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Home My WebLink About30071-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspecnor Town Ball Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30003 Date: 02/06/04 THIS CERTIFIES that the building Location of Property: 11365 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 142 Subdivision Filed Map No. ADDITIOHS MATTITUCK (STREET) (HAMLET) Block 2 Lot 18 Lot No. conforms substantially no the Application for Building Permit heretofore filed in this office dated JANUARY 30, 2004 pursuant to which Building Permit No. 30071-Z dated FEBRUARy 4, 2004 was issued, and conforms to all of the rec/ulremenns of the applicable provisions of the law. The occupancy foz which this certificate is issued is "AS BUILT" DECK ADDITION AND CBIMNEY INSTALLATION TO AN EXISTING ONE FAMILYDWELLING AS APPLIED FOR. · ~he certificate is issued to AURELIA LUKE BURGON (OWNER) of the aforesaid building. SI/FFOLK COIEqIqf DEPART~NT OF ~{~ALTH/kPPRO%L~L ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION Rev. 1/81 N/A N/A /~t~riJz~e~Signature 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 OP THE WORK AUTHORIZED PERMIT NO. 30071 Z Date FEBRUARY 4, 2004 Permission is hereby granted to: for : AS BUILT CHIMNEY AURELIA LUKE BURGON PO BOX 679 MATTITUCK, NY 11952 INSTALLATION & DECK ADDITION AS APPLIED FOR at premises located at 11365 MAIN RD County Tax Map No. 473889 Section 142 Block pursuant to application dated JANUARY 30, Building Inspector to expire on AUGUST MATTITUCK 0002 Lot No. 018 2004 and approved by the 4, 2005. Fee $ 300.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 7 5d80 APPLICATION FOR CERT~ICATE OF OCC~CY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topograptfic features. 2. Final Approval from Itealth Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of elec~cal installation fi-om Board of Fire Underwriters. 4. SWorn statement fromplumber certifying that the solder used/n system coma/ns less than 2/10 of 1% leadi 5. Commercial building, industr/al building, multiple re~tdences and s/milar buildings and installations, a certificate of Code Compliance fi.om architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For erdsting buildings (pr or to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey ofproperty sliowing all property lines, streets, building and unusual natural or topographic ~'eamres. 2. A properly completed application and consem to inspect signed by the applicant. If a Certificate of Occupancy ~s deuied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees l. Certificate of Occu~pancy - New dwell/rig $25.00, Additions to dweiling $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. CertificareofOccupancy on Pre-existingBullding - $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 Date. New Construction: Location of eropc~y: /~3~ House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Old or Pre-existing Building: b/ {check one) Street ( '~'?..- Block (D ~ )x~ ATFt ~-v c_lQ Hamlet Lot 0 { ~5 Subdivision Perm/t No. Date of Permit. ~:~* k.} .D~ Filed Map. Applicant: Lot: Health Dept. Approval: Underwriters Approval: Plamting Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Appl~llt-8~gnature Appticanv Owners Nmne: ,~f Architecq Engineer: ~c~_,~), ~' (t/o SCTM #: Dismc~: _1,000 Sec6on: ]~ Block: ProJect Subdiwslon t.ocalion: [1 ~3~o~ qFt~,~.J_, 'j%,l~J~__ Name: Single & separate Required certification: (Yes / Date Reviewed Project Description: N.A. NO YES AGENC ~A?ERMITS REQUIRED FOR REVIEW Permit Number Suffolk County Health' Dept. New York State D.E.C. Town Trustees ~Fown Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Notes: N/F' VANRYSWYt~ i"4 51'57'01 "E 69.72' ~EETS~-E-~EN-~ s~ Yr ~.~oP. u,E co,, ' 1/2 STORY' N COVERED WOOD PORCH MAIN ROAD NYS SURVEYED: 10 DECEMI3ER 2005 SCALE 1"= 30' SURVEY OF' AREA = 17,~14.~7 S.F. DESCRIBED PROPERTY OR S~TU^TE 0.Z97 ACRES MATTITUCK, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-142-02-018 GUA~NTEED TO: LINWWOD R. WOODHULL AQUEBOGUE ABSTRACT. CORP. FIRST AMERICAN TITLE INS, CO, CITIMORTGAGE SURVEYED FOR: LINWOOD R. WOODHULL SURVEYED BY STANLEY d. ISAKSEN~ JR. P.O. BOX 294 NEW SIjFFOLK. N.Y. 1 la9456 NY~ f.ic: No. 