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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32646 Date: 10/03/07
THIS CERTIFIES that the building ACCESSORY BUILDING
Locaticm of Property: 13200 SOUND
(HOUSE NO.)
County Tax Map NO. 473889 Secticm 141
AVE.
(STREET)
Block 4
MATTITUCK
(HAMLET)
Lot 32.1
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 24, 2007 pursuant to whicb
Building Permit No. 3342S-Z
dated SEPTEMBER 26, 2007
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 STORAGE BUILDING AS APPLIED FOR.
The certificate is issued to MATTITUCK PRESBYTERIAN CHURCH
(OWNER)
of the aforesaid building.
SUFFOLK COUl!lTY DEPAR'DmIlT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~~
Aut or1zed S1gnature
Rev. 1/81
'(~--1i @ jCn-\~ [\' TOWN ~;~~U~HOLD
In r-I.,",': '2 5 '--ll u~ BUILDI~~~~TMENT
U 'I LI!.J 765-1802
L- J
b, U , C,Ep- A PLICA nON FOR CERTIFICATE OF OCCUPANCY
TC'~'yrL.OF.S",''IHQ~L_1
This application must be tilled in by typewriter or ink and submitted to the Building Department with the following:
A. For new buildiug 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, Swom statement from plumber certifYing that the solder used in system contains less than 2/10 of I % lead,
5. Conunercial building, industrial building, multiple residences and similar buildings and installations, a certificate
afCode Compliance from architect or engineer responsible for the building,
6. Submit Plarming Board Approval of completed site plan requirements,
B. For existing buildings (prior to April 9,1957) non-conforming Jses, or buildings and "pre-existing" land IIses:
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
Date, 9/25/07
New Construction:
Old or Pre,existing Building:
(check one)
MATTITUCK, N.Y.
Location of Property:
12605 MAIN ROAD
House No,
Street
Hamlet
Owner or Owners of Property:
MATTITUCK PRESBYTERIAN CHURCH
Suffolk County Tax Map No 1000, Section __l.lLli<L
Block
4
Lot 32. I
SubdiviSion
__~ Filed Map,
Lot:
Permit No,
33 'i:?5-f:-
Dale of Pennit--2J 13/07
Applicant: MATT. PRESBYTERIAN CHURCH_
Health Oept. Approval:_.____
_ Underwnters Approval
Plarming Board Approval ____~_
Request for:
Temporary Certificate
Final Certificate: x x
(check one)
Fee Submitted $
/
Applicant Signature
co .,;, 3;< 4> 4"
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.
33425 Z
Permission is hereby granted to:
Date SEPTEMBER 26, 2007
MATTITUCK PRESBYTERIAN CHURCH
PO BOX 1411
MATTITUCK,NY 11952
for :
CONSTRUCT ACCESSORY STORAGE BUILDING AS APPLIED FOR.
(THIS REPLACES BP #17846-Z)
at premises located at
13200 SOUND AVE.
County Tax Map No. 473889 Section 141
pursuant to application dated SEPTEMBER 24, 2007 and approved by the
Building Inspector to expire on MARCH
Fee $
100.00
ORIGINAL
Rev. 5/8/02
MATTITUCK
Block 0004
Lot No. 032.001
33f?--s ::2-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
0f FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
p~ ~ ~ (/)KJ
DATE
lo-{}-~o7
.
I
INSPECTOR ~ ~
)1rf~ 7-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONS11IUCTION [ ] FIRE RESISTANT PENETRAnON
9~' n J /
REMARKS: :) ,..0 -r.. ;;;t:;l. >
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DATE
7-//,-07
INSPECTOR *~
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1.
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FO~IDATI~N _
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FOUNDATIO:I
(2nd)
2.
ROUGH FRAt-IE &
PLUMBING
3.
INSULATION PER N. Y.
STATE ENERGY
CODE
4.
FINAL
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ADDITIONAL COMMENTS:
.
.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.N orthFork.net
PERMIT NO. 33425-2
(REPLACES BP #17846-Z)
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic F onn
N.Y.S.D.E.C.
