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HomeMy WebLinkAbout29272-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29490 Date: 06/04/03 THIS CERTIFIES that the building ACCESSORY 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. 29272-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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE 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. 25117 12/09/98 PLUMBERS CERTIFICATION DATED N/A 't /I /'-, Aut ' zed ign ure 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. 29272 Z Date APRIL 9, 2003 Permission is hereby granted to: DERRICK S DOUBRAVA 495 FARMVEU RD MATTITUCK,NY 11952 for CONSTRUCT ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP#25305 . 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 Authorized Signature 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 THE WORK AUTHORIZED) PERMIT NO. 25305 Z Date NOVEMBER 2, 1998 Permission is hereby granted to: DERRICK & DEBORAH DOUHRAVA 495 FARMVEU ROAD MATTITUCK,NY 11952 for CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE IN THE REQUIRED REAR YARD AREA 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 OCTOBER 20 1998 and approved by the Building Inspector. Fee $ 150 . 00 Building IiWpector ORIGINAL Rev. 2/19/98 t 1 ' Form No.6 TOWN OF SOUTHOLD _ 3 20n7t ' BUILDING DEPARTMENT TOWN HALL 765-1802 l 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. /b 9103 New Construction: Old or Pre-existing Building: (check one) Location of Property: 7 �S arm V2 u )t�d House No. \Stree`t Hamlet Owner or Owners of Property:'bf nC,'�,L S• � J F?r., k b rUJC1 Suffolk County Tax Map No 1000, Section Ia \ Block (?yp^1 Lot ( o 3 Subdivision Filed Map. Lot: Permit No. r9q 01`7 a Z Date of Permit.—LA LA 011 Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature co �aR�9 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. wit is wttieipeAed that the r-effieval sheuw \ .s� daO Deborah A. Doubrava Owner BARBARA ANN RUDDER Notary Public,State of New York No.4855805 Qualified in Suffolk County_ Commission Expires April 14,Wako y+#. �n` M, } / .,. '$ x 2. 1 � 1'£ �a'�'` �9>< �A9-f= y�i�i•F �ft�� � � k� 4N A }!ice �j& ,t�,y+ ° ,k_ i x 1 , .' 9 "k'»St' ,•{s .. ' �''° M t 1 £ &'n '. b Y. _ � ✓ "S £v R�"ie 4,',t. 2',., k 1. yn�. 37SDtIN7D�VAYEIVUE , ,` EAST PATQIOGUFNEW YORK 11772 (516)286-6642 1 25117 DATE" 12/gM APPMCATIONNa ONFHLE . i VILLAGE: atbtuck TOWN: Southold ADDS. 495 Ewmwu Road ISSUED TO: Derrick Doubrana I I i INTRODUCEDBY- Hank's Electric Inc. LIC No: 2675E was examined on t 12/9/98 and found to be in compliance with the National Electrical Coale LOCATION: Base.. xx Ist 2nd 3rd Attic Det.Garage Hot Tub Pool xr SWITCHES RECEPTACLES FIXTURES HEATERS FANS G.F.L AIR.COAU 2 2 1 DISHWASHER DRYER CLOTHES WASH. GAP,DISP. RANGE OVEN WOKEDETECTOR i FURNACE OIL GAS CM MOTORS BELL TRAN. SERR-EtISCONNECT dtL7ER AMPS PfIASE OTHER 0 EQUIPMUff Outside,Res. 1-500watt pool light 1-1 LQhpmotor f 1-20Amp. time clock MO VISUAL DEFEL1111 1-20Amp. spec. Map#: 1000, Sect.