HomeMy WebLinkAbout27498-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28220 Date: 02/19/02
THIS CERTIFIES that the building ACCESSORY
Location of Property: 2100 ARBOR LA MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 121 Block 1 Lot 1.11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 10, 2001 pursuant to which
Building Permit No. 27498-Z dated JULY 25, 2001
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 BARN AS APPLIED FOR.
The certificate is issued to JAMES MILLER JR & WF
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 584602 02/19/02
PLUMBERS CERTIFICATION DATED N/A
ut rized 6ignature
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. 27498 Z Date JULY 25, 2001
Permission is hereby granted to:
JAMES JR & WF MILLER
2100 ARBOR LANE
MATTITUCK,NY 11901
for
NEW CONSTRUCTION OF A 361X50 ' ACCESSORY BUILDING IN THE REAR YARD
AS APPLIED FOR.
at premises located at 2100 ARBOR LA MATTITUCK
County Tax Map No. 473889 Section 121 Block 0001 Lot No. 001 . 011
pursuant to application dated JUNE 10, 2001 and approved by the
Building Inspector.
Fee $ 465 . 00
Authorized Signature
ORIGINAL
Rev. 2/19/98
Form No.6
• TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
t,
765-1802 r .
APPLICATION FOR CERTIFICATE OF OCCUP C 7
This application must be filled in by typewriter or ink and submitted to the Building Dep
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natura 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 I%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.-
equirements.B.- For existing buildings(prior toApril 9,195')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 Building- $100.00
3. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00,Commercial$15.00
r
Date. __x, ZA /Da
New Construction: Old or Pre-existing Building: ' (check one)
Location of Property: a i U o LLt 4cc. L'J 2 . 4LC C° k
House No. Street Hamlet
Owner or Owners of Pro
P�Y�.�.�2,t�.2 S 10c IO afCc r v!G I le'f_
Suffolk County Tax Map No 1000, Section Block WO I Lot CX)I V LL
Subdivision G3 �J Filed Map. Lot:
Permit No. L/ ! 13 Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate. Final Certificate: (check one)
Fee Su^b�'tted: $
C ` f Applicant Stgnature
TIER NNW YORK RQAlRD 4F FIRE UNDERWRITERS PAGE '
120/5089 BUREAU OF ELECTRICITY
40 FUMN ETRE,ET, NEW YORK, NY 10038
Dazs FEBRUARY 04,2002A n No. on le 13976802102 N 584602
THIS. 090TIF101P THAT ER T NO. 7498
only the electrW equipment as 40cribed below and introduced by the applicant named on the above application number is in the premises of '
MILLER, 2100 ARBOR LANE, MATTITUCK, NY
in du fallowing 40ad R 7 0e1 e200[M ls$FL M Znd l:l. QUT Section Block Lot
was exa+Idaed on end found to be in compliance with the National Electrical Code.
FIXTU
NOES COOKING DECKS OVENS DISH WASHERS I EXHAU FANS
R#CEPrAQLES TMER A K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P.
18 10 11 1
DR1f R pyo FIJT{IOf AP�4 O FEEDIRS $PECIAI REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT• K•Mr• Q}L H•f• 91bF, 11•P• AMT. Ng. A.W.6. AMT. AMP. AMT. AMPS. TRANS. AMT. N.P. SYSTEMS
�! NO.OF FEET AMT. wAtn
SERVI DI `rONNE4T I! :$ 4, E R V I C E
.,' •' • E I 0 I 41,�E JW VO "O f CR,.OND. Of CCC ND. NO.OF NI-lF6 Of W' NO.NO.Of NIVMALS OF NEUTR%1L
OTHER APPARAtIIs
BARN-1
ELEC. ROOM HEATERStl-.5 K.W.
PANEL80ARDS:1-7 CIR. 100
G.F.G.I:-4
TOP GUN ELECTRIC L
P.O. BOX 1464
SOUTHOLD, NY, 11971 GENERAL MANAGER
11
Per
ihWM!11199,
r M"tf R+4l1 .1919 Iho 1 Rt.thll 4Avr4 It Incorrect.IT1>Ip"M►i mRir be IelwnMw 4TY their Gtqdenflall.
CCERTIFICATE MUST NOT 8E ALTERED1
.2 749&
BUILDING PERMIT REVIEW CHECK LIST
DATE REVIEWED: Z/mac /01
Agf�
DATE SUBMITTED: / /O1
APPLICANT NAME:
SCTM#--- DISTRICT: 1,000 SECTION: /::2-/ BLOCK: d/ LOT:
STREET: lioo kkr &.,r CITY: SUBDIV. NAME:
PROJECT DESCRIPTION: AD AL AC R N/D: /4a
ARCHITECT/ENGINEER: �Q,Kw FAST TRACK: YES o
SINGLE&SEPARATE CERTIFICATION-REQUIRED: YESNO NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED M JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83)
ZONING: PERMIT ESTIMATE AMOUNT:—$— ox .00 PERMIT USE: EXISTING: INTENDED:
ZONING DISTRICT: R40 R80 AC CONFORMING: YES,Q NO REQUIRED LOT SIZE: 86t SQFT.
