HomeMy WebLinkAbout26490-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27987 Date: 10/02/01
THIS CERTIFIES that the building ADDITION
Location of Property: 600 OLE JULE LA MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 114 Block 12 Lot 13 .2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 18, 2000 pursuant to which
Building Permit No. 26490-Z dated MAY 10, 2000
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 AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DONALD FEILER & WF.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
c
or' ed Signature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 26490 Z Date MAY 10, 2000
Permission is hereby granted to:
DONALD FEILER & WF.
600 OLE JULE LANE
MATTITUCK,NY 11952
for
CONSTRUCTION OF A DECK ADDITION AS APPLIED FOR.
at premises located at 600 OLE JULE LA MATTITUCK
County Tax Map No. 473889 Section 114 Block 0,012 Lot No. 013.002
pursuant to application dated APRIL 18, 2000 and approved by the
Building Inspector.
Fee $ 75 . 00
Authorize ignaturt
ORIGINAL
Rev. 2/19/98
Form No. 6
-- -- V0 N -C"
TOWN OF SOUTHOLD
BUILDING DEPARTMENT �- l(0� Z
r._ TOWN HALL N' ` ` 1� 4 `''~V"
765-1802
� 1
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 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 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 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 $25.00,
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 Buildine - $100.00
3. Copy of Certificate of Occupancy - " .25,p
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .'.� ?J.��. . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . X. . . . . Old Or Pre-existing Building. . . . . . . . . . . . . ..
Location of Property. . . .(�oo. . .C.L:E. U L.e . . . �': . . .r. . . . . . . . . . . . . . .�vYQ - C . . . . . . . . . .
House No. • . • • Street , • • Hamlet.
Onwer or Owners of Property. . .�N. .... . . . . .` . . ..�;� . . . 0 . . . .. . „ . . . . . . . .
County Tax Map No 1000, Section. . .(4- . . . .Block. . . . ?:. . . . . . . . .Lot. . A3...2 . . . . . . . . . . . . .
Subdivision. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . .�.��.q(� .Z. ,Date Of Permit.01.0Jq?. . . . . . .Applicant. .�� �L*512-
. . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . .. . . . .. . . . . . .. . .Underwriters Approval. . . . .... . . . . . . . . . . . . . . . . . .
r
Planning Board Approval. . . . . . . 0 . . . . . . . . . . . . . . 0 .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . x. . . . . . .
Fee Submitt d: $. . 2 . . . . . . . . . . . . . . . . . . . . . 0
Dz a"l 9 ..-7
�. �o0 . . . . . . . .
APPLICANT
r
STATE OF NEW YORK )
ss.:
COUNTY OF SUFFOLK )
bt o- D �I Vaft- , being duly sworn, deposes and says:
That deponent is over the age of 18 years, and resides at
600 0 Lj--, au 1.,e !.N, M Orr 1 It-x4C .
2oao
That on the 11 day of , �1-- ,-4899-, deponent, being the
architect/engineer, licensed by the State of New York, hereby states that s/he
accepts full responsibility for the accompanying plans compliance with the New
York State Fire Prevention and Building ZT7L
Architect/Engineer
Sworn to before me this �oov
qday of IQQr\ 1999.
o�taPublic
LYNDA M.BOHN
NOTARY PUBLIC State of NOW%*
No.of sbioiom
CkAlified in Suffolk CounV
Tenn Expires March 8
cc: applicant
Applicant/ (1 ,Q Date
0v"Iers Name OJ( Lb Revlcwc(l
Architect/ Date
Engineer: �ZYN.0-1VA � Submitted
SC"I'M ll: 1�/2
District: 1_,_000 Section �� Block I,ot
Project „ Suhdlvision
t.ocatioll 6o-0 c e. v W"'v `k Name
Single& separate Required
certification (Yes/Nom_ __
1AGisUict/ ” �f/�/ �L
nmr �l svc _ Actual /�"'� �Y/� II���r���ciepc ,i�i;i�,<.1 �7o
key Rcy I
(Fro
Project Description:Yard _J60 hoposcd tsidc Yard _ PIolx)x �Jd IRcel 1"aid /� I' op)x cd _
AGENCY PERMITS Permit
REQUIRED FOR REVIEW N.A. NO YES Number
Suffolk CountyHealth Dep t.