#: 121, Block#: 07,Lot#: 03 HUGO S. SURDI PRESIDENT BUILDING PERMIT No. This certificate must not be akaed in any manner Inspectors may be identified by thea credentials BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE T6S-1sOZ BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS CATION I 1 FRAMING IcXrI'NAL [ ] FIREPLACE & CFIIMNEY REMARKS: CO I A DATE l INSPECTOR n' FIELD INSPECTION REPORT DATE COMMENTS saasas:saasxaxasssaasm---�x-xsaaxs11-=a=sr--=--2w---x-xx-3ssxxa--sxxa-aaaxx=x--==-axsxs¢za- Jz if I I f=1 H FOUNDATION OST) FOUNDATION (2ND) II N r �'� .LC.=--�x---x.-==-aa- -�-___-�-----3----xx-------------ax-===-s���C-��-=0s-------- 1 II 111 O � ROUGH FRAME & j H PLUMBING----�N a jl saaaaMa=ae-ms-aa—aaaasa� --s--�s-----auras ---r-s--a--m=as=a----sasxaar.-aasxaa INSULATION PER N. Y. H STATE ENERGY � 0 CODE A �" III�� sax�a=--=sasaeasaxxxa� asaa=sa=asaxa=mas---sur=ss=ss--xa N N H R FINAL N� NN p nN N a-�� -aaasaxaasa am�sr-sa---�aa�sa aaaamaaa----aaszaassazsaaeas O ADDITIONAL COHNENT S: sasaaaaaagxrsa-aax-xxxea:aa----ssaa�amaaxsaa aasaaaaaaaaaaaaa -a--xa- . "1 old `rn M�� V i� N� � Od yr CO H BOARD OF HEALTH . . . . . . 3 SETS OF PLANS . . . . . . . FORM NO. 1 SURVEY . . . . . . . . . . TOWN OFSOUTHOLD CHECK . . • - - • - - - . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . ; TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 . " � " � " " ' � � � � q� MAIL T0 : Examined . Approved ./�•. Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BLDG. DEPr T (Building Inspe or) APPLICATION FOR BUILDING PERMIT �her g Date . . .� . . . . . . � . . . ., 19fk 2 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 dMMW'd49j"J i tWursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otherjagp cable Laws, ces or Regulations, for the construction of buildings, additions or alterations, or for remova�I drdIr ITION,as'tteiWN'scribed. The applicant agrees to comply with all applicable laws, ordinances, build' g code,.housiug, jE�„�d„1P.O and to admit authorized inspectors on premises and in building for necessary inspac ions. ''A i . 7 tn_Itus Ya11TCN (Signature of plica*i ami 6W�i Ion) (Mailing address of app�igp�t ;;..;.1� t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, �electriciail,, 1lWoberlor builder. �7G' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !. . . . . . . `� � �, , , Name of owner of premises . .�:1 Eieel��G., , ..0©�/!` oig✓�. . . . . . . . . . . . . . . . . . . . . . . ' '` ' ' . . . . . . (as on the tax roll or Iatest deed) '� t If applicant is a corporation, signature of duly authorized officer. %! x »�w �* ya♦ (Name and title of corporate officer) �� ALL CONTRACTOR'S MUST BE SST FOLK�'trfJ )j ,k.'ICEI4SBD Builder's License No. . �/.�/.2 . -�. . . . . . . . .",',.1 Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. C?��I`.`LI. . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed rk will be done' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . eS . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . . . Block . . . 0.?. . . . . . . . . . . Lot . . .,a . . . . . . . . . . . . . . Subdivision . . VL.. �'SpG'frA-els . . . . . . . . Filed Map No. M. k . . . . . . Lot . . 02 g. . