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Home My WebLink About12054-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-11837 Date AUGUST 9~ 1983 THIS CERTIFIES that the buildin~ NEW DWELLING Location of Property 845 COREY CREEK LANE SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Eection 078 Block 04 Lot 023 Subdivision COREY CREEK EST8. Filed Map No. 4923 Lot No. 023 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 12~ 1982 pursuant to which Building Permit No. 12054-Z dated DECEMBER 3~ 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 ONE FAMILY DWELLING WITH ATTACHED DECK & PORCH. The certificate is issued to PETER & JOANNA MATTHEWS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 12-SO-105, 8/1/1983 UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-608098 - 7/1/1983 N/A Building Inspector Rev. 1/81 TOWN OF $OUT'HO~D BUILDING DEFARTMEN'I TOWN HALL SOUTHOID, N. ¥.' BUILDING pERMI'r (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) I~ULL N.° 12054 Z Date : · ........... ................. ~ ........................ , 19, Permission is hereby granted to~-- to ........................................................ ~ ........................................ ;r' .............. ~"~ ......................... ...... , .......................................... .......... et premi~ Io~oted ot ............................................. g ............. ~....,~, ................ ~ ........................................ ....... ~ .........~ ....... ! ................................................. -~ .................... '**"V ................ ~ ............... ~ ..... ~ ....... CounBt Tax Map No. 1000 Section ...... .~ ................ Block .!};;.;; ............... 1Lot No .......................... pursuant to application dated .......................................... ;..i....;;...., 19.....~.., and approved by the Bultdlng Inspector. Fee $ ........................ / i~ullding i!nspecto~ FORM NO. 6 TOWN OF SOUTHOLD Bu ildin[l 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 all 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 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. B. For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existi~g" land uses: 1. Accurate survey of peoperty showing all prop, erty 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 er land use $ Is'/$5.00 3. Copy of certificate of occupancy $1.00 ~ Date ....... New Building ......... Old or Pre-existing Building(Z) .......... = ZVacant Land ............ Owner or Owners of Property ........ ~ ............... County Tax Map No. 1000 Section ........... Block .............. Lot ........... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ ,., Request for Temporary Certificate Final Certificate Fee Submitted $ ............................. Construction on above described building and per~cable~codes and regulations. App,icant ..~ ~..-~ ..................... ~p_~_3~,~.. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE RTf~ -I~S in the following location; ~ Basement ~ 1st Fl. ~ 2.d Ft. Section Block Lot was exarrdned on J~ ~ ~7 ~ ~ attd found to be in complia~tce wlth the requirements of thls Board. 19 ' 23 19 2 F 1 ~00 CB ~, 1 2/0 1 2/0 6 ~pl~ Ave. COPY FOR 8 ~ OF CERTIFICATE MUST NQ! IN ANY 7G5-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FRAMING REMARKS: [ ] FOUNDATION 2ND £]INSULATION / FINAL INSPECTOR FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COML~N fS · ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ,/ / THE WATER SUPPL~ SYSTEMS FOR;i~ ! CONFORM TO T~! SUFFOLK CO. DEF: APPLICANi SUFFOLK COLIN'Il SERVICES -- F. CONSTRUCTION ~),, D^TE: H. S. REF. NO.:__, APPRovED: ~'! DEED: L. ~/. ,R. HOLE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 Examined ~....-~.. .... , 19~..~' Application No..../..~.~. ~-~.. .... Approved .~..~.'.(~.~... ~ ...... 1 ~Pe~it No.. Disapproved a/c ......... ~ J'~ ...... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~qEq~ .