HomeMy WebLinkAbout31851-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31523
Date: 04/12/06
THIS CERTIFIES that the building ADDITION
Location of Property: 5910
(HOUSE NO.)
County Tax Map No. 473889 Section 113
WESTPHALIA RD
(STREET)
Block 10
MATTITUCK
(HAMLET)
Lot 15.2
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MARCH 14, 2006 pursuant to which
Building Permit No. 31851-Z
dated
MARCH 14, 2006
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 REAR DECK ADDITION & HOT TUB TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to GEORGE S & BARBARA DEACON
(OWNER)
of the aforesaid b~ilding.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
2093011
03/30/06
PLUMBERS CERTIFICATION DATED
N/A
~~
Authorized Signature
Rev. 1/81
)1{ 3
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
PC) a()..;.. /2-1'-1
j,r.q. t-l-I 1-0 LeA.; v'l/- V
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This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new nse:
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 fonn).
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, 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 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. 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
Oat. ~'2...? -0 b
Old or Pre-existing Building: 7 (check one)
S 9/0 . W~t-~ ~~ Mltf-"I- r/-Vt-u.
House No. Street
Owner or Owners of Property: (1 ec loll: \) l'..A-€..D.J
Suffolk County Tax Map No 1000, Section ----1-1 ") - () 0
Tv UUur.X:J
New Construction:
Location of Property:
Hamlet
-!cJ - 00
Block
(] I )"-= CJ cJ "2-
Lot
Subdivision
Filed Map.
APPlicant:~eCJLy<
Lot:
Permit No.
Date of Permit.
\Jc.A c ,y....J
Health Dept. Approval:
~._ Underwriters Approval:
Planning Board Approval: ___.._._._.._
Request for:
Temporary Certificate
Final Certificate: :l!J.' heck one)
/it>~
. .f'. Applicant Signature
,
c
Fee Submitted: $
~~~H5f
Co 1:.- 3f5~3
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.
31851 Z
Date MARCH
14, 2006
permission is hereby granted to:
GEORGE S DEACON
MATTITUCK,NY 11952
for :
CONSTRUCTION OF A REAR DECK ADDITION AND HOT TUB AS APPLIED FOR.
THIS PERMIT REPLACES BP# 28128.
at premises located at
5910 WESTPHALIA RD
MATTI TUCK
County Tax Map No. 47388~ Section 113
Block 0010
Lot No. 015.002
pursuant to application dated MARCH
14, 2006 and approved by the
Building Inspector to expire on SEPTEMBER
Fee $
150.00
'"
ORIGINAL
Rev. 5/8/02
IID.IID
~ BY THIS CERTIFICATE OF COMPLIANCE THE ~
~ NEW YORK BOARD OF FIRE UNDERWRITERS ~
~ BUREAU OF ELECTRICITY ~
~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~
~ CERTIFIES THAT ~
~ ~
~ Upon the application of upon premises owned by ~
~ ~
~ GEORGE DEACON GEORGE DEACON ~
~ PO BOX 1234 PO BOX 1234 ~
I MATTITUCK, NY 11952 MATTITUCK, NY 11952 I
~ Located at 5910 WESPHALlA RD. MATTITUCK, NY 11952 ~
~ ~
~ Application Number: 2093011 Certificate Number: 2093011 ~
I Section: Block: Lot: Building Permit: BDC: ns11 I
~ 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: ~
~ Basement, spa, Outside, Pool/Spa, ~
~ 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]Oth Day of March, 2006. ~
~ Name OTY Rate Ratine: Circuit ~ Amount ~
~ Miscellaneous ~
~ connections for a $0.00 ~
~ self contained spa $0.00 ~
~~~~ ~
~ Disconnect 1 0 50 amp Pool/ Spa $0.00 ~
~ GFCI Circuit Breaker 1 0 50 amp Pool! Spa $0.00 ~
~ ~~~ WM ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ seal ~
~ ~
~ THTS TS YOTJR RRCRTPT ~
~ 1 of 1 ~
I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I
IID~~IID
3\~SI Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULA~N
[ ] FRAMING I STRAPPING D<r FINAL l!n e..> /tOT r:j)
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
j/~
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DATE J ~ ! 1- (j r;
INSPECTOR ~,~
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~ ~ - BUilDING DEPr.
1-/' INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ROUGH PlBG.
[ ] INS ION
[
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Ci-.-..A .1. fLt 5lj../ ~ 0f1 '
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DATE I~'V;/O J_ INSPECTOR
L
.
FIELD INSPECTION REPORT DATE
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PERN. Y.
