HomeMy WebLinkAbout29579-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDIi[G DEP~TMENT
Office of the Building inspector
Town Hall
Southold, N.Y_
CERTIFICATE OF OCCUPAiqCY
No: Z-30264
Date: 06/28/04
T~IS U~a{'FIFIES that the building ACCESSORY
~ocation of Property: 375 FD~MVEU RD F~TTITUCK
(HOUSE NO.) (STREET) (~A~LET)
County Tax Map No. 473989 Section 121 Block 7 ~ot 2
Subd/v~sion Filed M~p No. Lot
conforms substantially to the Application for Building Permit heretofore
file~ in ~h~ office dated J~3LY 11, 2003 pursuant to
Building Pe~t No. 29579-Z dated ~X/L¥ 15, 2003
was issued, amd conforms to all of 5he requiremencs of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ACCESSORY INGROUI~D SWI~IN~ POOL WIT~ FENCE TO CODEAS APPLIED FOR.
· ~e certificate is issued to MICHAEL C & MORGEN J HA~D
(OWI~ER)
of the aforesaid building_
~u~l'OI~K COUNTY DEPARTMENT OF
ELECTRICAL C~FIFICATE NO. 79207C 08/27/03
PLUMBERS CERTIFIC-A-TION DA'£~3 N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOmD
BUILDING DEPARTMENT
To%~n Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL
COMPLETION OF THE WORK AUTHORIZED)
PEPa~IT NO. 29579 Z Date JULY 15, 2003
Permission is hereby granted to:
MICHAEL C & MORGEN J HAND
375 FARMVEU ROAD
HATTITUCK, NY 11952
for :
CONSTRUCTION OP AN ACCESSORY IH GROUND SWIMMING POOL IN THE
REQUIRED REAR YARD AS REQUIRED
at premises located at 375 FARPP~EU RD
County Ta_x Map No. 473889 Section 121
pursuant to application dated JULY
MATTITUCK
Block 0007 Lot No. 002
11, 2003 and approved by the
Building Inspector to e~pire on JANUARY 15, 2005.
f "~ zed~ ignature
ORIGINAL
Rev. 5/8/02
Form No. 6
TOW'N OF SOUI'HOLD
BUILDING DEPARTM~,NT
TOX~H HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be fdled in by typewriter or ink and submitted to the Building Depmtment with the following:
For new building or new use:
1. Final survey of propclly with accmate location of ali buildings, propert3, lh~es, streets, and unusual natttral or
topographic fkatures.
2. Final Approval fi'om Health Dept. of water supply and sewerage<lisposal (S-9 farm)..
3. ApproYal of electrical installation from Board o f lfire Underwriters.
4. Swolm statement fi-om plumber certifying ~hat the solder used hi sys(em contains less tlmn 2/I 0 of 1% lead.
5. Commercial bnilding, h~dnstfial btdldin g, multiple residet~ces a~d sim//ar builcgm~ and installations, a certificate
of Code Compliance from arch/tect or engineer responsible for the building.
6. Submit Plmming Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accu. ratc survey of'propcrty shownig all properly lines, streets, bhild/ng and unusual natural or topographic
features.
2. A properly completed application and cousent to inspcct sigaed by the applicaut_ If a Certificate of Occupancy is
denied, thc Bu/Jding Inspector shall state ~e reasons there/hr m writm~ to the applicant.
1_ Certificate of Occupancy - New dwelling $25_00, Additions to dwellhig $25.00, Alterations to dwelling $25.00,
Swirminng pool $25.00, Accessory building $25.00, .Additions to accessory build/rig $25.00, Busniesses $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 Certi~cate of Occupancy - Residential $ l 5.00, Commemia[ $15.00
Date. ~_~Z3
Subdivision
New Construction: P'- Old or Prc-existiug Building:
Locationof?rorerty: %'- l&c
House No. Street
Owner or O,amci~ of Property: ~C~.~t
Suffolk County Tax Map No 1000, Section i ¢! '~ Lot
Lot:
Date of Permit.
Permit No. ¢2.._C~ J"'75 -7.-
Health Dept. Approval:
Plat, ning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
(check one)
Block
Filed Map.
