The URL can be used to link to this page

Home My WebLink About12052-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....g.~2..2.7.4 ..... Date ......... ........... 198.4.. THIS CERTIFIES that the building additiqn ................... Location of Property ..~$~. Central Drive Mattituck House Ho. Street Ham/et County Tax Map No. I000 Section . .~.Q .6 ....... Block ...0.2. .......... Lot . o' .q2..5 ........... Subdivision...CaUg.-..Ifi0.c~ .~.&L.~.s ....... Filed Map No..~.6.7..2...Lot No...~.4.~. ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ~ov. ember 12 , 19 .82. pursuant to wkich Building Permit No. 12052 · dated ..... .D.c..c .el .~q.e. T' .2 ........... 19 .8.2., 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 ......... ......................................an addition ,~.o existing dwe.~.~.~-.n.g.. .................................. The certificate is issued to .................. MARIE. D e LAL.L.A. ............................... , ...... (owner, le~e of the aforesaid building. Suffolk County Department of Health Approval no~. required UNDERWRITERS CERTIFICATE NO N 604081 Rev. 1/81 Building Inspector TO~N OF $OUTHO£D BUILDING (DEpARTMeNT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL ¢OMPLfiTION OF THE WORK AUTHORIZED) 1205g Z Dote ULL ? ...... and approved by the C0dlty Tax Map No. 1000 Section ....~....'~.....~.. ....... i. Blocl( .:-~...~....: ..-,~ pumuont to appUcotion dated ..............................;...~ ........ ;....~,.,., · Building I~spector. : , Fee $ ........ ; ............... Rev, 6/30480 nspeCto~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or topographic features. 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 building~ 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. B. 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. ,' Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Cop,/of certificate of occupancy $1.00 $5.00 Date .p~.,~(C./~ New Buirding ............. Old or Pre-existing Building(X) .... _~,. --=/Vacant Land 'i ............ Houso IVo, Street Hamlet Owner or Owners of Property ....... : ......... - ~ ,. .,q-. .................. County Tax Map No. 1000 Section .../~...~. ...... Block ...O.. ~ ....... Lot., .0.. ~-..,~. ...... Subd,v,s,on ....... F,,ed Map ...Lot No.. ...... PermitNo .......... Date of Permit ......... pplicant .,..........=..~' Health Dept, Approval . .~.'. ~. ~ ............. Labor Dept. Approval .. ~ .................. ,.. Unde~riters Approval. ¢~ ~ 0 ' /- ~/~3 ~ ..... ~ ...... v' ''~ ..... Planning Board Approval .................. ~ .., Request for Temporary Certificate ...... ~ ............. Fna Certificat~ .. ~ ...... - FeeSubmitted$..S,.q~ ........ - S~." V ,~. ~OG.~,~ Construction on above described building and permiCmeets all aOp~cabl~odes and regul~ions. Applicant ,~..~ ................... . ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS 1~ BUREAU OF ELECTRICITY , 0.,~ ~.,,~..o.~o.o.,~.~ N 604081 THIS CERTIFIES THAT o~ the e~trlc~l equipment ~ ~scribed below a~d introduced b~ t~ appllca~tt, ~a~d o~ the cboe applic~tlon nu.~ber i~ the premises of ~ie ~ ~.~ G/~ ~nt~l Drive~ ~¥;/0 Inlet ~.w4 ~tti~u~, N.Y. w~ exami~ted oti ~JV.y 1~ ~ 1~,}~ attd found to be in cotnpllattce wltb the requ~retttertts of th~s Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES FLUORESCENT DRYERS DISH WASHERS EXHAUST FANS S E R NO Oi~ERCC~COND, AWO OF CC COND. C NO OF HI LEG A W. G NO OF NEUTRALS A W G OF HI LEG OF N~UTRAL Electric C/3. lk)~i 143 kt~tt.Lt~% .N.Y. 11952 Llc#2~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ma their credentials. ~ ; , ~ ~MANNER~ FIELD INSPEQ~ION~.' COMME~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ODE FINAL ADDITIONAL COMMENT~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .¥ .... , ee ,,it No./. d. OCJ ? / Disapproved a/c ....... ; . . ...... _ ........ .,.,:-) .... (Bnilding Inspector) APPLICATION FOR BUILDING PERMIT Application N o.Z'. ~.~'..~.~:.~.~' ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot pkm to scale. Fee according to_ schedule. b. Plot plan showing locato ~ of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this ap~ cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon approval of this application, the Building Inspector will issne a Building Permit to the applicant. Such pern sbalI 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 Occupan shall have been granted by the Building Inspector. ~PLICATION IS tlEREBY MADE to the Building Department for the issuance of a Building Pe~it pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ~d admit authorized inspectors on premises and in buildings for necessa~ i~sp~tions. ~ ~ (Signature of applicant, or name, if a corporation) .......