The URL can be used to link to this page

Home My WebLink About23897-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24864 Date JANUARY 28, 1997 THIS CERTIFIES that the building ADDITIONS Location of Property 2255 GRAND AVE. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 107 Block 8 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 15, 1997 pursuant to which Building Permit No. 23897-Z dated JANUARY 22, 1997 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 WITH SHOWER ATTACHED "AS BUILT" AS APPLIED FOR The certificate is issued to ALLAN DICKERSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A d� /,�yi t'9Znq Inspector Rev. 1/81 FORK NO. s 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) N° 23897 Z Date .........1.. .�........................... 19. � Permission is hereby granted to: .. �o...... ��...... ............. .../.,U&L........ .."4....../ <l. ........ ...... . ........71.........`.f l f. ......./�ll�.�..-y �. ,,l s....... l..lT..�........�5........�..�.�� :�`.! ................ ............................6............... atpremises located at .................................... ` A ........ ............................................. 000, .................................................. ../. ....r!*1:.. ...................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ....�,Q.,7.......... Block .....0?........ Lot No. .Q„�.............. pursuantto application dated ......................................................... 19......... and approved by the Building Inspector. Fee $.... ` ... ... .. ... ... ...... .......................................... uil g Inspector Rev. 6/30/80 Form No. G TOWN OF SOU'I'11OLD BUILDING DEPARTMENT jAN I TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildin s streets, and unusual natural or topographic features, g Property lines, 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,pre-existing" land uses: 1957) non-conforming uses, or buildings and ` " 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, g $25.00, Swimming pool $25.00, Accessory building $25.00, Additions tp accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . ,7,a4Uary. .15,. .1.9.97. . . • • • • " " " New Construction. . • • • • • . . . . Old Or Pre-existing Building. A . . JPPck .as constructed)r- 'Fs hower House No. 00 , Location of Property. . .??� . • . . . . . . . . . . . GKT��• A"Nixe• . . . . . . . . . . . . • Matita�ck. . . . . . . . . . . . . Street Hamlet Onwer or Owners of Property:. . . .A�-.l.ari.C... •�iCk�xSon. c�xid.Chc�.��,vtt�. .AlCkexsOII. . . .. . . . . . . . County Tax Map No 1000, Section. . .l.Q7. . . . . . . .Block. . . .4 . . . . . . . . . . .Lot. . . . 3. . . . . . . . . . . . . . . . . Subdivision. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .Filed Ma . . p. . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . .. . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . Health Dept. Approval.. . . . . . . . . . . . . . . . . . . . . . . .. .Underwriters Approval . . . . . . . . Planning Board Approval Request for: Temporary Certificate. . . . . . . • • • • . Final Certical-e. . .X . . . . . . . Fee Submitted: $, • • • . KrI . . . . . . .�r :-..... . . . . . . . . . . . . . . . APPT.TCANT (QC) ��f Allan C. Di.(-kersen 1 BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . JAN I TOWN OF SOUTHOLD SURVEY . . . . . _ _ _ . . . . . . . . . . BUILDING DEPARTMENT CIIECK . . . . . . _ . . . . . . . . . . . . . TOWN HALL SEPTIC F• Oita _ . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 r:Oil FY ; � Examined . . . . .� CALL.i'2�. . . . 1. . . . . - - - - - • . ... . . . . . 19 M 99 AIL TO : Approved . . ��4let. . . . . .. 19Y Permit No. p7� .�ZL . . . . . . _ . . . . _ . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - • . . . . . . . . (B - d�- g pector) APPLICATION FOR BUILDING PERMIT Date Janua;ry, •15. , • , • 19 ,9 7 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 tie 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, ordinance , uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa &. .iO?IS . _ :. . . . . . . . . . . . . . . . . . . . (Signature of applicant; or name, if a corporation) 460 Paddock Way Mattituck". New. Y.oxk. 119.5�. . . . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... . . . . . . . . . . . . . . . . . . . .Owriez . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises .ZW 44.9... •Dickerson. and Charlotte Dickerson -- (as on the tax roll or latest deed) •APP d®V D-AS 4OTED If applicant is a corporation, signature of duly authorized officer. DATE: �L B.P.# . . . FEE BY: . . . . . NOTIFY BUILDING DEPARTIMENT AT (Name and title of corporate officer) 765-1802 9, AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: -Builder's License No. 1. FOUNDATION - TWO REQUIRED . . . FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Plumber's License No. • 3. INSULATION 4. FINAL - CONSIRUCTION MUST Electrician's License No. . BE COMPLETE FOR C.O. ALL CONSTRUCTION" SHALL MEET Other Trade's License No. . . . . . . . . , • , . , , • • • • • • . THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY 1. Location of land on which proposed work will be done. CODES. NOT RESPONSIBLE FOR ' ' ' ' ' ' , ' ' 'DESIGN OR 'CONSTRUCTION-ERRORS 2255 Grand Avenue Mattituck House Number Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hamlet County Tax Map No. 1000 Scction . . . _ .107. . . . . . . . . . Block . . . . .8. . . ..: . . . . . . . . Lot . . . . . 3. . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. Lot (Name) . . ... . . . . . . . . . . . ?. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . Deek as constructed L " 00I' S1 d,-uer b. Intended use and occupancy • Deck as, constxu�t�p1 �JhQpbr . S�Ow�r • . . . . . • . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . .1?ec.k (Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. 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.t • . . • • • • • • . • . . • • . 7. Dimensions of existing Y' type of use . . . . . ... . . , �, , , , , , Height isting structures, if any: Front . . . . . . . . . . . . . . Rear , , , ;, , , , , , , , , Depth . . . . . . . . . . . . . Number of Stories g . . . . . . . Dimensions of same structure with alterations or additions: Front. • • ' ' Depth . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . • �.. • . . . . . Height. . . . . . . . . . Number of Stories . _ 8. Dimensions of . : Front • Rear • • . . . . . . Depth Height . Number of Stories . ... . ' . . . . . . . . ... p . . . . . . . . . . 9. Size of lot: Front . . . . . 100. . . . . . . . Rear _ . . . :15Q . ... . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . 10. Date of-Purchase . 11114155. . . . . . . . . . • . . • • Depth 23.6. . . . . . . . . . . . . . . . . . • • . . . . . . • . . . Name of Former Owner William A.. kla.ppli, ¢. Harry.V. 11. Zone or use district in which premises are situated . ,R-49. ,Mesi-dential Low. Density) Mason 12. . Does proposed construction violate any zoning law, ordinance or regulation: y) . 13. Will lot be regraded " ' NO" " " " • • • • • • • • • • • • • • • • • •. Na 'A11an'C: 'Dickerson ' . • • Will excess fill be removed from premises: xYs No 14. Name of Owner ct premises Charlotte.DickersaA. Address Mat t tuck,- •NY -1-1.9}5.2• Phone No. . 29$-4956. . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . Address Phone No. Name of Contractor . Address . . . . . . . • . . • 15. Is this property within 300 feet of a tidal wetland? • � • " . " ' • • • • •Phone No. . . . . . . . . . . . . . . . wetland �cYes. . . . . . . . No. . .$. . . . . *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions;from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ------------------------ 1"A ced� 11 II i� 1/V 0 at t G �F T E.: STATE OF NEW YORK, COUNTY OF . .$UFk'OI,K, S.S • , ,ALLAN C_:- DICKERSON being duly sworn de oses and ' (Name of individual signing contract) P says that lie is the applicant above named: He is the •(Contractor, agent, corporate officer, etc.) 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 to before me this ,15 th . . . . . . . . . . . . . . .day of. . . . . . . . . . . .97 ., 19 . Votary Public, . . . . . . , Suffolk , • , , • , , , . , , , , �• .County BAR . . . . . . . . . . . . . .. . . . . . .. . . . . .. BAR DWHUN Allan C. Dickerson Notary Public , SaW"9W1brk (Signature of applicant) No.40190, Commisft EVIMO.OaL 31,ION