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Home My WebLink About8934-zFORM N0, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: ~0/27/00 THIS CERTIFIES that the building ACCESSORY Location of Property: 160 ROSE LANE PVT, 23 MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 99 Block 5 Lot 21.1 Subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 25, 1976 pursuant to which Building Permit No. 8934-Z dated OCTOBER 25~ 1976 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 AN ACCESSORY STRUCTURE. (CORRECTED FROM ORIGINAL CERTIFICATE ISSUED 1/12/Sl.) The certificate is issued to JOHN SULLIVAN & WF, (O~ER) of the aforesaid building. SUFFOLK COIINTYDEPARTMENTOFI{EALTHAPPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Autho~d Signature Rev. 1/81 FO]~M NO. ~ TOWN OF $OUTHOkD :. BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8934 Z Permission is hereby granted to: ..... .:. ~ ~. . . ~ ~ . . . ~....' " ". .~. ~/.:./~ . : . :~ ........ ~zf..,.~.~.....:....~.?..: ........ ,o ........ pursuant to application doted ............................... , 19. and approved by the Building Inspector. Building/Inspector FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate O[ Occupancy THIS CEP~TIFIES that the building ................................................ Location of Property .. ~1 (~.Q ............. ~f)~t.~ .~¢.llO ............. l~.~.t;.~.[~o~ ....... House No. Street ' ' ' Ham/et County Tax Map No. 1000 Section .. 09.9.. ...... Block . .05 ........... Lot .Q~}-~.. ,~4.0~5. ..... Subdivision .... X,~ ........................ Filed Map No....X ..... Lot No..~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. :O.q l;9~.e.r,.. 25. ......, 19 .'~(~ pursuant to which Building Permit No....8.c)..~.l~-. ,~ ............ dated .. 9.e. gOlpO~..~ .............. 19.7..(:t, was issued, and conforms to alt of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....... .m3..ag.qe..~ ¢9X7.. ¢.~ .r~. e t;uve, ........................................... The certificate is issued to ....~".3~Oi?-~p. ~q.,.. ~.u.:l,1. } .v.an ..................... of the aforesaid building. Suffolk County Department of Health Approval ...r~9.~..x'~qll.l..~..~. 91 ......................... UNDERWRITERS CERTIFICATE NO ........... r~9.~.. Building Inspector R~v 4/79 TOWN OF ,, Bu~lcIIng D~par~m~m~ Town C~e~ ~u~hofld, N, Y, !!~! APPLICATION FOR CER~FI~TE OF ~CUPA~Y A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to ~re Euil~ing Inspector with the following; for new buildings or new use: 1, Final su~ey of prope~y with accurate I~atlon of oil ~ildings, prope~ lin~, unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and s~eroge di~l~(S*9 form or ~1). 3. Approval of electrical installation from Board of Fire U~e~rlte~ 4. Commercial buildings, Industrial buildings, Multiple Resid~ and ~lmibr buildi~s installations, a certificate of Code compliance from the Archit~t or E~in~r res~nslble for the building. 5. Submit Planning Board approval of complet~ site plan requiremen~ ~em B. For existing buiJdings (prior to April 1957), Non-conforming u~s, or buildi~s land uses: ]. Accurate suwey.of pr~erty showing all prope~ lines, streets, buiidi~s a~ or topographic features. 2. Swam statement of o~er or previous owner as to ~e, ~cu~y ~ c~itim of ~i~i~. 3. Date of any housing code or safe~ in,action of buildin~ or p~i~s, formation requir~ to prepare a certificate. C. F~s: 1. Certificate of ~cupancy 2. Certificate of occupancy on pre-existi~ ~eUing or land u~ $5.~ 3. Copy of certificate of ~cu~ncy $~.00 New Bqi~ding ...L~.~Z~-Addition ................ Old or Pre~xistlng Duildi~ ................Vacant L~ .............. Subdivision ................................................................. Lot No ............. Bilk No ............. Ho~e Health ~A~pt. Approval ....... ~.J~ .............................. ~bor ~t. ~al ...... J~,.~ Underwriters Approval ....... ~,.~ ................................. Plannt~ B~rd ~p~l ,,,~,~ .............................. Eequest For Tempom~ Ce~ificme ........................................ Fin~ Ce~ific~ Fee Sub~i~ed $ ....... ~ O.')nstruction on above described building and permit meets all applicable codes and regulations, Applicant ...... ~~...~.~....w~~ ........................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County z (stomp or ~eal) ~FOR,]~ ~ NO, ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y. Examined ...... .,~,..,, ......... , ,,,proved .... '97 . Perm, ....... Disapproved a/c ........................ .~ .......................................................... ..... . .... ................... ................. ~' ' .:.....i ...... ::. [Bt/ilding Inspector) APPLICATION FOR BUILDING PERMIT Dote ~.~.,, ........ ,;~,,5.~,-. ........... ]~.?,.~.....,~ INSTRUCTIONS o. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building~ Inspector, with 3 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 I~ublic streets areas, and giving o detailed description of layout ofp~operty must be drawn on the diagram which is port 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 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 applicab e Laws, Ordinances or/`` Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as herein descr bed The applicant agrees to comply with all applicable laws ordinances, building code, housing code, and regulations, and t(~ admit authorized inspectors on premises and in buildings for necessary inspections. - "1 (Signature of applicant, or name, if a corporation) .................................. : ..... . ...H...~.~. .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~:~'. ~ ~. £c.. .................................................................. Name of owner of premises . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... ~..-T. .................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No. Location of land on which proposed work will be done. Map No.: -- Lot No. Street and Number .~ .~.£ k~" ' ~ .......... 'i, ......... t~.H..; ....... ~.A.T.~.. '~u~.c~. '~//~;'~ Municipality State existing use and occupancy of.premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~ O .N. ~ ' ' b. Intended use and occupancy ~'Tb.~ ~ r~, - ' ' 3. Nature of work (check which applicable): New Building.........~... ....... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost .~..~..0...t..8..0.~' ..................................... Fee ./...~..~ .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... Z':,'.,~' ............... Number of dwelling units on each floor ............................ If garage, number of cars ............. --q. ............................................................................................................................... 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 ...~.0. ................. I-[eight ...... .~. ........... Number of Stories ................................................................................................. ~.~' ............... 9. Size of lot. Front ........ ~...6..~..:...~..~. .............................. Rear ...... .I...0...0~...0.... Depth l/0,,~.'~ ,'/. 10. Dote of Purchase . t~...c:.~..,.....~..~...L~..~. .................... Name of Former Owner ..~.~s..~..~I..,..~..N.,,~,,,,,.,.~,;,A,,,~,,'~ 1 I. Zone or use district in which premises are situated ....~.~...,~..J..~....,~..~l....~...~...~....L,.. ........................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ L~...~. ......................................... 13. Will lot be regroded .,..,,~,,~. ............... Will excess fill be removed from premises: ( ) Yes ( ) No · t.' ~ ~ ~u~-c- u I~ ~.~.~. ........... Phone No..~..~J.~:z...q...~...~....~l 14. Name of Owner of premises .,'~.~......~..[...~- .......................... .~. Address i .'~...~...~....L~. Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... ~--- PLOT DIAGRAM Locate cleaFI)z' an~ distinctly all buildings, whetner existing or proposed, and indicate all set-back dimensions from property linesL Gig'e, s~treet and block number or description according to deed, and show street names and indicate whether interi~r~ar..c~r~er lot. IOO. o / ........ STA-['E OF NEW YORK, [¢ COUNTY OF ................................ f '~"~ /~.I~,..L,. ~.,.~..~........~....~...,b...l,,.~.~...A...~ ............................... be ng duly sworn, deposes and says that he is the applicem (Name of individual signing contract) above named. He is the ......... ~....O,r,2 ,/..b.(..(~...~ ................................................................................................................................. (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 thfs 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. me this Sworn to before...~.....~.. ~/ ..................................... ....... ........................ of applicant) NOTARY PUBLIC, Stale of New Yo~k No. 03-0267600 Qualified Jn Suffolk Co,remission ExpJre~ Mo~h 30, 19~.~ /v