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HomeMy WebLinkAbout1989-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. AMENDED Certificate Of Occupancy No. - · .Z-1.~.8. 7 -6 ........ Date September 15, 19.8.6. THIS CERTIFIES that the building.. O o ~.. f. a. r~ .i.l.x..d .w.e.1.1..i PR. w..i .t .h.. a..c .c .e.s.s. 9 .v .y.. s..h .e .d Location of Property Shirley Rd.~& Horton Ave. Mattituck, N.Y. House No. Street Hamlet County Tax Map No. ]000 Section ............ Block ............... Lot ................. Subdivision ............................... FLied Map No ......... Lot No .............. con£onns substantially to the Application for Buildin§ ?ennit heretofore fLied in th~s office dated ~.e.b..~ .~.~?.7....~ .3., ........ , ! 9 .~ .3. pursuant to which Building Permit No. Z 19 89 dated 7e bruary 13, ]9 6.3, was issued, and conforms to alt of the requirements of the applicable provisions of the law. he occupancy for which this certificate is issued is ......... Frivate one family dwelling with accessory shed The certificate is issued to Raymond Young ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval . .A.u.g ....2.1. ,...1.9.6.3...b y..P. :..M.a.k. 3~ 9.w.s.k.i. ...... UNDERWRITERS CERTIFICATE NO .................................................. Amends Co #Z1689 Rev. 1/81 FOP. M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1989, Z Date ........... Permission is hereby granted to: Dou~l&e..~Be.eb~..~i..8.Qn....i/C.....Ray~ond...Yo.ur~ ........... .~uteho~u~ .............................................. to..B..ul 1.el..n~..o~e..~a~l~....dw. eLlin~ .................................................................................... at premises located at ...l:lhl[z"J 8y...]~Oli~ll..&..JJ4);l'.tOtl..~',/~ ............................................................ ................................................. iL.~a.~ti.t, uck,.. ~.,Z:, ...................................................................... pursuant to application dated ........ ............... ~]~ ......~ ...................... l~.,~....., and approved by the Building Inspector Building InspectoI TOWN OF $OUTNOLD BUILDING D[PAR'~MENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y, CERTIFICATE OF OCCUPANCY No. Z..~,6~9 ............. Date ................... ~.~.~U~.~.....3P ............ , 19..~..~. THIS CERTIFIES that the building ~ocoted at ..(~]~'~.~.~X..~...~.,~O~'..~D.T~..,~.~.~. ............ Street Map No ..... ~ .......... Block No .......Y~ ........ Lot Ixlo....,.-~ ......... ,~.t~.~J,J;.l~.~t...~..t..~.t. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. ~'~bt~.a.~.~ ....... ~l~....., 19...~3 pursuant to which Building Permit No....~...~.~.~..~. dated ..................... ~.~'bt,~'.l~.~. ....... ~3., 19....(~ 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 ........ .......... P,~.l.~a.~.~ .. on~..f~.m_!ly...d.~mlJ, lng ..................................................................................... The certificote is issued to .....Rllytlloriti..!rotlllg ........................................... 0~1~.. ......................... (owner, lessee or tenant) of the aforesaid building. N.D. Approval Aug. 21t 1963 by P. MakJo~ski Building Inspector ( FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted m~ 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-(S-g 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date Sept. 15 1989 New C on s t r uc % i on ...... Old or Pre-existing Building ............ Vacant Land ............. Shirley Rd. & Horton Ave. Mattituck, N.Y. Location of Property ............................................. House No, Street Ham/et Raymond Young Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Appr~oval 8/21/63 Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... . .5, .0.0. bie/ced~gu latio~ Fee Submitted $ ...................... Construction on above described buil~meets al~ applica Apphca .......... FOF~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~h$~..:!,.e~..~g]...&..]{f~..~D.['L.,~,.I/'..~ ............ Street Map No ...... ~ .......... Block No ....... F~ ........ Lot No....,YJ~ ......... ~.~.~.,.~.r~.~ .............. conform~ substantially to the Application for Building Permit heretofore filed in this office dated .............................. ~.e,~ll~'.a~.~'. ...... .1,~....., ]9...~,,~ pursuant to which Building Permit No.....~...~.~..~..~. dated ..................... ~.eJbtzv. az'.~. ....... .'L.~., 19....6..] 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 ........ .......... F.r.~.v.a.~.a..an~...fa~il¥...~.~elling ..................................................................................... The certificate is issued to .....I:[/k~.