New York State D. E. C.
Town Trustees /
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
Notes:
4
t
! MATTn'UCK
f
i
7
MATT'ITUCK. QUADRANGLE
NEW YORK-SUFFOLK CO.
7.5 MINUTE SERIES
E
J
2 400 000 32'30" 2 410 000 FEET 110�•E, 7?30'
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a
Enalneers office or local govern
-
ent-1 determine whether other
permits are required.
New�York�SY �:
Suffolk"Co nt
'+93 000m.N.
Map 19 of 39
This map was promulgated,
pursuant to Article 24 of the En-
vironmental Conservation Law
(The Freshwater Wetlands Act)
on May 26, 1993 by the Com-
missioner of New York State
260 oocDepartment of Environmental
Conservation.
LEGEND
Approximate wetland
boundary
U Upland inclusion
AA-00 Wetland identification
code
55' ____ This line groups parcels that
have the same wetland
identification code. This line
does not delineate the
adjacent area.
* Denotes extended adjacent
area.
Notes:
This map indicates the approximate location of the
actual boundaries of wetlands regulated according
to the Freshwater Wetlands Act.
Map information other than the wetland boundaries
was prepared by the New York State Department
of Transportation and the United States Geological
250 ooSurvey. This locational information provided on the
map is for reference only. Marsh symbols do not
necessarily indicate the location of a regulated
wetland.
Adjacent areas of the regulated wetlands are those
areas within 100 feet of the boundary of the
a5g wgtland. These areas are subject to regulation pur-
At to the Freshwater Wetlands Act but are not
delineated on this map. An adjacent area may be
extended by special order of the Commissioner of i
1 t the New York State Department of Environmental
' Conservation or the local regulatory• authorit
Y
NORM
HWAY f
• Copies of Freshwater Wetlands Maps are available151P
_ 13 from the regional offices of the Department of En-
•gest vironmental Conservation. Maps are available for
Arm 39 inspection at these offices and local government
27 clerk's offices.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ J FRAMING [ NAL
[ ] FIREPLACE & CHIMNEY
REMARKS
L
DATE D _INSPECTOR AW
�'�1
FIELD, INSIIECTION REPORT DATE COMMENTS
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PLUMBING
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INSULATION PER N. Y.
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STATE ENERGY u n
CODE
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ADDITIONAL COMMENTS:
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BOARD OF HEALTH . . . . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . .
T0WN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TORN HALL SEPTIC FORM . . ... . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
CALL . . . . . . . . . . . . . . . . . .
Exanined. .. ........, 20,...
I MAIL
.. .... .��..., d�!°o Permi t No. LQ.�.!D�z. / gx, .. I�-q� -Z-
Approved .............
Disapproved a c .................................. !.•! �.�..l.`'.G .........
......................................................
...... .........\ !.....
1 (Building I tor)
APPLICATION FOR BUILDING PERMIT.
��p i
APR 1 8 2B s Date. . . . . . . . . . . . . . . . . 20. . . .
INSTRUCTIONS
a. 'hLis,a ISA.t-L6d. t: letely filled in by typewriter or in ink and submitted to the Building Inspector w
3 sets o 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 mist be drawn on the diagram which is part of
this application.
c. The work covered by this application my not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue 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 arry purpose whatever Lentil a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATICN IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Torn 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 lags, ordinances, building code, housing code, and
regulations, and to admit authorized inspectors on premises and in buil fonecessary . spections.
.. ..............�........
(Signature of t,
.or name if a corporation)
..
(Mailing address of applicant) Nkn1l,CJ:.
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ..�N 0,t,0 "!:.A FP-F-kc4 0"... L E�Y— ... . . . ... .. . ..... .. . . ... ..... ..
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Name and title of corporate officer)
Builders License No. ..........
Plumbers License No. ........... ..............
h
Electricians License No. .....................
Other Trade's License No.
....................
1. Location of land on which proposed work will be done................................................ . .............
Q................ UF�Iav!-e..... #4%.-TT I ��
House Number Street... ...........................
Hamlet
County Tax Map No. 1000 Section .... ....... Block ...... 1.2"..... Lot . .l3..
