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HomeMy WebLinkAbout1262-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED C.O. Certificate Of Occupancy No...gl.4,5.45 .... Date June 20 19.8.6 THIS CERTIFIES that the building ..... .O.n.o...f.a.m.~..ly...d..w.e.l.l.% .rig.. .................. Location of Property ..... ~ 45.0..h/gO;o.C.I~. IFF..QB.lEE. ............ .1~. T?.I. T .~.c~ ........... House No. Street Hamlet County Tax Map No. 1000 Section .... 1.0.7 ..... Block .. 9.8 ........... Lot ..... 0.0.2. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Nov. 21 1960 pursuant to which Building Permit No. Z1262. dated ...N.o.y :..2.1. ................. 19.6. 9, 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 ......... ..... One...~g.m.~.l.y..d.w.~..1.1.i.n.g..w.i.~.h...a.qq~..8.8.o.r.y, .D.u.J:. 1..d.i.n.q: ...................... The certificate is issued to ..... H.~ .I~.R.Y..T.-. ~Qg.~.C~ .b,~p..q~..~.~2 ..~:. ~o..~¢..c.~. ............ (owner, ~Xe~YJ of the aforesaid building. Suffolk County Department of Health Approval ...... ~/. ¢ ................................. UNDERWRITERS CERTIFICATE NO .............. I~./..A ................................. Building Inspector Rev. 1/81 FOP~M ~0. ~ TOWN OF SOUTHOLD BUILDING D[PARTMENT TOWN CLERIC'S OFFIC[ SOUTHOLD, N. Y. BUILDING PER~IT (THIS P,ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1262 Z Dote ..................... ~O'~'~Oe~..... 2~L ........ 19.~.0... Permission [s hereby gronted to: ?&F Bui'lffer'~'""~/O ....... ~o~'.arc~-.. ~ ~L.Z.~.~ ..... .......... t$~tti'tu~k ................................................ .......................... N'vY; .............................................. to ............. B~']:d" ~e~" ~ne..f ~m~.t¥...d~et.Z.:L.~g .......................................................................... et premises Ioceted et ........~'ood~.~.~,..~.~.~e ................................................................................. ...................................................... M~'~%'i~k.¥""~'~', ..................................................................... pursuont to oppHcotion doted ....................... ]~O'~e~O~'""~,' ............ ] 9...~0, and approved by the Building Inspector Building Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~,outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~c~'Jic,"*,~to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-Ex±s%~n~ C.O. $15.00 3, Copy of certificate of occupancy $1.00 Vacant land C.0. $ 5.00 ......... New Building ............. Old or Pre-existing Building ... ,~....... Vacant Land ............ 1450 Woodcliff Drive Mattituck Location of Property ................................................................... House No. Street Hamlet Owner or Owners of Property ?..e.~.~.. ?....~.o..m.a.q~...a.~.~..~..a.~.~.~...~,..~o.~.¢~. ................. County Tax Map No. 1000 Section ...~..0.7 ......... Block 08 Lot 002 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant ................................ Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ...... ¥ ................ Fee Su bm itted $ ~., .0.q ........................ Construction on above described building and permit m~. ~p~plic~able~co~d~.~nd regulations. Applicant .,~.~ .... : ~. Y. F.< ~.~ ...................... ~ ~ //Janet L. Womack ~ RICHARD F. LARK RICHARD F, LARK WILLIAM D, MOORE June 6, 1986 Building Department Town of Southold Town Hall Southold, New York 11971 ATT: Curt Horton Dear Mr. Horton: Enclosed is an application for Certificate of Occupancy for premises owned by Henry T. Womack and Janet L. Womack on 1450 Woodcliff Drive, Mattituck, New York. A previous C.O. was issued on April 26, 1961, No. Z 1038. Also enclosed is a Consent to Inspection and a check payable to the Town of Southold in the amount of $5.00. Kindly contact Mrs. Womack at 298-5236 to schedule a date to do your inspection. RFL/bd Enclosures Very truly yours, Richard F. Lark P.S. Also enclosed is a copy of a survey dated April 10, 1961. CONSENT TO INSPECTION JANET L. WO}~ACK , the undersigned, Owner'(~) do(es) hereby st~te~ is one of That the undersigned ~(~the owner(s) of the premises in the Town of Southold located at 1450 Woodcliff Drive, Mattituck, -New York · which is shown and designated on the Suffolk County tax map as District 1000, Section i07 , Block 08 , Lot o02 . That the undere~ned ~ (have) filed, or caused to be filed, an applica- tion in the Southold Tows Building Inspector,s Office for the following: Certificate of Occupancy ..... That the unders~ned does hereby give consent to the Building Inspectors of the Town of Southold to 'enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary wi~h respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations ot the Town of Southold. The undersigned, Sn consenting to such inspections, do es so with the knowledge and understandin~ that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations ?f the Town of Southold. Dated: June 6, 198,6 .