HomeMy WebLinkAbout28193-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28569
Date: 07/05/02
THIS CERTIFIES that the building A]DDITION
Location of Property: 475 PACIFIC ST MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 141 Block 4 Lot 16
Su~ivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 18, 2002 pursuant to which
Building Perm/t No. 28193-Z dated MARCH 20, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to WILLIAM & PENELOPE A MONTEFUSCO
(OWNER)
of the aforesaid building.
SIIFFOLK COUN~Iqf DEPARTMENT OF ~ALTHAPPROVAL
ELE~rRICAL C~TIFICAT~NO.
PLUMBERS CERTIFICATION DA'rKu
N/A
N/A
N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUIT~ING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 28193 Z
Date MARCH 20, 2002
Permission is hereby granted to:
WILLIAM MONTEFUSCO
475 PACIFIC STREET
MATTITUCK,NY 11952
for :
CONSTRUCTION OF A DECK ADDITION AS APPLIED FOR
at premises located at 475 PACIFIC ST MATTITUCK
County Tax Map No. 473889 Section 141 Block 0004 Lot No. 016
pursuant to application dated MARCH 18, 2002 and approved by the
Building Inspector.
Fee $ 150.00
lzed Signature
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
[ R~DG. D[PT. ' ,:
~:'~ ~F S0UTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and subtnitted to the Building Department with the following:
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.
Submit Planning Board Approval of completed site plan requirements.
Be
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 topograptfie
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.
New Construction:
Location of Property:
House No.
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No..~/
Health Dept. Approval:
Planning Board Approval:
Request for:
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.
(check one)
Old or Pre-existing Building:
Street Hamlet
/~"/ / Block ~ ~ Lot 0 / ~-~
Filed Map. Lot:
DateofPermit..~/~tg/~t~ Applicam:L~//7/~
/
Underwriters Appro~zal:
Temporary Certificate
Final Certificate: / (check one)
Feb Submitted: , 25',/
ApplicanJ/~ghature
BUILDING PERMIT EXAMINER CHECK LIST
APPLICANT: ~o~gr, Lc_o , I~[~, ~, r~
SCTM# DISTRICT: 1,000, SECTION:
STREETADDREss:d::/5~%,Tctc
PROJECT DESCRiPTION"-f~ e c <
BLOCK: /4 ,LOT:
CITY:
ESTIMATED PROJECT COST:
DATEISSL' ~'ED: / /02
DATE REVIEWED: ,...~/Fvt/02
I~AT~SUBMITTED: ~_/L~L/02
SUBDIVISION: 't///~
ARCHITECT/~':INE~ Lt~ t-f5 t0'/'''-zS/2A/ FASTTRACK?
SINGLE & SEPARATE CERTIFICATION-REQULRED? do NOTES:
LOTS 40,000SF -100-24. Lot recognltion.(CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Mcrger.(A nonconfo 'n ng at any time after 7/1/83
ZONING DISTRICT:
REQ. LOT SIZE:
REQ. FRONT
REQ. REAR 5-0
WATER FRONT?
PANEL #:/-//~/
~----~ -c~O CONFORMING? ,,,to
ACT. LOT SIZE: &~ .58, REQ. LOT coy. o.90 ~ ACT. LOT COV.
PROP. FRONT ~'*'" REQSIDE I5/~J" ACT. SIDE rZ~/z-?~
PROP. REAR ? I oo
DESCRIPTION: ~ ~
FLOOD ZONE: ,)(' ,
APPROVALS REQUIRED
SUFFOLK
COUNTY
HEALTH
D_F.,.PT: YES or~)(BED #): DTE: / / PERMIT #:R10-
TOWN SEPTIC RECEI?T: Y oNe) --
NEW YORK STATE DEC: eRe-nEc 9a/7s YES oK~
SOUTHOLD TOWN TRUSTEES: YES
TOWN ZONING BOARD APPROVAL: YES
TOWN PLAN. BOARD APPROVAL: YES
TOWN HISTORICAL PRE (SPLIA): YES
NYS ENERGY: YES OR ~. __
EGRESS (18 H min.? 4 sq total) .~,_~r VENT (SQ. FT. x 4%)
BUILDING PE,,~P~II~O~PEN/EXPIRED: BP '~ 7 2 -Z / C/0 Z-5~4"'3"' , /c'c',/
HAVEPRECOSf~__~)RN ,.?'~0/O BP 9?30 -Z/C/0 Z- dZ3~/o~ , ,4-3/'3
NOTES: ~P/ ,~/O
FEE STRUCTURE: FOUNDATION:
FIRST FLOOR:
SECOND FLOOR:
OTHER:
TOTAL:
1. ( //~3 SF)- ( SF):
SF
SF
SF
SF INIT OTHER TOTAL
SF FEE FEE FEE
SF X $__=$ +$ +$ = $ /'.fa
2. ( .SF)- ( SF)= SF X $__=$ +$ +$ = $
765-1802
BUll DEPT.
TION
[ 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ]INSULATION
[ ] FRAMING [ ] FINAL
[]FIREPLACE&CHIMNEY
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDA~TJON 1ST [ ] ROUGH PLBG.
[ ~J~IDATION 2ND [ ] INSULATION
[~J FRAMING [ ] FINAL
[ ] FIREPLACE & C~HIMNEY
RE
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOuNDATIoN 2ND [ ] INSULATION
[ ~'I~RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARK~
DATE ~~ /~/~ ,~1NSPECTOR ~~..~
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ]ROUGH PLBG.
