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Home My WebLink About32287-Z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-31798 Date: 09/13/06 TIllS CERTIFIES that the building FIREPLACE Location of Property: 4252 GRAND (HOUSE NO.) County Tax Map No. 473889 Section 107 AVE (STREET) Block 2 MATTITUCK (HAMLET) Lot 2.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 8, 2006 pursuant to which Building Permit No. 32287-Z dated AUGUST 15, 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 INSTALLATION OF FIREPLACE IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOSE L & JUDITH A PEREZ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPAR1.MENT OF HEALTII APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A -4:zzed~ Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~ 'f ;).5) ~~ (IN-t.- -m~i Oi-y, ilQS .2- 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, 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. R For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. 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 lnspector shall state the reasons therefor in writing to the applicant. ,. C. Fees I. 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. 8" /u/tl f ./ / New Construction: Old or Pre-existing Building:"/ (check one) Location of Property: tJu j ~ /Ij~ H!~: (/' ~ Street' Owner or Owners of Property: ~ ~ ~4 ~ Suffolk County Tax Map No 1000, ection /tJ T~ ClEf Block Lot ~lf / ~{~V amlet ~02~tJ~? Filed Map. Lot: 5'/~;b6 Applicant: r /~ Underwriters Approval: Subdivision Permit No. '5;?,,??.;. Z Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate 2~e- Final Certificate: \/ (check one) Fee Submitted: $ ~~.l~915 c <Y-t:-}flf<t' 3 I-~ <[ 7 Z TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING !>tFINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS. ~'~i~ Y rc~ uu. o!\ ~ , \.A::L DATE 5'".- ~)" .- 0 " INSPECTOR ~ ~ ~ 4 FIELD INSPECTION REPORT DATE COMMENTS ~'C . . ~!<I FOUNDATION (1ST) ~~ ~~ . ------------------------------------ . .. . .. C!i FOUNDATION (2ND) '" - ;.l":I .. .' ...c::z ';' ...,9 ., V) . N '" ROUGH FRAMlNG & . ~ . PLUMBING . -, I," , . ? i~ I. t"' INSULATION PER N. Y. ~ STATE ENERGY CODE . ,. ~ .r-:- . , \ . J IK-M'- . '){" J::;:;~ 71. -'\: ~ &K ~..A "IR /I FINAL ADDffiONAL COMMENTS 1 . <, '>..0 ~~ . r . . '. ,->l":I -~ - Cl~ .. ~>-l 4 ~O :z ::r: . . . ~ - ::r: . I:i !<I ~ 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. 32287 Z Date AUGUST 15, 2006 Permission is hereby granted to: JOSE L & JUDITH A PEREZ 4252 GRAND AVENUE MATTITUCK,NY 11952 for : INSTALLATION OF A FIREPLACE AS APPLIED FOR at premises located at 4252 GRAND AVE MATTI TUCK County Tax Map No. 473889 Section 107 Block 0002 Lot No. 002.005 pursuant to application dated AUGUST 8, 2006 and approved by the Building Inspector to expire on FEBRUARY 15, 2008. Fee $ 150.00 tt,~ Wk:- , Authorized Signature ORIGINAL Rev. 5/8/02 3 J ~i 1 C/ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health ""'" sets of Building Plans Planning Board approval Survey Check I So ,00 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/ PERMIT NO. Examined -------B:!L,204 Approved ~, 20A Disapproved ale Mail to: Phone: d f6 - 7 ) /5 Expiration ~ ~,20~ IC-k / Building Inspector lG n ;-~: -r:(--.'.f-~ I . ~ I 1'" !, I 8;\ _-1 ,-...... IUm.'2 APPLICATION FOR BUILDING PERMIT Date R(<f" 208b '- '- INSTRUCTIONS 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 aI~as, 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. APPLICA nON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South old, 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. e, if a corporation) . G /A/Vi f- ALL CONSTRUCTION SHALL (Mailing address of pplicant) /11w' State whether applicant is owner, 1~~JI€~I~f~~~eral contractor, electrician, plumber or builder o /J/ A.II; IL , A??ROVED AS NeiED Name of owner of premises 11?J~~ L. /Ehz- nAn" fJjJ<!i. BP # '3~7c .. .. tlln~RwmfER~~roll orlaW;~deed) 1,51). BY' f~ ~ Ifapphcant IS a corporatIOn, sIgnature ofd~!IfO\f~ElFlcer NOTIFY BLCI.Ji:ic D[Or,f',:M~NT AT 765.1802 8 AM TO ,,~"... FOR THE (Name and title of corpora€>OOeJPANCY OR FOllOWiNG IIJSPEC TI.:,S: USE IS UN'LA'W FUl 1. FOUNDATION. TWO REOUIRED . '. ' FOR POURED CC,CRETE 2. ROUGH. FRAM,I,G & PLUMBING 3. INSULATION 4. FINAL . CONSTRUCTION MUST BE COMPLETE f'OR C.O. All CONSTRUCTION SHALL MEET THE REQU NTS 0 THE CODES OF NEW T~ JR ONSIBlE FOR IDISleN OR CONS! RUCTION ERRORS. Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. O~Cy 1. Location ofland on which proposed work will be done: . 2.,)2... f;!?AtJD AI/EMU: I1f. 'J vel::. House Number Street Block 02.00 Filed Map No. , I'-Y-i , Lot eft} 2--. OOS- Lot " County Tax Map No. 1000 Section I () Z ()i) Subdivision (Name) 4. Estimated Cost 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ .A.....;~ /'l6.4i;,l,...;,") / (j b. Intended use and occupancy ~ /1't+v7 /2'.J~ 3. Nature of work (check which applicable): New Building AdditIOn Alter~ti n Repair Removal Demolition Other Work/~ /4.<;;. '].4I":J~ (Des . ption) / FO. I:> () (To be paid on filing this application) Number of dwelling units on each floor /~. p;.r: PO Fee 5. If dwelling, number of dwelling units If garage, number of cars Z- I , 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth 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 9. Size oflot: Front Rear Depth 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 V<ill excess fill be removed from premises? YES NO - - -- 14. Names of Owner of premises Name of Architect Name of Contractor Address Address Address Phone No. Phone No 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. 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 O~-o//~~ IZ-e I V' 'JO. E E 7' _ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, " ;', , " '~-d . (Contractor, Agent, COrPorate officet', etc.) Rt)' vr\:.A,~q!;,^"t:" ,-' ,,', ,.....,J~;f \ ,1..J~. .... of said owner or owners, and is duly authorized to perform or 4!1'le,JilW?~ t\1€:jtili-wQrk and to make and file this application; that all statements contained in this application are true to the.li~(\fliiN~#ledgd arnfbelief; and that the work will be performed in the manner set forth in the application filecl-tJi~ p:, ,:-. 1"' : C' ,-' . " ~fr . ~ '~','." ;; :'.":":;:'3':;J1i. (S)He is the ',''-- .... Sworn to, Wore m, ilii~ t~ t~~ Notary Public , , " NptaIy=~~YOrk ,j ~.JO-47~.154 CIItalifled io ffassau I Co' - a~ion Expire$ ~