HomeMy WebLinkAbout29485-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29847
Date: 11/18/03
T~IS CERTIFIES that the building ACCESSORY
Location of Property: 1705 VILLAGE LA
(HOUSE NO.)
County Tax Map No. 473889 Section 107
Subdivision
MATTITUCK
(STREET) (HAMLET)
Block 11 Lot 2
Filed Map No. __ LOt No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 11, 2003 pursuant to which
Building Permit No. 29485~Z dated JUNE 13~ 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.
· ~ne certificate is issued to RAYMOND VA~ ETTEN & WF
(OWNER)
of the aforesaid building.
SUFFOI~KCOI~Y DEPANT~NT OF~I~%L~{APPRO~-AL N/A
ELEt-£1if~J~ CERTIFICATE NO. 79260C 08/20/03
PLUMBERS CERTIFICATION DA'r~3 N/A
~A/z' d/Si~fture'
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. 29485 Z Date JUNE 13, 2003
Permission is hereby granted to:
R3~YMOND & VAN ETTEN
1705 VILLAGE LANE
MATTITUCK,NY 11952
for :
CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR
YARD FENCED TO CODE
at premises located at 1705 VILLAGE LA
County Tax Map No. 473889 Section 107 Block
pursuant to application dated JUNE 11, 2003
Building Inspector to expire on DECEMBER 13,
MATTITUCK
0011 Lot No. 002
and approved by the
2004.
Fee $ 150.00
· Authorized Signature
COPY
Rev. 5/8/02
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN IIALL
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 tbllowing:
A. For new bnilding or new use: 1. Final sun'ey 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 state~nent from plumber certitS'ing that the solder used in system contains less than 2/10 of 1% lead.
5. Cormnercial building, industrial building, multiple residences aud similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Plaxming 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:
I. Accurate survey of property showing all property lines, streets, building and mmsual 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,
Swinnning 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
New Construction:
Location of Property:
House No. -J Street
Owner or Owners of Property:
/
Suffolk County Tax Map No 1000, Section
Old or Pre-existing Building:
Block
(check one)
Hamlct
Lot
Subdivision
Pernfit No. ~ a) ~'.~'~o~.
Health Dept. Approval:
Date of Pemfit.
Filed Map. Lot:
Applicant: '5~t/,r"/O~J ~]~d
Underwriters Approval:
Platnfing Board Approval:
Request for: TemporaD., Certificate
Fee Submitted: $
Final Certificate:
x,~ (check one)
Applicant Signature
Issue Date
08/20/2003
Electrical Inspection Certificate
Electrical Inspection Service, Inc. Application Number
375 Dunton Avenue 79260C
East Patchogue, NewYork 11772
(63t) 286-6642
Issued To:
Street:
Village:
Terry & Ray Van Et'ten
1705 Village Lane
Mattituck
Section: Block:
Contractor: R. C. Electric Corporation
Zip:
Lot:
11952 Town: Southold
Lic. # 1610-E
Was examined and found to be in compliance with the National Electrical Code.
[] Commercial [] NVDefects [] Pool ~ lstFIoor [] Indoor [] Basement ~HotTub
[] Residential [] Det. Garage [] Attic [] 2nd Floor [] Outdoor [] Addition [] Survey
Switches Receptacles Fixtures GFI Heaters A/C Fans
1 1 1
Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
Meter Amps Phase UG/OH Jacuzzi Television CO Detector
Bldg. Permit: 29485-z
Other Equipment
1~20Amp Spec Rec
1-30Amp Pool Panel
1-20Amp Time Clock
¥
Hugo S. Surdi
President
Rough Inspection: 08/19/2003
Inspector: Eddie Rodriguez
Final Inspection: 08/19/2003
Inspector: Eddie Rodriguez
This certificate must not be altered in any manner. Inspectors may be identified by their credentials.
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (631) 765-9502
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
November 12, 2003
Raymond Van Etten
1705 Village Lane
Mattituck NY 11952
RE: 1705 Village La
TO WHOM THIS MAY CONCERN:
We are unable to complete your Certificate of Occupancy because of the following reasons:
X
X
X
__ An Application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
__ The check is (not in file)S25.00
__ No Health Department Approval on file
__ No final inspection has been completed.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 29485-Z
Please contact our office on this matter. Thank you for your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Z
Z
0
C~
Applicant/
Owners Nan e:
Architect/
Engineer:
SCTM #
Dislrict ~OOl~) SecUon O~ 131oc~
Date
Reviewed
Date
Submiued:
I ocaticm 1705'
.Single & separate Required
ccrtifica6on. ~Yes /
Project Description:
Subdivision
AGENC't*~ERMITS
REO I/IRED FO R REVIEW_
N,A. NO YES
Permit .
Number
Suffolk Count3' Health Dept. ./
New York State D. E.C. /
Tovm Trustees .,~
To,am Z~oning Board approval: //'
Town Pkmning Board approval' //
Flood Plane Elevation ?77
Flood Zone:
Notes:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ]/~,NSULATION
[~/] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE
INSPECTOR
g'P. EPORT DATE COMM2ElV~-
I*IEI.,D INSPECTION RE'PO ·
FOUND.-~.TION (1ST)
FO~A~ON (2~)
ROUGH ~G & 0
STA~ ~ CODE
ToWN OF ~OUTtlOLD
BUILDING DEPA. RTMENT
To~VN HALL
SOUTHOLD, NY 11971
TEL: (63l) 765-1802
FAX: (631) 765-9502
w~vsv, northfork.net/Southold/
Examined
Approved
Disapproved a.c
Expiration I '2'//~, 3 .20~_
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the follo~mg, before applying?
