HomeMy WebLinkAbout17820-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
r
CERTIFICATE OF OCCUPANCY
No 220188 Date SEPT. 5, 1991
THIS CERTIFIES that the building ACCESSORY
4328 WESTPHALIA ROAD
Location of Property 505 POINT PLEASANT RD. # Z1 MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 113 B1ock_09 Lot 011
Subdivision POINT PLEASANT Filed Map No. 720 Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DEC. I2, 1988 pursuant to which
Building Permit No. 178202 dated FEB. 10 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 ANTENNA IN REAR YARD AS APPROVED BY SOUTHOLD
TRUSTEES.
The certificate is issued to ROBERT G. & MARY ANN SMITH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLLiMBERS CERTIFICATION DATED N/A
Qil.F7i ~
Bui ding Inspector
Fosas xo. a
TOWN OP 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)
4 Z 19....1
N_ ~~7@2Q Date
Permission is hereby granted to:
~c~.%~--~-c..~
....~-~-.r... ~.:y.:.... ~.!9.~~.........
to
ct premises located at .~.~.~,~1r.!~. .....4~Q...........~.4'.!~{/.!~!:`.:`:`:.~
Counh~ Tax Map No. 1000 Sec~ti'on~...,.J~.~........... Block Lot No.....~~
pursuant to application dated ..i~?.~R'~:h:!^~.•.•••1••z••••••••••••••, 19...9., and approved by the
Building Inspector.
Fee $..°15
~ ~~:'L
Building Inspector
Rev. 6/30/80
( C
} (~~~,~'L1\\`~~~,~"'} 4, Form No. 6
' li ~ `y
E ~ ' ~ TOWN OP SOUTIIOLD
p,UG 291991 'tt~~ t BUILDING DEPARTC]BNT
~~.d TOIJN HALL ~~a0~(~„`°~" r~
L.,.,~.... t ; ~ ~ ~ ?
BLDG. I'JE}'T. 765-1£302 " `
TpWIV e5dl!1TtlcZfv. ~„a, ~ . ~,U,r ~
APPLICATION FOR CGRTIPICATI; OP'
OCCUP,\N Y 1.~Pd~d~~,Ej4~r-,~°s-.t ~..'a
This application must be filled in by typewriter OF.
inspector with the followin ~'r'~~1i~'~C~ b
inlc and submitted to the"'fSY~I.d~n~
1. Final surve of s' for new building or new use:
Y property eaith accurate to caCion 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 build ins, multiple residences and similar buildings
and installations, a certificate of Code C~;mpliance from archi_ect or ensineer
responsible for the building.
6. Submit Plannins Board Approval of completed site plan requirements.
For existins buildings Cprior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1• Accurate survey of property shocain;, all property lines, streets, building and
unusual natural or topographic features.
2• A properly completed application and a consent to inspect sinned by the applicant,
If a Certificate of Occupancy is denied, the Luilding Inspector shall state the
reasons therefor in writing to t}~e applicant.
Fees '
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling 525.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory buildins $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
5. Temporary Certificate of Occupancy - Residential
$15.00, C mmercial 515.00
Date .
ew Construction........ Old Or Pre-existing Buildins.. .
ucation of Property,„~J ~L y3dg 1Yaw~
House No• Street
/ ~/~~G/ Hamlup~
ewer or Owners of Property...?~~~~- ~ ~ /'v
aunty Tax Pfap No 1000, Section.. / / •
.Y, ~.......Bluck.... ~ .......Lot.... Q.~F
bdivision...,•, ~ " " "
Filed ~1:ip.• .Lot..
rmit No...~~~;Z(J.•_,Date Of Pcrmi.t..~(lL~/~I... /
ulth Dep[. Approval..... • " '
" " '•••••••••••••...Underwriters Approval........
~nnins Board approval
;uest for: Temporary Certificate..
Final Ccrticatc...~.,•~i!~~~4y~~~s
Submitted: . ~ A~~~~%~ Q'
~ Y~ 9%~71 ,
~f ~ ~ a ~j/ ~ APPLTCAhT
J R i
l
-'lELD II:SPEC.iU.: ~~U~
A_~E
~ ~OaK~IENT°
•o
1. ~ ~
H
y O
FOUIJDATION, (1st)
FOUNDATIOtJ (2nd) ~
2.
z ~
0
ROUGH FRAME & W
PLUMBING G
ti
H
3. ~
ra ~
cn
IIdSULATIOPI PER N. Y.
STATE ENERGY
CODE
s
a
4 . ! ~ ~
~ H '~4
FIiJAL
o
ADDITIONAL COMMENTS: ~
x
b•J
H
~ v..