'OWN OF SOUTHOLD ;UILDING DEPARTMENT 'OWN flTtLL OUTHOLD, NY 11971 'EL: (631) 765-1802 'AX: (631) 765-9502 ~vw. northfork.net/Southold/ xamined ~: 20 0 ~ Lpproved ~/0~, 20 ~q5 }isapproved aJc Expiration ,~/~ q~ , 269_3- PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health b~A 3 sets of Build/rig Plans xf/~'B Planning Board approval t'%p¢ Cheek Septic Form N.Y.S.D.E.C. Trasrees ~ ~ ~ Contact: B~l~ng ~pector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS _, 20 c>~ a. This application MUST be completely filled in by typewriter or in ink and svJomitted to the Building Inspector with 3 ets of plans, accurare plot plan to scale. Fee according m schedule. b. Plot plan showing location of lot and of bu/ldings on premises, relationship to adjoining premises or public streets or reas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applicatiom the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for Lr~spection throughout the work. e. No building s~all be occupied or used in whole or in part for any purpose what so ever until the Building Inspector sues a Certificate of Occupancy. f. Every building permit shall exp/ru if the work authorized has not commenced with/n 12 months after the date of suance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the inter/m~ the Building Impector may authorize, in writing, the extension of the permit for an addition six months. Thereafter. a new permit shall be required. 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, addifiuns, or alterations or for removal or demolition as herein described. The applicant agrees to co ,reply with all applicable laws, ordinances, bu/lding code, housing code, and regulations, and to admit authorized inspectors o'n premises and in building for necessary inspections. ~glgnature of applicant or name, if a corporation) (Mailing address of applicant~ State whether applicant is owne~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder lame of owner of premises ?~U~ ~t-~^ (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate office) Builders License No. ~/~ Plumbers License No. ,~/~ Electricians License No. ~/~ Other Trade's License No. ~,,/,~ Location of land on which proposed work will be done: House Numbe~ Street County Tax Map No. 1000 Section Subdivision (Name) -_ Hamlet Block O Filed Map No. .Lot o Rate existing use and occupancy ofprennses and tntmxted use and occupancy of proposed co, nstmct~on, ~, a. Exisfing use and occupancy ~.~,~-,~ ~,,.~ ~,~,,~.~ ~-~o~,~,.~ ,~,~ r>~ ~ c~,,~,~c'~ b. Intended Use and occupancy " 3. Nature of work (check which applicable): New Building Demolition 4. Repair Removal~ Estimated Cost q¢ If dwelling, number of dwelling units If garage number of cars Fee Addition Alteration Other Work ~.c -~'r,~ (Description) (To be paid on filing this application) Number of dwelling units 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 ~:r,~-r,,~c~ Rear Height ~_-~.~ Number of Stories ~-.~-,,~,~. Dimensions of same structure with alterations or a~Jdiliens: Front Depth ~-~-,,~ Height ~-~-,~, Number of Stories Depth Rear 8. Dimensions of entire new construction: Front ~t/'^ Rear Height ,-4^ Number of Stories ...,/~ 9. Size of lot: Front G~,~'$ Rear ~oq,"~7_ Depth 10. Date of Purchase ]c[~ Name of Former Owner ~,A~ h,J Dep~ ~ l 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO ~ Will excess fill be removed from premises? YES__ NO .~ 14. N~es ofOwn~ofpr~lse~LO~ ~ ~ess Phone No. &~ ~797- ~G Nme of~ ~a~ ~ ~c. Address %mT~o~ ~x ItqDt PhoneNo O5~- q¢~- 19¢¢ Nme of Con, actor N ~ Ad,ess ~A Phone No. ~ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO . * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MA2Y BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO ,~ * IF YES, D.E.C. 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. STATE OF NEW YORK) SS: COUNTY OF ) ~-.~W' ~, ~-..~ be/rig duly sworn, deposes and says that (s)he is the applicant (~ame Of/ndividuai signing contract) above named, (Smeisthe (Contractor. Agent, Corporate Officer. etc.) of said owner or owners, and is duly author/zed to perform or have performed the said work and to make and file this application; that ail s~atements contained in this application are true to the best of his knowledge and belief: and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /~ ,~ ~) day of fc ,~_~, 20 LYNDA M. BOHN ~IOTAR¥ F'USUC, State of New York No. 01 BO6020932 ~ualified in SCfolk County Term Exo~re~ ..... ,~ . :¢'~ /f~~a~ of ~pplicant