HomeMy WebLinkAbout29785-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31773
Date: 08/28/06
THIS CERTIFIES that the building
ACCESSORY
Location of Property: 18800 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 115
(STREET)
Block 6
MATTITUCK
(HAMLET)
Lot 5
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
OCTOBER 6, 2003 pursuant to which
Building Permit NO. 29785-Z
dated
OCTOBER 7, 2003
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 ACCESSORY ABOVE GROUND SWIMMING POOL IN THE REQUIRED REAR YARD
AS APPLIED FOR.
The certificate is issued to PAUL & BETH BOROWY
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
09/15/03
ELECTRICAL CERTIFICATE NO.
1165181
N/A
PLUMBERS CERTIFICATION DATED
.~
Authorized
L '///'.
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Signature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUII,DING DEPARTMENT
TOWN HALL
765-1802
~ , 8
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 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 2/1 0 of I % lead.
5. Commercial building, industrial building, mnltiple residences and similar buildings and installations, a certificate
-- of Code Compliance from architect k engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prio~ to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survej 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.
-1
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
Date. 13- I 5 - G::,
New Construction: ( poP I Old or Pre-existing Building:
Location of Property: \6'300 Mall. RA fl\O.J\-lt0CX_
House No. Street
( check one)
Hamlet
Owner or Owners of Property: P,:Lv l e:. Be- tvl
#47.365'1
Suffolk County Tax Map No 1000, Section 115
DD'OlJ Y
Block 000 Co
Lot 00 5
Filed Map. .<j 7) e 8 "I Lot:
Date of Permit. 10 - 7 - 0 ::3 Applicant: P tt.Ul 1- Be..1-t-1 '/30 fD lJ 't
Underwriters Approval: 0 il f', l-e
Subdivision
Permit No. 2. q 7 Z'> 5
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ),,5.00
Final Certificate:
/
(check one)
13~ '1j~
Applicant SIgnature
~.)6~S:L
~O -C 3n'75
lID. lID
I BY THIS CERTIFICATE OF COMPLIANCE THE I
~ 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 ~
~ ~
~ BETG BOROWY BETH BOROWY ~
~ 18800MAINRD 18800 MAIN RD ~
~ MATTITUCK, 11952 NY MATTITUCK, NY 11952 =
I Located at 18800MAINRDMATTITUCK,NY11952 I
~ Application Number: 1165181 Certificate Number: 1165181 ~
I Section: Block: Lot: Building Permit: BDC: NS11 I
~ Described as a Residential occupancy, wherein the premises electrical system consisting of ~
~ electrical devices and wiring, described below, located inion the premises at: ~
~ Outside, Pool/Spa, ~
~ ~
I was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was I
~ found to be in compliance therewith on the 15th Day of September, 2003. ~
~ Name QTY Rate Ratm" Circuit IJ;m; ~
~ Appliances and Accessories ~
~ Pool/Spa Bonding I 0 ~
~MringandD~C~ ~
~ Switch I 0 General Purpose ~
III Receptacle I 0 20 amp Pool/Spa ~
~ Receptacle 1 0 GFel ~
~ (Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have mI
~ frequent test and/or repairs made by a qualified person. ~
~ ~
~ ~
~ ~
~ ~
~ ~
III ~
~ seal ~
~ ~
~ I ~ 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. ~
~.~1iI
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.
29785 Z
Permission is hereby granted to:
PAUL & BETH BOROWY
Date OCTOBER
7, 2003
MATTITUCK,NY 11952
for :
AS BUILT ABOVE GROUND SWIMMING POOL IN THE REQUIRED REAR
YARD AS APPLIED FOR
at premises located at
18800 MAIN RD
MATTI TUCK
Lot No. 005
County Tax Map No. 473889 Section 115
pursuant to application dated OCTOBER
Block 0006
6, 2003 and approved by the
Building Inspector to expire on APRIL
7, 2005.
Fee $
300.00
ORIGINAL
Rev. 5/8/02
"
7-q 77S Z
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [)<f FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
F~ J~,~;p ~ Ok,
9_ }o - 0 S-
DATE I
INSPECTOR ~,~
J; 7 f5~
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] IN ATION
[ ] FRAMING [ , FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
'lEMARKS' ~ ~ cJ, /7"1
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DATE ~ INSPECTOR
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765.1802
BUilDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMA S. :.h~J!bA/fY~ Wi .
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INSllLATIONPERN. Y.
