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Home My WebLink About37374-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 7/25/2012 CERTIFICATE OF OCCUPANCY No: 35844 Date: 7/25/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: SHED 625 E Side Ave, Mattituck, Sec/Block/Lot: 99.-3-15.1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 7/5/2012 pursuant to winch Building Permit No. 37374 dated 7/19/2012 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" shed addition to existing dwelling as applied lbr. The certificate is issued to Keller, Richard & Janice (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Au~il6Jed Sij~fnature -/ 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 #: 37374 Permission is hereby granted to: Keller, Richard & Keller, Janice 625 E Side Ave Mattituck, NY 11952 To: "As Built" Shed addition to an existing dwelling as applied for Date: 7/19/2012 At premises located at: 625 E Side Ave, Mattituck SCTM # 473889 Sec/Block/Lot # 99.-3-15.1 Pursuant to application dated To expire on 1/18/2014. Fees: 7/5/2012 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION CO - ALTERATION TO DWELLING Total: $400.00 $50.00 $450.00 Building Inspector 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 w!th the following: A. For new building or new use: I. Final survey °f pr°perry with aceurateloeation of all buildings, property linea, streets, and unusual natumt or · topographic features_ - 2. Final Approval from Health Dept. of water supply and sewerage.disposal (8_9 formil. 3~ Approval of electrical in~talIation fi'om Board 6fFire Undenvdtem. · · 4. 'aw. om statement from plumb, or c, extifying that tho raider used in system contains leas than 2/10 of 1% lead.. 5. Commemial building, industrial building, mtfltipi¢ reaidenoea and similar buildings and installations, a certificate of Code ComPliance'from architect or engineer reaponsibl¢ for the building; .6. Submit planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957] ~ion-eonforming us~s, or buildings and "pre-existing" I~tud Uses: 1. Accurate survey of property showing ali property lines, streets, building and. unusual nalursi or topographic features. ' 2_ A properly c,9mp!eted 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. Certifica[e of Occupancy - Nex~ dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, ~ Swimmitig pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00,. 2. C~tifieate of Occupancy on Pre-existing Building - $100.00 ' 3_ Copy of Certificate of Occupancy- $:25 4. Updated Certificate of Occupancy. $50.00 5. T_empoFary Certificate 0fOccupancy - Residential $15.00, Commercial $15.00 Construction: Old or Pro-e~isting Building:. - ~-~ation of Property: (.0 ~ ~ ~' ~ ~)~,0..4qA~ House No. Street )w~ror Owners or Propert~ .._~ ~9- --'~r-~, ~tffolk .Corny Tax Map No'1000, Seetiqn (~ C~ Block l~lxlivi~i~n Filed Map. lealth Dept. Approval: 'lanning Board Approval: (check one) Underwrite~ Approval: ,equest [or: Temporary Certificate ec Submmed: $ ~ '¢~t4 Hamlet Lot Final Certificate: ~/// _ (check one) / ~// Applicam Sienature N OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~JI.ATION [ ] FRAMING/STRAPPING [~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ]ELECTRICAL(R~ ~ [ ]ELECTRICAL(FINAL) REMARKS: DATE r-~/~ t/~/~1NSPECTOR ~~~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTo~vn. NorthFork. net Examined 'l/Iq, 20 D, Approved Disapproved a/c Expiration dUL - 5 2012 DEPT. PERMIT NO. 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 Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Single & Separate Storm-Water Assessment Form Contact: Mail to: Phone:O~/~ ~ - iD I ~' I t ~3uilding Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,20 NAILING & CONNECTIONS REQUIRED. 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 Bnilding 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 pa~ for any purpose what so ever until the Building Inspector issues a Ce~ificate of Occupancy. f. Every building permit shall expire if the work authorized has not connnenced within 12 months a~er the date of issuance or has not been completed within 18 ~nonths from such date. If no zoning amendments or other regulations affecting the proper~ 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 Depam~ent for the issuance ora Building Permit pursuant to the Boilding Zone Ordinance of the Town of Southold, SuflBlk County, New York. and other applicable Laws, Ordinances or Regulations, for the constrnction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordiuances, bailding code, housing code, and regulations, and to admit authorized inspectors on premises and in boilding for necessary inspections. CERTIFICATION OF ~ ' ~ , a~ ~,~'~ ]S~natureofapp cantorname racorporaton) 0¢ 0/? 57 ~[:~ N~h:' (Mailing address offapplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises APPROVED AS NOTED' (As on the tax rolD~d~]d~B.p ~~ If applicant is a co¢oration, signature of duly authorized officer NOT ' - (R~]e and title of co.orate officer) ~FY BU~LDING DEPART~ERT Ar 7654802 8 AM TO 4 pa FOR THE Builders License No. r ~ 3'?dNG IN' DF"'>~NS7 Plumbers License No. Electricians License No. ~ 7 Mfi~ 'CONSTRuc UON & ELECTRICAL Other Trade's License No. E~T~ M,JS~ 8E CO~LE~E ~OR CO ~LL CONStRUCTiON SHALL MEET THE INSPECTION REQUIRFO RE OUIREMENTS OF mE CODES OF NEW 1, I,ocation of land on ~-hich proposed work will be done: YORK STATE. ~T RE~SI~E F~ House N~mber ..... ~ . ' ~'~ --. Hamle~ County Tax Map No. 1000 Section-II Block ~ Lot I:' ( Subdivision 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 Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work Fee (Description) (To be paid on filing this application Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specie' 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 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth Rear 9. Size of lot: Front Rear Depth 10. Date of Purchase 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__ 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 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 NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. is this property within 300 feet ora 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. .~ . .t. , ~ 17. If elevation at any point on property is at 10 feet or below, must provide topographical'dhta on survey. 18. Are there any covenants and restrictions with respect to this property? * YES · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) SS: COUNTY OF .) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named. CONNIE D. BUNCH Notary Public, State of Ney (S)He is the No. 01BU618505r' (Contractor, Agent, Corporate Officer, etc.) CommissionQUalifiedExpiresin SuffOlkApC~q: c!'131~ ~, of said owner or o~vn&s:, and is duly authorized to perform or have performed the said work and to lnake and file this application; that all statements,contained in th!s application are true to tile best of bis knowledge and belief: and that tile work will be performed in thfi3nan~e~!~¢! foxtb .in tb~ application filed therewith. Sworn to before me~rr~lg ,~%~ %:47.,":'. ils ~'~;. , ~"~ day,of ~ 201ox- Notary Public Si=nature of Applicant Insula-Dome Skylights 83 Horseblock Road Yaphank, New York 11980 631/924-7890 Fax 631/924-7870 www. insula-dome.com Ask Us About Our NEW INSULATOR II GLASS -