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HomeMy WebLinkAbout31676-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: z-31411 Date: 01/24/06 THIS ~ERTIFIES that the building ADDITION Location of Property: 955 BAYER RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 9 Lot 23.1 subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in tb~s office dated DECEMBER 14, 2005 pu~sna~t to which Building Permit No. 31676-Z dated DECEMBER 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" ROOFED OVER DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HELEN E SAWICKI (OWNER) of the aforesaid building. SUFFOLK COU1F~Y DHPARTT~NT OF IlEALTH ;%PPROViqL ELECTRICAL ~u~TIFICATE NO. PLI3MBERS u~TIFICATION DA'r~ Rev. 1/81 N/A N/A N/A Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765'1g02 APPLICATION FOR CERTIFICATE This application must be fired in by typewriter or ink and submitted to the Building Depar~ent with the following: 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 elec~ical installation from Board of Firc Underwriters. 4. Sw~mstatementfr~mp~urabercer~fyingthatthes~derusedinsystemc~ntaina~essthan2/~f~%~ead. 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 P~anning Board Approval of completed site plen rcqniremenis. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accuratesurvey~fp~pertysh~winga~pr~perty~ines~strcets~bul~dingandunusua~natura~rtop~gra~hic features. 2. A prope~y c~mp~eted applicati~n end a c~nsent t~ inspect signed by the applicant If a Certi~cate ~f ~ccupency 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, Altarations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $$0d00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate ofOccupency - Residential $15.00, Commercial $15.00 Date. December 14, 2005 New Construction: Location of Property: 955 House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 107.00 Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 25.00 Cc:, Date of Permit. L~-~%-O~' Old or Prc-existing Building: X Bayer Road Street Estate of Helen E. Sawicki Block Filed Map. Applicant: 09.00 Underwriters Approval: (check one)"as built" deck Mattituck Hamlet Lot 023.001' Lot: Final Certificate: X (check ~le) By t/ Applican~igffature Thomas ~. Sawicki, Executor 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. 31676 Z Date DECEMBER 15, 2005 Permission is hereby granted to: HELEN E EST SAWICKI PO BOX 1278 MATTITUCK,NY 11952 for : CONSTRUCTION OF AN AS BUILT DECK ADDITION AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 107 pursuant to application dated DECEMBER 955 BAYER RD MATTITUCK Block 0009 Lot No. 023.001 14, 2005 and approved by the Building Inspector to expire on JUNE Fee $ 300.00 15, 2007 . ed Signature ORIGINAL Rev. 5/8/02 AP, Pt=lOVED AS NOTED NOTIF"~ BUILDING DEPTk'I~k~NT AT 765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLE]E FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OFTHE COOESOFNEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY COMPLY WITH ALL CODES OF NEW ~ 0¢~' STATE & TOWN CODES AS tEQd,RED AN? CONDITIONS OF SC" -,~' .~ ~OW~,' Z~A SC: ._2 TOWN PLANNING BOARD SOL. "HOLD TOV;'N 'iTIUSTEES N.Y,S. DEC ALL CONSTRUCTION S MEET THE RE HALL Ts ~,v ru~,~ STATE' COMPLY WITH CHAPT~ ;46 FLeD DAMAGE PREV~NTI~ SOUTHOLD' TOWN CODE. FIELD INSPECTION REPORT FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING DATE COMMENTS INSULATION PER N. Y. STATE ENERGY CODE FINAL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765~1802 FAX: (631) 765-9502 www. northfork.ne~/Southold/ Examined Approved Disapproved a/c Expiration PERMIT NO. / / ,20 , ° BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: APPLICATION FOR BUILDING PERMIT Date December 14 ,20 05 INSTRUCTIONS a. This application MUST bc completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to seale. 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 hc kept on the promises available for inspection throughout thc work. c. No building shall bc occupied or used ill 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 cgmpleted within 18 months from such date. If no zoning amendments 9r 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, 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, ann regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ , fx [~ ESTA~EIOF HEnlaN ~I~. SAF~CKI ' (Signature[o~ ap~blicant or name, if a corporation) Thomas U. Sa~i~ki, Executor (Mailing address of applicanO State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises Estate of Helen E. Sawicki (As on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorized officer N/A ('Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 955 Bayer Road House Number Street Mattituck Hamlet County Tax Map No. 1000 Subdivision' .(N~le) Sc~ion 107 Block 9 .FiledMapNo. Lot 23.1 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ' "as built" deck b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units N/A if garage, number of cars Addition Alteration Other Work "as built" deck (Description) Fee $300.00 (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commemial or mixed occupancy, specify nature and extent of each type of use. N/A 7. Dimensions of existing structures, if any: Front Height Number of Stories R~ar Depth See attached Plan 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 Depth See attached Plan. 9, Size of lot: Front Rear Depth 10. DateofPurohas¢ 1948 and 1969 Name ofFormor Owner Brown andComiskey See attached survey. 11. Zone or use district in which premises are situated R-40 12. Does proposed construction violate any zoffmg law, ordinance or regulation? YES NO X 13. Will lot be re-graded? YES__ NO__Will excess fill be removed from premises? YES__ NO N/A Estate of Helen g. c/o Lark & Felts, Esqs., P.O. Box 973 14. Names of Owner of premises Sawicki AddressCutchogue,NYl1935~hone No. (631) 734-6807 Name of Architect N/A Address Phone No Name of Contractor N/A Address Phone No. 15 a. Is this property within 100 feet of a 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. X 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 OF SUFFgLK ) THOMAS ~I. SAWICKI being duly sworn, deposes and says that{-s)ho i~ the appli~ (Name of individual signing contract) above named, (S)Heis the Executor of the Estate of Helen E. Sawicki (Contractor, Agcn~ Corporate Officer, etc.) t e v}¥~'lxi'owner or~v'a~s-, and is duly authorized ~ ~,~., from o~ ha~'c ~,xf'ormed-h'~e-said~ofk-and to make and file this application; that all statements contained in this application arc true to the best of his knowledge and belief; and-ga~-work.w/lt-b~ ~rf~,m~t.i~the-mm~-te~.se~tot~h-im thc appik~atiol~ fit'~l-ther~wi~h. Sworn to before mc this 14th day of December Nota~ Public BARBARA DIACHUN NoI~Y Pul~, 81~s of Ne, v yo~k 20 ~5 '.". Y'AR D . .'.' . ", LOT .10 ...,. I ' LOT ~ II '. LOT'8 .... I'1 ..... LOT 7 ' " · '.: .'-' ..' : · ': .... .16o.oo,. o.~=,~.oo,'T'. , '~.~ ~.- ~. "' ' . .:-.. =......., . ,:., ....." '... .~ ~> . . . x . ~ .' . '. /.'.....: .... ". ' ' "' . '. ".. ' "'" ...~.... ..., · .. ~. .......... . . ~,.~,/..' ~...: .. :..% ., . ........ ·.. ....... '" :.~ ":.' .' ".. :.. '..':'..'.." ...'.: :~'..~z'7 . m~.~ ' ... . ~ . . . ..~ ' . . . '~ ', · ~ ': ~ ....... ~ . .: · .. ~ ~ . ..~_. i~ , '.',. 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