STATE ENlI:B.GY CODE
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ADDmONAL COMMENTs
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FEE: BY: ~7ff2
NOTIFY BUI ING O~oARmENT AT
765-1802 8 M TO 4 PM FOR THE
FOlLOWING NSPECTIONS:
1. FOUNDAT N - TWO REQUIRED
FOR POU ED CONCRETE E
2. ROUGH. RAMING & PLUMBING
3. INSULAT
4. FINAL .
BE COM ETE FOR C.O.
ALL CONST UCTION SHALL MEET
REQUIREME TS OF THE CODES OF
'YORK STAT. NOT RESPONSIBlE F
. DESIGN OR CONSTRUCTION ERROR
52'
COM Y WITH ALL COD
NEW YO K STATE & TOWN
AS RE IRED AND CONDIT
SOUTHOlD TOWN ZBA
SOUTHOI.D TOWN PLANHfJlIJ~
SOUTHOI.D TOWN TRUSTEES
/$ANrtI-PMlIif(lt)l.l$rm/EIJ IN TlECUR/IEIIT
"')~ IIS7TlIITPSTINDN/J)FCK/I$DVE
GllaJl/DS'AlWlNGPOaS. (NSI'I..(j. IGH RATE
2JDECKSNIE/JES/C/EI) TOlllmsrAIIJAlIVELDIlJ OFfllJ/JJfjf. AL 1ER
9)FENCEIIIil WmsrAIIJA2!JO/JJLDIlJCOIFC/IMIIG TO
BOCA!2I.92 .
(j ALL Cf>ENlNIJSIN TIHENCE AIIELESS TlEU
5) P/1OJ)UCT /JEETS OR EI/JEEIJS AllIlEQf/IREMENTS OF
BOCASECl !11
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ED AS NOTED
OlE.
OTAI1POOI.SlZESARE AVNLABLEON
MOOELS
OVPI. SIZES
f3'X1~
13'x22'
15'x24'
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Ia'Xl3'
52'GilL C
6,400 12'-ll'
7,000 12'..'
10.100 15'.Q'
13.050 15'.Q'
17,000 18'11'
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FLOOD lONE
COMPLY WITH CHAP R "46"
FLOOD'DAMAGE PREVENTION
UNDERWRITERS CERTIFICATE
REQUIRED
\ SlllE DECK IPDll5'.,' TO 'E' DIMENSION)
\ DECKS ME OPTIONPI.&
, NOT ilLL ME AVAlLW
, ."(: FOR ilLL POOl. MOOELS
END
DECK
IN POO.
LAOOER
OCCUPANCY R
USE IS UNLA FUL
WITHOUT CE TIFICATE
OF OCCUPAN Y
DECKSlJRFIlHDFENCElOPR~L ~ I
3'0 314'fROlf OECK SURFACE
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ALL CONSTRUCTION HALL
MEETTHE REQUIREME S OF THE .
CODES OF NEW YORK ATE.
CPTIONAI.
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SLI'PORT
JI5TE UNE
PlM' &
MOTOR
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UNER
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STEN.TH
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FOOTING
BLOCK
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IN' I~-S'
21'-6' 14-8'
2~11' IN'
30'.()' IT-2'
33'11' 2<<-2'
FILTRATlCWS(}{EJ./ATlC
S.E. CONSULT .ANTS, INC.
SmIllId&fe.kizmll
CIlSTOMER SER\1CE DEPMTMENT
B600 RIVER ROAD
DElNR NEW Y 11
S'Ml1T.MILlENNI~ TlTPl-I, ULTIMA
SOUTH BEACH
SPEC01iiB 02n6JJO NT W.B.M.
"IMMEDIATEL V"
ENCLOSE POOL TO CODe
UPON COMPLETION
BEFORE "WATER"
5
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TOWN OF SOUTHOLD PROPERTY RiC9RD CARD
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TYPE OF BUILDING
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RES. A/<l SEAS. VL. I FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
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Tillable FRONTAGE ON WATER
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Woodland FRONTAGE ON ROAD 2C I' , - 0'J'::?
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Meadowlarld DEPTH ffv ,
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House Plat BULKHEAD
Total
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Breezeway Fire Place ON~ Heat 1H flw DR.
Garage - , Type Roof ;:; fU3 U Roams Floor
j)NO f 1st SR.
Patio Recreation Room Roams 2nd Floor FIN. B
O. 8. Dormer Driveway
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CERTlFIED TO:
PAUL & BETH L. BOROWY
THE LONG ISLAND SAVINGS BANK
LAWYERS TITLE INSURANCE CO.