WHERE ACTUAL LOT SIZE FRO cARD ACTUAL LOT SIZE:. d� SQFT.
REQUIRED REQUIRED REQUIRED
1ST FOUND:FRONT: 'PROPOSED: SIDE YD:" '/ ' PROPOSED: '/ ' REAR:'PROPOSED: '
2ND FOUND:FRONT: ' ACTUAL: SIDE YD: '/ ' ACTUAL: '/ ' REAR: ' ACTUAL: '
LOT COVERA E: ALLOWED:_% EXISTING:_ sf_% NEW: sf_% TOTAL: Sf_%
CORNER? NO WAT ER FRONT? YES DESCRIPTION:
FLOOD CO CE ZONE: PRE-FIRM 311s/8o PANEL : FLOOD ZONE: ,
AGENCY PERMITS REQUIRED FOR REVIEW
INCLUDED IN APPLICATION
TOWN SPETIC PERMIT: YES or NO
SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED#): DTE: /_/_ PERMIT#:R10-
APPROVALS RE UIRED:
NEW YORK STATE DEC: PRE-DEc 9n/75 YES orAd
SOUTHOLD TOWN TRUSTEES: YES or
TOWN ZONING BOARD APPROVAL: YES orj&A
TOWN PLAN. BOARD—APPROVAL: YES or
TOWN HISTORICAL PRE LIA): YES or O
NYS ENERGY: YES OO : EGRESS: VENT: LIGHT:
BUILDING PERMITS O /EXPIRED: BP -Z/C/0 Z- ,
HAVE PRE CO'S : Y OR N BP -Z/C/0 Z- ,
NOTES: s' ,J„
e+v +e v s* sr a rei,re�
eCC/0t 7 Q
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR / &CU SF
SECOND FLR SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
I'OT /�—SF)- ( '—SF)= /3Gb SFX$ ,X =$ 3176 +$T_+$ = s
BUILDING aerr.
1 SPECTION
[ FOUNDATION IST [ ] ROUGH PLBG.
[ J FOUNDA7fON 2ND [ ] INSULATION
[ 1
FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
C
DATE 10tf INfPECTOR
suILuiNa DEPT.
INSPECTION i
[ ] FOUNDATION IST [ ] ROUGH PLBO.
[ ] FO A770N 2ND [ j INSU TION
[ FRAMING [ FlNAL y
[ ] FIREPLACE & CHIMNEY j
REMARKS:
DATE INSPECTOR �^^�
FULD INSPECTION REPORT IIA '�
,....af COMMENTS 1T
_
asaaas --=aaa=�:
H
FOUNDATION ( 1ST)'
b r
FOUNDATION (2ND)
sssxs= --xxaxxxaa sxxs�e ax-s�5�'ss=sa--������� �esxxa.������mxseaaasasaasr^
ROUGH FRAME & a
PLUMBING G
d
r°
IFSOLATION PER N. Y.
STATS ENERGY #
CODS
Of
l` y
FINAL
ADDITIONAL CQMPTS: r
y
iuwiv up auuinVvL BU1L1)1NUFtKMfl'AFPL1UAl10N CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 Survey
PERMIT NO. 2?4 9& Check
Septic Form
NX.S.D.E.C.
Trustees
Examined— 20_L Contact:
Approved � 20_!�j Mail to:
�1�/� x&ArL/J k2?
Disapproved a/c `vary`a�471 A)C� It?7
Phone:
Iluil'dingYnspector
APPLICATION FOR BUILDING PERMIT
Date 20,D _
INSTRUCTIONS
a. This 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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupancy
is issued 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 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 on premises and in building for necessary inspections.
(Signature of applicant or name,if a corporation)
45R55 MI9lN VA .S 040101 Ny
(Mailing address of applicant) aq
State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises
(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.
Electricians License No.
Other Trade's License No.
1. Location of land onAMR
sed work will a done:
2 ��Z���
1 oto
House Number Street Hamlet
County Tax Map No. 1000 Section Block " t
Int �
Subdivision Filed Map No.
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy. f2 ,,,,
b. Intended use and occupancy dCGG-, '7 ? �� er
Nature of work(check which applicable): New Building_Addition Alteration
Repair Removal Demolition Other Work
(Description)
•. Estimated Cost L/e,� � ��� Fee
(to be paid on filing this application)
If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
i. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
3
�. Dimensions of existing structures, if any: Front L v Rear Q t Depth Z
Height 3 0' Number of Stories Z
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories.
3. Dimensions of entire new construction: Front Rear Depth 3CQ
Height t /1,4## Number of Stories z
�. Size of lot: Front 4LZ.� Rear 69 Depth <
10. Date of Purchase Name of Former Owner
I 1. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be re-graded /tom Will excess fill be removed from premises: YES
X15K.
