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Home My WebLink About30803-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30688 Date: 01/13/05 THIS CERTIFIES that the building ADDITION Location of Property: 3865 GRAND AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 1 Lot 4.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 29, 2004 pursuant to which Building Permit No. 30803-Z dated NOVEMBER 29, 2004 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 "AS BUILT" SCREENED PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GEORGE T LAVIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized Signature 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. 30803 Z Date NOVEMBER 29, 2004 Permission is hereby granted to: GEORGE T LAVIN MATTITUCK,NY 11952 for CONSTRUCT "AS BUILT" SCREENED PORCH ADDITION TO A ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP426047 . at premises located at 3865 GRAND AVE MATTITUCK County Tax Map No. 473889 Section 107 Block 0001 Lot No. 004 . 001 pursuant to application dated NOVEMBER 29, 2004 and approved by the Building Inspector to expire on MAY 29, 2006 . Fee $ 150 . 00 1 d Author 1,6dE 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) 31)&03 PERMIT NO. 26047 Z Date OCTOBER 20, 1999 Permission is hereby granted to: GEORGE T LAVIN 53 AMAGANSETT DRIVE SOUND BEACH,NY 11789 for CONSTRUCT "AS BUILT" SCREENED PORCH ADDITION TO A SINGLE FAMILY DWELLING TO CODE. at premises located at 3865 GRAND AVE MATTITUCK County Tax Map No. 473889 Section 107 Block 0001 Lot No. 004 .001 pursuant to application dated AUGUST 6 1999 and approved by the Building Inspector. Fee $ 75 . 00 Authorized"'Si y ature ORIGINAL Rev. 2/19/98 � ! Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL lP 765-1802 —� � _ _ 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department UAbing: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, street;-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 1% 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. —ar f New Construction: Old or Pre-existing Building: r/ (check one) Location of Property: ��(m &r0_y\_j A Vg, hit A Tf1 T lrc_k, 1.( ��/. (dt� 2- House No. Street Hamlet Owner or Owners of Property: a (r- � �, L,Qy f n Suffolk County Tax Map No 1000, Section 01 Block Lotq. Subdivision Filed Map. Lot: Permit No. O EV 3 Date of Permit. 11-25 -�y Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ . �� } Appy ant Signature W�--- ILPERMIT REVIEW CHECK LIST Applicant/ / �l._J Date Owners None. ( �/2 /� Reviewed: 110 �90� Architect/ ,,,,// Date Engineer: /1e?zoL Submitted: SCTM #: District: 1.000 Section: / / Block: Lot: / •/ Project ��// � � Subdivision Location: 0 (O L Name: Sin&le&separate Requ' certification.. Yes o)�) Req. � Zoning District [Lot size: a� Actual: 3f (Lot coverage 2A Proposed:_ 1 Req. / (Front Yard 3Jol"Proposed: !�� 1 [Side Yard , Z Proposed: 1 (Rear Yard a Proposed: !� Project Description: a, AGENCY PERMITS Permit SQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. _ New York State D. E. C. Town Trustees Town Zoning Board approval: )OC-1 Town Planning Board approval: Flood Plaif Elevation ??? Flood Zone: to • 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ J FRAMING [ ] FINAL RE RKS: �G 7 DATE INSPECTOR- ` 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY ARKS: 4 - / ; l DATE �� Z�L(e INSPECTOR C]765-1802 suPT --� INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING [ INAL [ ] FIREPLAC & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: � DATE 0 INSPECTOR 30 8c) 3 Z 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ) INSULATION [ ] FRAMING �FINA LCYlDID 1TlON� [ J FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: � / �y O � Bp DATE r °2��° � INSPECTOR �/� LD INSPECTPON REPORT DATE COMMENTS ---------------- �I II b It II----- ------- -- - -------- -- H 'NDATION ( IST) II �I1 ------------- n INDATION (2ND) _------ J ---------- - - II- II IGH FRAME & tt—_---it----a- — PLUMBING _ u u ISI II �ir� 11 II II II II �, II X11 3ULATION PER N. Y. — H STATE ENERGY - 1t CODE i — II U tzj it U U II� a G,1 I II _k/el C• !!J Z ' U II —17 fl FINAL II M ADDITIONAL COMMENTS: V Lk N � o � x r Z b BOARD OF HEALTH . .. ....... . .. .. FORM NO. 1 3 SETS OF PLANS . . . . . ... ... . . . . . TOWN OF SOUTHOLD SURVEY .... . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT vfCHECK ....... . . . . . . . ... .. . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . .. . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: l�G, CALL ,l� �./�� F�mined 19.... MAIL TO: . . .. . . . . . . .. . . . Approved..l.J�..w.:�•., 19.... Permit No. aa!?A]..�. ................................... Disapproved a/c ................................... ................................. ........................................... .. ....... Building Inspector) KATION FOR BUILDING PBRMIT Date... . . . . . . . . .. , 19 INSTRUCTIONS a. 