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Home My WebLink About10033-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19394 Date SEPTEMBER 27~ 1990 THIS CERTIFIES that the buildin~ ADDITION Location of Property 1000 SOUND BEACH ROAD MATTITUCK~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 99 Block i Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 24, 1978 pursuant to which Building Permit No. 10033-Z dated NO%rF~4BER 24~ 1978 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 The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 DONALD G. & JESSIE A. WITSCHIEBEN N-440051 - JULY 2~ 1979 N/A // Bu/ilding Inspector FORM NO. 2 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? 10O33 Z Dote /~//' l/ <'~ ~/ , 7 ~ ........................................................ 19.......r~ Permission is hereby gronted to: at premises located at .............. : ....................................... ~...: ....................... ; ......................................... ............ ,.~ ........... ?-~ ...................... : ....... ~_...,..: ....... , .... ,,,,,, .~,,~ ....................................................... _~ , ........... :-~- ,,~,,,t ~o ~pp,c~,o, d~ted ............................... ::..X.....~.'I....., ~7~ ,........ ~,d ~pp~o~d by ~h~ ~uilding Inspector. Fee $.:.~. ................. M Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPA Instructions 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 a~pplicable. 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. C. Fees: 1. 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 Date .5.~..~.~'.~.~.4[.~..~., ?..?/../~..¢.¢. , , New Building ............. Old or Pre-existing Building ·, .~ ........ Vacant Land ............. Location of Property ./..07..~., ~ .~ ?/:.4.~.,,, .~.(t?.c//., ?..R).V:~..j,., .~..R.'r.'r j ?. ,u.~ .K. .............. House No, Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section ...~[.~. ......... Block ..... 1 ......... Lot... ~ .......... Subdivision ................................. Map No ............... Lot No..~.~'.-; ¢.~. ....... Permit No../.O, .O~,~,~-~. D~ite of PermitJJ.~ .P'~/.~.7·~..Applicant ~.~./).~.R'.. ~,. ~/./Z ~.~.~./...~...~. .... Health Dept. Approval .......... , ............ Labor Dept. Approval t~i~1/4' #r/~ ~ o,~ ?~ ~ .......................... Underwriters Approval ~'~ ~5/~-~¢'/ 7¢~./?.,,~.. .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. ~r; ~.~ ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ./~ .~.~J~0...~.~.. ~A/ ~ ~'¢.C../'/j.,¢· ~. ~'.)~. .................... Rev. 10-10-78 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION zND[ ] INSULATION FRAMING [~ ...,,,.KS: /~' ~ ~ DATE INSPECTOR TOWN OF SOUTHOLD FIFFIOE F1F BUILDING INSP~'OTOR TOWN CLERK'S I-IFFIOE J~OUTHOLD, N. Y. 11971 t£k. 7~5-~66D x~ SUF~V£¥ FOR DQNALD G. E, JESSIE A. W/T$¢H/~BEN FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ×amined ................. , ................ Disapproved a/c ........................................................................................... ................. ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............. ............ , .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the B~ilding 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 o7 areas, and giving a 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 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. .................................................................................................................. Name of owner of premises ........ ~.~J~.~ .~../~....~.....~....~..--~..~.~../.--~...~.. ..................................................... .l~,~.j.~..,~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) , ,L.~ Builder's License No .................~. ...................... ~... Plumber's License No ............ ..~ .................... .~... Electrician's License No ......... .~. .................................. Location of land on which proposed .,work wilt be done. Map ~a.: ......... ~:~..~. ................... Lot No ............. Street and Number ........ ~,..I.,~,..,.~,~,.~..~,..,0,. ,,~,,,~,,~$~,l.'4...,~,,,l~1.0.,~,, .~.~",~.~,,~,,,,~-r~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ....~...~.!.l~..~.~'..l~ .................................................................................... b. Intended use and occupancy ......... ~.,,.m~....k~..:~.:rl.~/~ ....................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ....v.Z ......... Repair .................. Removal .................. Demolition .................... Other Work ...................................................... Fe ? (Descr pt, ion) 4. Estimated Cost ............ ¢.~4.¢~..~¢4. ................... : .............. e .......................................................................................... '. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................... ...'??~.....~ ......... ~; ............................................................................................. 6. if business, commerciat 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 ..... ~..~.z..~.... ............. Rear .~..~---~,.~..'~. ............ Depth ........z~.~. ................. Height ....... ~,.~¢. ............ Number of Stories ....~2./~../.~ ............... 8. Dimensions of entire new construction: Front ......... /'~:2z~.. .............. Rear ...... ~,..~..,~'.'~.. ....... Depth ../.,~'.¢.,~ .......... Height ...:..~'.~.. ....... Number of Stories ......... ~..z~(./~.~.. ................................................................................................ 9. Size of lot: Front ........... ~.¢:~.~.z...~..'~..'~.. ................ Rear ......... ~.~:~:2.4..~.~,-} ......... Depth ..;~.,~.,~ ................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ I i. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ .~..~:~ ................................... 13. Will lot be regraded ...........~.~). ........ Will excess fill be removed from p~,,mises: ( ) Yes ( ,, ) No 14. Name of Own_,er of premises ~..4~..¢4¢):..M~/./~.c~i~,/.f/..~..~...~,J.,. Addres~~,~¢~. ~?-~one' No ....... ~ ............. Name of ~.....~--~.....~.'.,~,~fJ,~,~...J~.~. ......... Address ,-,-,-,-,-,-,-,-,-,~//;.~M.~.~.. ............ Phone No ~.~5~.~;; Name of Contractor ..... ,.J..b.U./9~,,,~..~.,.~.. ........................... Address ,~.(4~e.,%...~..i~ .......Phone No ....................... PLOT DIAGRAM /~/~ ~ Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate ~11 set-back dimensions from property lines. Give street and block number or description according to deed, and show street n~mes and indicate whether interior or corner lot. STATE OF NEW YORK~ I c ~ COUNTY OF ...~,,2~.....f¢'¢ t~../~./~.......~"~...../~.~.....~...~.. ................... be.rig duly sworn, deposes and soys that he is the appiicam · (Name bf individual signing contract) above named. the ..................................... .................................................................................................................... (Contractor, agent, c6rporote officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicotidn 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. Sworn to before me this ............ · ~,: ....... d~y of ...~ ........... , 19,~-. ..... ........... JUDiTtl T, TERRF// (Signature of applicant) Not~ry P~::i~, Stn'.o of New York t4o..~;., 32 .r'.'3~3 Suf, o.k County/L.~