STATE ENERGY CODE
FINAL
COMMENTS
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OWNER
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STREET
VILLAGE
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LAND
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IMP,
TOTAL
I FARM
DATE
Mkt, Value
LOT
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NORMAL
71'00
BELOW
NEW
FARM
Acre
Value Per
Acre
Value
Tillable 1
Tillable 2
Tillable 3
,voodland
Swampland
Brushland
FRONTAGE ON WATER
FRONTAGE ON ROAD I /3
House Plot
DEPTH
BULKHEAD
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. 9/6' x /600 :: /"Tt'l
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DOCK
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Garage
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IRecreation Rooml
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Total
Dormer
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~oms 2nd Floor
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i Driveway
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.FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD. N.Y. 1197!
TEL: 765-1802
o,() ?' ~J..-'v'-({{) "31 <?'5-;
Exanined..... .ilr"....... 20.-;,':-- . ;2::f31 ~ B <===
Approved.....;.;.!........ .~~ Pernnt!C. ................
Disapproved alc ..................................
BOARD OF HEALTH .,.............
3 SETS OF PLANS ...............
SURVEy........................
CHECK .........................
SEPTIC FORM ...................
NOTIFY:"3/_ 72.;2 -:5502-
CALL ;5(x:~'f5:9.-. ......'??'€C]
MAIL TO:...................
..................................
...................................
..............................................
..
r:) J~3l r u \L~ mil' . 109
! 1i.1 APPLICATION FOR BUILDING PERMIT
. M<\R I . ,,]
, , I
:. ~ - --J INSTRUCTIONS
L-..: ~ ",I
a. This application IIlJSt letely filled in by typewriter or in ink and subnitted to the Building Inspector'
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. relatiooship to adjoining prBDises or p.lblic
streets or areas. and giving a detailed descriptioo of layout of property IIlJSt be drawn 00 the diagr.... which is part of
this application.
c. The l<OIk covered by this applicatioo may not be COTIlI!nced before issuance of Building Penni t.
d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such
pennit shall be kept on the premises available for inspection throughout the 'WOrk.
e. !C building shall be occupied or used in -.bole or in part for any purpose whatever until a Certificate of
Occupancy shall haw! been granted by the Building Inspector.
!J -,'
,-
Date .~~l5tf."f/.~'y 7::? . . 20.~ 7-.-
APPLICATI<Jl IS IEREBY !WE to the Building Ilepartment for the issuance of a Building Penni t pursuant to the
Building Zone Ordinance of the Town of Southold. Suffolk Camty, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings. additions or alterations. or for I'E!ID\Ial or denr:>lition, as herein
described. The applicant agrees to ~ly with all applicable 1......, ordinances. building code, !loosing code, and
regulations, and to adnit authorized inspectors 00 premises and in building for necessary inspections.
.. ~~$.7:. .e-:x .c/5:<l.<;i.. ~~~.,:(~(;..
(Signature of applicant, or &m" if a corporat ion)
t?.o.#OA" /078 J ,4P1e.S,;1C?T AI':/.
...:c;>...........................~.................
(Mailing address of applicant) //9 ~7
State 'Whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumer or builG
.... ... .~~.l./de/:':. .:.... .... ... .............. .... ...... .........................................................
/' I . A
Nate of owner of premises.. '9.~p.~.l?{../3ri.1?../ltM!:d..~~~Rd.....................................
(as 00 thE( tax roll or latest deed)
~~.~~~~~~~.~A:.~~~ officer.
(Nate and title of corporate officer)
/
IkJi lders I..icense rb.
Plllli>ers License No.
.....~.. '.................
Electricians License !C. .....................
Other Trade's License !C. ~~,1..~~~.ff.3.
I. Location of land co Which proposed work will be dooe..............................................................
-2.1.(9... ..W9.~:I;a!.I~.4.~...~. .,./.!la.ft.'-7::lf;~ ~...... ...................................
ibJse IbJber Street A~et
Camty Tax Map !C. IIXXl Section .../!. :?...... Block . ..(.~... ...... lDt ..&.C? .(!?... ./."
Subdivisioo ..Zf?.!!.~.w.[.!g.</............... Filed Map !C. 9.$......~}.7... l1:)t.s...'1.t;.-::~~/0-fol 9:5
(Nate )
2. State existing use and nt"M'P""'"'Y of JI!'l!DIi.ses _and intended use and occupancy of proposed coostructioo:
a. Existing use and occupancy ....~~.<~.....................................................
M,.s~~ '"
b. Intended use and occupancy .............................................................................
'''~'-'''''''' v"- -..-.0\. ,....OC\..A WIoIlUI oifP.lHICalHer New' J).uJding .......... .Addition........... Alteration ........',
Repair ............ Renvval ............. ilemJlition ............ Other Work ....~.-:'>?.!'"..4~7...7.<"~
(Description)
..
10 00 U
Est imated Cost ......,;..................
fee
............................................,...
(to be paid on fil ing this application)
). If dl-4lelling~ rurber of dwelling units ............ lluDer of dwelling lIDits on each floor ......,.,.....,.
If garage, fUlj:)er of cars ......................................