~. .... ~ .... { ..../ ......,..;._ ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, (as on the tax roll orlatest d&d) '~ '' If applicant is a corporation, signature of duly authorized officer. / (Name and title of corporate officer) Builder's License No...~z~..~...C~ ............... PI tuber s Llcens.. No .................... Electriciau's License No...~. ....... .* ...... Other Trade's License No ...................... 1. · ......... ...... ....... House Num her Street Hamlet County Tax Map No. 1000 Section .............. Block .... o ~ Lot ~~a- ·.. I~( .............................. 8ubdi. visi°n · 2~' 'O"w~ ' :~(~..~. Filed Map No. t .~.7 ~. .... Lot ./..~.: ....... 2. State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy . . ~W.. :~...~.....7. .................................. t. Nature of work (check which ap,plicable): New Building .......... Addition .... X ......... Repair .............. Removal ............. Demolition .............. Other Work ............... ~ (Description) ' Estimated Cost (to be paid on filing this application) ;. If dwelling, number of dwelling enits ..... ~..... Nmnber of dwelling units on each floor ' i .......... If garage number of cars ~ ......... ~. It busmess commercial or m~xed occupancy, specify nature,and ~exten!(2~f each .ype 9tf use ..................... .... .fl'q~ ..... Depth . ~-.O.....' , . . t - - I. Dimensmns of.c;x~tmg structure's, if any: Front . . . ~ ~..'.4:[.22 ar .... ~2:-.. ~ ..... Height .... l.~ ........ Nmnber o~t Stories .... g., ,~"'~-'W.,. ............................................. Dimensions of same structure with alterations or additions: Front ..... ?ff..C{(. ....... Rear ...c'tf. ~. ........... Depth ... ~.~.~ ............ :, . Height .../.'~..t.. Number of Stories . ~... I Dimensions of entire new construction: Front ~ Rear ~ Depth .~ Iteigl~t ..... . .~ ........ Nunlber of Stories ...... '7. ......... ?. ........................ r .............. ). Size of lot: Front :../6'-~....~.i ............ Rear ..... /..~tT'O? ..... ....... Depth . ./.~.O..._. '. ............ ). Date o'fPurchase .'1~ .c,,.~¥ ./.5~K-o, ........... :.. Name, of Former Owner ~.o.,,~.,r~. ~,~-~{~ ....... I. Zone or use distr/ct in wl}~ch premises are situated.. ~..~a,~-,~..--"~..--~-. ............... ', 2. Does proposed construction violate any zoning law, ordinance or regulation: .. ~. ~ ....................... 3. WitJ lot be regraded ..... ~...-': ............. Will excess fill .be_e_rmr~,ovpd from premises: Yes $. Name of Owner of premises ~.[~v~ ~. ~. ~..a-ff.J~ddress .~v.~ .'..~.....ql? :~:. Phone No ................ Name of Architect .. _ ~7. .... , .............. '.. Address v,...~ · :, ............. Phone No ................ Name of Contractor ~ ...... Address . ,&.'.~.:. Phone No."2 3.~. r. (,'..(,. ~'~... PLOT DIAGRAM Locate clearly and distinctly ali! buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty 1/nes, Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. t rATE OF NEW'~RK . z~ ,S$ (Name of indMdual s g ~i ~g contract) )ove named. : e is the .,.. ' . ~ ~Contractof, agent, corporate officer, etc.) f said owner or ownem, and is dtdy' ~ ~" '~' ~ authorized to perform or have performed the said work and to make and file this 2pl~cation; that all statements cont;ained in this application are trt~e to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application fitecl therewith. worn to before me this .......... ..... .... ota~blic,¢ ..... ~.~...~j.. County ~ ~' ~ ~ ~ . .. . . . ....... - , ~rm tmr~ ~at~n ~, ,~ ' (Signatnre of applicant) Tel, 734-6782--Residence Office--734- 6693 CHESTER ORLOWSKI CONTRACTOR & BUILDER CUTCHOGUE, NEW YORK 11935 I M A'P or--, LOT I 4 ]B LOd I( 11 d A'PTA I N K I:D~D . E,~TAT E ~ -- VI ATT ITLI~K-., ? JHLET T 0 W H 0 r ,,B~. _~J. 3'-.N 0 LI) ,,.~ LI FFOLK dO, H.Y. ~.Y/T~A 1.. ',". /ob.O' · j,~,~,vje h'; 20102" APPROVED AS 'NOTED , ~. DATE~/~,~'/,¢¢~i' B.P. ~ /.~ '~ FEE: ~ ~"~--<:"~ BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOP, THE FOLO v -,,= !NS.~ECTiONS: 1. FOUNDATION - TWO REQUIP,ED FOR POURED CONCRETE 2. ROUo,4. - , RA,~.,N~ & PLUMBING 3. iNSULATION 4. FINAL CONS. xu,_. I,oN MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY {[~OD~$, NOT RESPONSIBLE FOR DF..~I6N 01~ CONSTRUCTION £P~OI~, copper 1ubing is used for water distributing ~ys em~ p~p~ng shad b of types K or L. onJy_._ L