Subdivision ...........�........................ Filed Map No. ............... Lot ...... .........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of
proposed construction:
a. Existing use and occupancy .......y I M(e.).A4.-- ..
YPAT
b. Intended use and occupancy ...........................................*joy WotA _ J?
....
` N•itnre of work (check wlniolr applicable): New Building .......... Addition ---- _ - nrcerer;o„
Repair ............ Removal ............. Demolition ............ Other Work .HF!N,,.flE C
200 (Description)
Estimated Cost ... .................
..... fee ..................................
oto be paid on filing this application)
• If dwelling, rurber of dwelling units ... ........ Ntnber of dwelling units on each floor
Ifgarage, number of cars .............%,- ......................
If !cosiness, cannercial or mixed occupancy, specify nature and extent of each type of use....'.................
Dimensions of existing structures, if 'l 152-1
' any: Front.............. RearDepth ?ti�->
height ...23.. ............ Ninber of Stories 1I/Z-
......................
Dimensions of sae structure with alterations or additions: Front ...�.•�i"°'^4
a
Depth .. .................. !!eight .................... Nudber of Stories ...................... ........
Dimensions of entire new construction: Front 3 2�"�" 1
• ........ .. Rear ..... ......... Depth
height ..... .:.................. Nurber of Stories Size of lot: Dont ..IC, !... Rear .... 3(oOt 9 1
Depth
0. Date of horchase ...??�!7I7S ..... Name of Former Owner �-SI£ D. ZCOt+NraoP_a
. .. . .. ................
I. Zone or use district in which premises are situated8
....
..........................t<:.........i.':t..............
2. Does proposed construction violate arty zoning law, ordinance or regulation: ..N.�
.................
3. Will lot be regraded ....��............ Will excess fill be removed frau premises: YES
4. Nares of Owner of premises 00(4P40 �.. Address Ole�vle W1MPq'1'•IZtC'GPhone No.2.AS
Name of Ardmitect �O N A w0 �lL ............ Address 1� Phone P
1142
m .. go.t.M.. . rb.?� .......
Nave of Contractor ....�e�oN a .... Address .......................PI . ....... ......
......................... ... woe No
5. is this property within 300 feet of a tidal wetland? * YES .K....... NO ,
*IF YES, SWnM TOWN TRUSIFE,S PM41T MAY BE W4nM.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
ran property lines. Give street and block r&uber or description according to deed, and slow street names and indicate
tether interior or corner lot.
saw Pyr f Pr� ON OA �
rAlr OF NUTI
JIY (IF U�o I lam....... SS
ON
being duly sworn, deposes and says that he is the applicant
`!acne of individual signing contract)
)ove named,
isthe .. .. . . ......................................
f ............
(Contractor, agent, corporate officer, etc.)
F said owner or wrwrs, and. is duly authorized to perform or have performed the said work and to make and ti le this
)plication; that: all statements contained in this application are true to the best of his knowledge and belief; and
rat the work will be performed in the manner set forth in the application filed therewith.
aorn to Fore me this
Notary Public 1 .....
LYNDAM.BOHN (Signature of Applicant)
NOTARY PUBLIC State of New yo*
Quel fi lM edI nBSu olk�
Term Expires March 8.%nl
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`y APPROVED AS NOTED
- -
N�OTI BUILDIN DE TM AT
765.1 02 9 AM TO 4$M FOR TNF
/ \ 1L 0 NDATNONE`:REQUIRED
'�6b �I 1LL���111 �� O� 2. RO GHpFRAMINGE3 PLUMBING
USE IS UNLAWFUL _ a INSFIN LArION
4 FIN L - CONSTRUCTION MUST d ,
{� I I AA � 11 WITHOUT CEF3TIFlCA - BE INSTRUCTION NPLETE FOR C.O. I_Q- (�-✓I yppp
I LD I L L,� 1 � —_._ __-- __._IF
THE EOUIREMENTS OF THE N.Y.
OF OCCUPANCY STAT CONSTRUCTION 6 ENERGY
^� � CODE NOT RESPONSIBLE FOR
\ : DESIG OR CONSTRUCTION ERRORS
DDTe Ta�erl FWonn Suwv�y P�`r — — " :80 H
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