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Home My WebLink About12022-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25802 Date: 06/29/98 THIS CERTIFIES that the building ADDITION Location of Property: 17275 MAIN ROAD/ROUTE 25 (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 115 Block 2 MATTITUCK (HAMLET) Lot 5 Subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 29, 1982 pursuant to which Building Permit No. 12022-Z dated NOVEMBER 17, 1982 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 WITH DECK TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BEATRICE D. HARDY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N589796 01/14/83 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ~i~g InSpector 'O~'~0U~o~D TOWN BUILDING DEP~RTMEN~ TOWN HALL SOUTHOL~D, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREM!S~ UNTIL I~ULL COMPLETION OF THE WORK AUTHORIZED), ! [ No. ~2022 Z Permission is hereby granted to: ...... ~.. .>. ~ 2~,.,~i :~....~.:./..~../,~" ' ,o ... ~..~:~z~.r..~.~..:.::~.r.~.,.~ .... ..,~ ......... , ........................................... ; ..................... ; ............. ;....~, ....... ...,~' ..........~ ........ ~ufi~ Tak Map No 1000 Section /.~ B~k ~ ~.~ ~lnt~ ~ 0~ PUmuant tb a~llcation dat~ ..~....~:~.~...L..:...,.~.,..,;...~?., 19.~. and epp~ by the B~tld~ng I~SPector. Form No. 6 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 fro~ 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. Commercial 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 Vpre-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. 0. · Certificate of Occupancy ~ dwelling $25._~, 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 - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential^S15.00, Commercial $15.00 ./.. .... Old Or Fre-existlng~%%~ ;'~ ....... ~ii'-'-/~iii : .... : .................... ty ' Location of Proper .......................................................... House No. Street Ha~et or ....... ............................... County T~ ~p No ~000, Section ........... Block ........... LoC .................. Subdivision Filed Map. . Lot ........ / OTP/~ ~ Date ../ / ..Applicant.. · ...... Permit No....~ ...... ~..-~. Of Permit. ;I Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval.......... ............ . · Final Certicate. Request for: Temporary Certificate .......... .. · ..... oo Fee Submitted: $ .................... APPLICANT Co-, o 5 1000771 THE, 'NEW'YORK BOARD ~OF. FIRE UNDERWRITERS ', BUREAU OF~ ELECTRICITY I~ ~:' , ... h ~l ' 813 JOHN 'STREET NEWYORK, NEW yORK 10038~ TH S'CERTF ES'THAT' . ~ ' ~ ' . ' _ ;' , __~ I *~*~t~alea~io~t~c~J~a~d~nt~uc~bytheapphcant~°nth ~ Pp ' ~'~,1 O RANGES DISHWASHERS EXHAUST FANS and ectrzc Co ~ ~ : .,..' . /. .. 'i'-~ ,~ ~' ~i :-.L:. ,L the ~ff~ ~f t~e ~ard if inc~rre¢t. Inspectors may De ,aentmea Dy their creaem~als. FIELD INSPE~C'Ti~ON 1. FOUNDATION (1st) FOUNDATION____~(2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL COMMLNTS ADDITIONAL COMMENTS: Approved ..... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No./¢~.O..~.0 ........ Disapproved a/c ...... ~ ............. ~. ......... ................ ........ .d/. .... X./.. " (Building inspected APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted 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 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 commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throug~aout 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 building for necessary inspections. //3_ 'T> ~ ...... D.~/.'.fl.,. ,dff....-4.:./..~..._.~ ........... (Signature of applicant, or name, if a 9orporation) ...... .!7c?' ........... (Mailing/[~dress of app ' rio State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .................................................. Name of owner of premises .... ~.].?~...~/~..}-.,['... ~.(¢~ .~./~.~ .... ~./~..]Qg~.. ~.C/ ..................... on the tax roll or latest deed) ,] If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ¢.d~. ................ Plumber's License No .... h ~..~. ~ ......... Electrician's License N~].~. '~./d. ~ ta~.~.~ ...... 1. Location of land on which proposed work will be done ...................... .,. / 2..uc.o...?. ..................................................... House Number Street Hamlet County Tax Map No. 1000 Section ...... {.( .5. ...... Block ...... .(~...~.. ...... Lot ..... .~...Q · .~.--. ...... Subdivision .............. ~. ...................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premise{ and intended use and occupancy of proposed construction: a. Existing use and occupancy .... Il.~.4f J?. ?..g .................................................... b. Intended use and occupancy .... ;~} ./~./.9.~. {.'~.~.,~- .................................................... Nature of work (check which a~plicabl~ ): New Building .......... Addition .. ~.~ .... Alteration .......... ~epair ......... ~. Rembval ............ Demolition .............. ' cYO Other Work ............... (Description) ]b~stim~ited Cost .... rC.C~..O.l.~.O.O. ................... Fee ~...f.~...-~.. ........................ ~ .(to be paid ~ ~ing this application) If dwelling, number of dwelling .units.. ./ ......... Number of dwelling units on each floor ................ If garage, number of cars ..... : ...... , ............... 6, If business, commercial or mixed occup 7. Dimensions of existing structurds, if an~ Height.. .............. Number of I Dimensions of same structure with alte~ Depth .................... :.. Hei~ 8. Dimensions of entire new construction: mcy, specify nature and extent of each type of use ..................... : Front ............... Rear .............. Depth ............... ;tories .....~ ............................................ itions or additions: Front .... ]... ] ........ Rear .................. Itt ...................... Number of Stories .............. !. F t t . ' ..... ront ..... /.~. ...... Rear .../~. ......... Depth . .7. 0.. ......... Height: ~. ( ~./d~. ' Number of ~ tories ./. 9. Size of lot: Front ' ' Rear Depth 10. Date of Purchase Name of Former Owner 11. Z .... hp ' ' J ....... ,one or use district m wine remlses ar situated .......................................... 12. Does proposed construction, ,_violate any zoning law, ordinance or regulation: ................................ . . · ~./.,~ .'.. ................. Will excess fill be remoyed from premises: Yes (~ 13. Will lot be regraded 14.NameNameName of°f°f ContractorArOWnercintect' of premises .~(6 ~0. ht~.¢ ig~' ~.'~' " "?~ii!iii ~;~i' ' '' ' ! !iiii i!i' ~'~." ~5/Ii' ' ' ' . Lpcate clearly and distinctly all} buildi~ property lines. Give street and block !numbe] interior or corner lot. ' STATE OF NE.W ' above named. PLOT DIAGRAM gs, whether existing or proposed, and, indicate all set-back dimensions from or description according to deed, and show street names and indicate whether .............. being duly sworn, deposes and says that he is the applicant tact) ounty* (Signature o~icant) of said owner or owners, and is duly auth( application; that all statements contained ir work will be performed in the manner set fo: Sworn to before me this ~ ........................ d. ay of ..... Notary Pu ..:...':-~.. JuDiTH T. TERRY' 'c State of NeW Yor~ rized to perform or have performed the said work and to make and file this this application are true to the best of his knowledge and belief; and that the th in the application flied therewith. He is the ........................... ](Contractor, agent, corporate officer, etc.) S~ATE ~ON~TP, UCTION & ENEPCY DESIGN OR CONSTRUCTION ERR ~S OF' P~OPEP..[ Y 5UP..VEYED F'OI~ GOWING "FO~,, I't OF- $OU1-HOLD~ F~O A D [;3- MOt qU~. 1Pim! GUA~A~T'E~;D TO Ti-tiE. TiTLP:, G, LJA, f;~.AIITf:~I:L O.3t',lPAHY