HomeMy WebLinkAbout32337-Z
FORM NO. 4
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32033
Date: 11/28/06
THIS CERTIFIES that the building
ADDITION
Location of Property: 3420 NEW
(HOUSE NO.)
County Tax Map No. 473889 Section 115
SUFFOLK AVE
(STREET)
Block 9
MATTI TUCK
(HAMLET)
Lot 5.1
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 25, 2006 pursuant to which
Building Permit No. 32337-Z
dated SEPTEMBER 5, 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 BASEMENT ENTRY ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to MICHAEL J & STACY SHEPPPARD
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
/~~
Authorized Signature
Rev. 1/81
,
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"'Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application mnst 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 featnres.
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 Plamling 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 lISes:
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 sib'llcd by the applicant. If a Certificatc of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. I'ees
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. Tempormy Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. ----1JJ;lm.
New Construction: Old or Pre-existing Building:)( (check one)
Location of Property: :lOu fH (It(l.,LI D~. __
House No Dr ~ ~.tUS~1.t~t)C A-v-€. .
Owner or Owners of Property: --.!-\ \~I(\ 1.\ .J] 6TD.t^f ~~ (Je.t..t-J
Suffolk County Ta~ Map No 1000, Section _~_S Block '1 Lot
Subdivision
j77a.iJil~A t L
Hamiel
S:.I
Permit No. 3'),,3372
Date of PenDi!.
Filed Map. _ ________ Lot: ____
cr 10/ ()f.o ._ Applicant ;=). \--urfXb-cd--
Underwriters Approval:
Health Dep!. Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate: Y (check olle)
;Mau 117A!:wwA
. Apiicant Ign
Fee Submitted: $
d-5,OO
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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.
32337 Z
Date SEPTEMBER 5, 2006
permission is hereby granted to:
MICHAEL J SHEPPARD
200 AIRWAY DR
MATTITUCK,NY 11952
for :
BASEMENT ENTRY ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at
3420 NEW SUFFOLK AVE
MATTI TUCK
County Tax Map No. 473889 Section 115
Block 0009
Lot No. 005.001
pursuant to application dated AUGUST
25, 2006 and approved by the
Building Inspector to expire on MARCH
5, 2008.
Fee $
150.00
/-
ORIGINAL
Rev. 5/8/02
3 (}-)37 ;L
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING o<i FINAL
[ ] FIREPLACE & IMNEY [ ] FIRE SAFETY INSPECTI
REMARKS:
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DATE
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INSPECTOR ~-: ~~4-
3)-337 Z-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
~FOUNDATION 1 ST [] ROUGH PLBG.
~ FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
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DATE
INSPECTOR ~~
,
FIELD INSPECTION REPORT DATE
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
COMMENTS
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
BUILDING PERMIT APPLICATION CHECKLIST
PERMIT NO.
::)..:.) ~ ?, --=j ~
Do you have or need the following, before applying?
Board of Health
"",,----, /'
"""""'" 4 sets of Building Plans ,/
Planning Boa1)i approval
~ Survey /
Check ':II:
Septic Form
NYS,D.EC
'rrustees
Contact:
Examined
)
L
Approved
Disapproved ale _.__
,20
,20~
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--or'
Mail to:
/
Phone)' r t - d.d.3 3
~
Expiration
,20_
2.5
APPLICATION FOR BUILDING PERMIT
,20
Date
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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 oflot 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,
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 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,
(~t<;;'rJ Of~;~ica~;:f::~-;~(~~:rp~:at~o~; (I
?J'-I.}c\ (tll\ ";:)u...(.:r~ j\ t: f-k{
t )hlt\.lt~l~.~ddress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
o~~"t('-
Name of owner of premises ~L\ ~i1 (uJ ,;,~tcu~.\.. t E)t-x,_\;:-> ex\..\-d
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized otTlcer
(Name and title of corporate officer)
Builders License No,
Plumbers License No,
Electricians License No.
Other Trade's License No.
L
County Tax Map No. 1000 Section
Subdivision
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9 ,..J38JO ,011 C I
Block ':' ',~I1<:2nt~Lot :.)
Filed Ma; No.8.' ,bloqd - tot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy iC,,":'.,:,(\ Cd'{Jt'
b. Intended use and occupancy \~( c:" ( \. ( {\CC '
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Alteration
i ~)O
(To be paid on filing this application)
N umber of dwelling units on each floor
(Description)
4. Estimated cost;! n cJr)
5. If dwelling, number of dwelling units
If garage, number of cars
Fee
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 oflol: Front
Rear
Depth
10. Date of Purchase
Name of Former Owner
II. 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 -L Will excess,fill be removed from premises? YES_NO X
. 'Y" Xl j ','" ,. j
., \" "J,.. t ." 'Trtll ( :0'-\'-...' 'r.' 'j" '''~)
14, Names of Owner of premises ~.u {1,,(J.(. ;j, )1(:U'~Addres' - Cc' ti ";";, \'\(;Ir Itt.'d'hone No. ,J-' 1\.1. 0<. ~
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _ NO ~
* IF YES, SOUl'HOLD TOWN TrtUSTEES & D.E.C. PERMITS MA Y Sf;: REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES_NO 'v
* 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.
,
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(S)I Ie is the
/1 -,
/ {C-(, being duly sworn, deposes and says that (s)he is the applicant
g ~ontract) above named,
UCo Yjf' .y-
(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 tile 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
perfomled in the manner set forth in the application filed therewith.
Swo
2012ln
ub lie CNIl!!. BEST
HIteW't'orlI
NolIIJ 1 7127
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SURVEY OF PROPERTY
SIWA TE: MA lTl1UGK
TOWN OF SOUTHOLD
SUFFOLK GOUNlY1 NY
SURVEYED 12-10--'<8
AMENDED 12-10-<1<1,
03-28-00. 0"1-25-00.
10-22-00
S.C.D.H.5. REF~ RIOQQ0251
SUFFOLK COUNTY TAX ~
1000 - 115 - Q - 5.1
,/F
CERTIFIED TO,
STACY SHEPPARD
MIGHAEL SHEPPARD
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NOTES,
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MONUMENT
1.20 AGRES
A = 52415 SF OR
SL'F?OU< CCUNTY DEPARTlVIENT OF HEJ>.L Trl SERVICES
11:':>:1::: VAL OF CONSTRUCTED WORKS FOR
ASJ:NGU FAMILY RESlDEi{CE
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Date ",:.:;1 (, 'J ",~U'y.s.R-ef.}:o._...L~t9.,:::-9'7-02S'"
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be sacis,octol)' FC;;'~ O~F,Di',00MS,
St he:1 A. Costa, P.E., Chief
Office of Water and Wastewater Management
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.Cert,flcat,o,," ,nel,e.teo lIe<'~on s,~n,a tnu tnis
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Uno 5<.w'-.nors Sa."'ert,f'cA.,ons snoll r....""l,-
totMPers01ltoc....0..'...surv.1J.prOpac.0
ano on ~'s !>enoll to .ne 'ltle "","pany g~ern""n'
tal .gen"",,,o lono,,,,,, ''''''>tu<lon hat... n.~.on_ ..no
to,...assignHsoftMleno,ng.n."tutH>n Cectif,,,.
t,ons ore not tC'''''ferOllI. '''aG<l,',.n.l ,,'U"u"OM
JOHNC. EHLERS LAND SURVEYOR
6 EAST MAIN STREET
RIVERHEAD,N.Y.11901
369-8288 Fax 369 8287
N.Y.S. DC, NO. 50202
REF.: TIGER/PROS/98-263FN
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