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HomeMy WebLinkAbout29925-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sonthold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29949 Date: 01/08/04 THIS CERTIFIES that the building ADDITION Location of Property: 1305 THERESA DR (HOUSE NO.) Cotulty Tax F~ap No. 473889 Section 115 Subdivision MATTITUCK (STREET) (HAMLET) Block 15 Lot 12 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 4, 2003 pursuant to which Building Permit No. 29925-Z dated DECEMBER 9, 2003 was issued, and conforms to all of the recfuirements of the applicable provisions of the law. The occupancy for which this certificate is issued is "AS BUILT" DECK ADDITION TO ~ EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to FRANK & BARBARA MOOR JR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~F~n_LTH A/~PROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 //~i z ed~/signat ute 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. 29925 Z Date DECEMBER 9, 2003 Permission is hereby granted to: PRANK & BARBAP3~ MOOR PO BOX 246 MATTITUCK,NY 11952 for : AN "AS BUILT" DECK ADDITION TO AN EXISTING SINGLE PAMILY DWELLING AS APPLIED FOR at premises located at 1305 County Tax Map No. 473889 Section 115 pursuant to application dated DECEMBER Building Inspector to expire on JUNE THERESA DR MATTITUCK Block 0015 Lot No. 012 4, 2003 and approved by the 9, 2005. Fee $ 300.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTttOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY _.TkisT~lS~5 'haTath3~ ~e,d in by typewriter or ink and submitted to the Building Department with the following: A. 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 electricai 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 bulld./ng, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Plann/ng 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 consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in wrking to the applicant. C. Fees ~i 1. Ce~fficate 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. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Date.-T~.,~4 7~ 2_e~O.h~ Old or Pm-existing Building: (check one) Location of Property: ] .:~0.4;" Yh.g r.~g& /~ r'[v~ ~414 l"~', ~ House No. Street Hamlet Owner or Owners of Property: ~K Suffolk County Tax Map No 1000, Section Subdivision bg~9 Permit No. Health Dept. Approval: Block /.5"- Filed Map. _ ~/Z~"(a Applicant: -J~m~ ~ Underwriters Approval: Lot j ~2- Lot: ~.5~ Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 2~ ~ O Final Certificate: v~~' (check one) Applicant ' LOT$1 MAP OF: lOT $5 "DEEP ' HOI_£ CRE.£1q ESTATES" AT MATTITUCK TOWN OF $OUTHO£D SUFFOLK COUNTY NEW YOt~ K PI£ E NO. 4~5~ ' FLIED ,lAIr.28,1965 donack associates land surveyors and consulting engineers 31:3 west main street riverhead,new york 11901 (516) 369-1717 (212)746-3020 Jan. 19,1983 dob Ne 8;5-202 1000-115-15-:12 Scale: I": 30' Applicant/ Architect/ Engineer: SCTM #: [District: ~ Secfiou: [/~ I31o~k: Lot: Date Reviewed: Project A i ,f , t & Subdivision Single & separate Required cerlification: (Yes / No) Req. .~ ~ / · Rcq. ~L~ Req. Projeot Description: ~ )< g 0 cvs b [4-. AGENC~,2PIgRMITS ~QUIRED FOR REVIEW N.A. NO 'permi(, YES · Number Suffolk County Health Dept. New York State D. E: C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation 277 Flood Zone: NOtes: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [ ~ [ ] & CHIMNEY REMARKS: DATE / ~'"~/~/©~ INSPECTOR / 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING [ ]FIREPLACE & CHIMNEY REMARKS: [ ] ROUGH PLBG. [ ] INSighT*ION INSPECTOR ~(~WN O~-5OU~HOLD UILDING DEPARTMENT ~oOWN HALL UTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. nor thfork.net/Southold/ 3 Approved /o>-~/~ ,20 -~ Disapproved a/c PERMIT NO. /-~uilding lmspeetor BUILDING PERMIT APPLICATION CHECKLIST DO you have or nee~t ttte following, before applying? Board of Health --.,4 sets of Building Plans pl~nnlng Board approval ~Suxvey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: _~ ~? APPLICATION FOR BUILDING PERMIT = Date ~]~. ~ ,20Og £ ' ....... ~STRUCTIONS a. T~s application ~ST be completely fi~ed in by t~ewfiter or ~ ~ ~d sub~tted to the B~l~g ~spector wi~ 3 sets ofpl~, acc~ate plot pl~ to sc~e. Fee accor~ng to schedule. b. Plot pl~ show~g location of lot ~d of buil~gs on pr~ses, relatio~p to adj o~g pr~ses or public s~eets or ~eas, ~d wate~ays. c. The work cov~ed by ~s application my not be comenced before issa~ce of B~l~g Pemt. d. Upon approval offs application, ~e Bffil~g hspector will issue a B~l~ng Pe~t to the applic~t. Such a pemt s~l be k~t on the pr~ses available for ~pection ~oughout the work. e. No buil&ng s~l be occupied or used ~ whole or ~ p~ for ~y p~ose w~t so ever ~til the B~lding ~pector issues a Ce~ificate of Occup~cy. f. Evew b~d~g p~t s~ll expire if the work auto,ed ~s not comenc~ witch 12 mom~ a~er the date of issu~ce or has not be~ completed wi~ 18 months ~om such date. If no zo~g men~ts or o~er re~atio~ affect~g the prop~ ~ve been e~cted in the ~tefi~ ~e B~l~g ~sp~tor my au~o~ze, ad&tion s~ mont~. ~er, a new pe~t s~l be req~ed. ~PLICATION IS ~BY M~E to the Buil~g D~m~t for the iss~ce of a B~l~g P~t p~su~t to the B~l~g Zone Ore,ce of the Town of Southold, S~olk Co~ty, New YorL ~d other applicable Laws, ~ces or Relations, for the co~ction of b~gs, ad~fio~, or ~teratio~ or for removal or demolitio~ as here~ described. The applic~t a~ees to comply wi~ ~1 a~hcable laws, or~ces, b~l~ng code, hous~g code, ~atio~, ~d to a~t au~ofized i~pectors on pre~ses ~d ~ buil~g for necess~ ~spectio~. ~ (Si~~r ~ff a co¢orafion) ~Iing ad'ess of applic~t) r //q~ State whe~er applic~t is owns, lessee, agent, ~chit~t, ~e~, gener~ ~n~actor, elec~ci~, plmber or b~ld~ Name of owner of premises /~ OO ~ (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and rifle of corporate officer) Builders License No. /[/ Plumbers License No. .4/./,4 Electricians License No. Al 1,4 Other Trade's License No. Location of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Section //.,~' Subdivision ~~ -_~ Block Lot Filed Map No. 6t2 ,.fig Lot /2- 35' 2. State exiSting use~-and occupancy of premises and intended use and a. Existing use and~occupancy ~P.~ d.~x[~( occupancy of proposed construcaon: b. Intended use and occupancy Nature of work (check which applicable): New Building Repair Removal Estimated Cost If dwelling, number o f dwell/ng units If garage, number of cars Addition Alteration Demolition OtherWork E>Clq/,.~ 2'>,~-~ - -- J(Descfi~ion) Fee cjp, rSF)O ,5h3 (q~o be p~d on filing ~s application) Nmb~ ofdwe~ing ~its on each floor ~/~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~ ~_, ~ ~ Rear Height 2,5',/t9 ~ Number of Stories ! Dimensions of same structure with alterations or additions: Front Depth Height. 8. Dimensions of entire new construction: Front Height Number of 9. Size of lot: Front /'~O ~ Rear ~6)'" Number of Stories Rear _Depth Depth 2~, Rear Depth /,52,2/2 -/5~,// 10. Date of Purchase/~gr. Z4 lqsd 11. Zone or use ~sMct ~ wMch premises ~e situated 12. Does proposed construction holate ~y zo~ng law, or~n~ce or relation? YES NO / 13. Will lot be re-gaded? ~S NO /Will excess fill be rmoved ~om premises? ~S NO 14. Nines ofO~er ofpr~ses ~ Ad&essp¢ ~7~ Phone No. Z~f-~S~ N~e of~chite~ ~td &. F~;~ Ad'ess/IYZ~a,h ~ ~hone No X~7~-~ Nme of Con,actor Address Phone No. Name of Former Owner 15 a. Is tiffs property witkin 100 feet of a tidal wetland or a freshvCStcr wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO__ * IF YES, D.E.C. PERMITS MAY BE REQU/RED. 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. STATE OF NEW YORK) SS: COUNTY 5~r'~- w ~-. fi/( t:>O c ~'~ xc. being duly sworn, deposes and Says that (s)he is the applicant (Name of individual sigfi/ng contract) above named, (S)He is the C..D ~/xc~ V' (Contractor, Agent, Corporate Officer, etc.) of said owaer or owners, and is duly authorized to perform or have performed the said work and to make and file this apphcation; that ali statements contained in this application are true to the best ofkis knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th/s 0 ~ ~N~)tary~blic Szgnature of Ap~icant ~