicant)