HomeMy WebLinkAbout36516-ZTown of Southold Annex
54375 Main Road
Southold, New York 11971
7/19/2011
CERTIFICATE OF OCCUPANCY
No: 35072 Date: 7/19/2011
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
ACCESSORY GARAGE
1175 CENTRAL DR1VE, MATTITUCK,
Sec/Block/Lot: 106.-2-29
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/1/1900 pursuant to which Building Permit No. 36516 dated 6/28/2011
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 one car garage as applied for.
The certificate is issued to
Achey, Katherine
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36516 7/15/11
Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 36516
Permission is hereby granted to:
KATHERINE ACHEY
1175 CENTRAL DRIVE
MATTITUCK, N.Y. 11952
Date: 6128/2011
To:
CONSTRUCT AN ACCESSORY GARAGE. REPLACES EXPIRED BUILDING PERMIT #
14151
At premises located at:
1175 CENTRAL DRIVE
SCTM # 473889
Sec/Block/Lot # 106.-2-29
Pursuant to application dated
To expire on 12/27/2012.
Fees:
1/1/1900
and approved by the Building Inspector.
PERMIT RENEWAL
Total:
$12.50
$12.50
Building Inspector
FO~M NO. ~
TOWN OF $OUTHOLO
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
No~ z
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to: ~ __ -- /~ ~
....~.~i....~.~........:..~.~
..~..1.~..~....~.~.~ .........
.~..~....~.~m...,..:..~.~.~..~ ......... .
~ ....... ~.~. .................... ~..~. :. ~..~ ...........
.................... .....
at premises located at ...J..J,..-)..~'.. ...... ~~..,~L~-,~ ...............................................
pursuant to application dated ...... ~.......~....~,..~.~.. .................. 19..~.....~., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
~orm No. 6
TOWN OF $OUTHOLD
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 0f property with accurate location of all buildings~ property lines, streets, and unusual naturat or
topographic features.
2. Final Approval from Health Dept. of water supply and sowerage~iisposal (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" laad uses:
1. Accurate survey o f property showing all property lines, streets, building and:unnsual naturai or topographic
features.
2. A properly completed app}ication 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
· Swimming po01 $50.00, Accessory building $50.00, Additions to aoeessory building $50.00, Businesses $50.00:
2. Certificate of Ocoupancy on Pm-existing Building - $t00.00
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. '~" [ c~ / I
New Construction:
Location of Property: I } '~ ~ QO~/-~ ~ t~-
House No. Street
- OwnerorOwnersofPmperty: ~.~ ~ d'2_4~/x_~ '
· lluffolk~ountyTax Map No 1000, Section ] O (~,
Subdivisibn
Old or Pre-existing Building:
PormitNo. ~2)'{~, ~-- / [~ DateofPermit.
Health Dept. Approval:
(check one)
Filed Map.
Lot
Lot:
Hamlet
Applicant:
Underwriter~ Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate:
Foe Submitted:f $(j,~t/,Q { ~-) ~ . ~
(check one)
Applicant Signature
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (63 I) 765-1802
Fax (631) 765-9502
ro.qer.richertC, town.southold.ny, us
BUILDING DEPARTMENT
TOWN O1* SOUTItOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Margaret Lynn
Address: 1175 Central Dr City: Mattituck St: NY Zip: 11952
Building Permit #: 36516 Section: 106 Block: 2 Lot: 29
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ Basement ~ Service Only [~
Corn medcal Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 3 ph Hot Water GFCl Recpt
Main Panel A/C Condenser Single Recpt
Sub Panel NC Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment: detached garage
Ceiling Fixtures ~
Wall Fixtures ~
Recessed Fixtures ~.~
Fluorescent Fixture ~
Emergency Fixtures~
Exit Fixtures [~
HID Fixtures
Smoke Detectors
CO Detectors
Pumps
Time Clocks
TVSS
Notes:
Inspector Signature:
Date: July 15 2011
81-Cert Electrical Compliance Form
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802 '
INSPECT
[ ] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING ~,~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CO#S'IllUCTI~ [ ] FIRE RESISTANT PENETRATION
REMARKS:
INSPECTOR
DATE
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ~ELECTRICAL (FINAL)
REMARKS:
DATE
i NSPECTOR~~~-~
FIELD ~NSPE'CTION "'
FOUNDATION (1st)
COMMENTS
/
FOilN DATION ( 2nd )
ROUGH FRAME &
PLUMBING
iIiS!JLATION PER N.
STATE ENERGY
G~ODE
FINAL
ADDITIONAL COMMENTS:
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved...~.~... ~-., 19~.~. Permit ~..
Disapproved a/c .....................................
................................ ......
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Received ........... ,19...
a. Tiffs 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have been granted 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatio~as, and to
admit authorized inspectors on premises and in building for necessary insp~ct~_,_z~ ~ /f ~ z~
,~Signatur_e ~ppl~_, or ~na~h ifa oorp~orati~g~,,.
(Mailing address of applicant) hq 55l_
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ./~.6~ .......................
(as on the tax roll or latest d~ ........................
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's LicenseNo ..........................
Plumber's License No .........................
Electrician's License No .......................
Other'Trades License No... Z ~..~,*: ~....fi-..].~.'~....
1. Location of land on which proposed work will be done ..................................................
// .z . . . .c. . . ...... . . .......................................
House Number Street Hamlet
County Tax Map No. I000 Sect~n~c/~/(~"'~'"'-~'~?~'} Block..~-.~-.....'~.. .... Lot...~..'..~.~....
Subdivision. ~.~. A?.~. ~&~.'....~..-(..X. y ........... Filed Map No. //~..Z..<z~7..... Lot . .k~r). .........
(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 "c~'r,~ ~1 ?~(M'c~_ -- kc_cOx :
3.
Nature
of work (check which applicable): New BuildingS..4 '~'q3 ~ Addition .......... Alteration ..........
Rep~ ~'t '~ ...... Removal .............. Demolition .............. Other Work ...............
-~ C) ~ (Description)
4. Estimated Cost . /0/?.2 /~
.................................... Fee ..............................
(to be paid on f'fling this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
If garage, number of cars .. ~} .....................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ................... Number of Stories
8. Dimensions of entire new construction' Front 'q' Re ~ ~ ' ............. ; ........
................ ar ............... Depth . .'~L;br. .........
9. Sizeoflot Front /ff.~..:~ Rear /. F-)~::~,~.? no,~*h /~'~'),'~') ...........
10. Date of Purchase .. ~-... f.]:: .].~. .............. Name of Former Owner .~.q~/~.a- ~ v/~q .~.~.
11. Zone or use district in which premises are situated ........ ' ....... q
12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. ~
13. Will lot be regraded ~.O. 'r~','c ...... .~..,...,. .....Will excess fill~ be r~moved from premises: Yes (No.)
14. Name of Owner of premises/lq'th..~'~,d..~..,~7 b.-~ .)/Address //~.-.~.(.~d,l't't-~{ /~.,.. Phone No.~.~f.~/'~.~.--.~..d.~
Name of Architect /.Address ~-~ ~.'~ ' ' '
............................................... Ph~.= ~,u ................
Name of Contractor .......................... Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
STATE OF NEW YORK,
COUNTY OF ................. S.S
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
(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
............-' '~f~%. ~: ~. ~.0~.. /'~' ' '~' ' "' ' ' 'day °f ' '~3'~4'~ ' .......... 19~'~'
Notary Public ............... County ~,,~-~-~ . ,/' ·
elephone (681) 765-1802
n.$omnolo.n¥.u$
REQUESTED BY:
Company Name: J~ ,t ~ ( -*~"
Date:
Name:
License No.:
Address:
Phone No.:
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
JOBSITE INFORMATION:
.lcf
lOOO Section:
(*Indicates required information)
Block:
*BRIEF DESCRIPTION OF WORK (Please Pdnt Cleady)
Lot:
(Ple~ase Circle All That Apply)
*Is job ready for inspection: '
*Do you need a Temp Certificate:
Temp Information(If needed]
*Service Size: 1 Phase 3Phase
*New Service: Re-connect
Additional Information:
100
Underground
YES NO
YES NO
Rough In Final
150 200 300 350 400 Other
Number of Meters Change of serVice Overhead
PAYMENT DUE WITH APPLICATION
82-Requestforlnspecfion Form
~ MA'P
//
LOT
13'/, :BLK. :Lt
CA'PTA
.I~.,.qTAT E~
M A'rTITLI~ K
II,IL-ET
T0~,/M OF'
..~OLITH O
..~ LI F'FOLK
.,,9~a~ I~-- 30'
' /oo. 0'
¼
13'1
'- ?OO. 0
Zo
-
"' 5~5.0'"
G f_kl~ ~l OT F__.g
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
APPROVED AS NO~ED
FEE: ~''~'' ~' BY: ~ ~'
NOTIFY BUILDIN~ DLPARTMENT AT
765-1802 ~ A~vl TU 4 PM ~R THE[
FOLLOWING IN~P~C': ~;~:
1 FOUNDATIOr~ ~,..~. REQUIRED
FOE POURE;
2. ROUGH FR,' ~INS & ?LUMBING,
3. INSULATION
$. F~AL COV,.,[~I_;TiO~ MUST
~ COMPLE] E FOR C.O,
ALL CONSTRUCTION SHALL ME~'
THE REQUIr~MENT~ OF THE
STATE CONSTRU~N & ~ERGY
CODES, NOT RES~NSIBLE FOR
DESIGN OR CON~T~iON ERRORS,
f-LOOP-,
_ 4x~?z:, ~,~r~-,:~...~_ .......