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Home My WebLink About8354-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF OCcuPAN~ No Z--24806 Date DECEMBER 17, 1996 THIS CERTIFIES that the buildin~ ADDITION Location of Property 4485 WESTP~%LIA RD. MATTITUCK¢ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 13 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 14, 1976 ~ursuant to which Building Permit No. 8354-Z dated JANUARY 14~ 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 ADDITION TO EXISTING ONE FAMILY DWELLING A~ APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FREDERICK & CAROL TAYLOR N/A N/A ~il~ing I~sp-ector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLk-I'ION OF THE WORK AUTHORIZED) Permission is ~. I~,,_ere_x~ e~-l~ran.~ to: _ ~/ ....... ..~...~~..~..-....2z...~.?.:.. ................ ~ .......... :; ............. :...;. ...... ;.i: .......................... ~, ....,~e. ,~~.~-~.' ~~~~.~~ ......................... ...................................... : .................. ~....;...... ....... :.~~...~ ..... , .... pursuant to a~plicatlon dated -¢: ~ ~ " . 19' : and Buildin0 Inspoctor. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN FALL 765-t802 APPLICATION FOR CERTIFICATE OE OCCUPANCY This applicatiou must be fzlled in by typewrzter OR ink and submitted to the bu!ldlng inspector with the following: for new bu~_!ding or new use: 1. Final survey of ~property with accurate locatmon of all buildzngs, property lznes, streets, and unusual natural or topographzc features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial buildmng, industrial bulld3_ng, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responszble for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and ':pre-existing" land uses: i. Accurate survey of property showing ail property lines, streets, building and unusual natural or topographic features. 2. A properly completed applzcation and a consent to inspect signed by the applicant. If a Certifzcate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions co accessory building $25.00. Businesses $50.00. Certificate of Occupancy on Pre-existinR Buildinm - $100.00 Copy of Certp_ficate of Occupancy - = .25g Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residential $i5.00, Commercial $15.00 Date .../. ....................... New Construction ........... O,ld Or Pre-existing B_u~ilding..~... ............ ~ , > ,~ tion of ......... ............. ..... Eouse No.~/~ ~-greet ~ H~I eU co~=~y ~ ~p ~o ~000, s~o~ .... ZZ.~ .... ~zo~ ....... x.~ ..... ~o~ ...... ~ ............. Subdivision .................................... Filed Map ............ Lot ...................... Perm~_t No..~. ~.~....~. ...... Date Of Permit .~. .... Applzcant ............................. Health Dept. Approval... ~/..~. .................. Underwrzters Approval....~..~. .................. Plannzng Board Approval .... ~..~ ................ Request for: Temporary Certificate ........... Final Cartmcate....../~..... Fee S~bm,.tted: $...~.~..'.~.~. ............... FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PEBJ~AIT Date ............. INSTRUCTIONS o. This application must be completely f,lled in by typewriter or~ in ink and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. - b Plot plan showing locahon of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and g,ving a detailed description of layout of property must be drown 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 wdl issue a Building Permit to the applicant. Such permi[ 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 thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, 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 tc admit authorized inspectors on premises and in buildings for necessary inspections. .2;. (Signature of applicant, or name~,4f a corporation) o .......... ...................... (Address of applicant) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electricman, plumber or builder. ......... ..... z... ................................................................................................................................ Name of owner of premises ...f..~..~...~..7.~...~./.~....~. ....... ~.~....~r~....~.. ...................................................................................... If applicant ~s a co~orate, signature of duly authorized officer. (Name and title of carpal,rate officer) Builder's License No.../:...~.,; ............ [lectrician's License No ............................................. Other Trade's License No ............................. ..-TT. .............. Locahon of land on which proposed work will be done. Mop No.' ........................................Lot No .......... ~ ....... Street and Number ........................................... .~..~.,~.~../.... .............. Municipality State existing use and occupancy of premises and m*.ended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... l ....... ~.Z.I~Y' ...... ~....~/..~.~..~..J...~/..~ .......................................................... b Intended use and occupancy ..................... ~...~..C/~. ,~..~.~-~. ................................................................................. 3. Nature of work (check which applicable) New Building .............. Add~hon ............. Y Alteration ......... Repair .................. Removal ................ Demohtlon....._~.'~... .]--Other Work ...................... .~ ............... ~ ~ (Desc iption) t ~ ~ ~'~--~ Fee ../~..~... ...................................................................... 4. Estimated Cos ............ : ................................................. i (to be pa~d on filing th~s apphcahon) 5 If dwelling, number of dwelling umts ..........................Number of dwelhng units on each floor .......................... If garage, number of cars ................................................................................................................................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7. Dimens,onsofex,stmg structures, fi any: Front ..... /_~/.t.--~. ............. Rear ...... ..~.....~. ................ Depth ...~...~.. ...... He,ght ......J...-~...~ .......... Number of Stones ........ .~ ................................................................................................ Dimensions of .~ame structure with alteratlons~or adda,ons Front ......... ..~....~....( .............. Rear ......~'.i~ ....... Depth ....../:L...~...: .................. He,ght ......... /....~. ............ Number of Stones ..... ~ ........................ j. ................ 8 Dimensions of entire new construct,on' Front ........... He,ght ..... /,...'~.,,! ....... Number of Stories .......... ! ................................................................................................ 9. S,ze of Io,' Front ........ ~ ..................................... Rear ... j...~..I. ..................... Depth .....;~..... . 10. Date of Purchase .... l~...~..~...~...~..~ ....... .]...~.....~...O.. .......... Name of Former Owner ...... 11. Zone or use distr,ct in wh,ch prem,ses are situated .... .~..~/~..~. t..~.?..~...~. J.. :~....DC....L.. ............................................... 12 Does proposed construction violate any zoning law, ordinance or regulahon- . ........ .~[....~. ..................................... 13 Wdl lot be regraded ....... .~.~.....C~. ............ Wdl excess fill be removed from premises: (,~) Yes ( ) No 14 Name of Owner of premises ....F...~..~..~.?.~...~..~...~..~......~-...~..~..~.~.../~Address ,.~...~...?.,.~......l~,.~,~.~.~.,~o~'ne No. ~..~.,7..,.~..~.,.~.2 Name of Architect ... I t ~ Address ...i~/...~ZT~..!;..~..?...C..~... Phone No ..................... Name of Contractor ........................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether exmting or proposed, and red,cate all set-back d~mens~ons fro~ property lines. Gwe street and block number or descnphon according to deed, and, show street names and indmat whether interior or corner lot -I . ' STATE OF NE~/cY,--O._P~ ~ t ~ ~ c S COUNTY OF ...~.~?.~.~f-/~...q.k.~. ...... fo. ~ ~ ....................... ~.C.~..~.~.~.t~.....~ ........ t.~..~.~be,ng duly sworn, deposes and says that he ,s the apphca (Name of indiwdual s~gning contract) above named. He ~s the ....................................... ~..~..b.~.~ ..................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f this apphcat~on; that all statements contained m thts apphcchon are true to the best of h~s knowledge and behef, a, that the work wdl be performed in the manner set fo~h in the applicahon filed therewith. Swam to before me th,, :~~ ~.~:~ ~~ ...... ~..~... day Of ..~.~.~.~..., 19.~ ~ ................................ ..... [ .............. ELIZAB~H ANN ~[VILLE NOTARY PUBLIC ~t~/e of New Yor~ ~o 52 ~]25~50, Sulh~lk Countyx