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HomeMy WebLinkAbout29273-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29489 Date: 06/04/03 THIS CERTIFIES that the building ADDITION Location of Property: 495 FARMVEU RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 121 Block 7 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 9, 2003 pursuant to which Building Permit No. 29273-Z dated APRIL 9, 2003 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 DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DERRICK S & DEBORAH A. DOUBRAVA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A //or& Si ature 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. 29273 Z Date APRIL 9, 2003 Permission is hereby granted to: DERRICK S DOUBRAVA 495 FARMVEU RD MATTITUCK,NY 11952 for CONSTRUCTION OF A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#25938 . at premises located at 495 FARMVEU RD MATTITUCK County Tax Map No. 473889 Section 121 Block 0007 Lot No. 003 pursuant to application dated APRIL 9, 2003 and approved by the Building Inspector to expire on OCTOBER 9, 2004 . Fee $ 150 . 00 Author ed natu ORIGINAL Rev. 5/8/02 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 TH WORK AUTHORIZED) 'a°1 y')'> r C��l PERMIT NO. 25938 Z Date AUGUST 11, 1999 Permission is hereby granted to: DERRICK S DOUBRAVA 495 FARMVEU RD. MATTITUCK,NY 11952 for CONSTRUCTION OF A DECK ADDITION AS APPLIED FOR. at premises located at 495 FARMVEU RD MATTITUCK County Tax Map No. 473889 Section 121 Block 0007 Lot No. 003 pursuant to application dated JUNE 22 99 and approved by the Building Inspector. Fee $ 75 .00 Authorizbd Signatoffre COPY Rev. 2/19/98 dLclklForm No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 30� TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: 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 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. 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 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- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $15.00 Date. LA l l l0 3 New Construction: Old or Pre-existing Building: (check one) Location of Property: 4qS- F` MVf V. K_('► House No. Street Hamlet Owner or Owners of Property:��e�- p\Lk S 4- Suffolk County Tax Map No 1000, Section la\ Block 000n Lot UO3 Subdivision Filed Map. Lot: Permit No. cP q 0 0 3 Z Date of Permit._T10 3 Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: v"" (check one) Fee Submitted: $ Applicant Signature co � a9�g o�Og�f FO�,�c O c� Gyp W Town Hall,53095 Main Road v, Fax(631)765-9502 P.O. Box 1179 Gy • Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION December 23, 2003 TO: Derrick S. & Deborah A. Doubrava 495 Farmveu Road Mattituck, N.Y. 11952 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance- CHAPTER 45 Other Applicable Laws, Ordinances or Regulations 45-8 At premises hereinafter described in that: ACCESSORY SHED HAS BEEN BUILT WITHOUT FIRST OBTAINING A BUILDING PERMIT. In violation of SOUTHOLD TOWN CODE YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY. The premises to which this ORDER TO REMEDY refers are situated at: 495 FARMVEU ROAD, MATTITUCK, N.Y. SUFFOLK COUNTY TAX MAP #1000-121.