HomeMy WebLinkAbout25240-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28467
Date: 05/29/02
T~IS CERTIFIES that the building ACCESSORY
Location of Property: 1350 OLE JULE LA MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax ~ap No. 473889 Section 122 Block 4 Lot 1
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 27, 1998 pursuant to which
Building Permit No. 25240-Z dated OCTOBER 19, 1998
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 BUILDING AS APPLIED FOR.
The certificate is issued to RONALD S DOBERT
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENTOF~RALT~APPROVAL
ELEC-rKICAL C~TIFICATE NO.
PLUMBERS ~TIFICATION DA'r~u
N/A
N/A
N/A
Authori ~d SignatUre
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
$outhold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 25240 Z
Date OCTOBER 19~ 1998
Permission is hereby granted to:
RONALD S DOBERT
1350 OLE JULE LANE
MATTITUCK~NY 11952
for :
CONSTRUCTION OF AN ACCESSORY BUILDING IN THE REAR YARD AS APPLIED
FOR.
at premises located at 1350
County Tax Map No. 473889 Section 122
pursuant to application dated AUGUST
Building Inspector.
OLE JULE LA MATTITUCK
Block 0004 Lot No. 001
27 1998 and approved by the
Fee $ 35.00
ORIGINAL
Rev. 2/19/98
Fornl ~o. 6
1 ()~V,N OF SOUTtlOLD
BUILDING DEPARTMENT
TOWN IL&LL
765-1802
APPLI( :ATION I;OR CE1CI'IIrlCATE OF (~
This application must be filled in by typewriter or ink and subnfitted to the Building Department 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 Apl2roval fi'om Ilcatth [)ept ofwmcr sul,ply and sewerage-disposal (S-9
3. Approval cd'electrical iustall~fion fi'on~ Board of Fire [}nde~vriters.
4. Sworn statement fi-om plumber cenif~,ing that the solder used in system contains less than 2/10 of 1% lead.
5. Co~nercial building, industhal building, multiple residences and si~Mlar buildings and installations, a certific
of Code Compliance from arclfitect or engineer responsible for the building.
6. Sub~t Pla~g Bo~d Approval of completed site pl~ r~rements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "Pre-existing" land us~
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 Occupam
is denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
1..:Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.0(
Swimming pool' $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.0
2. C6Wdficate of Occupancy on Pre-existi~g Building - $100.00
3. Photocopy of Certificate of0ccupancy - $ 0.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Dat~.
N~w Constmcti°n:
Location of Prop~B~.
Old or Pr~xistl-g Buildin~
Itous¢ No. Street
OwnerorOwnorsofPropert~. '~,o~P~:> ~. ~C~'~---~'.~/-
(~hcck one)
Suffolk Cotmty Tax-Map No 1000, Section
Subdivision
PermitNo. ~,~64:5>,~' DateofPermit.
Health Dept. Approval:
Block ~'~ Lot /
Filed Map. Lot:
Applicant:
Underwriters Approval:
Platmhlg Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~:~ ~
Final Certificate: Y (check one)
Applicant Signature
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765-~.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ROUGH PLBG.
[ ] INS/UJ.ATION
[L~INAL
] FIREPLACE & CHIMNEY
DATE
INSPECTOR
~OUNDATION
(1st)
FOUNDATION
(2nd)
ROUGH FRAME &
-PLUMBING'
I~SULATION PER N. Y.
STATE ENERGY
CODE
L
FINAL
ADDITIONAL COMMENTS:
SU~VgY .............. "' ..........
C~C~ .....
$~TIC ~ORIt ...................
liOTtl~¥ {
ail. 4'01 ....................
'Da~e ................ ,19 ....
IHSTRUC'rIOH~
a. 'thts epplicaCic~ ~uaC be conpletely filled in by ~riCer ur tn i~ ~ ~ ~ ~ ~ildi~ I~cor ~i
3 ~cs o~ pl~,. ~roCe plot pl~ Co ~ale. ~ ~[~ to ~.
b. ~loC pl~ ~i~ l~Ct~ o[ loc ~ o~ ~ildl~ ~ ~s, ~l~Cl~dp ~ ~ol~{~ ~ Or ~flic
s~r~Ca or areas, ~ &ivi~ a ~ca[l~ ~ri~i~ o[ lay~C o~ pro~rty ~t ~ dr~ ~ tim d{~ ddd, I~ ~rt of
~taci~, for cl~ ~c~ti~ O[ ~ildi~, ~!ici~ or alCeraCi~, or ~r ~l ~ ~IiC~, ~ ~in
'~Si~tur~ Og *~li~C, ~ ~, t[ *
FOLLOWING BISPEC"I10~: '
I FOUNDATION . TWO REQUIRED
FOR POURED COI~ETE
'2. ROUGH - FRAMIN~ &~i~G
· 3. INSULATION *
4 FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
Dlu~beca Licaase 1~ ............
/i..~LLiCONSTRUCTION StiALL MEET
Electricians l.tcaase tqo ............... ....... ~k~--/c~=,~ ri'lYE/REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
O{;he~ Tr~e__'a License [qo ..................... . COOES. NOT RESPONSIBLE FOR
location al: lurxt ~ ~[d~ prolx)aed ~ork vlll be dona ............. ;,,..,,,,~-~{GN,4~q,c-~ikIO~R~71ON'ERROH~ ....
PLOT D~A8RAtt,
t~Jte ctenrly nnd distinctly all ~tldl~n, ~fl~r ~lnttng ~ ~, ~ t~tcata a11 ~t-~ dt~nat~n
sd~tlmr lflterlor or ~r lot.
d' ..
(I1~ (!t _~~~l~.q(.: ~/¢ . ~ z ~ /~
/~~i. ~ 4 ....................... Imf.Il duly
................... ~.(~ ................... ., .........................
(~t~etor, ~t~r~mte o[~leer, ere,)
of ~ld t~r or ~rn, ~ Iff t~ty ~tl~rl~ to ~rfom or ht~e l~rfor,ml th~ ~ld ~rk taxi to rake o~l file this
that tl~ ~rk viii l~ ~r~l In tl~ ~mr ~t ~rth tn tiaa a~tle~ttm
(SlDmt~re o~ A~l. leant)
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