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HomeMy WebLinkAbout11704-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy bio. Z11564 Date March 23 1983 THIS CERTIFIES that the building ?.c. ?.e.s.s.a..i?. .................................... Location of Property 300 Deerfoot path Cutchogue House No. Street Hamlet County Tax Map No. 1000 Section ... ?~? ..... Block ... 9~ ......... Lot O'15 Subdivision....~??.~.e., .C.o.¥e. ................ Filed Map bio...~.~.~.9..Lot No. '~e conforms substantially to the Application for Building Permit heretofore f'fled in this office dated .... M. a. y..1.3. .........., 19 · 8..2pursuant to which Building Permit No. '1 '170~-Z June 2 82 dated ............................ 19 .... 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 ......... ...... .A.c.c.e.s..sg.r.~r' storage building The certificate is issued to .... . .~.t..hg.w...J....M.a..r.t.i.n. ................................... (owner, ~a-o~'tenarrt) of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOBM NO. ~ TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 117O4 Z Permission is hereby grontecl to: ............. ~.~ ........ :...~f~.m ........... ~..~.~~.~,...~..~:...~/ ~, ~-,~, ,=,~ ~, ~.~...._~~.~.~ ........................................... ......................................................................................................... .... ~~...~f~ ........... ~'..~..~.~. ....................... ~ .~ _~ ............... c~,~ T~, ~p No. lO00 S,~*~ ..... ~.~Z ..... B~k ....~.~ ....... ~, N~..~.~ ..... /B,'iI~] Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subn~itted 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 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 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. 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 ..~ARCH. 21, 1983 New Building UTILITY Old or Pre-existing Building(X) --~/Vacant Land ' Location of Property . ~.0,0~.p.,eerf~o.o,t pat.~., Cu. tcho~Lze House No. Street Ham/et Owner or Owners of Property lV[athew J. Ma]~bin County Tax Map No. 1000 Section .... O .~.'7 .... Block ..... .~..'7 ...... Lot .... O.Z ,~.~' ..... Subdivision ..... ~.'J .~.,~..~. .... (~.qV./~. ...... Filed Map No. ~.~-~.~ 0 .Lot No, .. J.~. ....... Permit No. ,/./. ,'7 ...... Date of Permit ......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. U d ite s Appr I .~. J, ~./~, ' n erwr r ova ................. Planning Board Approval .................. ~ ·., - Z ~equest for Tempora~ Certificata ..................... Final Certificate ...... - ......... FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ?~DATE COMMENTS FORM N~. I BU! LDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Ex.mined ¢ .., Disapproved a/c .... :.::..~.. · .--?.-~. · ....... ..~ .......... / (Bufl/difl'g Inspector) APPLICATION FOFI BUILDIN~ PI:RMIT INSTRUCTIONS a. This application must be completely f'gled in by typewriter or in ink and submitted ~ to the Building Inspector, with 3 sets o£ 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 pre.raises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be co__ed before issuance of Building Permit. · d. Upon approval of this application, the Building ~ill issue a Building Permit to the applicanL Such permit shall be kept on the premises available for in~ection throu~ work. " e. No building shall be occupied or used m whole or in ~ any _purpo.se whatever until a Certificate of Occupancy shall have been granted by the Building InSPectbr. APPLICATION IS HEREBY MAD£ to the. Buildhig D~t for the issuan~f a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Co~nty, New York, and i~her 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 taws, ordinances, buildin~ code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nece (Signature of apffficant, or name, if a corporation) · Z BOX 302, Cutchogug, N.Y. 1~935 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWNER MATHEW J. & REGINA I. MARTIN Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corpo~n, signature of duly ~. rized officer. (Name and title o~orporate offi55/O ' Builder'~ License N.~ .... %~...~. ......... Plumber s License No. ...... N,<. ............... X Electrician's License No ........N~ ............. \ Other Trade's Liet nsc No. ....... ..x~. .......... 1. Location of land on which proposed work will be done .................................................. #XX 300Deerfoot Path, Cutchogue, N.Y. ~935 House Number Street Hamlet ,,.~t County TaX Map Nd. 1000 Section ..... .O..(~.7 ....... Block ..... iO..~. ........ Lot...0.42-- ............ Moose Cove · . ............. . Subdivision ..................................... Filed Map No.. ~ ~.3.(~). .... Lot '1_6. (Name) , 2. State existing use and occupancy of premises an~ intended use and occupancy of proposed construction: Residency ~ a. Existing use and occupancy .................. ~ .................................................. Residency Utility shed b. Intended use and occupancy .............................................................. 3. Nature of work (check which applicable): New Building ~.~f ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost . . .$.5.0.0., .0.0. ........................... Fee . 3.1.0.'.0..©. . .Y i ......................... (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, 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. Dimemion~ of entire new construction: Front . ...~.0...f.t., ..... Rear P .f..t: ......... Depth ........ Height .... 8...~.t.. ......Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ..... ~ ~d.,. ................... Will excess fill be removed from premises: . Yes No 14. Name of Owner of premises .................... Address ................... Phone No. ~.'! :J- .'..L. ?:'.,~, Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether e~.isting or proposed, and, indica~ all set-back 6ime~ls/o~a from property lines. Give street and block number or deseriptim~'according to deed, and show ~t~eet names and indicate whether interior or comer lot. i STATE OF NEW YORK. coum¥ or..s.u?.Fg.rE .......s.s ....... ?I.A.T.H.E..W..3.:..~I.A.R.T.I..N ....................... being duly sworn, deposes and says that he is the appti~mt (Name of individual signing contract) above named. He is the ........ .0?.N..E.R ......................... . ................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to mak~ and file fids application; that all statements contained in this application are tree to the best of his knowled~ and belief; and that the work will be performed in the manner set forth in the application tiled therewith. · Sworn to before me this .............. ...?.ff...~...day of...~.~ ............. ,~.~.. Notiry Public, . .... County /-~ t D J- -- No. 4244014 ~ '"' (Si~stu~ of al~i~)