HomeMy WebLinkAbout28211-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28826
Date: 08/27/02
'l~IS cERTIFIES that the building
Location of Property: 225 PINE ST
(HOUSE NO.)
County Tax Map No. 473889 Section 141
Subdivision Filed Map No.
ADDITION
(STREET)
Block 1
MATTITUCK
(HAMLET)
Lot 36.3
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated 5ULRCH 21, 2002 pursuant to which
Building Per~it No. 28211-Z dated MARCH 22, 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.
l~ne certificate is issued to ANTHONY J & DIANE M BLADOS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF ~RALT~ APPROVAL
ELEt-I'~ICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~s3
N/A
N/A
N/A
tho~zed 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. 28211 Z
Date M_ARCH 22, 2002
Permission is hereby granted to:
for :
Ai~THONY J BLADOS
830 BAY VIEW AVENUE
MATTITUCK,NY 11952
CONSTRUCTION OF DECK ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR
at premises located at 225
County Tax Map No. 473889 Section 141
pursuant to application dated MARCH
Building Inspector.
PINE ST MATTITUCK
Block 0001 Lot No. 036.003
21, 2002 and approved by the
Fee $ 150.00
Authorized Signature
Rev. 2/19/98 COPY
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
t__
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. Ifa 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. Copy of Certificate of Occupancy- $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15~0
Date.
New Construction: Old or Pre-existing Building: ,- (check one)
LocationofProperty: {3~5 '~,'r~' ~.~"~ ~'[t~_~-/' ~ ~
House No. ~X Street
Owner or Owners of Property: .~ld~Or-~ C~ /~/rv, j,-i~ ,~~ Hamlet
Suffolk County Tax Map No 1000, Section I ~ [ Block_ I Lot
Subdivision
Permit No. c~ ~ ~ ~t - '2.-
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~:~q~"~ Or,.)
Filed Map.
Applicant:
Underwriters Approval:
Date of Permit.
Lot:
Final Certificate: j _ (check one)
AA~icant Signature
ILO lNG PEI IT-t Jbzl VIE--W GHF C'K
Applicant/
Owners Nmne:~
Architect/
Engineer
SCTM fi:
t)istrict: LO00 s~c~jo,,:/¢/ mock:
Date
Reviewed:
Date
Submi[ted:
Pl'oj¢cl
Single & separate Required
certification: _(Yes / No)
Req.
Zolling Dislricl:~ ~ II~( size:
Req / Req
Project Description: ~_
Subdivision
Name:
I'roposed: ~C~ ~
AGENc~ERMIT$
~REOUIRED FOR REVIEW
Suffolk CoUnty Health' Dept,
New York State D, E, C,
Town Trustees
Town Zoning Board. approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
NO
Permit
..YES ~Number
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [~X'] FINAL
[]FIREPLACE&CHIMNEY
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST [ ]ROUGHS.-
[ ] FOUNDATION2ND [ ].~,Ui:A~ION
[ ] FRAMING [/,~FINAL
REMARKS:
[ ] FIREPLACE & CHIMNEY
DATE
INSPECTOR
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBENG
~S~ATION PER N. Y.
STATE E~RGY CODE
TO~'~N OF SOUTHOLD
BUILDING DEPARTMEN
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
Exammed
Approved
Disapproved aJc
Expiration
,1 ]~'~, 20 0.~
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the follov4ng, before applying'?
Board of Health
3 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
20__
Phone:
Building ~_ .
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20
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 perm&
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 the Building Inspector
issues a Certificate of Occupancy.
f. 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 fi.om such date. If no zoning amendments or other regulations affecting the
property have been enacted in the Inter/m~ 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.
~ (Signatu~ o~/a~plicant or name, ifa corporation)
(Mailing address of apphcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises (-~C~4¥~C:)r-/M ~'x..~.[ ~ f'~- ~.2.9[~¢~
-~ (As on the tax roll o~-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.
Location..qof land on w,h/c.,h, proposed__w{)rk will be done:
House Number Street
County Tax Map No. 1000 Section [ k~ \
Subdivision
(Name)
2. State existing u~e and occupancy of premises and.intended use and occupancy of proposed construction:
a. Existing use and occupancy ~c-,.,, -[.}-.~w,,~.~.4 Q'~Ig. Dq
b. Intended use and occupancyOth.q -~r-x(g. lm, ]~ &D~-I ],rn~ ~5/dd.¢_.~c 6o_(-/c-~t'~ o,~
t J t
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work ~1~_ ~_~
4. Estimated Cost ~..?) .~O O
5. If dwelling, number of dwelling units
If garage, number of cars
Fee
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stodes
Rear
Depth
10. Date of Purchase
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stodes
Dimensions of entire new construction: Front c9 -] ' Rear c-~c~ '
Height ~ ' I ~ \ Number of Stories
Size of lot: Front I ~ 8' Rear 1 (~(-* '
Rear
Depthq'~{'4)xcr~ oQ-O0 ~
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__
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
* 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
* 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.
STATE OF NEW YORK)
SS:
COUNTY OF )
¢~'. ~ ~ o-d~.~.5 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)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;
~hat 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.
/- ' ~l'gm(t~re of Applicant
'37.