-7-3 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offen a punishable by fine or imprisonment or both. /- GrLZXSH BINSPECTOR (Cert. Mail) G 62003 :. Debbie Doubrava 495 Farmvue Rd Mattituck,NY 11952 June 26, 2003 Town of Southold Building Department Main Rd Southold,NY 11971 To Whom It May Concern: Please be advised that the shed located in the rear yard of 495 Farmveu Rd, Mattituck will be removed upon the sale of said residence. it is antieipated that the mmeyal should Sk_tc oS/ Deborah A. Doubrava Owner 1 BARBARA ANN RUDDER Notary Public,State of New York No.4855805 Qualified in Suffolk County_ Commission Expires April 14,aiO. p BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name: B Reviewed: ✓��f'� Architect/ Date Engineer: Submitted: /�1 A Q SCTM #: District: 1.000 Section: Block: �_ Lot: Projectl�y+s_ Subdivision Location: 7� Name: Sin,le&separate Required certification: (Yes/10 1 Req. Req. Zoning District: [L.ot siu: Actual: 1 [Lot coverage -Proposed:_— 70 Req. Req. Req. [Front Yard Proposed: [Side Yard Proposed: 1 [Rear Yard Proposed: ] Project Description: _ •.. AGENCY PERMITS Permit REQUIRED FOR REVIEW N / NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Pla*p Elevation ??? Flood Zone: JV to • Are x, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN TION [ ] FRAMING [ FINAL [ ] FIREPLACE & CFIIMNEY REMARKS: ZZ � off-` DATE���` �j INSPECTOR - .D.INSPECTION�RRPORT�e DATE »Mi,i=� _=�COOHMNTS-_a ------------ , C) M � M 004DATION ( IST) p jj N �V 309DATION OND) N N td u N M n UGH FRAME PLUMBING q u a y N � < 4SULATION PER N. Y. N� STATE ENERGY CODE p a /��l C12 a N p I O p p � FINAL N a � N l l ADDITIONAL COMMENTS: GT'4/zt�� /ems 1 �H ( � 1 OH H z BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PL.INS . . . . . . . . . . __.-_�_� TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . K CHECK T^�_1.5'�_.'..���J`_ �T.CLD BUILDING DEPARTMENT . . . . - - - . . . . . . . . . TOWN HALL SEPTIC FORIi . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.. 765-1802 NOTIFY *. •���: S � • Examined •�� CALL . . . . . 19 �� a �a�� MAIL TO : Approved . . .� 19 Permit No. ���� . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . t (Building nspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . i�-1/. . . . . . . .. 1949. 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the BuildYng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Reguiations, 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) S l rm v,C4� . ?�4 . . .�Ylc.lc- t7 11 gS—� (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . .ewn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises bc<. .� . . . . . . '.�?a�brciUC,. .CL�Z�. . :!�E�q�jrc�h ,/y- �Q�IOrcc vrc.. . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . �— Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's.License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ���-. . House Number Street Hamlet County Tax Map No. 1000 Section . IP?1. . . . . . . . . . . Block 0.7 !� 3 Ill ,. 1 Lot . . . . . . . . . . . . . . . tw[J R i'.. Subdivision/ 0 . U-Ect> `; C.( 4�t- ; . . . . . . . _Filed Map No. . . . . . . . . . . . . . . Lot . . .o?.,?. . . . . . . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . 0"./.44,X� Ev�:p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancycQc , , , , • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition Repair . . . . . . . . . . . . . . Removal . • • . . . . . . . . De • • • • • • • • • • Alteration " � . . . . . . • • Demolition . . . . . . . . . . . . . . Other Work . . G?(f1.,L. . . . . . 4. Estimated Cost . . . . . . 6 .D, , , , • , (Description) . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . , , Number of dwelling units on each floor .. . . . . . . If garage, number of cars . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each t e 7. Dimensions of existing structures if any: Front (Q3 Yp of use . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . .a . Rear . . �3 . . . . . . . . . Depth . ? . . . . . _ Dimensions of same structure with alterations or additions: Front �,3• • • • • ' ' ' ' ' ' ' ' ' ' ' . . . . . . . . . . Rear Depth . • • • ' . .�¢. . . . . . . . . . . • . Height . Number of Stories . p2, , ' 8. Dimensions of entire new construction: Front ' ' ' ' ' ' ' Height . