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Home My WebLink About3072-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z-15647 Date April t5, 1987 THIS CERTIFIES that the building Addition to existing one family dwelling 265 Walnut Avenue Mattituck, N.Y. Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 142 .Block I .Lot l 6.2 Subdivision ............................... Filed Map No ......... Lot No .............. confoms substantially to the Application for Building Permit heretofore ~ed in this office dated May 1, 1966 3072Z (1966) ..................... pursuant to which Building Permit No ...................... dated ... p.a.y...1.,.. ! .9.6.6 ............ 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 ......... Addition to existing one family dwelling as applied for. The certificate isissued to THEODORE & MARTA ANDRUSKI ..................... /o',;,,~.;,..~x:_~...*¢~ y~g x .................... of the aforesaid building. Suffolk County Department of Health Approval ............. N../.A .......................... UNDERWRITERS CERTIFICATE NO. N 80 1200 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FORM ~0. ~ 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? 3072 z Permission is hereby granted to: ~.;... ~,'~.~ :.. .:.. ./..~-.L~ !~ % ............ ~x'.t ....... ;~.~.....L~-~..~,4~ .................... to ..~,,...,A,...L ....... ~.~ .......... w.,..Lh,... ........ 4: .,-~,...../~ ........... }.,2....>:, ............................................ , .... at premises located at .~..,~/...~....~.T.,t.~,L..~..C.')/..'~..'f.../.~..:~.(¢':. .......... ~,..¢).....~..J....A....L,..(?..?...!....~ (.;.: .............. ............................................................. 4 ~ ~ ~j C ~:L.../:.~.....L.~ .......... T. ......... .;.~ ................................................ p~rsuont to app"cotion do~ed ........................... Z~..A.:I ...... ~. ........... ~9.~..~., and approved by the Building Inspector Fee $...~...,*~ ...... Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 05 JOHN STREET. NEW YORK. NEW~J~::I~3E ,,.,. ""~ ~' ~ ~..,,...~o.o.~..~,o, N 801200 THIS CE~IFIES THAT o~y t~ ~tdc~ ~u~me~t ~ ~ ~ a~ int~ by t~ ~i~t ~ ~ t~ a~ ~t~ numar in t~ p~m~s of in the followin~ h~atio~ ~,~ ist rl. ~ 2~ FL~* S~tlon ~ ~xamin~ on andfound to be in compliance with the requiremeRts FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES 3 3 MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SiliV]C;E OlSCORNECT S E R V I C Electric Wat~ Heater: 1-4. ~c, ck A.w.O. ,.o. o~ .,-LEO NO, COND. OF CC* COND, OF HI-LEO Defects ~ved ~ per o~t lette~ of 3-10-87 Goodale ~l~ctrical Cont. 7355 Main ttoad ~ttituc3c, N.Y. 11952 Per_ L-- This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. tlltlllillllJtllll~t1111~lltll~J~l!lli tl~llllllllllllltlllllllllllllllllltlll FORM NO. 6 TOWN OF SOUTHOLD Town Hall Southold, N.Y. 11971 765 1802 APPLICATION FOR CERTIFICATE OF Instructions A. This application must be filled in typewriter OR ink, and submitted ~a ~ 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. Fees: 1. Certificate of occupancy New Dwelling $25.Q0, Accessory ,$]0.00 Business $50.00 2. Certificate or-occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .~¢.'~,//, ............... NewCons truc tion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~-..~'..~.~. ................. ,/~.v~..~.....~..~..*. .......... House No. Street Ham/et Owner or Owners of Property . . ............................. County Tax Map No. 1000 Section .../. ?(..2~;.. ..... Block .... / .......... Lot.../.~'..~. ?. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~.o. ~ ~.. Date of Permit ~.'//~/'~'.Applicant ..~-~p:... ~..-~/..~-..~.~ .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . ~..-. ~.0.1. ~ .0.Q ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $... ~..J.~,..~.'.~ ................ Constructi0h on above described building and permit meets all applicable codes and regulations. Applicant .... ,~.~. ?..~".~. .... ~.~-..~ .~. ~-~. .................... Rev, 10-10-78 FOEM NO. 1 TOWN OF SOUTHOLD I~UII. DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ~ .......... ! ............ , J9 ...... Approved .......................... '..~ ........... , 19...~.!., Permit No.......,..,...,~)~7 ........ -~--...,..'~-~'' .............................. f 3'ii i;' ................................. APPLICATION FOR BUILDING PERMIT 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 o 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 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 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 and regulations. (Signature or oppncont, or nome, If a corporation) L~aoress at opp icont) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ............................