ROAD
(RT 25)
N 89.03'00" E 86.00'
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SUFFOLK COUNTY TAX MAP DIST.: 1000, SECT.: 115, BLOCK: 6, LOT: 61
UNAUTHORIZED AL ITRA TION OR
ADDlTIDN TO THIS SURVEY IS A
VIOLA TION DF SECTIDN 7209 DF THE
NEW YORK STA IT EDUCATION LAW
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OT 1
otSTANCES SHOWN HEREON FROM PROPERTY UNES
TO EXlSl1NG STRUCTURES ARE FOR A SPECIFIC
PURPOSE AND ARE NOT TO BE USED TO ESTABUSH
PROPERTY LIINES OR FOR ERECl10N OF FlENClES
CEIlTIFlCA 11 ON INDICA TED HEREON SHALL RUN DNL Y TO THE PERSON FOR WHOM THE SURVlEY
IS PREPARED AND ON HIS BEHALF TO THE COMPANY. GDVlERNMENTAL AGENCY, AND LENDING
INSl1TUl1DN USTEO HEREON. AND TO THE ASSIGNEES OF THE LENDING INSl1TUl1ON
CERl1F1CAl1ONS ARE NOT TRANSFlERABLE TD ADotl1ONAL INSl1TUl1ONS OR SUBSEQUENT DWNERS
LOT
7~'3"
5'..7"_
92.67'
SURVEY
ESTA TES,
MAP
INC
OF: I
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DA TE OF FILING: SEPT. 8,1965 FILE MAP NO.: 4453
MATIlTUCK, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK
LISA McQUILKIN
LAND SURVEYING
54 SECOND STREET
WEST SA YVILLE, NEW YORK 11796
PHONE: 516-563-4952
D~_T~:._?~~~_2_~ 1_9~7 ~I~~A~_[~_~"~_~9:J!,l~E_. ~~'__ Q1-03J=-~~.
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S 88.45'30" W
\
LOT 12
LOT "
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COPIES OF THIS SURVlEY MAP NOT BEARING
THE LAND SURVEYORS INKED SEAL OR
EMBOSSED SEAL SHALL NDT BE CDNSIDERED
TO BE A TRUE VAUD copy
1
MA TTITUCK
PERMIT NO.cJ'11-YS- t:-
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
",./
3 sets of Building Plans
Planning B~d approval
Survey 1-
Check ft
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
Examined
Approved
Disapproved ale
,20 3
,20~
Expiration
r!~ ,20~
Mail to:
Phone .J?S- g /05
iSm
APPLICATION FOR BUILDING PERMIT
'" i
, ,
~_.',
Date
/0/3
,
,20D3
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink 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
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 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 completed within 18 months 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, 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, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
~~n~r~r name, if a corporation)
1e,~OO kUI/\. ~,~,ttt+ocK, ~ y
(Mailing addrds of applicant) , II f{ S Z.
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
DW(\>{/
Name of owner of premises Pa.v\ + B.z.t~ Borowy
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I. Location of land on which proposed work will be done:
le,eOO Mot< d' R.~ !vk +\ I+(.l{.. ~ tv Y
House Number Street
Ilq~2.
Hamlet
County Tax Map No. 1000 Section 1\5
Subdivision
Block 0
Filed Map No. -445
Lot _MH!~'\'''q
,.v~ ,ji':' ':: Y7~4....",
AlII!luZ ,ame, c,..],D .N!
O~ ,t -'Ilht':i;lh"r
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition Alteration
Other Work.Q.,h-x.:>e 9{,{)0Ild fool
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specity nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Depth
Rear
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
Depth
9. Size oflot: Front
Rear
10. Date of Purchase
Name of Former Owner
I I. Zone or use district in which premises are situated
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 of premises Bt';\j-l'x-\t., Roro'1' AddreSS_~~~I\Ik> (2J
Name of Architect Address fI-' f-J Y
Name of Contractor Address
Phone No. ~t'(t-.JIOS
Phone No
Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO _
* IF YES, SOUTH OLD 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.e. PERMITS MAY BE REQUIRED.
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.
ST ATE OF NEW YORK)
SS:
COUNTY OF )
'Be..~ L... Go,.-O l.,.f Y being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the otJnp,..-
(Contractor, Agent, Corporate Officer, etc.)
of said owner or 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.
Swor?J,o before me this
3- day of
20 llJ-
-t!2Ad--~
Signature of pphcant
IOIIIfIt J.1lOIlOSII
IIoIIry Public. SIIII Of..1lIl
.D. 01006095321, SllfllkCiLIIIIJ
Tn &phi. 7,ZI..o.:J-