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Home My WebLink About35831-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34564 Date: 09/17/10 THIS CERTIFIES that the building ACCESSORY GAZEBO Location of Property: 4615 WESTPHALIA RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 113 Block 13 Lot 2.1 Subdivision Filed ~lap No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 18, 2010 pursuant to which Building Permit No. 35831-Z dated SEPTES~3ER 7, 2010 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 "AS BUILT" ACCESSORY GAZEBO AS APPLIED FOR. The certificate is issued to JAMES M & MARY ELLEN RUHF (OWNER) of the aforesaid building. SUFFOLK COUN~TY DEPART[~gNT OF HB;kLTH APPRO~-AL Z.~'nlICAL C~I~TIFICATE NO. PL~ER~ c~KTIFICATION DA'i'~U N/A N/A N/A Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35831 Z Date SEPTEMBER 7, 2010 Permission is hereby granted to: JAMES & MARY ELLEN RUHF 4615 WESTPHALIA ROAD MATTITUCK, NY 11952 for : "AS BUILT" ACCESSORY GAZEBO AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 113 pursuant to application dated AUGUST Building Inspector to expire on MARCH 4615 WESTPHALIA RD MATTITUCK 18, Block 0013 Lot No. 002.001 2010 and approved by the 7, 2012. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 BUILDING DEPARTMENT TOWN HALL 765-1802 BLDG D£Pf. APPLICATION FOR CERTIFICATE OF OCCUPANt; Z- TOWN OF S0UfHOLl} 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 (8-9 form). 3. Approval ofeteetrical installation from Board ofFire Undenvriters. :.4' Sworn statement fromplumber cgrtifying 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'~ompleted site plan requirements. "B, .For existingbuildings (prior to April 9, 1957) non, conforming uses, or buildings and ~*pre~xisting" land uses: 1. Accurate survey of property, showfiig all property lines, streets, building and tmusual natural or topographic features. 2. A Pr°POrly c°mpleted applieation 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. CerOficate of Occupancy - blew 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. Certifieatc of O~cupancy 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 /qCw Coastmctinn: ~[ Old or Pm-existing B~uilding: (check One) House No. Street Owner or Owners of Property.. ~'F/"x~ ~-¢ 3-~ [~ ~¢ "SU~olk County Tax Map No 1000, Section. iq - Subdivision Permit No. Date of Permit. Health Dept. Approval: (x/ ~ Planning Board Approval ~ ~- Hamlet Filed Map. . Applicant: Underwriters Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: ~4~ (check one) (~licant Signature (J TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~ ] INS~~N [ ] FRAMING / STRAPPING [~'I:INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ]FIRERESISTAI~FENLrrRATION INSPECTOR DATE OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Exmnined ¢/7,20 Approved ~/~7, 20 Disapproved a/c Expiration PERMIT NO. AUG I 8 20]0 BEDE OEP]. TOWN OF SOUIRO[f) BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plansl~)~ ~"~,-~ Planning Board approval Survey Check ~C~C) . C)~ Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: :~ector 2ATION FOR BUILDING PERMIT Date INSTRUCTIONS ,20 /D 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 tbroughout 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. fi 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 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. ',,;NLAWi-,. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~'~V~ g4 _J~'~ If applicant is a co~,x~ratig_n, sig99tu/e of duly authorized officer ~d title :>~officer) ' Builders License No. ~: : Plumbers License No. Electricians License No. Other Trade's License No. 1. Location/~ Iff' of landM]on ~- 9~LO [~c~ D6which Pr°~pgsedx -~ ,,wr~k~ill be done: House Number I Street - County Tax Map No. 1000 Section Subdivision (Signature of applicant or na~fa corporation) t (Mailing address of applicant) / / (As on the tax roll or late~i 'db~my- #?q.~o -~I _ NOTIFY BUILDING DE~ARTMEN 765-1802 8 AM TO 4 PM FOR ~c:- FOLLO~NG INSPECTIONS: 1. FOUNDATION - ~ REQUIRED FOR POURED CONCRETE 2. ROUGH - FR~, ~UUBI~, STRAPPING, ELECTRICAL & CAULKIN~ 3 INSU~TION 4 FINAL- CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FO~ C 0 ~A[L.C~N~TR~TION SHAM MFETTHE ~ATE NOT RESaO sto OR CONSmuCTtOU Filed Map No. :., ,* Lot 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 3. Nature of work (check which applicable): New Building ")k Addition Alteration Repair ,~ Removal Demolition / .~3ther Work' - ' 4. Estimated Cost X [ Fee / \~ / \(To be paid on filing this application) 5. If dwelling, nuflpber of ~lling units Number Cf dwelling\units on each floor If garage, nulber of car% ]---- ~ 6. If business, c?mercial or mixe~cq pancy, specify na~/re and e~tent of e~ype of use. 7. Dimensions ot~ existing structures, it~ ty: Front ! Rear ' Depth Height / Numt er of Stories - Dimensions (~f 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 of lot: Front Rear Depth 10. Date of Purchase Il/~ff" 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? YES NO 2>~ 13. Will lot be re-graded? YES NO ~>~ 14. Names of Owner of premises Name of Architect Pk) ~ Name of Contractor p)t ~ Will excess fill be removed from premises? YES NO__ Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * 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 }x( * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO 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. any covenants and restrictions with respect to this property? * YES NO ~ 1 8. Are there · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF ~,1~ I~-S)S: ] O. {q~.S ¢_.01 ~a~' being duly sworn, deposes and says that (s)he is the applicant (I'~ame of individual signing contract) above named,. (S)Heisthe -¢,; :,4o.~, :'<, ~'".,. . ,. :~dQ~r,~ctgr, Agent, Corporate Officer, etc.) of said owner:.~ ;or ff~i¢~i'~,~ ,--_and;i~l~;t~mtth°rized to perform or have performed the said work and to make and file this application; that statements Contained'intl~iS.application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set £ollh in the application filed therewith. Swor~ ~ befO~ea~n;;his//~ 0 (Zg ~- 20 I0 - · I ..... ELL Notary PuSher N°tatYl~l~l,_.S_tate of New York Signature of Applicant F Il ,? - )3 -.jT~ OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET ~/6 /5 V l LLAGE LOT FORMER OWNER RES. LAND I SEAS. VL. IMP. FARM COMM. CB. MICS. TYPE OF BUILDING TOTAL DATE REMARKS Mkt. Value AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Acre FARM Tillable __FRONTAGE ON Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Value Per Value Acre DOCK ~xtension 113.