HomeMy WebLinkAbout27990-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28173 Date: 01/16/02
THIS CERTIFIES that the building ALTERATIONS
Location of Property: 805 CAPT KIDD DR MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 106 Block 5 Lot 9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 17, 2002 pursuant to which
Building Permit No. 27990-Z dated JANUARY 4, 2002
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" ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to ERIC SCHARPF & JENNIFER RIGNEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
xlt�\
A` horized Signature
Rev. 1/81
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. 27990 Z Date JANUARY 4, 2002
Permission is hereby granted to:
ERIC SCHARPF
805 CAPTAIN KIDD DRIVE
MATTITUCK,NY 11952
for
ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
'h 'o
h-S
at premises located at 805 CAPT KIDD DR MATTITUCK
County Tax Map No. 473889 Section 106 Block 0005 Lot No. 009
pursuant to application dated DECEMBER 17, 2002 and approved by the
Building Inspector.
Fee $ 300 . 00
thorized S
COPY
Rev. 2/19/98
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 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:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and a 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. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential $15.00, Commercial$15.00
Date. I l L I O a,
New Construction: Old or Pre-existing Building: (check one)
,� L
Location of Property: 2-D':S oI.1 ►,c�, K"kM ci r (`�o►� IyC�
House No. `` Street Hamlet
Owner or Owners of Property: C r a C_ 1
Suffolk County Tax Map No 1000, Section it-in Block C�Cp'S Lot OQ�i
Subdivision Filed Map. Lot:
Permit No. D__�9 CDZ Date of Permit. �J QZ Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitt d: $
jAp 1 ant Signature
yea-1eo2
suauiNa oar.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I TION
[ J FRAMING [ FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
DATE D YINSPECTOR
IBLD It�sPS Io RRPORT DATE
CCOMMENTS
y
COM =,_�====x
r6MATION ( 1sT)' � S'
0
ILMA,TION (21RD) _ V
KWGII FRAME
•PLUMBING
t4SULATION PSR N. Y.
.STATE RNSRGY '� p-
U
CODE
FINAL
9
APUTIONAL Conba i;
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TOWN OF SOUTIIOLD BLUDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 ✓3 sets of Building Plans
TEL: 765-1802 PERMMT NO. L�� Check i�, �
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 20 O Z Contact:
Approved 1 20 6 7/ Mail to
Disapproved a/c
Phone:
Building Inspector
i 10 PLICATION FOR BUILDING PERART
Date �� 20�
loviN(Zf 4110 L;40LD
INSTRUCTIONS
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 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 a Certificate of Occupanc,
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 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.
(Signature0f applicant or nam , a corporation)
address of applicant)
Mcg� t\� og5a
State whether applicant is owner, lessee,agent, architect, engineer, general contractor, electrician,plumber or.builder
Name of owner of premises Lk U2 SJrNnCJ2'1 T ^ �-. 4nQ.A-1
(as on the tax roll or 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.
1. Location of land on which proposed work vriR-11,q dpne:
Sem 01oP7 u n 4jcl d,- MAL 0\-f V9sa
House Number Street Hamlet
County Tax Map No. 1000 Section. Block Lot `1
Subdivision Filed Map No. Lot
(Name)
4
2. State existing use and.occupancy of Irqmses and intended use and occupancy of proposed con§ttuction:
a. Existing use and occupancy I n47 o
b. Intended use and occupancy 1�� - � =� �`c'{ �-� •r
3. Nature of wor (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work (Y1p 44 C,tnm
(Description)
4. Estimated Cost � �Db% . Fee
(to be paid on filing 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. N
7. Dimensions of existing structures,if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front l� Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front 0 Rear Depth
Height n Number of Stories C)
9. Size of lot: Front Rear Depth i 0
10. Date of Purchase OI 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 L 14 Will excess fill be removed from premises: YES NO
14. Names of Owner of premises Address Phone No.
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 )
�: P r �4r SCA- "'QJ being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
;S)He is the (!)tkpn PP,_
(Contractor,Agent, Corporate Officer, etc.)
A said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
:hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
)erformed in the manner set forth in the application filed therewith.
iworn to before me this
/7 may of 120(3 /
Notary Public ignature of Appli
iLENE D.HORNE
a+y Public,State of New york
No.4951364
Qualified in Suffolk County-
�IMJSSion Expires May 22,
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TAX MAP ; 0,00 • IoCo-5 -9
-- CJUPANCY OR ---
EX I SrIN(� USE LS UNLAWFUL
J:� I T'GH EN WITHOUT CERTIFICATE
ExI STINCq izFEMIOV5 7 OF OCCUPANCY
l71 N I N tel p�o o Nl >; N'r R`T' no a(z,
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NOTIFYBu1L�DING DE A
765-1802 S AM TO 4 PM FOR Tw
IJ E W 30Co � FOLLOWING INSPECTIONS:
N r R'.e Poc K. 1.77.R M 0 V K P`FO FOUNDATION
lla T I O{i�DINI NCRETE REQUIRED
STAIR. *-PO"GIIN"AMING & PLUMBING
3 INSULATION!
AL - CONSTRUCTION MUST
COMPLETE FOR C.O.
X I �7T1 NC.I - ----- S Z LL CONSTRUCTION SHAD. MEET
THE REQUIREMENTS OF THE NX
$a q R eoo M STATE CONSTRUCTION S ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION&go"
I
NEW we0op,
STA I Iz. * IZA I L. I N Cl
_ �AnTI1�,La FL��I2 Pi-AN .