] FOUNDATION 2ND [ ]INACTION
FRAMING [,/~] FINAL
[
REMARKS:
] FIREPLACE & CHIMNEY
gmLD e~sr~c~o~ m~PORT I DATr I CO~r~S
FO~DATION (1ST)
FO~ATION (2ND)
~_/
PL~B~G
~S~ATION PER N. Y.
STATE E~RGY CODE
/ /
~D~ON~ COUNTS
TOWN OF SOUI OL1)
BUILDING DEPAR~
TOWN I~I~L
SOLqTHOLD~ NY 11971
TEL: 765-1802 ·
Approved ~
Disapproved ate
,20 o"~'
,20 r'L'.a
a. This applicahon MUST be co~,2.1~-!7 til!~:l ia by ~ or iliink --8 mbmillexl to tl~ BuJldirg Impec~or with
sets of plans, accur~.plot plan tO scal~. F~ aooordi~,o ~h~tule.
b. Plor p/an ahow/ng locm/on 0flat and ofbnilai,,~ on P~-,~imh ~!~Oon.~ip to acljoining im'emjs~s or public.streets c
areas, and waterways.
c. Thc ~ork cowred'by tt~ at~ m~y not bo oof,~,i~,~xl'b~-oro imman~ ofB~,~l~ pmmit
d.. Upon at~aroval of th]~ applilml/oaa, tho Biii!et+,g liizp~r .wfi/'ism~ a Bulling P=mit ~o tt~ applicant. Such a per~
shah be kePt on thc l:n-t'm",i~ep awailable for in~m~--tio~/=OUghOU~ tt~ work
e: No buiM+ng ~h,ll be ocoupiod or usod in whol?' or in t~. for any purpo~ wl~-so-ever umil a Certfficae of Ocdupa
is issued by th4 ]~uili-l~g II~Ocgor,
APPLICATION IS ~I~B_y lVlAD~ tm ~ Bail~g D~pmtuae~ for tho imsua~ 0£ a Biff/ding pernut pursuant to the
Building Zone Orctin,woc of thc'Tow~ of Souihold, Su~lk Com~v New'York'-~
~egnnanons. rot mc comon o, mm~m~, ada!il/oas, or alt~ral/om or for removal or &maoli~on ~ hmmin describe& The
appl4cant agrees to ¢or, k,ly wiih all appliembl~ laws, oliillml~, tmila+ng ood~ holming oode~ knd r~*lmfi0ns, and to admit
authorized in.,peetor~.0n pre, ,{:~ un4 in bn,~a%g for n~'.~*m-ySnzpootio~.q..
· (S?~.Ofappti~m~me, ifa corporation)
State whether applicant is. owner, l~ee,'ageaX, a:t~, ~ngin~ar, g~ne~al c~'~°r, el¢~aSc/a% ph:rnber or.broider
If appl/ca_nt is a COrporation, sSgnature of duly authO~zed officer
(Name and rifle of corp0ra~ offio~r)
Builders Licens~ No. '
Plumbers License' No.
Elecnici an s License No.
Other Tracte's License No.
4
1. Location of land on wkich propom~l work will be done:
Ho~e N~ S~ ..
County Tax M_ap No; t 000 S~ion / {'//t (5)0
Subdivision . ....
Fil, d Map No. ." Lot ~
Repa/.r Remov~ Demolition
4. Est/mated Cost . Fee
~5~ If dwelling, nurnberofdwell~ngtmlts I
tf garage, number of
Addition Alteration
,Omar Work r'~'o/vq- ?o/-~/4
(D~pdon)
Number of dwelling urfits on each floor
(to be paid on ~il~.g this application',
l
6. I/bus/ness, commerc/aI or m~xed oCCUPancy, speeifynature az/d ex[ent.ofeaeh type ofuse.
7. Dimensi0usofexi~gs~m~F~ //~¢'~* Rear 5.~>'(:2
Height. . . Number of Stories ~
Dimensions of same simcture with alterations or ~Jdtllons: Front' .~/z/' '~.,"
q3'
Depth _~-~ ' ~" H~ight Number of Stories
8. Dimensions Of entir~ new c°mtruction: Front '~¢ '~ 3' R~ ~'~ "
Height '/ 'Number of ~ode ,/
9. IfC' . '
Rea r
Depth.
JoYcE M. WILKINS .
N~Noary Public, State of New York.
4952246, Suffolk County
Term'Expi~-es Ju?e 12, C;,Q~O3
10. Date 0£ Purchase / Name of Former Owner
12. Does proposed.comUuction violate any z0rang law, ozdh,~nce or r~gulatio~ ,4/0 .
13. Wil/lotberergraded' fig? ' W fll~xc~s~qll~emmoved.frompremises: YES
Nme of' Contractor . . Ad&e~ Phone No,
15. ts th/s property ..... ·
wzmm- 100 feet o£ a ~1 wetland? *YES - NO
orF YES, SOUTHOLD TOWN TRUST~ES ?m~rrs MAY BE I~QUIRED
16. Prov/de survey, to scale~ With acc~e fomd~o~ pl~ md d/stances to ~lines.
SS:
COUNTy OF . )
(N~e b~/nd/¢Sdual sQm~g co. act) above r~:rmed, ~ . deposes arid say~ th~' (s)he is the appl/ca~t
of said owner or owners, ~ j~ duly ~ to perform or ~ t:~m-n~ ~ ~aid wolk and to make and file th/§ applJcatioll;.
[hat all statements confa+ned irt this al~lica~on
pta-formed (-n th~ ~ ...... ~ .... ?,~, ,~.¥= ~ uae w me best 9fkb knowledge ~
......... =~ ~ imm m tile a!~llcation ~Iled ~th. ' ~ w'"- .... , az/d that th~ wonk wStI be
Swor~ to before me ~ .' · "
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