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . /��L. . . ` �L ES�(�CT/CG b. Intended use and occupancy . /8 Y.36 /Zx /2 L �2o O5c� 7r 0oL dOI jX Nature of work (check which applicable): New Sv4hiig . . . . ... . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . � O 06 (Description) Estimated Cost :. . . . . . . . . . . .". . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` oto be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage,numbQfAars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �bu * rmnFpi 1 or mixed occupancy,specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . existin structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height 1. . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Dimensions'of same stricture with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . I . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . -S. Dimensions of entire ne�construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . weight . .�. . : . . . Number of Stories . . . . . . . . . . . . . . . `Q. let:'Front• . . . . .(.?.GP, "I,. . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth �'�:x•. 95 . . . . . . . . . . . 6:"""1ate of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PK Zone or use district in which premises are situated . . .. . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . O. . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . Will ex'�j, ss fill re�noy� frQ p e�?;i�s,�� Yts No 14. Name of Owner of pr mises'lt��/.C.�- l 64(¢ 4. Address`. .. T �y��'S�. 4hion'6v1s ky.r .� . . . . o s aT. , cFrs ?.4— Name of Architect �.ZG'. eYP. . A resp �!`�. P e 9. Name of Contractor . A-�1/a T0c-eKtz°,d/b��A �'ress .� oo is7�. Sg�No: -.l�laRa. . . . . 15. Is this property located within 300 feet of a tidal �� wetland? *Yes . . . . . No . *If yes, Southold Town Trustees Permit may be requMed. PLOGRA 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. UNAPPtCYED AS NOTED8 P# 'a6 -a . U' eLAVVFU"L t o p I F T p r',! op r r, s - N.., WM" sink We OEPA ENT 7d5-1802 8 AM TO 4 PM FOR HE FOLLOWING INSPECTIONS: s I FOUNDATION - TWO REQUTA[_o FOR POINTED CONCRETE Z. ROUGH - FRAMING i PLUMBING S. INSULXION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.¢ UNDERWRITERS CERTIFICATE ALL CONSTRUCTION SHALL MEET REQUIRED THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS "IMMEDIATELY" ENCLOSE POOL TO CoDg UPON COMPLETION BEFORE "WATER" STATE OF NEVJ YORK CNTY OF . S.S O� !1�' y • •' dam.. . 2 . • • • . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is theAl-j . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements 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 �� . . ay of. . � d46 er- . . . . . . . ., 19 Notary Public, . . . . . . . . . . . . 