Board of Health
3 sets of Building Plans
Planning Board approval
Sun'ev
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Phone:
Building Inspector
APPLICATION FOR BUILDING PER~IIT
Date
INSTRUCTIONS
,2O
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
~treas, and waterways.
e. 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 ecanpied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Eve~ building permit shall expire if the work authorized has not commenced within 12 momhs after the date of
issuance or has not been completed within 18 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 ~vriting, the extension of thc permit for an
addition six months. Thereafter, a new permit shall be required.
.'APPLICATION IS HEREBY MADE to the Building Department Ibr the issummc 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 ali applicable laws, ~rdinances, building code, housing code, and regulations, and to admit
auth°rize~w~}~e~md in building f°r necessary inspecti°ns'ENCLOSE POOL TO CODE J,~j~.
UPON COMPLETION
BEFORE"WATER' OCCUPANCY OR
'~ -'~ Q~gn~ture of-app4~cam or name. ifa corpoffi~-n)
USE Iff UNLAWFUL
UNDERWRrrERSCERTIFICATE WITHOUT CERT
(~[ailing address of~pplidant) ' - -
RIEQ UIRE , c nC.I.IPANCY ·
State whether appttcantis o~ net, less~a~ agate, ~tc'.mt~cr, ~ngmeer, general contractor, electrician, plumber or builder
APPROVED AS NOTED
Nm'neofownerofpremises~'~a,L,~mOVlC~- ~lciD ~f~eD DATE: ~//3/.3
(As on tl~e tax roll or latestF~ed) /~'-o, BY:~
If applicant is a corporation, sibmature of duly authorized officer NOTIFY BUILDING DEPARTMENT AT
' 765-1802 SAM TO ~.?M FOR THE
(Name and title of corporate officer) FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
Builders License No. 2. RoUGN - FRAMING & PLUMBING
Plumbers License No. :3. INSULATION
Electricians License No. 4. FINAL - CONSTRUCTION MUST
Other Trade's License No. BE COMPLETE FOR C.O.
ALL GQNSTRUCTION SHALL MEET THE
1. Location of land on which proposed work wil],b¢ done: REQUIREMENTS OF THE CODES OF NEW
1-]('~% ~', I/C~ e_. In, t¥'lG~-I -~ lC' K YORK STATE. NOT RESPONSIBLE mR
I4ouse ~umber I Street Ham~'~'~'q ~ CC4q"~LIC'll~l ERROR~
County Tax No. 1000 Section '/07 Block /[ Lot
Sub&~4s~on % I][QQe_ ~3Q!'~Oi- Filed Map No. ,3gO/~c] Lot /
ame)
2. State existing use and occupancy of premi, se~ and intertded use and occupancy of proposed codstruction:
a. Existing use and occupancy ["~
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated CostTQ(D~C)C)C) o_o
5. If dwelling, number of dwelling units
~f garage, number of cars
Addition Alteration
Other Work/O'2r'c~)nc/ Er'x~l
(Description)
Fee
(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
Depth Height Number of Stories
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
9. Size of lot: Front Rear Depth
l O. Date of Purchase
Name of Former Owner
I l. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO t//'
13. Will lot be re-graded? YES "f NO Will excess fill be removed from premises? YES v/NO
14. Names of Owner ofpremises~~.~Address/Td~,) I/,[k~e, /0 Phone No.
Name of Architect ' Address t Phone No
Name of ContractorFBcr~ec~ (~c~n~d ~)c~ Address ~Phone No.
15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES__NO __
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO __
* IF YES. D.E.C. PERMITS MAY BE REQUIRED. ;~ V
16. Provide survey, to scale with accurate foundation plmi'~'~'~stht:icCSWg{ lT~{e~tv lines
l 7. If elevation at an3, point on property, is at 10 feet or below must prbvid[ top(~raphical'data On sup,' 'cp. .... -~'~'
STATE OF NEW YORK)
.... ... · $.S:
COUNTY O~ )
~:~' ,t~f",'h'tt'4~ being duly sworn, deposes and says that (s)he is the applicant
(4X~me of individual signing ~ont. ract) above named
tS)He is the (~t_t'?dyfi~t ~- , -.
(Contractor, Ag~orporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed ~ the manner set forth in the application filed therewith.
Sworn .39 before me this ' '-
,(cfi da3' of .'-~_t.,--~ -(.f ' '-20 O.~
~~bnc -: '''~ '"-'c
RO~ S. ~0
~ ~ A~fl128. ~ r
MAIN ROAD
{N,Y$. RT£.25)
LOT /$
MA P OF
C£RT/FI~D TO:
SOU THOL D ,~ VIIVGS
CHICAGO TITL£ IN, gU/~ANCE
, 'V/L L W GE .......
MA NOR"
RAYMOND
CO.
VAN £TT£~
THERESA VAN P~N
~~ ...... ~, ....~ ....... :~ ~',
lana surveyors and
_ . eons ultmg eng'
313 west mare sfme~
rive~ead,new york IBOI
(212) 74~
(516) 369-1717
May 26, 1983
I000-107-1 I-
dob N-~ 83-273
ole:l"= 30'