H
H ~
O b
z
• ~
. - y `'!L
' d.
m
^e
H
~,F Q
K'~ TETr.7G5-iS0'_
p~0 Opy TORN Or SOUTIIOLD
..43
L£~:a~(.;,,.'~[. = c OPPICC OP BUILDING INSPECTOR
Wit'.; ~+,$~+a' ~z„ P.O. BOY 728
~04~~~~'~'~ TOWN f[ALL ' '
,,ryol dap SOUTI[OLp, N.Y. l 1971
I (";~C°>L`'~1~~1~~!{'aloe°jY
~
AUG 2 9199(
( ~~'®!.[3a. Cif=~s>`~~,.`..°' i~
F,.~~, rovv~ a:,~ ~oii~~€~o~ AI
• To~"4Thom This May Concern,
We arc unable to complete your Certificate
oL- /Occupancy becau~e,of the following reasons.
nn application For Certificate of Occupancy
is not on file.
No [Inderwritera Certificate on file.
/Y% Tlic ~hecY, is (¢~cl/not on file. }
No t[caltlt Dept. l~.pproval on file.
No final inspection has been made.
Please contact our office on this matter.
Thant- you for your cooperation.
Bui]di.nq Permit ~ 2 ~ Z ~ c+--~,.'T,N,~~~c~
Bu.ildi.n~[ Dept.
No Plumber g~l.cler Certificate on file. ,
( all permit; involving plumbing being
iaucd after April 1 , 19II4 }
y S
w~ ~ v "v'''~
FRANK A. KUJAWSKI, JR., President rt ca Yat., ~ TELEPHONE
ALBERT J. KRUPSKI, JR., Vice-President '
- 4~z a
a (516) 765.1892
JOHN M. BREDEMEYER, III ~y ~ ,
JOHN L. BEDNOSKI, JR. ''~1®1 -jai
HENRY P. SMITH
BOARD OF TOWN TRL'51'EES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 1 1971
February 2, 1989
Mr. David B. Cross
Cross Devices
14065 Main Road
Mattituck, New York 11952
Re: David Cross to construct a satellite antenna on Bob Smith's
property located on Westphalia Road, Mattituck, N. Y.,
Tax Map Number 1000-113-9-11.
Dear Mr. Cross,
The following action was taken by the Board of Town Trustees
during their regular meeting held on January 26, 1989 as follows:
WHEREAS the Town Trustees have conducted an on site inspection
of the subject property.
RESOLVED that the Town Trustees approve the request made by
David B. Cross for a waiver to install an in-ground satellite antenna
on Bob Smith's property located on Westphalia Road, Mattituck, N.Y.,
identified on Suffolk County Tax Map as 1000-113-9-11.
Please return to the Building Department for a determination on
the need for any other permits which may be required for this project.
Very truly yours,
\\J~ ~
Frank A. Kujawski~~ ?
President
Board of Town Trustees
FAK:jmr
cc: Bldg. Dept.
Board of Appeals
file
c~o~~ o~vic~s
Y
1
TYPICAL SYSTEM INSTALLATION
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CROSS DEVECES
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~~~i ' P.O. 80X 567
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y65-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMARKS: ~ _
C~ ~
DATE ~ ` INSPECTOR
~
tdo~wrn9
' ~i
CREEK ~5pp0 l
pq~r~~~> ~ye,AAb/ ~s~f'i~~1iEDAS ~D
N7A , ;s~~ DATE: B.P. 11 / 7 a,D '1L
e FEE: ~ 8Y: 6'eLs.
NOTIFY BUILDING DE A TMENT AT
N 7SS•1802 9 AM Tp 4 P FOR THE
~y o FOLLOWING INSPECTI N
m- 1. FOUNDATION REQUIRED ~
~ °m t, FOR POURED CONC E E ~
7 ~ 2. ROUGH -FRAMING i4 PLUMBING
SD ~ ~OSC ~ 3. INSULATION
{ ~oCa„k~ 5/H7 ~ 4. FINAL - CONSTR TION MUST
a 8E COMPLETE FOR ,
p "/lprt4 Tom. ALL CONSTRUCTION AI.L MEET
AN To=r THE REQUIREMENTa THE N.V.
T _ STATE CONSTRUCTiO ENERGY
m o CODEB. NOT RES IBLE FOR
oa DESIGN OR CONSTRU I N ERRORS
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OCCUPA Y OR
USE IS U ! WFU!