'r'�`�. . . . . . . . . . . . . County ANNE DIl2UM N ry Publc, Sate cf t4aw York / No. 4--r:91CS . . . . . . . . . . . . . . . . . Qualified in Suttoi° o (Signature of applicant) Term Expires � Z 1 LO MkC,� SUFFOLK COU TTY 13E PAWRIENT OF tIrmuti SERVICES r _ APPRt_1V, Lt1p'CON ST".11l MI)NVGR.EC FOR A I {iLF FA11IIi,Y iFr1Z?i ti';' . Date MAA 1 1 S I The sewnge displfnl n water supply fticl!iticu c:; Lhi:tucetisn hrvr• bcc ' inspected and;or corti ed by this Depactmi.y cr .ot;t;;t r,.,ic;i,.11 rd r`rr;7d t be satisfactory 1'0R/' 1 Xl 4UM 01: _ ►�f..i"�?,0C. t , 'St hen n OtTic f VRICT and Wgs'cwrtr.r htratr.;;cmrrt THE LOCATION OF WELLS, SEPTICr v TANKS AND CESSPOOLS SHOWN - � HEREON ARE FIELD.OBSERVATIONS AND OR DATA 013TAINED FROM OTHERS. _ YA12 M 13 IZS -- �iJ Kcpoc s t 4,m.s lEmr ba ll • � —31,1 — M `r.s►t. V. � LIt1 M OCCUPANCY OR 2,7 /.4 �iWdt USE IS UNLAWFUL s WITHOUT CERTIFICATE I Kia " zss '� C��TE �54 ,1.e v♦ p �4''V'4 d'7,u YrS'a�'O Fw.' it 38 41•S I L.P �S -74 , I _r 73 � Ua4 PDA Z3.L'1 CSD Recr:ived TO CODE I;� SuffolkCounty IET vV 'R" _ MAR 0 g 1998 Dept. of e�Ith S ices Of�York�tlEodnuation Law, b Ihia doc�xnent N a vlolallon o18scNon 7200 SURVEY OF: ISOr Zq CerNNceaorw Indloated heraon eMO tun only to Nue porton for whom N N prepared and an We bahafl to the TNN Company,povamrnantal AAopaa and Landlrp /�/�� O� lnMlluaon 1NNd harem,and b 1M aeelgneas of ttw MrdM"h0lNrdlont a tubae- , _ �` oP of"downwrd not beeft NN prolemalmea inked sal of embossed 0 f- seal"not be considered a valld true copy. The oft*C Nt(of dkrrsNW use shown lwreon from of Intended t the properly Ones are /U I'rsa.- /- -� l f Ia a tpidlk Purpose and uN and Nwrabre an not Intandsd 10 OWda IM erection d �/ NrN / f�sw ya4< *"a.Mill Ki*416corletruction. .P�.paardkq ot,plsanat,add lim to twOn l a arty other O N♦ The eiNNnoa of dght of ways addle saeemarra of record,N any.not shown are �( net e• qP S x ATE: 1 21 Q8 SCALE: 1' CERTIFIED ONLY T0: t DESTIN G. GRAI+ A l�ow+hnoi► Alm LA-n_a T-I i�_ ,:` w LAND SURVEYOR N - CE y 9y A 73 WOODLAWN ROAD nFSTIN G.GRAF N.Y.S.LIC No.50067 ROCKY POINT,NEW YORK 11778 PJB lct o 1 LI— 01-- 03 PHONE(518)821-3442 w-CR ..rc0.946%a nt. C 1-1*,e*TREATED MOOD O I Pt.79 ANC„OREO TO CONCRETE: Q£NEST CONCRETE PPE CAST . �1 • roh�G f I � _ SR:rrtufRS �.� s i i S.D O - _ - i,1.TEa ( ' I —!E SLOPE c i I 8 s Baas To F FR F 3M S : E ' 11 II O O e I I FORM TIES ILTLTcgonc PUMP i t V W ( = '• TO RETURNS t- ITO WASTE iROL'EDNFLINER , - PIPING ARRANGEMENT _ _ 3c�N� 1. �J, VINYi� LucEi C S CONCRETE -- . SIDE :i E%O STEPS PLAN POultED CONCAr7E e Y:NYL LINER i••• .; ` _SET TT.' ZAL r / •�:.P�'..� 1 F:BTR '- l 1 �• +A l'L S T=T1CN �\ //A+I.Cj/,Q•a•%�`i�•` i.+ ' ( M:ULDc_ 4•SSNC— 122'.1 r- �I a l �1 SECTION 1O1 FOAM TIE � I13� L.- 8 '0- — I 13. 1— L 2 s SsyO BOTTOM �( _ ` 1 BARS STEP + SECTION B- 8 OPTIONAL PEI. Y t.•���•.Z� �Ytw. GRADE PLAN •'. ts' •--, c• r • TY PICA L WA LL r-1_ --T- 12 • t I SECTION . Q-_ A OPTIONAL STEP SIZE � a f � C I 0 � E >< G CAP � NEIy. TYPE 2. P$�•T R• R R. R 7L R R ISan YK Gg I I I 1 ( I NOTES— WALKS TO 1g d •O" C,I,� CDNTRAG'TOR AWAY FROM SMOOTH- NON Sx10 TYPE- SLOPED WATER OISPCSAoL iA'+L * $ANDY T. &ODECKEi3. l>�I I 1321 I I I TD Su1TSLOCALEREGULATIOmS NERS •• 'v'� SUIM KING POOLS -id's 32• 16 32 s e 112 • 4 St2 lasoo PROPEATt , ?; tes 3616 36 112 I e 112 I s • STs 1200 • � �a�a oesia`',/,��' ROUTE ?5A 20•>. Yo 120 I -O 112 110 1 12 6 I 6 `goo 12,400 i ciL'SS:c` o ROCKY POINT, NY 1.177_