HomeMy WebLinkAbout31287-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31066 Date: 07/26/05
THIS CERTIFIES that the building ADDITION
Location of Property: 10575 SOUND AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
Cowry T~ Map No. 473889 Section 122 Block 1 Lot 4
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 11, 2005 pursuant to which
Building Permit No. 31287-Z dated JULY 15, 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 "AS BUILT" DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to MATTHEW MEYER
of the aforesaid building.
(OWNER)
SUFFOLK COLFNTY DEPARTMENT OF H]L%LTHAPPROVAL
ELEC'~RICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~i'~3
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
· ~ Form No. 6
\ ,-(~: TOWN OF SOUTHOLD
- ~\/\- \ ~~ "BUILDING DEPARTMENT
"~. - --' "\ TOWN HALL
, ~L ..~c. ?.~'~ 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:
I. 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 Appro'~al 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 a copsent 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
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $2,5.00, Alterations to dwelling $25.00,
Swimming pool $25.00. Accessory building $2.5.00, 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'.0.15
4. Updated Certificate of Occupancy -' $'.50.00'
.5. TemporaD' Certificate of Occupancy - Residential $1,5.00, Commercial $1.5.00
New Construction:
Location of Propert>:
Old o.r Pre-exit. ting Building: ~ (check one)
House No. Street
Owner or Owners of Property: /'rrlo,~·
Suffolk County Tax Map No 1000, Section, ~1'"'} ~ ~' o[
Subdivision "' ..
'~-'> Permit No. Date of Permit.
Health Dept· Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Block
Filed Map.
Applicant:
Underwriters Approval:
Final Certificate:
Lot
Lot:
(check one)
Hamlet
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE ~'~ '?- / -'- O_~
INSPECTOR
FORM NO. 3
TOW/q OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
COMPLETION OF THE WORK AUTHORIZED)
UNTIL FULL
PERMIT NO. 31287 Z Date JULY 15, 2005
Permission is hereby granted to:
MATTHEW MEYER
1004 GRANT AVE
PELHAM MANOR,NY 10803
for :
AN "AS BUILT" DECK ADDITION TO Ai~ EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 122
pursuant to application dated JULY
Building Inspector to expire on JANUARY
10575 SOl/ND AVE MATTITUCK
Block 0001 Lot No. 004
11, 2005 and approved by the
15, 2007.
Fee $ 300.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN'HALL
?OUTHOLD, NY 11971
I~EL: (631) 765-1802
FAX: (631) 765-9502
,n~v. northfork, net/Southold/
PERMIT NO.
Approved
Disapproved ~,'c
BUILDING PERMIT APPLICATION CftECKLIST
Do you have or need the thllowmg, before apply ~ng~
Board of Health
4 sets oPBmldmg Plans
Planning Board approval
Survey.
Check
Septic Form
NYSD.EC
O 8 -ALC-A'
APPIACATION FOR BUILDING PERMIT
· INSTRUCTIONS Date
~' , 20
x ~- a. Th~s apphcanon MUST be completely filled tn bs' typewmer or mmk 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
c. Yhe s~ ork 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 tbr 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 expi're it' the work authorized has not conmaenced within 12 months ai~er the date of
[ssu0nce or has not been completed within 18 months fi.om such date· If no zoning amendments or other regulations affecting the
propert) have been enacted in the interim, the Building Inspector may authorize, in s~Titing, the extension of the permit for an
addition six months· Thereafter, a new pegmit shall be required
APPLICA F[ON IS HEREBY NL~DE to the Building Department for the issuance ora Building Permit pursuant to the
Building Zone Ordinance of the Town of Soathold, Suffolk County, New York, and other applicable Laxxs, Ordinances or
Regulanons, for the construction of builthngs, 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· ~, ,
(- i~m ~r al~,/fa colporat,o.)
t ' (Mading addres~ ofapplicanti
State whether applicant is o~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises X~"~J~,t~..,O s~..~
(As on the tztx roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
[Name and title of corporate offi&rl
Builders License No. "~ 2..~ ~'~.--.
Plumbers License No.
Electricians License No.
Other 'Frade's License No.
I. Location of land on which proposed work will be d~ne:
/o ~'-7 ~ ~'o o ~c,, -,4,r8..' . ~.~/"F~ t~'ot..,t<..
House Number Street Hamlet
Count>. Trax Map No. 1000 Section 2~C'"1 ~ Block ['Z-2.- .
Subdivision Filed Map No.
(Name)
Lot ~ [ - ~ .
Lot
2. State existing use and occupancy of premises and intenql.ed use anqt occupancy' of proposed construction:
b. Intended use and occupancy_
3. Nature o f work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost Fee
5. If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Work ~ ,o.r.c:~ d~
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
If business, commercial or mixed qccupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if an>: Front 2_ (,,~ Rear ~ Depth
Height ~-'~,) Number of Stories 2
Dimensions of same structure with alterations or additions: Front
Depth. .Her~]ht. Number of Stories
Dimensions of g~ntire new construction: Front '3 } Rear
Height /~ ~t Number of Stories 0
Size oflou Fl'oat ~'~ -~' ' Rear ~Z,~'~ Depth
Rear
Depth
I 0. Date of Purchase -Name of Former Owner
l 1. Zone or use district in which premises are situated ('it~ O.,i~i "~.-,~-~.-- .
12. Does proposed construction violate ~.h) zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO"~"~W~II excess flit be removed from premises? YES NO
14. NamesofO~nerofpremises VY~r~*"t'l~--: Address ~..~.o,.~-ttO~'} PhoneNo. '~"~
Name of Architect Address Phone No
Name of Contractor Z.'.'.'.'.'.'.'.'.~~ Address ~TJoc.) Oe-~ Phone No. ~__..~:~
l 5 a. Is this property within 100 feet or: a tid~:l wetland or a freshwater '~etland. * YES NO
· IF YES. SOUTHOLD TOWN TRUST~ES & D.E.C. PERMITS MAY BE REQUIRED.
b. [= this properly, within 300 feet ora tidal wet[and? * YES NO ~
· IF YES, D.E.C. PERMITS MAY BE P~. QU~IRED.
16. Prox ide survey, to scale, with accurate foundation plan and distances to property, lines.
17. If elevation at any point on properly is at ]0 feet or below, must provide topographical data on survey.
STAFE OF NEW YORK) ·
SS.
CD[n'4TY OF
~e'~ O~ ~ O~,1~ .O..-~'~ being duly sworn, deposes and says that ts)he is the applicant
(Name of individual sigmng cc~ntract¥ above half,ed,
(SlHe ts the ~ Cl,-,~r2- · : '" '
(Contractor. Agent,.goworate Officer, etc )
ot'satd ox~ner o~ ox, nets, and is dub' authorized to perform or have perforated the said work and to make aaa file this application,
that ,all statements contathed in this application are true to the best of his knowledge and belief; and that the work will be
performed tn the manner set tbrth in the application filed therewith.
' NOTAI~Y{~JBLIC, STATE OF NEW YORK / (._ ' ~
-MO. 01DI6077825 ~ ·
qUALIFIED II~ RICHMONI)
CO, :IO,i EXPIRES.
iJul. 1, 2005-11:39gM ~R$[OTTA & RICIOL[AIIO
FIELD INSPECTION REPORT I DATE
FOUNDATION (1ST)
FOUNDATION (2ND)
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
;I
4
.0".£ .0-.£
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