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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.