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Home My WebLink About34529-ZFORM NO. 4 TOWN OF SOL~fHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33633 ate: 04/02/09 THIS u~I(TIFIES that the building PLAYGROUND Location of Property: 11280 GREAT PECONIC BAY BLVD LALrREL (HOUSE NO.) (STREET) (HAMLET) County T~ Map NO. 473889 Section 126 Block 6 Lot 18 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 25, 2009 purs,,~nt to which Building Pex~lit No. 34529-Z dated MARCH 25, 2009 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 PLAYGROUND AND GAZEBO AS APPLIED FOR. The certificate is issued to MATTITUCK PARK DISTRICT (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELBt-rKICAL c~RTIFICATH NO. PLU~ERS CERTIFICATION DA'£~U N/A N/A N/A /~~ ~horized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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: 1. 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 !nstallation 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: 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. April 2. 2009 New Construction: Old or Pre-existing Building: (check one) Location of Property: 1 'l?RO el.I- Pac~onic Ray Rlvd House No. Street Laurel Hamlet Owner or Owners ofProperty: Mattituck Park District Suffolk County Tax Map No 1000, Section 1 26 Block 6 Lot 1 8 Subdivision Filed Map. Lot: Permit No. ~ A ~ ,, ~, ,, Health Dept. Approval: Date of Permit. Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ o Final Certificate: xx (check one) Applicant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~)ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34529 Z Date MARCH 25, 2009 Permission is hereby granted to: PARK DIST MATTITUCK PO BOX 1413 MATTITUCK,NY 11952 for : CONSTRUCTION OF A PLAYGROUND SHELTER & EQUIPMENT AS APPLIED FOR, THIS REPLACES BP# 27349. at premises located at 11280 GREAT PECONIC BAY BLVD LAUREL County Tax Map No. 473889 Section 126 Block 0006 Lot No. 018 pursuant to application dated MARCH 25, 2009 and approved by the Building Inspector to expire on SEPTEMBER 25, 2010. Fee $ 0.00 Authorized Signature ORIGINAL Rev. 5/8/02 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) ~5~9 Date JUNE 5, 2001 PERMIT NO. 27349 Z Permission is for : CONSTRUCTION hereby granted to: PARK DIST MATTITUCK PO BOX 1413 MATTITUCK, NY 11952 OF A PLAYGROUND SHELTER & EQUIPMENT AS APPLIED FOR. at premises located at 11280 County Tax Map No. 473889 Section 126 pursuant to application dated JUNE Building Inspector. GREAT PECONIC BAY BLVD LAUREL Block 0006 Lot No. 018 5, 2001 and approved by the Fee $ 0.00 Authoriz~ Signature ORIGINAL Rev. 2/19/98 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ] FRAMING / STRAPPING [~ FINAL ~: [ ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION REMARKS: [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION DATE __? '~-7 ~ O/~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION ~FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [//~FINAL [ ]FIREPLACE&CHiMNEY [ ] FIRE SAFETY INSPECTION [] .RE RESlST,~r OOI~R~ [ ] .RE RES~TANT ~.NETRA11ON REMARKS: INSPECTOR INSULATION PER N. Y. /o c> o -./.~ ~, _ ~ - ?/~=TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET I I'~._'~ (~ VILLAGE DIST. SUB. LOT FORMER OWNER N/?~,~, /~ ,~,, E W///~ ~,_~.....' ACR.> I " RES. S~S. VL. FARM / CO~. CB. MICS. Mkt. Value ~ND IMP. TOTAL DATE RE~RKS / '/ AGE BUILDING ~ONDITION N~ NORMAL BELOW ABOVE FARM Acre Volue Per Value A~ Tillab;e FRONTAGE ON WATE~ Wo~l~nd FRONTAGE ON ROAD Meadowland DEPTH Hous~l~___ ~ BULKH~D Total DOCK COLOR TRIM M. Bldg. Extension Extens~ ~ Garage Patio Total /,cz y Foundation Ext. Walls Fire Place Type Roof Recreation Room Dormer Both Floors Interior Finish Heat Rooms 1st Floor Rooms 2nd Floor Driveway LR. DR. MATTITUCK PARK · DIS T. 2.$A¢c~ BUILOI,.NG DI~. PAIkTMEN~ SOUTHOLD, ~ 11971 TEL: 765-1802 Examined ,20 Approved ~l~[' ,200~ Disapproved adc Do you have or need the following, before applying ? Board of Health 3 sets of Building Plans Survey. Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building slEg~ctor APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS /'~ ,20,~t/ 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 tl'ds 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 a Certificate of Occupancy is issued by the Building Inspector. 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 akerations 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 adrdt authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a co-.oration) ,£ / (Mating a~ess ofapplic~t) State whe~er applic~t is owner, lessee, agent, ~c~tect, engineer, gener~ con,actor, elecffici~, plmber or b~ld~ N,eofownerofpremises (~~ ~ ~~ (as once t~ roll ~test 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. Location o£ land on,which prouased work will be done: 5/d~,//~H~amle~t ¢ Hbuse Number ~ S~eet ff County T~ Map No. 1000 Section /~¢ Block ¢ Lot /g Subdivision Filed Map No. Lot 6-7,7 a. Existing use and occupancy b. Intended use and occupancy //,~tT~,d.t' //f~/Z~ ~-r'/~"~lf~/JO, ~ ~ ~/~_~./~ 3. Nature of work (check which applicable): New Building Addition Alteration~ Repair Removal Demolition Other Work 4. Estimated Cost ~. oc-- fO 5. If dwelling, number of dwelling units If garage, number of cars (Description) Fee d-- (to be paid on filing this application)/~r~ Number of dwelling units on each floor _//.,~_/' 6. If business, 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 Dimensions of same structure with alterations or additions: Front _Depth Rear Depth / . . Height Number of Stories 9. Sizeoflot: Front 10. Date of Purchase Dimensions of entire new construction: Front Height fd~ ~ Number df Stories Rear .Depth Rear .Depth Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: .,,/~. 13. Will lot be re-graded ~//~ -f-~,~)~/'~ Will excess fill be removed from premises: YES ~ 14. Names of Owner ofpremises/~lff/~ ~/~'~/~.Address D~,~/J~.v//f~'/..,? Phone No. 6~-~"/~ff Name of Architect ' / Address// / Phone No ' Name of Contractor Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES NO ~ · IF YES, SOUTHOLD TOWN TRUSTEES 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__ ) ,, f?"/~,/~/)~' ~' /ffg~-//A/~~ ' - being duly swom, deposes and says that (s)he is the applicant - (Name of indi~l'dual s~gning ~ontraqi)labove named, (~)He is the 5/0q/Jdr'.i~f/~:,~ t~ (Contractor, Agent, Corporate Officer¢/otf 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 tree 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 ~~~~~f day of 20__ L ' N~tary Public ' /i S~gnature of ~pl'lc~ Co Ouali~i~ la Suffolk ~ ELE\/ATION F~OOF FRAt'"IN~ PLAN 765-1802 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING B, INSULATION 4. FINAL - CONS'rRUCTION MUST BE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS SECTION ~EAM LAYOUT _o-r