Underwriters Approval:
Final Certificate:
(check one)
Issue Date
8/27/03
Electrical Inspection Certificate
Electrical Inspection Service, Inc. Application Number
375 Dunton Avenue 79207C
East Patchogue, New York 11772
(63t) 286-6642
Issued To: Michael Hand
Street: 375 Farmveu Road
Village: Mattituck Zip: 11952
Section: 121 Block: 07 Lot: 02
Contractor: Hank*s Electr!c inc. (L)
Town: Southold
Lic.# 2675-E
Was examined and found [o be in compliance with the National Elec[rical Code.
LJ Commercial [~J NV Defects [] Pool [] 1st Floor ~J Indoor U Basement ~ Hot Tub
[] Residential [] Dot. Garage J Attic LJ 2nd Floor [] Outdoor I~ Addition [] Survey
Switches Receptacles Fixtures GFI Heaters A/C Fans
2 1 1
Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
Meter Amps Phase UG/OH Jacuzzi
Television CO Detector
Bldg. Permit:
Other Equipment
1-20Amp Spec Rec
li-30Amp Tim, e Clock
1-20Amp Time Clock
Hugo S. Surdi
President
Rough InspecUon: 08/19/2003
Inspe~Lor: Eddie Rodriguez
Final Inspection: 08/19/2003
Inspector: Eddie Roddguez
This certificate mus[ not be altered in any manner. Inspectors may be identified by their credentials.
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSU.~I. ATION
FRAMING [ ~.-']"F I NAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE ~//.-.~/O'~ INSPECTOR ~~~
77 ,
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUG~B~.
[ ] FOUNDATION 2ND [ ]~JI.ATION
[ ] FRAMING [,~FINAL
REMARKS:
] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
DATE
FO UND_a_TION (1ST) --
..' :~ ~
'
~_~ON p~ N.Y. :.
~T={~ ~ CODE
~.' ~ ~ : ~ ·
//
~D~'lO~ CO~
. ~
...... [~
'OY~q~ OF SOUTHOLD
UI-[,DING DEPARTMENT
OW~g HALL
O .UTItOLD, ~ 11971
EL: (631) 765-1802
AX: (631) 76~-9502
BUILDING PERMIT APPLICATION CHECKLIST
Do you trove or ~ed the f~llowing, bcfcr~ mpplyiag?
Board of Health
3 sexs of Bailding Plans
Plan'~;,,~ Board approval
Survey..
Sep~c ~onn
Trustees
Building Lnspector
; ~ . ·. APPLICATION FOR Bbi.~DING PERM/T
:.L .............. t i Date
a. ~s app~cation ~ST be eo~letely ~ed ~ by ~e~t~ or m ~ ~d ~b~ed to ~e Bml~ ~pector wi~ 3
~rs ofpl~s, ~ccmte plot pI~ to s~e. Fee aceordlng ~ ~ehed~e.
b. Plot pl~ show~g loc~on of lot md of b~ on'pr~qs~, relafiom~p to adjoining premses or pubgc s~ts or
cas, ~d watemmys.
c. The work covered by ~ app~cafion may not be cc ....... e~ced helot= issu~c~ ~fB~ding Pe~t.
d. Upon approv~ o ......
f ~s a~oaflo~ ~e B~dmg In~or wffi ~sue a B~ding P~it t0 the applic~t. Such a pe~t
,~ be kept on the pre~e~ a~il~blo ~r ~o= ~o~out ~e work.
e. No b~ding sh~l be oc~ed or ~ ~ Whole or ~ pm for my p~ose w~t so ov~ ~ ~e B~ld/ng lnsp~tor
roes a C~cate of Ocenp~cy.
I f. Ev~ b~g p=~t ~ ~ ~e work a~o~ ~s act co~n¢~ ~fhin 12 m0n~s ~er ~e dare
;~ce ~r has not be~ compl~ ~in 18 moa~s ~om su~ ~m. ~n0 zo~g ~men~ts or o~er re~fio~ affec~g the
~ ~ qav* bern ~ m ~e ~t~ ~e B~d{ng Tn~ ~y ~o~e, ~ ~Sng; ~e
~tmn s= mon~. ~m, a n~ p*~t sh~ be re~ '
[ -~PLICATION IS ~y ~E to ~e B~ D~tm~t for ~e is~ of a B~d~g Pe~t p~s~t to
t?d~g Zone Ord;=~=ce of~e Tom of8o~o14 8~oR Com~, N~ Yor~ md.o~ ~p~oable Laws, Ordi~cea or
:.~latiom, for'~e come,on ofb~, ~d~fiom, or ~t~fions or for removM or d~li6on as here~ described.