Trustees
Stonn-Water Assessment Fonn_
Contact:
Mail to:
Examined
,20_
Approved
Disapproved ale
,20_
Phone:
Expiration
,20_
Building Inspector
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date 9/24/07
,20_
,
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. Ifno 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 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. [!~
r}r &'J ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of Owner of premises MATTITUCK PRESBYTERIAN CHURCH
(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.
El ectri cians Li cense No.
Other Trade's License No.
1. Location ofland on which proposed work will be done:
'f3e6o SOUND AVE.
House Number Street
MATTTTIJCK, R.Y
Hamlet
County Tax Map No. 1000 Section
Subdivision
14 ]
__a;:".,1
Lot 32. I
Lot
(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
STORAGE SHED
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work STORAGE
Alteration
SHED
(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, 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 20 .
Height Number of Stories
Rear
22 .
Depth
9. Size oflot: 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 bere-graded? YES_ NO~ Will excess fill be removed from premises? YES_NO-1L-
MATTI TUCK
BOX 14 II Phone No.
Phone No
Phone No.
MAn .PRESBY .CHUR6ilidress P.O.
Address
Address
14. Names of Owner of premises
Name of Architect
Name of Contractor
IS 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.
18. Are there any covenants and restrictions with respect to this property? * YES_NO_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF~
12.
(Name of individual signing contrac
AolX\ T
(Contractor, Agent, Corporate Officer, etc.)
being duly sworn, deposes and says that (s)he is the applicant
bove named,
(S)He is the
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.
Sworn to before me t~
~'8" day of .
,O~\Q.~~
Notary
20 i23:.
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400 Ostrander Avenue, Rlverhead, New York I 1901
G3 I -727-2303
ACCESSORY SHED FOR
MA TT1TUCK PRESBYTERIAN CHURCH
How<3rd W. Young, land Surveyor
Thomas C. Wolpert. Professional Engmeer
Robert C. Tast. Architect
Ronald E. Pfuhl, Landscape Architect
Mattituck, Town of Southold
Suffolk County, New York
OWG. PREPARED
SCALE: AS NOTED'
JOB NO. mpc shed
AUG. 13, 2007
A-1
FLOOR PLAN
ASPHALT SHINGLES OVER 15# FELT
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o ~~TH '74~EV~~.ION
Young If: Young
400 Ostrander Avenue, Rlverhead, New York I 190 I
(;3 I ~ 727 ~2303
ACCESSORY SHED FOR
MA TT1TUCK PRESBYTERIAN CHURCH
Howard W. Young. Land Surveyor
Thoma::; C. Wolpert, Profe551onal Engmeer
Robert C. T .:;1st. Architect
Ronald E. Pfuhl, Landscape Architect
Mattituck, Town of Southold
Suffolk County, New York
DWG. PREPARED
SCALE: AS NOTED'
JOB NO. mpc shed
AUG. 13, 2007
A-2
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Young If: Young
400 Ostrander Avenue, Rlverhead, New York 1 1901
(;31.727.2303
ACCESSORY SHED FOR
MA TT1ruCK PRESBYTERIAN CHURCH
Howard W. Young. Land Surveyor
Thom<35 C. Wolpert. Professional Engineer
Robert C. T <3st. Architect
Ronald E. Pfuhl, Landscape Architect
Mattituck, Town of Southold
Suffolk County, New York
OWG. PREPARED
SCALE: AS NOTED'
JOB NO. mpc shed
AUG. 13, 2007
A-3
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400 Ostrander Avenue. Rlverhead, New York I 190 I
G31-727-2303
ACCESSORY SHED FOR
MA TT1TUCK PRESBYTERIAN CHURCH
Howard W. Young, Land Surveyor
Thomas C. Wolpert. ProfessIonal Engineer
Robert C. T .3st, Architect
Ronald E. Pfuh!, Landscape ArchItect
Mattituck, Town of South old
Suffolk County, New York
DWG. PREPARED
SCALE: AS NOTED'
JOB NO. mpc shed
AUG. 13, 2007
A-4
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