-13-2.1 2/06 ;OLOR 7-00 Ext. Walls Fire Place Type Rooff RecreatiOn Room Dormer Rooms ]st Floor Roo~s 2nd Floor DriveWay LR. DR. BR. FIN. B 3 Interior Finish Heat Town of Southold ~-~_)~ ~/~' ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM ~O~ PROPERTY 7tON: ~.C.T.~ ~: THE FOLLOWING A~IONS MAY REQUIRE THE SUBMI~ION OF ~ 1~ ~, ) STORM-WATER, G~ING, D~INAGE AND EROSION CO~ROL p~NA D~ s~n ~k ~ ~=~ I ~rl~U BY A DESIGN PROFE~IONAL IN THE STA~ OF N~ YOR~ SCOPEOFWO~ - PRO~S~ CON~UCTION ~ / WO~~ [ Y~ No a. ~at is ~e T~al Ama of t~ Pm]e~ (In~e Total Ama of all Pa~ 1~ wi~in 1 ~ll ~ Pmje~ Retain NI S~Water ~ Genemt~ by a T~ (2") In~ ~11 ~ SEe? the S~ of Wo~ for P~ ~s~) b. What ~ ~e To~l ~ ~ ~ Qeafl~ [S.F./~) ~b item ~11 i~ude all m~ff ~at~ by ~ deagng a~ ~n ~ as ~ ~ all an~ G~nd Distu~ for ~e ~ SEe Im~en~ and the pe~nent ~afl~ of ~s~ a~? imams ~.) (s.F.,~) 2 ~s ~e ~ ~an and/or Su~ey S~ NI P~ PRO~E B~ PRO~ D~ON ~ ~ ~ ~ Dmin~e ~ I~g ~ & L~n? ~b ' item ~all In~e all ~ Grade Cha~es a~ ~ ~e ~CCTV a~~N ~ itemmu~bemaln~in~*mugh~t~eEnflm C~s~on Ped~. ~sfl~ G~e In~Mng mom ~an 200 Cubic Ya~s ~~ ~ of Material ~hin any Pardi? U 5 ~11 ~is ~pii~tion Require Land DJs~ A~fi~ En~t~ an ~a in ~ss of F~e (5,000 S.F.) ~uam Feet of Ground Su~? -- 6,, ~ere a NaOmi Water ~ume Runni~ ~mugh ~ Site? Is this Pmje~ ~in ~e Tmaees jud~i~n ~eneml DEC S~PP RequJmmen~: or ~in O~ Hundr~ (100') feet of a We~a~ ~ d~a~ of ~ (!) or ~ ~; ~ d~s ol ~ ~an ~e ~ ~ [ 7 ~, ~e be Site preparation on Exis~ng G~e SI~ am pan ~ a la,er ~ p~n ~ ~1 u~ d~ ~ or ~ a~ ~ ~nd; whi~ Ex,ed Fifteen (15) f~t of Venial Ri~ to i~di~ ~s~ a~ ~g ~il ~n~ ~ ~ ~n ~e (1) ~ ~m One Hu~md (10~) of Ho~tal Distant?~ 2. ~ S~ ~ ~ ~ ~ ~ ~l~t ~ ~ ~ ~ 9~11 ~ Pmje~ Require ~e ~a~nt of Mat~al. ~u~d. ~ s~ ~ ~n~i p~ ~at ~ ~ ~ ~ Re~l of V~e~O~ an~or ~e ~ns~ of any ~s~ ~ ~u~ ~ ~n~ ~ s~ ~r d~mes and ~ ~m ~m ~in ~ T~ ~ght~f-Way or Road S~ ~'Aq~OFNEWYO~ ~, ~p ,, q~at I,. ............................................................................... ~g d~y s~m, de~s ~d says ~at h~she ~ ~e app~t for ~d~th~sheis~e . . .~.~.5.....{~.: ~ ~ [~ ~ ~er ~or ~presen~five of ~e ~er or ~, ~d is duly au~o~d to peffo~ or have ~ffo~ed ~e ~d work ~d m~e ~d ~e ~s application; ~t ~I sm~menm con~ed ~ ~ app~mOon ~ ~e to ~e best of his ~o~e~ ~d beliefi ~d · at ~e ~rk ~1 ~ ~ffomed in ~e met set fo~ ~ ~e applimfion fried h~. Sworn m ~fo~ me ..................... 1.~ ................. day of ............................................ FORM - 06/10 ~uaJifled in SillolkCk County · zxn,n~ss~on Expires Sept. 29, ~{ 18' , .. !,?r?~.%~ I SUFFOLK COUNTY DIS~'R/¢T SECTION LOT. S LLC SURVEY OF DESCRIBED PROPERTY AT I~ATrlTUCK TO~'N OF SOUTNOLD. SUFFOLK COUNTY. NEE YORK SUR~RY 24. 1997 ~ALE , I' - I00' ~ ~ ~ z~ ~, lo'Y? HARRY P. HILLEBRANO · LAND SURVEYOR II CHURCHILL LANE - SMITH,OWN. NEW YORK TEL..(~/6) 54J-5139