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Home My WebLink About8524-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cedificate O[ Occupancy No. Z10637 Date August 19 1~.1. THIS CERTIFIES that the building ................................................ 4055 Halleck Lane, Mattituck, New York Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section . .1.! ~ ....... Block ...0.! .......... Lot .... 0.0..5.,.0.0.6. ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 22 19 76 ..................... , ... pursuant to which Building Permit No .... .8.5.2.4...g ........... dated . . . .A.B.Ri: .1..2.2. ............... lcd.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 Dwelling Helene Holtz The certificate is issued to ........................................................... of the aforesaid building. Suffolk County Department of Health Approval ...... .Nf.~. ................................ UNDERWRITERS CERTIFICATE NO ........ P.e. $ .d.i.n.g .... .............................. Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHO~D Town CLERK'S omcE SOUTHOLD, H~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8524 Z Permission is hereby granted to: ..... ~e&ene..~.loiL~;~ ............................................. : Mattit~ck FOI~Vi NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate Iocatian of oil buildings, property lines, streets, an6 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. Commercla[ buildings, ~ndustria~ buildings, Multiple Residences and similar buildings and installations, 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 19,57), 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 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 in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $,5.00 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1.00 ............ ............. New Building ......~...'....... Addition ................ Oldor Pre-existin~ Building .~'-;-'z...-..x. Vacant Land .............. Locat,on of Property ........ ........ ............ / ~ l-- Owner Or Owners Of Property ...... .~.~-~---~/~.,~.....~/--~..~..~ .................................................... Subdivision ................................................................ Lot No ............. Block No. '"v~'"' House Na ............. Permit No.~.~.'.~.'~..~.....~<.. Date ~er, mit..rT/.Z.z:..~//..,.'.7..~..Applicant .~..~ .~..L/'~2,~...~..~...~....,'~.:~.~.. ...... Health Dept. Approval ............ 7~.4~ ....................... Labor [Dept. Approval ...t~../,.~.,~ ............................. Underwriters " ' ~.'.../,~ Approval .............................................. Planning Board Approval .., ~ ........................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... FeeSubmitted$ .................................... '7-'/~, ~ [~¢20~ ~//;~_. - ~/ -" Construction on above described building and pa:it meets all a~plioabl,~ Codes and regulations. ....... ....................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County · FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property 4055 Hallock Lane, Mattituck~ New York House No, Street Hamlet Helene Holtz Owner or Owners of Property ....................................... ..................... County Tax Map No. 1000 Section . .1,1..2 .......... Block ..... 0.1. ........ Lot. 005 . .0.0..6... Subdivision ................................. Filed Map No ........... Lot No .............. ........... 4/22/76 .......... Permit No8524 ;~ Date of Permit Applicant ................................ Health Dept. Approval ........................ Labor Dept, Approval Underwriters Approval ........................ Planning Board Approval ........ Request for Temporary Certificate ..................... Final Certificate ...... x. ...... Fee Submitted $....5...0..0 ..................... Construction on above described building and permit meets ail appli,ca,bte o~des a~d r~ulations. App]icant ._~.~ ~,., ~ ,~.~, .~...'~.~.. .............. Rev. 10-10-78 ,, 'z_ ...... Approved ................. ~,; ....... ~ ....... , 19.'2,~.i. Permit Bio. TOWN OF SOUT.OLD BUILDING DEPARTMENT TOWN Cu=,K's a. 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 public streets or areas, and giving a detailed description of layout ofproperty 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 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 'g ~ pp 'can~, or name, ir a corporation),/ ............. (Address of applicant) H~ :~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~_~.........~..~...z~...~....Z=... ....... ../~...~... ....................................................................................... If applicant 'is a corporate, signature of duly authorized officer. (Name and title of corporate officer) u.der's Lic se ........... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ................................................ Location of land on which t~rol~ose, d~work will be. done. Mop No.: .............. ; ............. Lot No ................... Number .~/~ .(,-~..~. ~..~.~. ,~.. ~'% ~'~ .............. ,~'/2, .~..' ........................................................ Street and ....... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... ~-~-~....~.. '~.M..~... ....... , ............................................................................... nded se ndoccu nc b. Inte u o po y ................................... ~..4,~f.... ......... : .................................................. propcrty lines. Give street and block number or description according to deed, ~vhether interior or corner lot. , ,-------~ ~ I~ ~.------(I ~, '~/*~- 3. Nature of work (check which applicable): New Building'. ................. Addition .../f......... ..... Alteration ...... ........ Repair. ................. Removal .................. Demolitior. ................... Ol~her Work ......................................... ~ ......... xt - ¢_~-- O (Description) 4. t']stimoted Cost ............................................................ Fee ...{..~....::....,.. ..................................................................... (Io be paid on filing this application) 5. If dwelling, number of dwelling edits ...... .0.~('/~' ...... 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: Fron~ ......................... ~ Rear ................................ Depth ..... Height ........................ Number of Stories ..... ~..*.'f;T..,1 ............ ~....¢¢~[.~ "' ~ .... t Iterations or additions ~l'ont Rear uimen~ions o~ some srrucrure w n a : ............................................................. Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensiol~s of entire new construction: Front ...[.~,~..,~.~' ............... Rear ....xtra... .................... Depth ,...~... ............... Height ....... [..~..[~. Number of_ __St°ries ..'..~.. .............................................................................................................. __ 9. Size of tot: Front ...¢:~K~/gt~cPf;.....J..%~,,..-?..Z...¢l.~.. Rear .......~ ........................ ,... D~epth .../..C~.~..:'.."~... ..... - '¢/JJ' of Former Own~er~~ ! 10. Date of Purchase ....... t,-, '"/~.~/.~../., ....... .z. ......................... Name, ..~; ...................... ............. or uae .n prem.ses .~..~_¢¢,~,..14z'~.,.=..~. ............ ~_~ ......................................... 11. Zone 12, Does proposed construction ,violate any zoning law ordinance or regulation: ........ -~,J.(~. ........... ~..~ ....................... 13, Will lot be regraded ...... .[..'h/..O. ........... Will excess f I be removed from premises ( ) Yes ( )No 14. Narne af Owner of premises ...~...~..~,~'.F~.(.~.~r~../.~.~.~,lT).---,~,~, ...... Address .']./,,~.,~,~:~,.~'J;.fTt4e~....-' ~ ~ Phone No.'..~...~..;.,~. ~..~.'¢/ Nome of Architect ..,.~i,~¢,~...,..~.~L~,.~..'~,. ................ Address .......... !~ .................... Phone No ..... t.t..~ ....... (..!.. i'.!~_~me of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly al/ buildings, whether existing or proposed, and indicate all set-b~ck dimensions fram end show street names end indicate ...... I I ~ ~l--~-~ -'---~ //~--t) ~ ~ r/ ?-I-AT~ OF NEW '~fORJ</ ' ~ / [ ~ S ................................................................................................ bein~ duly sworn, deposes ond s~ys that he is the (Name oF individual signing c~trocf) above named. Fie is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) oF s~id owner or owners, and is duly authorized to perform or have performed the said work and to make end fi~e ~his application; that ali statements contained in this application are true to the best of his knowledge and belie~; lbo* lhe work wilt be performed in the manner set fo~h in the application filed therewith. Sworn to befo~e this , ~ ........... ~.~dov of ........ ,~ .................. , 19Z~.. .... ....................................... (Signature of applicant) JLIDlYF{ ~. (,, n,~ston [:xpir~ March 80, i9~7