14. Names of Owner of premises lµ�w� Address-2-100 �'V Phone No. 2-`L 8- 1 ZSq
Name of Architect Allyw Address Phone No
Name of Contractor 3lw �F-Gw+g Address'43''�9'1N 9b. Phone No. '7&1--1&61
15. Is this property within 100 feet of a tidal wetland? *YES NO ✓
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
16. Provide survey, to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
iTATE OF NEW YORK)
SS:
�_OUNTY OF )
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
;S)He is the 1�9 �
(Contractor,Agent,Corporate Officer, etc.)
)f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
:hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
)erformed in the manner set forth in the application filed therewith.
3wom to before me this
day of , 20_L
Notary Public Signature of Applicant
ELIZABETH A STATHIS
NOTARY PUBLIC,State of New York
No.01 ST6008173,Suffolk Cou
Tenn Expires June 8,
NASSAU—SUFFOLK BLUEPRINTING CO. INC. ^dl)I6
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31 �j�2S�s6Jaiv= — ��Q�- —31 _ TTPICAI R T ULAR SEPTIC T K
(iorep 9`&*S.F ? 3 a9 ft�s X34
PIN- S 67•s3r48�N x \ a�.� F-rL — _ — — --
t. DATUM: Assumedt'�' 13 I _ —
2. S.ClX Lot Nlerlboeo dwwa tow:Q raWlRge
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SURVEY OF ATIZMATT1TUGK
TONN OF-SauTNot_D ODU\4 TY CF SUFFC)LK,N.Y.
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A ftag *?"MAP OF:TH NITON SMI-l" SECtI dN 2
VIOLATION
ON LSA OF SECTION 7209 OF Tit NEW YORK STATE EDUCJI' l 'I 2 ,t : 7AM E S i DEBh R A M L LLE R
SURVEYED FOR:
NKEST� i� MAP � ' ms
SEALoR tSSED SEAL SHALL S �BE OOONiDoCERTIFIED TO TIONAL TITLE COMPAMY
BE A VALID TRUE COPY.
GUARANTEES INDICATED HEREON SHALL RUN ONUI TO IVE PER"
FOR WHOM THE SURVEY 6 PREPAI4ED, ON HIS BEHALF TO
THE TITLE COMFW4Y,G"4NMENTAL AGENCY AND LENDING ' C
INSTITUTION LISTED HEREON, AR40 M THE ASSIGNEES OF THE SCALL "_ ' DATE:
LENDING INSTITUTION GUARANTEES ARE NOT TRANSFERABLE Fa'U T1ov Lew.AT-10, 5-10-89
VqqAl
TO ADDITIONAL INS'TTTUTIONS OR SUSSEOUENT OWNER3. SILK QTY TAX MAP �Of NEW
UByoR
EASEMENTS ANO/OR SUBSURFACE STRUCTURES RECORDED Olt SURVEYED BY art K, hE/s �-
UNREOORDED ARC NOT GUARANTEED UNLESS PHYSICALLY DIST.1 SE`s;I 8LK•I LOT LOTHAR K. REIS o s�
EVIDENT ON THE PREMISES AT THE TIME OF SURVEY.FT•3E * MOPOW E OCATION 4 MANE LANE
THE OTS OR DWENSION3 SHOWN HUWAK FAM RTHE EAST NE LA ES 1`!
PROPERTY LINES TO THE STNItiIURES, ARE FOR SPECIFIC
F mwwE AND USE. THEREFORE THEY ARE NGT INTENDED - LtC:* 492 50 �°
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moi► �,..,- DATE'. B P N 7 4f
44d-s-- BY — OF FOUNDATION LOCATION
-STAU- -43 t�15jl � I u >Rte f NOTIFY BUILDING DEPnr lwl AT HAS BEEN APPROVED.
765-1802 9 AM TO 4 1'X1 ' I IF
I FOLLOWING INSPECTI0i
1 FOUNDATION - TVI, I ' ' D
GPEdJ TD FOR POURED CONC, t"
INSUL
glSLEN+11A ` - - - - - - - 4 FINAL -BE COATI CONSTR F I I OCCUPANCY OR
_ _ _ M ETE F
._ _- -_ . _- _ . - - - _ - .. - .. . _ - .. .,,. _ ALL CONSTRUCTIOF {-T
USE IS UNLAWFUL
I
THE REDDIREMCN _' _lIGY' Y. WITHOUT CERTIFICATE
A' CODESTATES NOT RRFFF' N FOR
_ OF OCCUPANCY
i (� ' DESIGN OR COPISTRUCi iON EFRORS
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IS -o
Southold, NY 11971
STALL �1 STr+f.L �2 -' - - Sa '-O•'
(516) 3231817
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45805 Main Rd.
Southold, NY 11971
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