9licit a~ees to co~ly ~ ~ app~ble laW% or~c~, ~d~ng code, ho~ code, ~d relations, and ;o admit
~ho~ed inspeotors on praises md ~ b~ d;ng for ncccss~ ~ecfion~,
~g a~ess of applic~Q
qe whe~er applic~t is cruet, less~, agen~ ~c~t~t, ~qe~, gen~ conWa~or, eleo~, pl~b~ or b~lder
[ioPlicaat i'C¼Ct t I (.As on t]~ tax roll'or latest deed)
is a corporation, Signaturo of duly authorized officer
(Name and tide of. corpora.to oftice-r)
ffders License No.
mb~s License No.
etr~.¢ians License No_
ter Trade's License
Location of land on w~hic~a--proposed worl~ will be done:
House N~b~ ' ) S~ ~]'~t
~ounry Tax Map No. 1000 Secedon_l~Z.i
Siubdivision
Block 0-7 --Lo~ 0oQ,' d)
Filed Map No. Lot
Repair
Estimated Cost
If dwelling, number of dwelling ~m~ts
If garage, number of cars
' Fee
Alteration
(Description)
fro be paid on filing tkis application)
Nlrmber of dwelling nnits on each floor
6. If business, commercial or mixed occupancy° specify natur~ zud extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear Depth
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rear
8. Dimensions of entire new constmc~d, on: Front Rear Depth
Height Number of Stories
9. Sizeoflot:Front_lq6.0O' iq5.5 ' Depm (o-n°' '
10. Date of purchase
Name of Form~ Owner
11. Zone or use district in wh/ch premq~es are situated
12. Does proposed constracdon violate any zoning law, ora~n~nce or.regulation? YES__ NO
13. Will lot be re-graded? YES ¢' NO__Will excess fib be rmnoved from premises? YES
14. Names of Owner of premises m,oJ~a&.t 4,~d Addres~ ~7~
Name ofgz'chitect k~u3 3oh. tlSon Addr~ t~ahi~ ~JO Phone
Name o f Conlractor/dt~r~, 'fi- [¢a~,rP_e~ Address
15 a. Is this property within 100 feet of a fide/wetland or a freshwater wetland? *yE$ NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PEKI~rfS MAY BE RI~QI. JIRED.
b. Is th/s property wSthin 300 feet of a tidal wedzud? * Y]~S NO
~ IF YES, D.E.C. PERMITS IVL4.Y BE R2BQLrELED.
I6. Provide survey, to scale, with accurate fotmdation plan and ri/stances to property lines.
! 7 ~- elevation at any point on propm ty is at 10 feet or belo;w, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNI'Y OFz:=~ u )
~r C" ~ ~ ~ [ 4xL4 vi, ~_ b=Lag duly ~wom, d~po~es a.acl ~aya that (s)he i~ ~ho applicant
(S)He is dee
(Contractor. Agent, Corporate Of~cer, cbc.)
of said owner or o,xmers, and is duly authorized to perform ar have p~wformed the said work aad to r,~ce and. file th/s applicadc
that 'all statements conta~cd La this application are fmc to thc best of hJ~ knowledge ami bollefi and that tho work w/il be
performed in the ma~er set foi'dz in the appli~at(on filed therewith.
Sworn to before me fl:ds
Not,~'y Public
Sigaat~e of App~icaut
14~lO0
THE LOCAT!ON OF WELLS, SEPTIC
TANKS Ab.'-'E~ C!~5:FOCL. S ~.-',[ iOWN
HEREON AR? f[~Li} OB$CRVA-FiONS
AND OP, fZC,:A O~TANN~D FROM OTHERS.
CERTIFIED ONLY TO:
By
DESTIN G. GRAF N.Y.S.
SCALE: ["': ~_.~0'
DESTIN G. GRAF
LAND SURYE~OR