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Home My WebLink About22792-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No= Z-26261 Date= 02/08/99 THIS CERTIFIES that the building ADDITION Location of Property= 3855 MILL LA MATTITUCK (HOUSE NO.) (STREET} (HAMLET) County Tax Map No. 473889 Section 107 Block 4 Lot 3 Subdivision Filed Map No. __Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 12, 1995 pursuant to which Building Permit No. 22792-Z dated MAY 28, 1995 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 ADDITION TO EXISTING ONE FAMILY DWELLING WITH OPEN TRELLIS AS APPLIED FOR. The certificate is issued to NANCY E SUTKUS (OW~R) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N-365472 10/04/95 12/21/98 PECONIC PLUMBING & HEAT. FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HA~.L SOUTHOLD, N.Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE V~)RK AUTHORIZED) ~,~ ......... -"~M..~ .................. ~......:~ 22792 Z ....................................................... ~/zz~..../..~..c..~ ........ /.~.,~......,. ............................... CountyTax Mop No. ]000 Section ....... .,,~.....~......~..... Block ......... ~ ........... LotNo ......~ ................. Building Inspector. Rev, 6/30/80 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 inspector 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. Commerci~l building, industrial building, multiple residences and s/milar 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. For existing buildings (prior to April 9, 1957) non-conformt-g uses, or buildings and Vpre-existing" land uses: 1. Accurate survey of property showing sll property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Cert/ficate 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 $25.00, Alterations to dwelling $25.00, Sw4mmtng pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. BusL-.asses $50.00. 2. Certificate of Occupancy on Pre-existing Buildina - $100.00 3. Copy of Certificate of Occupancy - , 4. Updated Certificate of Occupancy -.$50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~ate ~Z..~.. ~ ./~. .... conat~ctinn ........... ,~,~ ,,,,~. ~°l~ Or Fre-~i. ting~_Building ....." House No. Street H-~I et ~wer or Owners of p y ............. ../. ................................................. ~nty ~. ~p ~o ~000. 8.ction.m 9 i ~ ~ ~ .~ot'...~D. lbdivision ................................ ... . Filed Map ............ Lot .................... .. :~mit Ho .... Date Of Permit ................ Applicant ........... alth Dept. Approval ......................... . Undetwrrtt:ers Approval ......................... .arming Board Approval ........................ :quest for: Temporary Certificate ........... Final Certicate ........... · ,. Submitted: $ ..... .~...~. ................... . . (~. 5_~ ~ ( APPLZCANT Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit No. ~~ Owner: ~0~o~ ~ ~l~c~k~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this day of 19 9~ County 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] INFLATION ] FIREPLACE & CHIMNEY DAT'~~f INS'ECTO~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS: //]/ROUGH PLBG. ~ ] INSULATION [ ] FINAL DATE ~ I~ ~'~ INSPECTOR / / ~& 7~2 --2- 765-1802 BUILDING DEPT. ] FOUNDATION 1ST INSPECTION [ O~~UGH PLBG. ].~UNDATION 2ND FRAMING [ ] FIREPLACE & CHIMNEY INSULATION FINAL REMARKS: INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [~/]//FOUNDATION 1ST [ ] ROUGH PLBG. [~*"~ ~, 1 FOUNDATION 2ND[ ]INSULATION [ ] FRAMIN0 [ ]FINAL [ ] FIREPLACE & CHIMNEY INSPECTOR LU 0 Z LtJ ) ) PROVIDE OPENINGS FOI EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OP N.Y. STATE BUILDING COOF.. PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1% LEAD. If copper tubing is used for Water distributing of types K or L only SYStem; piping shall be PLUMBING ~,' ',~, ALL PLUMBING WASTE / x",~,~ & WATER LINES NEED / ,- ~, "~,~STING BEFORE COVERING APPROVED A~ NOTED FEE: NOTIF'Y BUILDING DE~J~NT 765-1802 9 AM TO 4 Prf~FOR THE FOLLOWING INSPECTIONS: 1. I=OUNDATION TWO REQUIRED FOR POURED CONCRETE 2. RQUGN . FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Approved . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., I tNo ......... Disapproved a/c ..................................... ................................ BOARD OF HEAL'rlt ~ ......... SETS OF PLANS . ..'.'.