~ ? ~' Janet L. Womack ' (pri?~,name)" """' (signatUre) " (print name) TOWN OF ~OUTHOLD BUILDING DE;PARTMEI~'T ~l'OWl~ CLE~I~K'S OFFICE; SOU?HOLD, lq. Y. TH!IS cEHTIFIES that the building located at ..,W~dcli~...D2iVe......l .............. Street conforms ~ubstantially to the Application for Building Permit heretofore ffl~'d in this office dated ................... NOV~,P...2i'., 19.~. pursuant to which Building Perm~ ~o. ~ ....... dated ............... N~,~b~p.....~t...., 1950..., wa~ issued, and conforms to all.,of?he require- ments of ~he applicable provisions of the law. The occupancy for which t is ~'ertificate is ~owner, lessee or te~ant) of the aforesaid building. FORM NO~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xam nea ....................... ~ ................ ly Approved ................. !.~. ................... 19..~,t....Permit No......~....:/..~.-T.,~..~... ........... Application No. /~ ~ ~ APPLICATION FOR BUILDING PERMIT Da t e..~'./.~.-.'.......~... .................................. 19...~...,~?.... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted in duplicate to the Building Inspector. 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 location, c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this qpplication, the Building Inspector will issue a Building Permit to the applicant, Such permit shall be kept on the premises available for inspection throughout the progress of 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 Buiidin9 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 and reaulations. (Signature of applicant, or name, if o corporation) ....... ............ (Address of applicant) qtate whether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~..,~/.,'~....~.../_~.....,..~../..~./~/..~'~..~..'~...~... ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ...~..~.~.....~....~.../....~..~'~. ....... ~..,.~,. ~...'.~..~ ................. ~../~.../.~'...'..~.~.....~'.....~... ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing useandoccupancy .......... i ................. i'"~'~"~ .......................................................................................... b. ntended use and occupancy ....... ~~.. .................................................................................... 3. Nature of work (check which applicable): New BuiMing .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ......... ,~ .......... Other Work (Describe) .................... 4. Izst.mated Cost ........ .~,.~'.~,....~ ..................................... e..../. ................................................................................... (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 ar mixed occupancy, spec [fy 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 .......~....'~..~...~ ......... Rear ,..,,/...-~'...O,,,~ ............ Depth .... /'~'~ 10. Date of Purchase ................... l..~..~...O. ......................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................. '..~..'".....'~..;.J,,A.~. ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~,.~ ...................................... 13. Name of Owner of premises .~..~....~...,~..~.....~.4.~.~../..~.~.,~:.~'A~ress--// ~ z/,~ ......... .~~ . .~.r.~.:...Phone NO ..................... Name of Architect.......L,~.-~...~.. .......... ,, .................. Address ......... .~,[ ...... ; ......................... Phone NO ..................... Name of Contractor..~..C,(..~. ~--~.~,-¢~.~......, ....... AOdress4~.4~...~'..~..~'--'~ .......... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot, STATE OF NE~,~¢,~ ) S S COUNTY OF ..~.~' ........ ) ................ ~. ....~.~. .................. being duly sworn, deposes and says that he is the applicant .............. [Name above, named. He is the ............................. ~..~; ....................................................................................................... (Contractor, agent, corDorote 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 stetements contained in this application are true to the best of his knowledge and belief; and that the work w I be performed in the manner ~set forth in the application filed therewith. Sworn to before me this ~n,,, ~'~/~t~ ~OKEN ............