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Home My WebLink About30943-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30752 Date: 02/08/05 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 465 FARMERS RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Ta~ ~ap No. 473889 Section 139 Block 3 Lot 29 subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 7, 2005 pursuant to which Building Permit No. 30943-Z dated FEBRUARY 8, 2005 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 INSTALLATION OF NEW BOILER IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES & BLAMCHE DUGGAM (OWNER) of the aforesaid building. SUFFOLK COUNT"f DEPARTMENT OF ~ALTH;%PPROVAL N/A ELECTRICAL CERTIFICATE NO. 2040509 01/27/05 PLUMBERS CERTIFICATION D~l'mu N/A ~rized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Tins application must be filled in by typewriter or ink and submitted to the Building Department with the following: Ao For new building or new use: 1. Final survey o f 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 (8-9 form). 3. Approval of electrical installation from Board o f Fire Underwriters. 4. Sworn statement fi-om 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 fi.om architect or engineer responsible for the building. 6. Submit Planning 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. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inapect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelluig $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to aecessory 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 New Construction: Location of Property: Old or Pre-existing Building: House No. Street OwnerorOwnersofProperty: ~'~e~.~ ,c Suffolk County Tax Map No 1000, Section /~7~ 887 Subdivision Permit No. ~ (~ C~ t-J 3 :-~ Health Dept. Approval: Date ofPermit..? / Date. (check one) Block Filed MaD. Hamlet 7 ,. Lot: Applicant: ~, Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (check one) cant Signaltne~ 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. 30943 Z Date FEBRUARY 8, 2005 Permission is hereby granted to: JAMES & BLANCHE DUGGAN PO BOX 930 MATTITUCK,NY 11952 for : INSTALL NEW BOILER IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. "AS BUILT". at premises located at County Tax Map No. 473889 Section 139 pursuant to application dated FEBRUARY Building Inspector to expire on AUGUST Fee $ 300.00 465 FARMERS RD MATT I TUCK Block 0003 Lot No. 029 7, 2005 and approved by the 8, 2006. I Author,~ zed/ S igna~TTrr e ORIGINAL Rev. 5/8/02 BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by BURTS RELIABLE INC JAMES DUGGAN PO BOX 696 465 FARMERS RD SOUTHOLD NY 11971 MATTITUCK, NY 11952 Located at 465 FARMERS RD MATTITUCK, NY 11952 Application Number: 2040509 Certificate Number: 2040509 Section: Block: Lot: Building Permit: BDC: ns11 Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, Attached Garage, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 27th Day of Janua~.,, 2005. Name QTY Rathe Ratin~ Circuit Type Appliances and Accessories Furnace I 0 Oil Wiring and Devices Switch 2 0 General Purpose seal I of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. L) ¢.,, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ':~B SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ~s~vw. northfork, net/Southold/ Examined ,20__ Approved 20__ Disapproved Lc Expiration 20__ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before app154ng? Board of Health 4 sets of Building Plans Planning Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 waterways. 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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months fi.om such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector 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, 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) (Mailthg address of applicant) State xvhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises '~+./ ~'~d t/? ~- ,'lf~ /q (Ag'6'n thorax roll or latest deed) If a~lica,nt is a cgrpo, ra~ion, si_.~gnature ot[~t~1) a~a~orized offi~6y (Name and title of corporate offer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. House Number Street County Tax Map No. 1000 Section /'~? Subdivision (Name) Hamlet Block g Lot 6>~¢ Filed Map No. Lot 2. State existing use and occupancy of premises and intended us,~ a~l.qccupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ,/ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work ?'5~,~, (Description) 4. Estimated Cost ~.~(~) ~ ~, Fee t~ / J_~ (To be paid on filing this application) 5. If dwelling, number of dwelling units /L,,/./~//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 type of us 7. Dimensions of existing structures, if any: Front Re~ / ~ Depth Height Number of Stories /'~ / / ~ / v/,// Dimensions of same structure with alterations or additions: ~ont ____ Rear Depth Height , ' ~ / ,N~mber of Stories //¢ Depth Height Number o.~2Stt~s / / / 9. Sizeoflot: Front Rear Depth 10. Date of Purchase Name of Former Owner .///~ l 1' Z°ne °r use district in which ~remises are situatedr~" °7"~,.~ 12. Does proposed construction ~iolate any zon/31~g law~ ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO )//Will excess fill be removed fi.om premises? YES NO 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a fi'eshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora 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 oil survey. STATE OF NEW YORK) SS: COUNTY OF / being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (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 tl~ Notary Public BARBARA ANN RUItI~EH Notory Public. State of New York No. 4855805 Qualified in Suffolk County ~ Commieeion Expires April 14, Signature of Applicant