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Home My WebLink About31661-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-31327 Date: 12/08/05 TIqIS CERTIFIES that the building ELECTRIC IN ACCESSORY Location of Property: 2015 GABRIELLA CT MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 108 Block 4 Lot 7.53 Subdivision Filed Map No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 2, 2005 pursuant to which Building Permit No. 31661-Z dated DECEMBER 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 ELECTRIC INSTALLED IN EXISTING ACCESSORY SHED AS APPLIED FOR. The certificate is issued to LISA JACKSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~EALT~ APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2066740 PLUMBERS CERTIFICATION DATED N/A o8/18/o8 Authorl zed 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 typewriler or ink and submitted to the Building Department with the tbllowing: A. 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. B. For existing buildings (prior to April 9, 195'~) 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. Certilicate 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 ofProperty'c~0 I~ House No. Street Owner or Owners of Property: ~3~[.a '~5~-~['h~ Suffolk County Tax Map No i000, Section I~)~ Date. Old or Pre-existing Building: ~' (check one) Block q Lot Hamlet Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $-- ~a~ Date of Permit. Filed Map. Lot: Applicant: L ,~L ',-~gS[~:~/') Underwriters Approval: Final Certificate: [ ~ (Check °ne) 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 Located at ALAN HUBBARD ELEC. P.O. BOX 2241 126 CLOVER PLACE AQUEBOGUE, NY 11931, 2015 GABRIELLA COURT MATTITUCK, NY 11952 LISA JACKSON 2015 GABRIELLA COURT MATTITUCK, NY 11952 Application Number: 2066740 Certificate Number: 2066740 Section: Block: Lot: Building Permit: BDC: ns11 Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, pool house/shed, Outside, 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 18th Day of August, 2005. Name QTY Rate Rating Circuit Type Miscellaneous 2 buildings-pool house & shed Wiring and Devices Outlet 4 0 Fixture Fixture 4 0 Incandescent Outlet 6 0 General Purpose Receptacle I 0 General Purpose Switch 3 0 General Purpose Paddle Fan I 0 Receptacle 4 0 GFC1 seal 1 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. 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. 31661 Z Date DECEMBER 8, 2005 Permission is hereby granted to: LISA JACKSON PO BOX 476 MATTITUCK,NY 11952 for ELECTRICITY IN AN EXISTING ACCESSORY SHED AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 108 pursuant to application dated DECEMBER Building Inspector to expire on JUNE Fee $ 75.00 2015 GABRIELLA CT MATTITUCK Block 0004 Lot No. 007.053 2, 2005 and approved by the 8, 2007. ORIGINAL Rev. 5/8/02 (~ -, 0o TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? www. northfork.net/STold/ Examined /~j,20 ~ *pproved Disapproved affc ~ '77// ~ Expiration ? ~' ~ 20 ~'~ ( ~' ~ 9%~ APPLICATION FOR BUILDING PE~IT Board of Health 4 sets of Building Plans Plamfing Board approval ~dtS"/-~ Supvey PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Contact: INSTRUCTIONS Mail to: Phone: Date ///-~C~ ,20 D37' 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 ;vhole 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 issum~ce or has not been completed within 18 ~rtonths 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 of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suf±blk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or tbr remova/1,qr demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildingfcode, ho~in~ code, and regulations, and to admit authorized inspectors on premises,~ i'~,~,,-_and in building tbr necessary inspecti~s. //~,~ aPrnuYeP/ $ NOTED (Sigkn~f applican or name, ifa corporation) HO? ~5 ,-i ~_,~'~ IMailing address ~)f appli~antJ/~/..¢,//'/~'"~ State whether apl~i~r, lessee ageat,Thtchttect engineer, general contractor, electrician, plumber or builder ~ ~'~}L~'O~'I~F '.'QNCRETE Name of owner 4&·' .L~..kii. Ps'SDN ,. L~.~ ,_3 &;(.. 0 C4'~.~/'k ·a:~-,,,., __.,.I'INAL - CON ~qUCTION MUST (As on the tax roll or latest deed) If applicant is a ~o&~P~!_~, ,es, J~r/~ki~re~ duly authorized officer "*LL'k;ONSTRUcTION./BEt4E[ 'g r~ ,~..__..SHALL MEET THg REQUI Et NT , ~,-,,a, =. flor RESPONSII3LE FOR DESIGN OR CONSTRUCTION ERRORs. REQUIRED Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Loc_ation of land o~n which proposed wo~ will be House Number Street Hamlet County Tax ~,No. i~00 Section iiO~ Subdivision~-/I 1~{ ]~ ~S~ Filed Mg~'~o. "' ' "Lot'. 2. State existing use and occupancy ofprern(~,~ and i/ttenr~cJ tjse a. Existing use and occupancy t,.)~)~t/ ~/~; ~"~[ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost If dwelling, number of dwelling units_ If garage, number of cars an,,d~ occupimcy of propose, d,,oOn, str a,c~on: Fee Number of dwelling units on each floor Addition Alteration Other ~ IDcscription) (To be paid on filing this application) 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. __ 7. Dimensions of existing structures, if any: Front 3(~0 Rear ~,) (.jo Depth ~[o Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear Height 9. Sizeoflot: Front J50 10. ate om, chase / q Dimensions of entire new construction: Front Number of Stories Rea t.50' Name of Fornler Owner 11. Zone or use district in which premises arc situated Rear Depth Depth 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO/" 13. Will lot be re-graded? YES NO /Will excess fill be removed from premises? YES NO/ 14. Names of Owner ofpremisesLJ~ "~O(.,b~Address~)'¢I~' 60 n dt~CCphone No. ¢z/g- Coa Name of Architect Address Phone No Name of Contractor 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 }MEQUIRED. b. Is this property within 300 feet of a tidal wetland'? * YES NO L' '" * IF YES, D.E.C. PERMITS MAX' BE REQUIRED· NOJ 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 on survey. STATE OF NEW YORK) SS: COUNTY ~--~/~/0~ ~ ,~,..~ffd...// _ heing duly sworn, deposes and says that (s)he is the applicant (Name of individual.siglaing contract) above named, (S)He is the (Contractor, Agent, Corporate Officer. etc.) of said owner 0r 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. Signature/of Applicant