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Home My WebLink About8654-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28021 Date: 10/19/01 THIS C~u(TIFIHS that the building ADDITION Location of Property: 685 SIGSBEE RD (HOUSE NO.) (STREET) County TaxNap No. 473889 Section 143 Block 2 Subdivision Filed Map No. -- Lot No. -- LAUREL Lot 13 (HAMLET) conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 15, 1976 pursuant to which Building Permit No. 8654-Z dated JUNE 17~ 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 SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRANK C. & NANCY A. TODRICK (OWNER) of the aforesaid building. SuFfOLK COUNTY DEPART~T OF HEALTH APPROVA~ N/A ELRt-rmICAL CERTIFICATH NO. N-349337 08/01/77 PL~3MBER~ CERTIFICATION Ik%'£~u N/A '//k~oriz~d Signature Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8654 Z Permission is hereby granted to: ~....a...~.e,.~...T~z.$.~l~ ............................... ......... .~..t..t..$.~ ................................................. build a~ luld~t~on on oxistLul~ dvell....L~. lot f 1 liatt Pazk Pzo~ ....................... at premises located at ................ .~. ................................................................................ .......................................... ,...S.$O.~...~.~ ........... ~.t,;t.tm~ ....................................................... pursuant to application dated ................. ~,.l~...?......J..~.. ................... , 19...~..~.., and approved by the Building Inspector. Fee $...~.,~1~ ......... BLDG. DEPT. ~:~VN Q~ SQUTt4OL~ .I Form No. 6 ~O~C TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 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 1% lead. 5. Co~mmercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible 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 Upre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. 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 to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - ~ .~5~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Co~anerctal $15.00 New Construction... '~' '/f ''ck\O~d Or Pre-existing. Budding... ~ .......... ' House No. Street Hamlet Onwer or Owners of Property. . ' ..................... County Tax Map No 1000, Section...~.[~. ...... Block .... ~ ......... Lot ..... ~..~.. ............. Subdivision .................................... Filed Map ............ Lot ...................... Permit No .... ~. ~5~..~.Date Of Permit.~ .~\~.~ .%.~...Applicant..~..~<..~-~..~. ~.1.~.~<.. .... Health Dept. Approval .......................... Underwriters mpproval...~.[~.~.~.'Q .......... Planning Board Approval .................. ' / Request for: Temporary Certificate. i ii.i .i.'Final Certicate ........ ~.. Fee Submitted: ak THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- BUREAu OF ELECl~ICITY 8~ JONN STREET. NEW YORK. NEW YORK 10038 ..,. ~ugust 1. 1977 · .~,~'-,,o-,¥,,.,,,.~u 871961 N /... ~"-' I~att:[tueu--~ T · --~ ~. nu. ~ reco~e ~ Blvd. J5 Ho~ton Avenue. ~~N, ~ u,,,rea m any manner; f~urn fo ~ office of ~ ~r ' ' --.E . .. ~. TOWN OF SOUTHOLD PROPERTY RECORD CARD .. a s~s. v~ ~A~ co~. c~. ~,sc. ~k~. AGE BUILDIN~ CONDITION NO~ BELOW ABOVE ..... Acre Value Per Value ( ~re lane 1 lable 2 lane 3 ~odland ~mpl~d FRON~A~ ON WA~R ~land FRONTAGE ON ROAD .~j~ ~ ~"~ ~ ~se~ . ~_ _~ DEPTH BULKH~D ~1 D~K ~ension ~ ~, :tension ~tension ,,/..~ ,~ 2. / ~ ,rch reezewoy lrage ~ .B. )tal' 3 COLOR TRIM ~oundation :.xt. Walls Fire Place Roof I(~creation Dormer Driveway Bath / Floors Interior Finish Heat ~ ~r Rooms 1st i Rooms 2nd Floo ~'-' - Ko IPOI~M~ NO. I TOWN OF SOUTNOLD BUILDING DEPARTMENT .~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ,. / 7 Approved .. . 7~ Permit No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildm Inspector, with 3 sets of plans, accurate plot plan to scale Fee accor' ' b. Plot plan showing ocot on of ~ ......... ' dtng to schedule, g · . . . .~u~ una or Duno~ngs on premises, relationship to ad'oini · · areas, a__n.d g~wn.g a detaded descr~phon of layout ofpropert~ must be dr ........ c . - ..... u,I ,ne a ogram .w.h~.ch fs part of this application. · /he work covered by this applicahon may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this application, the Buildin Ins ector i · . . · · · shall b~e,ke, pt.,o,n, the pre.raises available for inspectiong thr~ueghou~' ~s~e,~ Bu,ld,ng Perm,t to the appl cant Such permit e. ~,~o Du,,a,ng shall De occup,ed or used in whole or in part for an,,'l~r~ shall have been granted by the Building Inspector· ; ~ '~ whaTever unt, a Certificate of Occupancy .A.P..PLICATION IS HEREBY MADE to the Building epartment for the issuance of a Building Perm,t ursuo Regulations, for the construction of buildings, additions or a,terations, or for removal or demolition, as' herein described. Bu,ld,ng Zone Ordinance of the Town of Southold. Suffolk ,County, New York, and other appl cable Lawsp, Ordi~atntc°esthoer The applicant agrees to comply with all applicable laws, ordinances, bui admit authorized inspectors on premises and in buildings for necessar lil~;~g code, housing code, and regulations, and to r~ ,n,~ections. ................. ...... ~ ~ qz~aaress O~al~plicant) '~'.' ............... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ....... Builder's License No ................... .~ Plumber's License No. Electrician's License No. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ..... Name of ~""~"~"'~ ' ' ' "'~"~' ~ .......... ~'~-'~'" ' ~ ~' I, owner of premises ........................... ~ ........................... .d?....~. Other Trade's License No. .............................................. Ma No Location of land on which pJ~po, sed wor.k will be do, l~ p _.: '~,~-~l~,..p~,/t.~'~,~t ...~-....~.Z Street and Number ........ ;,,~,,,L.,~.,~,.b~, ..... "0... .... .............. · ..... State existinn use ann .............. ' ...................................... ........ ...... I~Un~-y or prem~ses~ ana intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~ I' I' ........................ b. Intended use and occupancy .......................... ~.~..~..(~.....~..~......,~..4~I 3 Ncture of work (check which applicable): New Building.. ................. Addition .................. Alteration ~ ' ~ Repair .................. Removal .................. Demolitior .................... Other Work ................................................... ~ .~..~...~....~....~.. ................. , r-- LYC) (Description) 4. Estimated Cost ........ :....~....~. Fee~"/'~:--'~'"'~i~""i~'~"~ p '' iling this application) 5/If dwelling, number of dwelling units ............................ N~mber of dwelling units on each floor ............................ If garage, number of cars 6~/I~ business commer i I ........ i""'. .................. i ............ i .............................................................................................. · - ~ , c a or m~xea occupancy, specity 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 ........................ Height .................... Number of Stories ................................................. ;-..-, ............................................................. 9. S ze of at' Front .~....0. ,~ Rear ~(--) j ~ ~z~ z _o ....................... ] ..... ~-'~':zz ..................... .~. ...... ~ .................. Depth ..... ./....7...~...~ ........ 10. ate of Purchase ....................... t/..C~.~..~.~. .................. Name of Former bwner .............................. (J 1 1. Zone or use district in which premises are situated .................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..... ~..~. ................................ 13. Will lot be regraded . ....... ~....O.. .......... W, LII excess fill be remove~?oq~e~.is~s:.( ) Yes ( ) No ]4. Name of Owner of premise~"~.~.~..~-..~...~.~.~..~.....~.~.j~l'~. Address ..~J..~'.~l'~.~ Phone No. ~..~.~.."~....~...~. Name of Architect .............................................................. Address ................................Phone No ....................... N~m.e of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from aropr:rty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. %'ATEOF NEW~R~ /'/I " ..................... ~~'~:.ii~. · ~---~/~.~.~..~: · -r- · .'~. ·: · .~.1.... being (Nomo'~of individual si§ning contract') ............. above named. duly swo'n, deposes and says that he is the opplicon~ hie is the (Contractor, agent, corporate officer, etc.) of s~id owner or owners, and is duly authorized to oerform or have performed the said work and to make and fiJe this application; that all statements contained in tk~is applicction are true to the best of his knowledge and belieF; tho~ the work will be performe/?l in the manner set forth in the applicat on filed therewith. Sworn to before me this ~1 .............. 7. ..... day of ..~...~,- ~..'.... 19 ~'~ ~ ~ ~ , ....... . ...... ...................................... ....... ~ '/~7 ~' . . ~o,~c'~::~ "'~~ture". of applicant) " ,/~ ' ~ Comm. Expires March 30, / / / / Survey for FRANK 8 ROSE TODRICK Mattituck Town of Southold Su ff. Co., N.Y. NOTEI ·· MONUMENT LOT NUMBERS REFER TO "AMENDED MAP OF PROPERTY OF MATTITUCK PARR PROPERTIES,, INC.,' FILED IN THE SUFFOLK COUNTY OFFICe. Scale: ": 50' Aug. 19, 1955 GUARANTEED TO~ INTER-COUNTY TITLE GUARANTY MORTGAGE CO. RlVlrRHEAO SAVINGS SANK LAND SURVEYO~ .R IVERflEAD AND-