~ ..... SURVEY ................... CIIECK .................... SEPTIC PORH .............. CALL ........ HAIL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit· d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 whatever until a Certificate of Occupancy hall liave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or {egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. "he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. ..---'V - .... ................. - (Signature 8f applicant, or name, if a corporation) :.u. z (Mailing address of applicant) irate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ..................................- ........................ 'qame of owner of premises . .~ .ct..vt?...~...~. %.~.. 5! .5'7. .................................................. (as on the ta[x roll or latest deed) f applicant is a corporation, signature of duly nuthorized officer. (Name and title of corporate officer) Builder's License No .... l .~... c.~. ~.~. _ .].~/.~ ...... Plumber's License No .... ~ .e'F.~0.~ ¢~.. ~.~.tS. ~. ~. :}~ Electrician's License No ....~.o. ~..~ .% 1'5...~'J~.c..']-'w t ~ Other Trade's License No ...................... · Location of land on which proposed work will be done .................................................. llouse Number Street Hamlet County Tax Map No. 1000 Section .... i. ?..~. ....... glock .... ~ ........... Lot...Z ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) · State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... [~.°-2.3. {~er'~.'.~.%.g. - ) /~ot>. ~..~ b. Intended use and occupancy .... .~. ~..g.t. ~. e:'..~ S.&?" } 3. Natu~-e of work (check which applicable): New Building .......... Addition .. ~ .... Alteratic)~ . . Repair .............. Removal .............. Demolition .............. Other Work .... i'' .. (Desc-~tion) 4. Estimated Cost ....... '~1. 6,.).o.*..e.t..-T'. ................... Fee ................................. .... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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 ty~pe of use ............. l ....... 7. Dimensions of existing structures, if any: Front .... ,.~.~t. ....... Rear . . .3...7,. ........ Depth ...~. ~ ......... Height ..... 2'-. 3".t ..... Number of Stories ..... '.~ .................................................. Dimensions of same structure with alterations or add/lions: Front .... ,L/.fi' ......... Rear .... ~. v¢. ........... Depth ........... ./71..~. .......Height ..... .~...~. J ............ Number of Stories ...................... 8. Dimensions of entire lgew construction: Front .... ~.~'.. ! ...... Rear /~ t Depth .,t--,~/~ ''~ Height ....... l..~. ..... Number of Stories ....... .~ ........... iiiiiiiiiiiiiii ...... i. i. 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated.., l~¢~t d.e~T~/~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .I.'xJo, ........................... 13. Will lot be regraded ......... ~x[ c> .......... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~I.,tv..~.5 .~3~.-~'~.. i. i. i k'ddress . ~.].'~.,./~.~c f( ....... Phone No. 9~ff.. ~: ....... Name of Architect ........................... Address ................... Phone No ........ ~ ....... Name of Contractor .Q~.%ei-.~.~. ~.o.~.~,.~.e ......... Address .~. Iq~.~.hqqtce ........ Phone No..ri .7. q.-~ [g~... [5, Is t:h±s propert:y wit:h±h 300 feet: of a t:tdal wet:land? ~Yds ........ No....~ ..... ~'If yes, Sout:hold To~n Trust:ets Perm±t: may be requ±red. - n ~_.~ LOT DIAGRAM Locate clearly and distinctly all building, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number,~ol- descriptioh according to deed, and show street names and indicate whether interior or comer lot. TATE OF NEW YORK, S.S OUNTY OF ............... .~ _ ~ ......... .~..-.~.0. X .~..~w.... ~.c..~r. }].']..~, .~.0 ...........being duly sworn, deposes and says that he is the applicant (Name of ir~dividual signing contract) r)ove named. e is t,,e ............................. .............. ' ............................. (Contractor, agent, corporate officer, etc.) ' said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in tiffs application are true to the best of his knowledge and belief; and that the ork will be performed in tlie manner set forth in the application filed therewith. yom to before me this ./.<~.~ ....... day of ..... . .)~..< .~. ......... . . ...... ~/ Notac/Public, Slato of ~1o~ ~oyk (Signature of applicant) N6. 4822563, Suffolk County