WI~HOUF CE ~FICATE
- _ - OF OCCU 116CY
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N. BJ°i2 JO"E 1 25;,24
201.91 'R/r•`~TUoIb &,rp °'~'fr, AgrpO YV a/RWR
N' `m. S tQe ¢tR
eRn
551.6 RasoneP ~ K
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~~y / flevieio"' YOUNG 6 YOUNG
. PE ?UL. d/p/87E A00 OSTNANDEN AVENUE, PIYEP HEAD, NEW YOH" i
ALOIN W. YONNO HOWAflO W. YOUNG
Hror[i • ANO L"M° i1111V[YOII
4eN° • 11p1! epi
uuutxomm unrenoN a ewmox $URVEY FGR:. N r [ u S,FYE OF ryEw e N
ro mN wrn n e rmmioN a F
ranox roor or rw rw rorx Hen JOSEPH G MUNZ aG~"po W `G`Gy+ '
ew.iwN us wrvn Nu NN wriN
J.Er ro u.v." nrwmi
• NONUNENT m „~~`~oo~, ° 1C
°°"4r~,r^•~•=.rya.,,,... n. AY MATTITUCK r~reE tip visio of
n.n iG .I4r ~m~e inl w•Yi f ~ VIN I ~ Gq
i.~,,.~ ~i~ ur q,• ~ iRVYhPf ~,~~~IIIII~ ' ~Fi~~• i~~ is r,
,OA~ ~ / BOARD OF HEALTH , , , ,
V~'' L- 3 SETS OF PLr1NS
_ FORM N0. 1 SURVEY ~ ~ ~ ~ ~ ~ ~ ' '
TOWN OF SOUTHOLD CHECK , , , ,
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.:765-1802 CALL
• MAIL T0:. PQ, {3a~ SW,. • • •
Examined 19 _
Approved ..?~lP./. $9 19 Permit No.~.~ ~ ~.(2.~ `k-; <<~~~`"f.f.`~a I-l\~',~ ` i i~ i:I'i~e
Disapproved a/c ~ ~ ~ ~ 2 ~ ~ i
~1~
TOWN OF SOUTHO!<O
• . ~ - . • - -(Building Inspector) . • ~ •
APPLICATION FOR BUILDING PERMIT
Date /Zc 15
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-
cation.
e. 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 Building 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 r oval or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, build- e, h ins code, regulations, and to
admit authorized inspectors on premises and in building for necessary insp~~~
Signature of applicant, or name, ~f corporation)
' (Mailing address of applicant)
State w ether a pli~c,/arptt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~4C /Y%?
Name of owner of premises .../4~, O , fr7.~: - J~?•.
(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 . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . / ' .1,[
1. Location of land on which proposed work will be done. ..!~[~,~,/~/t4~q /~v~ i~~7.
House Number ~ Street\ Hamlet
Count Tax a No. 1000 Sc tion BlPck Q 9, O I~
y Lot
Subdivision ~•!~..~~'~Q•~Q~• • • • • • . Filed Is1ap No. , , -~Q, , , Lot ...Q. .
(Name)
State existing use and occupancy of~premises and intended use • occupancy of proposed construction:
a. Existing use and occupancy f / rq~: , ~~/C ~~~'?S'
b. Intended use and occupancy ~ ~
3. Nature of work (check which applicable): New Building , Addition Alteration .
P Rem~yal
Re air De oliti n Other \Vork . 4.n!; ,
; ,
.1
N3~1/%w~j~ar~/ 07'x' .5~~%%.~r ~ /4~iri7°ranq ~
4. Estimaicd Cost ,7~t ~/O (Description). .
. Fee ,
B (to be paid on filing this application)
i g
5 If dara11ennumber of carsvellin units Number of dwcllin units on each floor ,
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , . ,
7. Dimensions of existing strvctutles, if any: Front . , . , ~ 1,. , , Rcar 'Depth`: .
Height Number of Stories • • • .
Dimensi t~ s ructure with alterations or additions: Front Rear .
Depth . IIeight Num cr Sto3~{es
8. Dimensions of entire new consh,ruction; Front , ~,i,3, , p~,F.,~wl.~~„/f5e/1 SC ~C»+~
Height , . Nuth~er of Stories .
y..
9. Size of lot: Front , ..s~J~,~.l,... , Rear ~A Depth ...~i~.t~?. .
12. Does oro osed construct ontvto ~e off~o~~Lg caner
• . , ' • • •p remises are situated . , ../~Qsfofle~!~.. . .
P P late any zoning law, ordinance or regulation: . /~/1 . .
l3. Will lot be regraded ~®L, ~.....y y \Vill excess f 1 ~je remowej~ fro premises: Yes No
14. Name of Owner of premises . 4P!t~ 9•.:S~!'+.~1/t ,Address M!~~?!~~!~'!!,/1tone Noo~$'-,>vs'~7, , , , .
Name of Architect , ..................Address ...................Phone No............... ,
Name of Contractor ~ Address ...................Phone No.....~~'~:...:...
IS.Is this property located within 300 `feet of a tidal wetland? *YL~S.!'~.NO....~
*If yes, Southold Towp Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly alb buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block!I number or description according to deed, and show street names and indicate whether
interior or corner lot.
it ,
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i
II
STATE OF NE~V YORK
.St/ 'IS.S
........OF.,.
~ro
Ctf~~Y (N~c, o~dividual si~>~ ~ ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant
~ Ong contract)
above named. - -
He is the .......,~~!!!.tCX?,r............>.
(Contractor, agenf;;corporate officer, etc.)
of said owner or owners, and is duly authorized to p5rform ort~ltave performed the said work and to make and Gle this
application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
work tviJl be performed in the mannei set forth in the application filed therewith.
Sworn to before me this
........................day of~,....................., 19 .
Notary Public . County ,
. • • • • • . • (Signature.of applicant)