'. If business, canrercial or mixed occupaxy, specify nature and extent of each type of use........ _... _...." +..
3.
I.
2.
3.
Dimensions of existing structures, if any: Front................ Rear.............. + Depth +..,.......... _..
l!eight ............ ............ lbWer of Stories ......................
DiIrensions of sa:re stn.cture with alterations or additions: Front............... Rear +.. +,. +... , _...
Depth .................... Height .................... lbWer of Stories ...............
Dimensions of entire new construction: Front .,.............. Rear ............... Depth ......, ... '...
l!eight ......................... lbWer of Stories .....................
. /72..'h. /7;<.1C. dY'i7o
SIze of lot: Front ...~..;:...,........ Rear .................... Depth ...........'.........
Oate of Purchase ....( <? ,/. .:?-. c:.~ .c;'. .. Nare of FOIIIEr Omer ........................................
Zone or use district in ...ich premises are situated ..............................................................
~s proposed coostruction violate any ZOI1i~ 1.... ordi~e or regulation: .. ~ Q '~~'" ......... ...._
wIn lot be regraded .................... WIll excess h 11 be ramved fran preuuses: ~ (I{) )
Nares of Omer of premises ~':';"'. y.E:. ~;;K~'~ 1-.. Address ::::;.1'. Q i.:.J?~"{;!(;(';.[fs~Itv:Jre No.bS/~.'~8..Zf. j Z/
::: :::~~:r':f'~l.i~d.~)~;'!~~b~::::;:lI.~if.~;~:&~::~~~~:: ?l.;;i:;(?~
/ --
Is U.is property within 300 feet of a tidal ....tland? * YES .......... em.-..-?...... ..
*1F YES, fn1I1IID TlUl '11llJS'l'FE.'> PIlRMIT HAY IlEmlQJIRED.
L
5.
PLOT DIAGRAM
Locate clearly and distinctly all buildings. .nether existing or proposed, and indicate all set-back dimensions
mu property lines. Give street and block nudJer or description according to deed, and shaJ street nares and indicate
tether interior or corner lot.
i\'IE (Xo' tI'.W/~ '. (Ie ss
lJNIY (Xi' ;-I. :'~ . -,P-. , ,'. . . , . . . . .
(r):-s'+ t..~ ,{ (;J'." c. ,(. >W"- "'. -~ .{( '1' 1
...... ~,.............c-:<c,...............................""ng du y swam. deposes and says that he]8 the applicant
:<m! of individual signing contract)
<JVe oared, -'J I '1.
I; _' J
r. i, 'I' , .'{ l '., . ~
__>--"-.,1\\.--,_ 't '-"""'.' '., "'\ ~_-: '_, '. - - ,- _
]!l the .........". ~... ,:T.......... J......................................................................
(COntractor, agent, corporate officer, etc.)
: said ~r or "",""rs, and is tIuly authorized to perfonn or have performed U'" said work and to nBke and file this
"lication; that all stat€fTEnts contained in this application are true to the best of his knowledge and belief; and
,at the ""rk will 1", perfonred in the 1R'lnner set forth in the application filed therewith.
",m to before rre this
...... ./. .'~:'. . . .day of ... rfL!!: . .I.'. .. .29.:'. .:-:-'.
. rL>..... /{ ;(~ /! v;..-t:l,
Notary Publ1c .. ..>&'.. c.. s......... (.'.:..............
./
NOTARY
l)lA
. (,' [--Jew York
,I
... .c.':-.. ..': ~~. .~~!\ .l.\r..... .'.~. _....
(Signature of ^~licant)
GuaLf;.,:-.., I!' ~'".",G,~,County._
Commis~~inn l~XP\'C::; !I.!~ ,(__ ",._~
-I,.-lox..A,'J
.. .
,
C '\.\
..
~$ EMt &,ut SjJ4 ad 5crtlM. 1..
...,........... '" EafJlAu.""Jor,.......~.
P.O. Box 1078. 1374 Main Road
JAMESPORT, NEW YORK 11947
(631) 722-5502 FAX (631) 722-5782
e-mail: eastendleisure@aoI.com
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,,"M"v'OITrQ~ crRTIFICATE
urHjL.n..\,;.'.....~' -'
HcQU1RED
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l{,j,..JiAv' "
APP~VED AS NOTED
DATe'.0/ Z B.P.#. 2B~~
~~ To By.---nP 1'2....-
NOTI BUILDING D~
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION. TWO REQUIRED
FOR POURED CONCRETe
2. ROUGH - 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
3 I ~')-
~cd<-~l f>lc.-,-"
s J'-t)( Cc. S,!< c::..E 0 PriZ..
OCCUPANCY Oli
..._.. I""" ''''''!: 'H-~!,,",.r.1
u::,t I;) Ulnl\~HUL
WITHOUT CERTlFIC;'7E
OF OCCUPANCY
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