- - - -' - ....... ...................................................................................... Name of owner of premises A...~)....A. ......... .~..!..(~...~..kJ~.i,~.,J~ ......................................................................... .... 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 .... ~:...~.~...p...r~,.c~¢~,~,~,....,~..~.~ ............. O. ....... ....... ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ,( .............................................................................................. b. Intended use and occupancy ................... !! ................ ~./.....~.,~.~./~.. ............................................................ 3. Not, Ire of work (check which applicable): New Building .................. Addition .................. Alteration .............. Rep~ ir .................. Removal .................. Demolition, .................. Other Work (Describe) .................................... 4. Estir ~ated Cost ...~i...~....~..~.-. ....................................... Fee ' (to be paid on filing this application) : 5. , If d, velling, number of dwelling units ............................ Number of dwelling units on each floor .............. ; ......... If gc rage, number of cars ............................................................................................................................... 6. If I:~siness, commercial or mixed occupancy, specify nature and extent of e.a_9h type of use ........................ 7, Dim msions of existing structures, if any: Front ............ ./...~.~. .......... Rear ....... ./...~z. ................... Depth .?.~...~.-~, ......... Hei ht ........................ Number of Stories ........ ~.~ ................................................................................................. Dimbnsions of same structure with alterations or additions: Front ....................................Rear ........................ Depih ................................ Height ............................ Number of Stories ................................ Rear ....~...,). ............... Depth ...~.) ........ 8. Dimmsions of entire new construction: Front ....~..c_"). ...................... Hei ht .................... Number of Stories ..... .~ .......................................................................................... O ~ /O'~ '~,/~. ........Depth ....... ~..~'.....f. ........... 9. Size of lot: Front~... ....................... Rear .......................... 1 1. Zon ct in which premises are situated ................................. 12. Doei proposed construction violate any zoning law, o~dinonce orj,~.,,, -~ ,.regulati°n? ...... ~.'/..¢.~ ...................................... 13. Na~e of Owner of premises .~'.'!..~.;~.~....~..~..!.~..~.?)...A..~..~..~.Address ../..~...'l~.'J.'J..,...!..\..,,.:~..f.~.~. ........... Phone No ................ Nar6e of Architect ...................................................... Address ............................................ Phone No ................ / A(.: .... .............................................. A 'r ? ¢ No. No eof Contractor 4"f, ~*~,~(-L~/~.~,-~- Address ....... l ....... . ........................... one ....... ......... rri PLOT DIAGRAM Locote~ clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back d~mens~ons fr property lir~es. Give street and block number or description according to deed, and show street names and ,indic whether mt~nor or corner lot. STATE OF qEW YORK, ] c ¢ COUNTY 01F ,.~,o~,,rz,,~.c,,,~,~,,.,~,~.°. .............. · ~1~'.'/t..."~..~,...,~...,..~.~"¢:..-~, ......... .~4..~ .... .~. ~...~..t.,~ing,, ~ duly sworn, deposes and says that he is the applic~ t ~(i~16r~e'of'ir~di'Vi~l'6al ~gr~l~g application) above named. He is the ............. ~;..~. ...... r~..~r.....~,~)..~.....~.~....X.~:..~ .................................................................. j ' ~ ~ ~ ' ' (Co~r~r, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke gnd fJ this application; that all statements contained in this application are true to the best of his knowledge and belief; ar that the wo~k will be performed in the manner set forth in the application filed therewith, Sworn to before me this ................ ....... ............... Nora rv P u ~1~ c, (.{; ~ff~....'... ~~ County(Sig n atu re of a ppi ica ~t) No. 52-0618~00 Suf~[x Cou Comnuss~on Exgl~es ~rct~ 30,