'chis application mast be-completely,filled in by typewriter or in ink and submitted to the Building Inspector 3 sets of plans, accumate 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 mast be drawn on the diagram which is part oi this application. c. The work covered by this application may not be commenced before ispi of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sud •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 HEMBY MALE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Tbwo of Southold, Suffolk County, New York, and other applicable Laws, Ordinances-or Regulations, 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, ordinqwfs, building code, ing code, and regulatioos, and to admit authorized inspectors on premises and in build* r mace i . ...... ... .. ..t ............................. (Signature of licant, or name, if a corporation) 96-b--:G P hV E . M4171 Tu C.Ic (Halling address of applicant) I�{�l *fti State whether applicant is owner, lessee, agent, architect, engineer,'general contractor, electrician, plumber or buil ................ �d.�_l ZZ.......................................................I.........I................... . . Name of owner of premises ........ ..��. .�............ � ....�,-:AifW ........................................... (as on the taK roll or latest deed) i If applicant is a corporation, signature of duly authorized officer. .............:........................................... (Name and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... ..... �.�?... 0 u -� L 1. Location of land w which proposed work will be done........ ............ .............(, �`C.l.�.�.��.. t ... .�. . ............................................................... St House Number reet Hamlet County Tax Map No. 1000 Section .......7...... Block .......1........ Lot ....i.:j...... Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy qt ptop6bW6 o�s ct�,uc ;gf: .�.� C / ... , wow}o A:�: �'• 8. Existing use and occupancy ....... .. .....................rui.i:.w:... .:..::.. ......�.... x;. b. Intended use and occupancy ....... ......: .. �. fit.:................ ............................... Repair............. Pabval. ............. Demolition ............ Other Work ....' pCY•� ..O Q�...... (Description) `7T Estimated Cost .. .... fee .............................................. tt (to be paid on filing this application) If dwelling, number of dwelling units ......l..... Number of dwelling units on each floor ................ Ifgarage, number of cars ............W.0..................... If business, commercial or mixed occupancy, specify nature and extent of each type of use.. Dimensions of eadsting structures, if any: Frgnt..;U.I„3....... Rear ,/ f.. -j� Depth .....�'��........ Height ......................... Number of Stories ......I.... P� �S �l '�("C >/� c C Dimensions of sane structure with alterations or additions: Front ..:1.U�.3 ri... Rea .. Depth .....5.2............ Beight .................... Number of Stories .. .. .. Dimensions of pgtire new ruction: Front .. rte„,.... Rear ..�;L ........ Depth ....t z..... Height .... . ................ T Number of Stories ...... ... --.. //�� 7 f/ Size of lot: F �f Front ...� 9........... Rear ..Sb..� ............. Depth .....�.7 Date of Purchase .-9A -:'L.....L Name of Former Owner .....T.!°.4 Zone or use district in which premises are situated ................................ .......................... Does proposed construction violate any zoning law, ordinance or regulation: ......N.Q............ Will lot be regraded ...... Q......... Wiillr excess fill be removed from premises: _ yES NO Names of Owner of premises 1.7.5 t p1 4:.!!.l-�n!!!!!1 Address �Q �i!,l /ri.... Phone No. Name of Architect .................................... Address ........ ................ Phase No. ...... Name of Contractor .......arviJ.J.V. -. ............ Address ........ .......................Ph(ne No. .............. Is this property within 300 feet of a tidal wetland? * YES .......... NO ...X..,, *IF YES, SMMUD MM 7MS= PERMTr MAY EB TUgM. PLOT DIAGRAM locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions o property lines. Give street and block number or description according to deed, and show street names and indicate :her interior or corner lot. V t� T Cr ND1 YM, SS UY OF ... V'N .being duly sworn, deposes and says that he is the applicant oe of individual signing contract) re maned, isthe ........... .w:.;. ......................................................................... (Contractor, agent, corporate officer, etc.) ;aid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this lication; that all statements contained in this application are true to the best of his knowledge and belie£; and the Work. Will be performed in the manner set forth in the application filed therewith. .n to before rre this q U4..4 . . ............... ......C.... .. (Signature of A licaut) so NOTARY PUBUCMStaatt a Nervllbdc No.011306020932 Oualified in Suffolk Cor Term Expires March 8,20A y pe 1 N W 2 . 0.1 LL Imo, W � , UND RWRITERS CERTIFICATE 1 t I 0 REQUIRED -2- rt for', 0 O l► 1 �"- 417�/ iy'� TME N.Y Q o .. T- ENERGY SI E FOR \Z - O � v • \ LIC ION ERRORS a USE is LN11"AMNIFUL of OCCUPANCY / S U R E__y OP I_A r_l f�) L_ 1 M C1 U 1 L_V I MA-1-1- l T U C r'1 t- A>,I C--) 0R'vE_7y r r.a G -I CEJ lam.) d F 0U-T H C)L f _5 4 �E G u; _4 L7 :f>_r - 1�r-c.)L K C� C-)�J r.I -F`4 1•..1. -•I. \.�- f-5, CF--- C_ -, C_ -r M I, C-)0 0 - -7 - I . 1 SIO - s1 C1. E R T ► F I E.. I> T'r_.> r�1 F 1"F-'�:>I'C,l. i 1 .�a►.1 - �3 O C= I C.C.)R, P. ',=� T F_ti.i.��r - F,)Xs,_'T_E7: U tJ El ?4 1 D258 M C)Fz"-r C-IA 6;- aL. rte)E\,,J �53_�51530 Q � 6p7.5 - Y 4 'LxWr AA - All I t IK wo Olt b 'rl i Cs� ; a 1 e r, a NJ t, B * 4 ` {{ s ' i I r i j I IV u t- %CIA v ► i ., 1 ii e, n t I I I I � Y F ! Y I ! r � � O.