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Home My WebLink About30922-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30751 Date: 02/08/05 TIIIS CERTIFIES that the building ACCESSORY Location of Property: 465 FARMERS RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 139 Block 3 Lot 29 Subdivision Filed~4ap No. __ LOt No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JAR-gARY 25, 2005 pursuant to which Building Permit No. 30922-Z dated JANUARY 27, 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 ACCESSORY STORAGE SHED IN THE REQUIRED REAR YARD AS APPLIED FOR "AS BUILT". The certificate is issued to JAMES & BLJ~NCHE DUGGAN ( OWNER ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~LTI{ APPROVAL ET.RC-I'KI~AL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'r~ N/A N/A N/A ~lzed Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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: 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 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. Bo For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. 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. Fees l. 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. UpdatedCertificateofOccupancy- $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 Owner or Owners of Property: 21 ..D,4, Suffolk County Tax Map No 1000, Section /~/7 ~ ~ 8 ~ Subdivision Permit No. 3OC~ Health Dept. Approval: Date. (check one) I~P,-r~ tD<~,~ tr.._ Lot Block Filed Map. Lot: Date of Permit. ~ \ '~') \ 0_~ Applicant: '~ Y9 0 a a .~. R] Underwriters Approval: Hamlet Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,~.S, ~ Final Certificate: (check one) /~ppncant :~gna~ure FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) FULL PERMIT NO. 30922 Z Date JANUARY 27, 2005 Permission is hereby granted to: for : "AS BUILT" JAMES & BLANCHE DUGGAN PO BOX 930 MATTITUCK,NY 11952 ACCESSORY SHED IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 139 pursuant to application dated JANUARY Building Inspector to expire on JULY 465 FARMERS RD MATTITUCK Block 0003 Lot No. 029 25, 2005 and approved by the 27, 2006. Fee $ 150.00 ! Authorized Signature ORIGINAL Rev. 5/8/02 FIELD INSPECTION REPORT I DATE I COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS TO *tO tSOU HOLD BUILirNG~DEP ARTMENT TOW~ HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 w~v. northfo~rk.net/Southoid/ PERMIT NO. Examined / F~,, 20 ~73~ Approved /~7 , 20 /dj'~ Disap~l~('ed a,'c Expiration I /../ ? 20 L)6 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? 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 ,20 co/ 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 I8 months from 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 cfa 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 auth°rized inspect°rs °n premises and in building f°r necessary inspecti°ns~e,z?~/ ( ' (SignatUre of applicEtnt or name, if a corporation) -to, Z4 7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises d~.-~l&--~ /,t Z/(.*,~& "i- (As on thc t~ roll or If applicant is a co~oration, si~ature of duly authorized officer '~ · /)~- ~ ~' ' ~m~nd title of Curate officer~ --/~.. _v ~IOTIFY Bt"T~]'~, c,Jt' :~,'.' FO~ THE Budders L,cense No. (~ Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision (Name) FC':-. ' c L:r~EO C :,,CRETE 2. RC,,/3H - FRAM'qG & PLUMBING 3. INSULATION 4. FINAL - CONS' %lql ON MUST BE COMPLETE F~.q C,O. ~AU CON~TRUCTC,~ SHALL ME~ THE DESIGN OR CONSTRUCTION ERRORS. Block D ~. o O Lot O~ ~ o o Fil~ Map No. Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intendeduseand occupancZ 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration OtherWork ~c,~ ~ ,, £ t~ta A- -Fo ~.'oO3 (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and 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 Rear Depth_ Height Number of Stories 9Dimensi°ns Rear Depth ~ ' --~ Height of en[ire r~ew construction: Front im ~/ ~s Number of Stories Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 1 l. Zone or use district in xvhich premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO l 3. 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 freshwater wetland? *YES * 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. NO 16. Provide sutw'ey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at l0 feet or below, must provide topographical data on survey. STATE OF NEW YORK) , . 1 · . ss: oowt6 w COUNI..Y O F~) ('~'"'7¢'md /~~ being duly sworn, deposes and says that (s)he is the applicant (~./a~e of mdwidual sig/tifig 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 xvork will be performed in the manner set forth in the application filed therewith. Sworn to before me this ?__<;'- day of/~:~[~:l~ll~__ 20 O:~'~ ~"~ Notary Public susAN ~ I~KER NOTARY pUBD ~. State ot NeW Yo~ No 0~TO507~120 Oualitie~ in Suitolk Coun~