~OT~..~O~ ........................................... O.~d~lP,~. ......................... (owner, lessee or tenant) of the aforesa'id building. H.D. Approval Aug, 21, 1963 by P. Makjowski BARRETTA R.S.L.I, CORP. 28 East Old Country Road Hicksville, New York 11801 (516) 931-5656 MATT i TLiCK C E R T I F i C A T L-- O F O C C U P A N C Y GENTI_EMEN ~ iN REFEI(~ENCE TO THE ABOVE P!~EMIOES PI.EASE I:'IqOVII3E US WI-Ii4 ALL COl=]F~; OF CE~RTIFiCATE5 OF OCCUPANCY~ C:E~T~F'ICATES OF: COMPI,.ET~ON i~nd/of COMPLIANCE AND AI.L. COF:tES OF SU~SEQLJENT PIERM~T~J. THANK YOU FOR YOLiR~ COOPERATION IN THiS MATTE~, ~ FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y~ Approved ........................................ , 19 ........ Permit No ................................. Application No.....~......~...~. ............. Disapproved a/c ...~~.....~ (Building In{l~ctpr) APPLICATION FOR BUILDING PERMIT Date ....................... .~..e...~...u~....~...~.~.......~. ~....., 19...6.3 .......... INSTRuCTIoNS a. This application must be completely filled in by typewriter or in ink and submitted 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 application. 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 o 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 pa rt 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleCtrician, plumber or builder. ................. g. on ac.t,.or .......................................... ................................. Name of owner of premises ....... .R..~QD.~t...~Q.g,g.g ................................................. ~,.,..;....r...; .............................................. If applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ....... ~ ........................... Lot No: ....7-,.,xX. ........ Street and Number ..JD~;L;~.'J.e.~...~Loax~,..&..~o~.t;c~..~,~'~, .............. Me.:J:;.t,J..~.g,l:te .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .V~cnZ3.t,..].o.t; ....................... . ............. b. Intended use and occupancy ......... D~e...~a.133J,'l~'...cL'~e'l].l~g .......................................................................... 3. NaCure of work (check which applicable): New Building ..~ ...... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .............. ~{JeJ]J(]~..~...~ ................... Fee ..... 3-0 ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............Q~f~ ........... 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 ......... .br.~ .................. Rear ......... ~ .............. Depth .~..-..c)/..~.)4-..~.9 ..... Height ............................ Number of Stories....O~e ....................... 9. Size of lot: Front ......... 3,OJ~ ............... Rear ....3~00 ................. Depth ....]:.~...~. .............................. 10. Date of Purchase ..... ~:Lo~'...;bD.._'lC).~'.~. ................... Name of Former Owner ....... .~.(]..1.~..~....¥..O.~g ...................... Il. Zone or use district in which premises are s~tuated ................... J~.....~;[.~.t; ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. .~...O. .................................... 13. Name of Owner of premises ...... ~.O...%~...§ ...................... Address ............................................ Phone No ..................... Name of Architect .......... ~.......]~.~.9.~.~ ........................ Address ............................................ Phone No ..................... Name of Contractor .~..,...~..e..~.~..~...~;...~.O.]Q ................. Address .................. ~..~,~.q..[3,f}][.~..e. ..... 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 inte~ Dr or corner lot. STATE OF NEW YORK, ) COUNTY. OF .,.~.~'~.o.~c ....... ) S.S. ............................. DD.1z~].a..~,.lqee.13e ..................................... being duly sworn, deposes and says that he is t~e applicant (Nome of individual signing application) above named. He is the ...................O.Q~t;~.~Q~ .............................................................................................................. (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 oil staCements contained tn~,~l~ application are true to the best of his knowledge and belief; and that the work will be performed'h~r~3~l~t~.~.,~_.ll~th, in the application filed therewith. Sworn to before me this Com~,ssion Ex~pireUO's°MaU"~c'~)am~]~ ~ ~ ~ /? .................. 3.~. day.~f "4 ........... ~e:~'.~,.~ ............. , 1.9..~,. - ~Q~_.r...,~:, /~c~ ~/~ ,,.~/~ ........................... 1...~..:.........'~.. ................ Notary Public~.~x~...~....~ 'a'~"":'"qq?"i~i~nature of applicant)