HomeMy WebLinkAbout36709-Z Town of Southold Annex 12/16/2011
54375 Main Road
coSouthold,New York 11971
Zr
oy *n
CERTIFICATE OF OCCUPANCY
No: 35342 Date: 12/16/2011
THIS CERTIFIES that the building SHED
Location of Property: 5640 WESTPHALIA ROAD,MATTITUCK,NY.,
SCTM#: 473889 Sec/Block/Lot: 113-10-15.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/14/2011 pursuant to which Building Permit No. 36709 dated 9/23/2011
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:
construct an accessory 12'X 24'shed as applied for
The certificate is issued to Springer,Ryan&Springer, Lisa
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Au o i ed Si atur
=Y TOWN OF SOUTHOLD
rat�
BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 36709 Date: 9/23/2011
Permission is hereby granted to:
RYAN & LISA SPRINGER
5640 WESTPHALIA ROAD
MATTITUCK, NY 11952
To: construct an accessory 12' X 24' shed as applied for
At premises located at:
5640 WESTPHALIA ROAD, MATTITUCK, NY.
SCTM # 473889
Sec/Block/Lot# 113-10-15.5
Pursuant to application dated 9/14/2011 and approved by the Building Inspector.
To expire on 3/24/2013.
Fees:
ALTERATION OF ACCESSORY BUILDINGS $215.20
CO -ACCESSORY BUILDING $50.00.
Total: $265.20
Building Inspector
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT �b5 r7 O
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
Ar For new building or new use:
1. Final survey of property with accumte-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 2110 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 cQmpleted 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.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.W
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of.Occupancy-$_25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate o€Occupancy -Residential $15.00,Commercial$15.00
Date.
New Construction: /\ Old or Pre-existing Building:' (check one)
Location of Property: S�(p�Q (J<444/1 k ,N �4/7`i��C! (
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section_ �� Block l0 Lot
Subdivision p Filed Map. Lot:
Permit No. 76 / Date of Permit. /�-�3- / Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one
)-
Fee Fee Submitted: $ XA-/
Applicant Signature
O OF SO(/l�o! - ---
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION .
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE ( �' INSPECTOR
FIELD INSPEeTION REPORT DATE COM VIENTS
W.
FOUNDATION(1ST)
C �
-- -- --------------------------
FOUNDATION(2ND)
O
Q
. H
ROUGH FRAMING&
PLUMBING H
' cv
p H
INSULATION PER N.Y. �
STATE ENERGY CODE
' � 4
C�
FINAL
ADDITIONAL COMMENTS
f66,570
C
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined 20 Single&Separate
Storm-Water Assessment Form
!� a Contact:
Approved / _ 20 Mail to:
Disapproved a/c
Phone: qgy- �L/y
Expiration ,20�3
4
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date �—�J , 20 P
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 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 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 from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,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. f
®C°� i
°' FAN C 9 R (Signature of applicant or name, if a corporation)
.USE IS UNLAWFUL �y� we,�
WITHOUT CERTIFICA Mailing address of applicant)
State whether applicant is owner, IeQFe,QW, i 0 , tigineer, general contrmlar�,ale et
1i4n,,plum"r or builder
C'
C)oLie/ r)ATE ��/ B P F 67a�
Name of owner of premises X4--, fi 54 FEE: «Z.BY.
(As on the tax roll or 1 �PP DEPARTMENT AT
8(lZ 8 AM TO 4 PM FOR THE
If applicant is a corporation;,signature of duly authorized officer FOLLOWING INSPECTIONS:
I. FOUNDATION-TWO REQUIRED
(Name.and.title of corporate officer) FOR POURED CONCRETE
Builders License No. 2. ROUGH-FRAMING.PLUMBING,
STRAPPING. ELECTRICAL&CAULKING
Plumbers License No. 3. INSULATION
Electricians License No. 4. FINAL-CONSTRUCTION&ELECTRICAL
Other Trade's License No. MUST BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
1. Location of land on which proposed work will be done: REQUIREMENTS OF THE CODES OF NEW
1Y�O=STE. NOT RESPONSIBLE FOR
�Cfl YO Weep �4 �rG /�c� !�-�4/ CON4rR�1CILON ERRORS.
House Number Street IIaRVTAIN STORM WATER RUNOFF
PURSUANT TO CHAPTTR236,
County Tax Map No. 1000 Section 3 Block 0 OF THEO1d1 T UM. _S
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and o"ppancy of proposed construction:
a. Existing use and occupancy S f/c am,;/- h a h z M
b. Intended use and occupancy
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)
5. 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 Rear Depth
Height Number of Stories
9. Size of lot: Front M_ q(& Rear 172- l(P Depth
10. Date of Purchase 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 NO
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* 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 X
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
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; ust'provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this-property? *YES NO ,(
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SSc
COUNTY OF
Y ?3 t -A
b, ..,. being duly sworn, deposes and says that(s)he is the applicant
(Nam'e of individual:sigiiiiig;c x14�'!)'ak p- e named, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the c, c ,'1 ;s +i:!�} '::? No.01BUQ185050
is"!"•(:' OI1tC7Ct01>"A"ent Corporate Officer, etc. Quallfled in u o County
C` n g p ) Commission Expires April 14,2�
of said owner or owners, and is du�ly-autlibri�zed to perform or have performed the said work and to make and file this application;
that all statements�corttained.m tl.ls app,licatjonfare true to the best of his knowledge and belief-, and that the work will be
performed in thetmaiiiier"settfortli,.iti�tlie,appllication filed therewith.
Sworn to
Notary- ubIiQ`, i'T +, _ rti Signature of Applicant
SURVEY OF PROPERTY.' I
SITUATED AT 4'r31 I
z MATTITUCK
c toT(ap) I TOWN OF SOUTHOL :''
SUFr OLK COUNTY, NEW YORK
LpT79; 'i2 + TAX No. 1000-113-10-15.5
S.C.
I j Lp•r�.�) o• E SCALE I '=50'
a
O1' I N7a6� �`•" I OCT08ER 27, 1999
i t o OECFMBER 1 I. '999 REVISED MAP
MARCH 2l, 200; ADDED TEST HOLE
S_ cr I�UARY 6. 2002 ADDED PROPOSED WATER TINE
I l z I E EBRUAR'i 1 1, 02 REVISED PP.OPOSEp 40USE
I w 3 ) JUIY 19, 20U FOUNDATION ION I OCATION
DE F_MBER 20, 2002 FINAL SURVE'f
I I r AREA = 40.021.48 sq.
I o i
0.919 ac.
/co1 I
I 1p7 ��
! _ BERS SHOWN THUS: LOT 8O REFER TO I
r I suns va• I. LOT NUM I
y i n..ef•, •„•; MAP OF TOLLEWOOD
z STwrr FR-1 FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY
HOUS[a OAR�GC R I AS FILE No. 175
ON JANUARY 25, 1927
ALL OFFSETS ARE SHOWN TO FOUNDATION. '
i!; � j �°' yam-�" a.l ^ p
no ��i �/�` -_•�`' (1J 4'1 `�-•� 5 Lc.No..QBGfl
Jos h A. ingegno I
Land Surveyor
2S�•y� � 6 wO�. �� Fifth S,rr.P..S,�ENsoiv
vHOKc(651)727-3oao rc.c ups
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+ rN[Ot51[1��y R[WrD.iG FAO N��FY wu�901 N�.ae�.W� 9J=�-OY63
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