HomeMy WebLinkAbout2010-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hale
Southold, N.Y.
UPDATED
Certificate Of Occupancy
No. z-I6112 Date September 1, 1987
THIS CERTIFIES that the building ONE FAMILY DWELL ING
Location of Property 2985 Grand Avenue Mattituck, New York
hi s'o hie: ........................................................Street
County Tax Map No. 1000 Section 107 . .Block 8 .Lot 4
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
March 25, 1963 Z2010
........................ pursuant to which Building Permit No ......................
dated ..... M.a ......... r c h 25, ..1 ........... 963 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 FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR
THOMAS S INA CAPPIELLO
The certificate is issued to ..................... [o~t~'o'r,'l~XtC:~t~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval 8 / 19 / 1963
UNDERWRITERS CERTIFICATE NO. N / A
N/A
PLUMBERS CERTIFICATION DATED:
Building Inspector
UPDATES CERTIFICATE OF OgCUPAI~CY Zi673 dated August 19, 1963
Rev. 1/81
FOI~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.° 2OlO Z
Date ...................... lil, l~P.J~ ....... ~ ............ 19..(~.
Permission is hereby granted to:
& ~R~..lty' ..&--Son.--the ......................................
............. ~lat.tit~ele .............................................
to ..... ~t~.td...r~w...o~...f.a~tt.y.. ~ett. i.l~ ................................................................................
at premises located at ~l~/.~....~l~i~a~ld...&,V~ ...........................................................................................
................................................ ~Iat t~.t ~lek~......No.Z~ ..........................................................................
pursuant to application dated ........................ ~,I~T'ch'"'"~5 .................. 196.~..., and approved by the
Building Inspector
Fee $.'1 0,~0 ...........
FORM NO. 6
TOWN OF SOUTHOLD
Building 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-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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
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 $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 "
2. Certificate of-occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years SI0.00/
NewoO.,Struct-ion ...... OIOorPre-exist,ngBuilO[ng X.~.: ~. ~acant~nd/
Locat,onofProperty .... . ............
o~, o~ ~,~ o~ ~rop~t~ ...~r.~.~.. ~ ...............................
,o. .... [.c.'7...'.. ....... ..... ..........
Subdivision ......................... ~ · .~ ..... Filed Map No ....... , .... Lot No ..............
Permit No. ~J. ~.. Date of Permit ~./~ ~./~A~Ol'cant..~.~..~.
~ealth ~e~t. AO~roval ........................ labor De~t. AOOroval ........................
Unde~riters A~Oroval ........................ ~lannin~ Board A~roval ......................
~equest for Temoorarg Certificate ..................... F~nal Certificate .......................
lee Submitted S ~0 .
Construction on above described building and ,~t meets all applicable codes and regulations.
FO~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 ...~/.~......(~I*.I~P_~ .~..e ....................... Street
Map No. Y~XXX ............ Block No....XXX ........... Lot No. ~ ......... ~.t.~$..~C~.~ ..............................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.............................. ~aP.~.~ ......... ~. ......... , 19.63._ pursuant to which Building Permit No..Z.~.'..O..]....O....
dated ........................... ~.o~....~.~'. ......, 19..63.., 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. r.i.v.~.e .. o~'..e...£~m:Ll~'...a.~ell~g ...........................................................................................
The certificate is issued to ..A,...}t.*~L~...~..~.O~t..~O ......................... O~A'~.~i~.~ ..............................
(owner, lessee or tena,nt)
of the aforesaid building.
H.D.approval
FOE1?I NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .......~, ..C~-/~.... ~:...~...,
19...~.~
Approved '' 19 ........ Permit No. ~ ~b./9 ./
0
Disapproved
Q/C
.......... ?" .................................... ~'~z'"':~-
Application No....,~l...O../.....(~.. .........
APPLICATION FOR BUILDING PERMIT
Date ................... teza~eb;...../!.,~ ........... , 19..(~.,~..
INSTRUCTIONS
o. 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 drown on the diagram which is port of this opplica-
tion.
c. The work covered by this app[ication 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 applic.ant. 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, alterations, or for removal or demolition, as herein described.
The appNcant agrees to comply with all applicable laws, ordinances and regulations.
[-~9tlar-m'e 6pj~l.~an~, or name, if a corporation)
........... }lat'i;2t~lck ...............................................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....A.,....1F!.9~..L..~/~..&..,,~,~:tl...~[I~C .................................................................... t ............................
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 ....~/.~.....GI'.~IIII..AI~ ....... t,l~.~t,i.t, Dllk ..................................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction.
a. Existing use and occupancy ........ ~&e.atl'l;....~¢ ............................................ .......... ~ ............................. : ...........
b. Intended use and occupancy ........ O.1a~...~t~t.i.iL.~..¢l~19~.],l.I.~ .................................................................
3. Nature of work (check which applicable): New Building ......... :3r,:r,.~'" Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................
4. Estimated Cost ....... .~{~)(~)..~/.~ ................................ Fee ......... .1.O .........................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..........O~e ............... Number of dwelling units on each floor ............................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature .end 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 ..... 66 .................... Rear ............. 6(~ ........... Depth ......... .;)6 ...............
Height .............................. Number of Stories ......
9. Size of lot: Front ..... ;~0.~ ................. Rear ....... .1{)3 .................... Depth .....1.~i~. ..................
10..Date of Purchase .......................................................... Name of Former Owner ....... l~le~-~& .....................................
1 I. Zone or use district in which premises are situated ...... ~.lt.....d.~.~ .........................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............. Irt{) ............................................
13. Name of Owner of premises '""~.~'~e'~"]:.'].~'"&"~'"' Address ................. ~'a~'l~:.t,~ ......... Phone No ...................
Name of Architect ............................... n. .................. Address ................................................ Phone No ...................
Name of Contractor ............................... .~ ................ Address ................................................ Phone No ..................
PLOT DIAGRAM
Loca,te 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 NEW YORK, )
COUNTY OF '",~'<~?L~. ....... ) S.S.
· ' ',L ............ ;.;;¢~; .~¢~.~;.)..~.~,. .......................................... being duly sworn, deposes and says that he is the applicant
u'~ame or ma~waua]' s~gning application)
above named. He is the ............... j?~'.t~..&..~o~',,.~'~,.~..]:.d~;~ ..................................... ~ ..............................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said wo~k 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
................. ~.. day of .................. '~e~ ............. , 19....~ /~'~ rj~ ,~ ~ ~ ~.~_ ~' ~
~o~ary ...... rum c ~ ' ~/ ~ ~"'~ ~"~ ,. .... "~' ~ / ,~,.~.~,~.,..4~W..~.~r;~ ...... ~ ~/~'.~ .~.;,-~..
.... ~'"tZ~~'t~:~e~ {(Signatur6 of appli~a,n0' ...................