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . 9. Size of lot: Front ' • Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . .' 144 Rear . . . . . . . . . . . . . . . . . . . . . Depth . . . 11. Zone or use district in which 199$ ' ' : : Name of Former Owner �. /�t, �. . . . . . . . . . premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: .X11 t�q 13. Will lot be regraded . Will excess fill be removed from premises: Yes 14. Name of Owner of premises�QcC iS-k oda No Name of •�• `�� Address ��d �i�ry�VeK . /��, , , . Phone No. <7-qk Architect .Address . Phone No. • . . . • ' ' ' ' ' ' ' ' ' ' Name of Contractor Address 15. Is this property within 300 feet of a tidal wetland?. • * " " " " " • Phone NQ• *If yes, Southold Town Trustees Permit may be required. . . . . � PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. Y STATE OF NEW YORK, COUNTY OF . . . . . . . . . . . . . . . . . S.S . ' ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) lbove named. leis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) • ' • ' ' ' ' ' ' ' ' ' if said owner or owners, and is duly authorized to perform or have performed the said work.and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this WWW DINOO n NaWy Public.Stale d Now York . . . . . . :. . . . . No 479M . . . . . . . . .day of C. . . . . . . . . 19 .l. 7 aa�tiedin County 6)�} , Commission EVj=Dec.31,19! / -otary Public, . . . . .!4 !. 4 . . . . . . . . ... ��,�� �( unty (Signature of applicant) h 3q- IE I ?,7. 14 THE LOCATION OF WELLS, SEPTIC TANKS AND CESSPOOLS SHOWN HEREON ARE FIELD. 013SERVATIONS AND OR DATA OBTAINED FROM OTHERS. M ► I I13 IZS IIENr eon 4'rt>rs — 31,1 — M �' WeKdyoR'SErLO*Pfif,r.2td,3.l.5bwf p r ° 34 38' 41.5 �/ �MD —Q�1,vWue.3IEh.LY — �S T►� 6JUe,-74 R=zS.o if N 4o-3o 1:� vEIA z3,2-7� Unauthorized alteration or addition to this document is a violation of Section 7209 of the New York State Education Law. SURVEY OF: Certifications indicated hereon shall run only to the person for whom it is prepared and on his behalf to the Title Company,Governmental thel Agency and Lending /1 A A �� Institution listed hereon,and to the assignees of the lending institutions or subse- t ��Y'� v quent owners. , Copies of this document not bearing the professional's inked seal or embossed MArTrj I'NL V I Tam t __ //��►►''�� seal shall not be considered a valid true copy. The offsets(or dimensions)shown hereon from structures to the property lines are for a specific purpose and use and therefore are not intended to guide the erection of fences,retaining walls,pools,patios,planting areas,addition to buildings or any other construction. The existence of right of ways and/or easements of record,it any,not shown are 4' - ' not guaranteed + �'^ SURVEle DATE: I ZI q,5 SCALE: 1 CERTIFIED ONLY T0: h ► DESTIN G. GRAF N 1 LAND SURVEYOR LICE U. By Q� �� , 73 WOODLAWN ROAD DESTIN G.GRAF N.Y.S.LIC No.50067 ROCKY POINT NFW V(1RK+ i 77A T A„ 1 n • Top View of Your Deck The Scale is 1/8" : 1' ;2 5- 76* 4 4• 3'82r 17 8• ,s![DING DEPARTM50FAf9 AM 4 PM K6 !wG INSP CO01 TIONS: R THE ,CUPANCY Oft�) ihiDATION - TWO REQUIRED �� I� UNLAWFUL POURED CONCRETE ,ROUGH - FRAMING a PLUMBING �,` ITNUUT CERTIFICATE INSULATION 4. FINAL - CONSTRUCTION MUST CIS OCCUPANCY BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION i ENERGY CODES. NOT RESPONSIEI.E FOR DESIGN OR CONSTRUCTION 1111110RS ib r FA r ALLI>zbES �-xc� cCq AIL -D'&C k bfAMS: 7 x e, CCk PA-0 Lo-p E ---- Fa 07- I N� `�+q _C. ` >I d.(� MIN . 3 bQ�Iov1� � 1 C ODAK 34-+ �+�:�_ s� ac_�cA 5" or-. �t --T�) C=t t CON CCT\0(U ,R R . 6klA .-TF.C©`Ty�� IST AAc qov,- • 3D View of Your Deck '4w: 1 3D View of Your Deck y0. f,AST !FL eV/`T1 `t� v • 3D View of Your Deck F q Yf' dM w y y�� s,�Y•w�i