HomeMy WebLinkAbout32936-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32780 Date: 12/06/07
THIS CERTIFIES that the building DECK ADDITION
Location of Property: 165 SELAR
(HOUSE NO.)
County Tax Map No. 473889 Section 106
LA
(STREET)
Block 9
MATTITUCK
(HAMLET)
Lot 4.4
Subdivision
Fil.ed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 16, 2007 pursuant to which
Building Permit No. 32936-Z
dated
APRIL 24, 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 DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MICHAEL & LISA FANDREY
(OWNER)
of the aforesaid building.
SUFFOLK COUl!lTY DEPARTMEI!IT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATIOlII DATED
N/A
~od~
Rev. 1/81
_I' ~ - 07
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This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
.... ,1
",-: Ii: I'
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 2/10 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:
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 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. D G ... 3> . t. 0 ~ I
New Construction:
-..., I) 'l.~ '<. Old or Pre-existing Building:
(check one)
Location of Property: 1105' )~L\>.\" \...~~l ",l)..\-Ia.~~~)\l N.'i.
House No. Street Hamlet
Owner or Owners of Property: /Y1. II..... .. l;>",- {- (:>.c->Q(\I:':1
Suffolk County Tax Map No 1000, Section 'il) """ \I)\, q-L\>,-\ Block Lot
Subdivision Filed Map. Lot:
Permit No. } 'L q 3 to -:t.. Date ofPermit.~ Applicant: rn; \~ i. ~l?- ~{\ l\\- ~
Health Dept. Approval: rJ \ J>.. Underwriters Approval: w \f>o.
Planning Board Approval: ,J \ A
Request for:
Temporary Certificate
Final Certificate: ---.::..
( check one)
Fee Submitted: $ 'l.,:S ,0
f\,{\. ~ Il.. \Q ~
Applica 19nature
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(.t)~3~ 7 rD
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.
32936 Z
Date APRIL
24, 2007
permission is hereby granted to:
MICHAEL & LISA FANDREY
165 SELAH LANE
MATTITUCK,NY 11952
for :
DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at
165 SELAH LA
MATTITUCK
County Tax Map No. 473889 Section 106
Block 0009
Lot No. 004.004
pursuant to application dated APRIL 16, 2007 and approved by the
Building Inspector to expire on OCTOBER 24, 2008.
Fee $
200.00
AtMA~~ :;i~"
J Authorized Signature
ORIGINAL
Rev. 5/8/02
3 f)-~ J b Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
NFINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
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DATE
Il ~;1-7~ ~ 7
INSPECTOR
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3e-13~ Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
0. FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
~ FRAMING I S!RAPPlNG [] FINAL
r _
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON
REMARKS:
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S.-- 3~- 07
DATE
INSPECTOR ~~
], ';-1 3 b :2-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
p<fFOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONS'IRUCTION [ ] FIRE RESISTANT PENETRATION
REIlARKS'e<AL 7- ~
~~
DATE S-Io - tJ7
INSPECTOR *~
.
FIELD INSPECTION REPORT DATE COMMENTS I UJ
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FOUNDATION (1ST) '11 u -r.x y '-1t-' J I ~ E5
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FOUNDATION (2ND) IV ) rr
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ROUGH FRAMING &
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INSULATION PER N. Y.
STATE ENERGY CODE
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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OWNER
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ACR. ,.. .. REMARKS
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DIST, SUB,
LOT .z..
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TYPE OF BLD,
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IMP, -+OTAL DATE
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FRONTAGE ON WATER
TILLABLE
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WOODLAND
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FRONTAGE ON ROAD
DEPTH
MEADOWLAND
BULKHEAD
HOUSE/LOT
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Extension ,5,,15"= S25 ) 'i?l-f I 3<0 1 9'1'-' Ex!. Walls Ye5 Interior Finish l.R
Extension ,,,,r'J_ ~-~ Fire Place Heat
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Patio (,e Ie.!> ~4ftl Woodstove BR.
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Garage 2 z"Z 'I ;; S :2.f3 /.2S' LLn Driveway Rooms 2nd Floor
O.B.. /;1 /61-/(","'-/60 ,p,1 (06
Pool S tv&;<.V"''' (~A/I/.J/I\ Sl'or '3~
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PERMIT NO.
?.)'1-?' b-c-
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
Contact:
Mail to:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALe
SOUTH6LD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SoutholdJ
f/?4- ,20~
iFf 20fl
Examined
Approved
Disapproved alc
ID/~..JI, 20 of
Phone: ~g '1, S'R 15 .~
Expiration
fCI/_
Building Inspector
JR\6'li
APPLICATION FOR BUILDING PERMIT
Date ~~(', \ I"
,20~
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
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 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.
\'N\'~~~.\J,.. -:r",~., '\_
. (Signature of applicant or name, if a corporation)
\'"
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~~~\:.~
Nameofownerofprernises ~..<:~se.."'-\ '.. \..',~.... {\l,,'~~~G~
(As on the tax roll 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 09and on which proposed work will be done:
\ h '> ')~_L",,~ \..~..I.... rl\~\X.\",,/\-
House Number Street
Hamlet
County Tax Map No. 1000 Section lOb
Subdivision
Block CJ
Filed Map No.
Lot '7. '-/
Lot
(Name)
2. State exist!n~ 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 '''-...,.
Other Work
Alteration
4. Estimated Cost
'tt [I ,(l c \J
(Description)
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
Depth Height Number of Stories
~Rflar
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
II. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO L
13. Will lot be re-graded? YES_NO_ Will 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 OF s\JH~\ ~
rv1 \ <:..-\,1;>,."'- \ {. "'~f'>\).~5 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
c) ....1,.} efJ..
(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.
Sworn to before me this
I"'~' day of A~(\...,.( 20~
~~~~..
otary Public
~"6'fA~;/~&~tlc State of New York
No 01 JU6059406
Qualified In Su1folk COMunl~9 2012J
Commission Expires ay I
otY)4~L ~u-JL\~
Signature of Appl
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