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HomeMy WebLinkAbout28393-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28876 Date: 09/19/02 T~IS ~I{TIFIES that the building ACCESSORY Location of Property: 945 NEW SUFFOLK AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax ~ap No. 473889 Section 114 Block 11 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 15, 2002 pursua_~t to which Building Permit No. 28393-Z dated MAY 15, 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 ACCESSORY GAPJkGE IN REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to DWIGHT & JANE EDSTROM (OWNER) of the aforesaid building. SD-FFOLKCO~DEPARTMENTOF~IEALT~kPPROVAL ELRt-i~ICAL CERTIFICA~ NO. PLUMBERS CERTIFICATION DA'r~o Rev. 1/81 N/A N/A N/A FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUITDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28393 Z Date M3tY 15, 2002 Permission is hereby granted to: DWIGHT & JANE EDSTROM 945 NEW SUFFOLK AVE MATTITUCK,NY 11952 for : CONSTRUCT ACCESSORY GARAGE AS APPLIED FOR. THIS PERMIT REPLACES BP 12903. at premises located at 945 NEW SUFFOLK AVE MATTITUCK County Tax Map No. 473889 Section 114 Block 0011 Lot No. 023 pursuant to application dated MAY 15, 2002 and approved by the Building Inspector to expire on NOVEMBER 15, 2003. Fee $ 97.80 Rev. 5/8/02 COPY FORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12903 Z Date .... J~ ...................... , 19..~..~. Permission is hereby grant~l to: ...... i i iiii i...iiiiii .... ~.~.~:.,....~.:.~.:. ....................... ,-~ at promises I~ated at ............................................................................................................................ Co~.~ ~.~ ~p uo. moo s~ct~o~ ........ LL~. ........ ~k ........ LL .......... Cot uo .... .9.~..~ ......... Building Inspector. and approved by the Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY wing: This application must be filled in by typewriter or ink and submitted to the Building Department w~h A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and hnusual 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 fi.om 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. Bo 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 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. 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 $15.00 New Construction: Location of Property: flohs% No. Owner or Owners of Property: ~ ~ ~ ~'- ~ Suffolk County Tax Map No 1000, Section ~g~ Block ~ /[ Lot Date. ~ Old or Pre-existing Building: (check one), Street Hamlet Subdivision Permit No. ~ Date of Permit. Health Dept. Approval: Filed Map. Applicant: Underwriters Approval: Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~-q~o,, co-Z gr/¢ Final Certificate: ~,~-/ (check one) x, ~.~ Applicant Signal~fi'~ TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX "/28 TOWN HALL SOUTHOLD, N.Y. i 1971 TEL. 765.1802 'Chis is to advise you that the j~b. Rn~e~.b.uildlng permit no. 12903Z issued to Jane & uwzgnt ~os~rom on 3/6/84 for Accessory is completed and a final inspection has ( ) has not ( x ) been done. tn order to complete this file, it ts necessary that ;, Certlf[cate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $10.00 payable to the Town of Sou[hold. Please indicate to Whom the Certificate of Occupancy is to be mai[ed, and arrange with this office for an inspection (late Occupancy or [,se is ,nl. awful without a Certificate of Occupancy. Please help o., to clear up th.is matter so that legal act[on does not have Co be taken. Thank you for your prompt attention. Very truly your , Victor Lessard Executive Administrator VL:gar cncl. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]~.ATI~N [ ] FRAMING [/,~FINAL [ ] FIREPLACE & CHIMNEY DATE INSPECTOR ~£ELD INSPECTION FOUNDATION ( 1 st ) COMMENTS FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C, ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~ .o,,4-..c~..~ ..... ,19~.~. Approved M .a+..~.~. .~. ...... 19~.q.. Permit No. J.~.~.O..~..-73:.. Disapproved a/c ..................................... Received ........... 19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall have been granted 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 regulation_s, and to admit authorized inspectors on premises and in building for necessary inspections. ''' i~i~na'-'-~r/~i it~t~licant, ..... or nam/'a '~e] ii ~ 'c~)}t~(~ ~a'tid~) .... °. f,.(../x'.¢ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ........................................................ of owner of premises ...... Yq/-? .~...,5/. ,~'" /!/' '~ $ ~/c9' x,~ ~ . - ..... Name .... ' ............................... :J' '~$' h[O/l~g ' ' ' '~(as °n t he t ax r°ll °r lat~/~t~:e~tJ~/2-,q-_B. P. If applicant is a corporation, signature of duly authorized officer. FEE:-4~/0, BY: . y. ~'.]~. NOTIf':-'.' ~' ,!Lr')ING DEP.AP, TMEN~'-~ 765-18"o 9 AM TO 4- PM FOR THE FOI..~ r~,,,f,,,% !hJSDECTIONS: 1. FOLF-~.^TiON _ TWO REQUIRED FOD P"~tJ~ED CONCRETE 2. ROUGH - FRAMING 8,,, PLUMBING 3. 4. FIh.h*~ C©N'$T~!h'7?-ION MUST '~ r-mE FOR C. O. ALL CONC,-rRUCTiON SHALL MEET Other Trade's License No ...................... TIlE RFC~,,~r~rM~NTS OF THE N.Y. STATE CONSTRUCTION & 1. Location of]and on which proposed work will be done ................. C©f'~ES: '' 'Ng~ ' '~S'P~/~(B'L'E' ' FOR ...7...9..,7./.. ........... .?. (q re. .?f. .,4./.,c. . . ............ . . . s... House Numar Street Hamlet County Tax .',lap No. I000 Section .... ./'./.~. .......... Block .... F./. ............ Lot tv 7~- (Name and title of corporate officer) Builder's License No ........ .~..~.C..~-. ............ Plumber's License No ......................... Electrician's License No. No ~xa = SubdMsion ..................................... Filed Map No ............... Lot ............... (Name) State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy__-_,,._-- ,, ./~, ,~,-~. ~,~/~-~,, ,'¢~,, ~~., ~/~Q~', ~ ~~,1 ,~~, , , b. Intended use and occupancv~~l .~.q ~ ~ · C...~~~..~7m.. ~.;'. ............. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ...................................... Fee ...................................... (to be paid on filing this application) $, 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 ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ........... , ........... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... ./.d..., ..... Rear ..../.g..' ........ Depth ...4.6. ......... Height ..../.5~. ~ ........ Number of Stories ........ .0.0 .C.. ........................................... 9. Size of lot: Front ...................... Rear ...................... Depth .... .. ............. 10. Date of Purchase ............................. Name of Former Owner t,~OO~.-----:~.. 11. Zone or use district in which premises are situated ......... ~.g $ ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... .~ ..... ~ ............ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises,~/..~/~./...~?.~?.~.~.~ .... Address .?.c,~.~,.- ..~.~./.~...f~.~..e.... Phone No..-ff. ~'.~..-.,f'./.~.(. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NE\.Vf., YQp, K' t. o o COUNTY OF~ *'~ (~ame of individual signing contract) above named. deposes and says that he is the applicant 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; that 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. SWorn t0%efore me this ...... :', ;2,¥ Pubhc ./ ............... ~'~,,~ ~. 'i~'s~' ''' /9/ I'~, t,l?~10~l · ~1~ C*~tl~,/ ' '- .... ~ ....... ' .................... J,,,~,~ ~,,,~ ~,~, ~, ~ (Signature of applicant)