~ ...... ,19~. INSTRUCTIONS a. This 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 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 ~tll applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ..... JOHI~ .R, .DI~I~$F,¥, .I~0, .................... (Signature of applicant, or name, if a corporation) ~~ 0utoh~ gu~,. ~]Y.. 11955. (Mailing address of applicant) · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. Builaer ........................................................................ Name of owner of premises .. Peter. $. J~*ano. ~{*tt~be~v~ ................................................. (as on the tax roll or latest deed) If applicant is a ~ora ~~ofjduly authorized officer. Bui~icense No .......................... Plumber's License No...G.~.~.rg.*..~.~r.%.i.n.~.k ........ Electrician's License No. a~.O.E.l..~.e.%r.i9 ........... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .... .e/.~..C?r?7' .Cr?.~.k' .h.a.n.~:..h?.%..~.2.5. ??.r?¥. ~.??.k. ?.%: Seuth~ld, ~ ~_%- N.Y. 11971 House Number Street Hamlet County Tax Map No. 1000 Section 78 Block /~ Lot 2} Subdivision ..... .O.e.r.~7..O.r.%e.k..E?.%kt?p ............. Filed Map No..~.9.2.5 .......... Lot ...2-.5 ........... (Name) 2. State existing use and occupancy of premises and intended Use and occupancy of proposed construction: a. Existing use and occupancy v~cant ~orel0erty b. Intended use and occupancy ene familj~ dwelling 3. Nature of work (check which applicable): New Building .. X ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. stimatedCos, .... .o.,ooo Fee (Description) (to be paid on filing this application) $. If dwelling, number of dwelling Units ...... 1. ........ Number of dwelling units on each floor ................ If garage, number of cars ..... ! .......... 1 ........................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...n./.a. ............... 7. Dimensions of existing structure~, if any: Front .... n./.~. ........ Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ....... Rear Depth .................... :.. Height ...................... Nmnber of Stories ...................... Height 9. Size of lot: Front . 100 . Rearl. 2.0. ...... ................................. Depth ...ave~, .205 ........... 10. Date of Purchase .... 1Q/~38 .................... Name of Former Owner 11 Zone or use district in which premises are situated reeidential 12 Does proposed construction violate any zoning law ordinance or regulation: na 13. Will lot be regraded .... r~e... ................... Will excess fill be removed from premises: x Yes No Name of Architect .......... ~ ................. Address .................... Phone No ................ Name of Contractor ......... ' ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all jbuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. gee attached ~urvey STATE OF NE~[~i~ORI~,/ ~ ,~ S.S COUNTY OF~ .... ...... Jeh!a.R..Demp,~y, .Pr,,i4~ .n!? ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the.. ................ ~u$~*r ......... ~ ................................................. ~ ~<~ o.C~r, actor~ent, corporate officer, etc.) of said owner or owners, and is dui}, authorized to perform or have performed the said work and to make and file this application;.that all statements contained in this application are true to the best of his knowledge and belief; and t~aat the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this SUFFOLK CO. HEALTH DEPJ'F. APPROVAL H.S. NO. /~ 542-'-:.;.,c~ STATEMENT OF INTENT ~,: THE WATER SUPPLY AND SEWAGE DIS~AL ~. ~* gg~:. ~-~.-- CdNFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. ~ ~3,~0:~ h.~e. APPLICANT ,, ,, , / 7)~:':?" SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY H.S. REF. NO.. /~ - ~0- SUFFOLK CO. TAX MAP DESIGNATION: DIST. ~CT. BL~K PCL DEED: L. ~.~. P. . - :. TEST HOLE STAMP ~T~ ~W. ~B~ OF ~IS SURVEY MAP ~t ~AIl~ ¢ / t ~ ¢:~ ~l~ mmmUTtON USTm ~, ~' LAND I~[YOR~ SUFFOLK CO. HEALTHH. S. No.DEPT' APPROVAL SYSTEMS FOR THIS RESIDENCE WILL SUFFOLK CO. DE~T, OF HEALTH A~LI~ANT SUFFOLK COUNTY DEPT, Of HEALTH SERVIEES -- FOR APPROVAL Of CONSTRUCTION ONLY SurroL~ ~. ~Ax ~. D~Si~NA~ON: DIST, rSECT. BL~K ~L. SEAL If copper tubing is used for water distributing sys,em; piping shall be o[ types K or L onl~y OCD? C¥ OR If copper tubing is used for water distributing system; piping shall be of types K or L only DATE: ~[_~"' ~' I~ ~ NO~ING D~ME~ A~ 765-1802 9 AM TO 4 PM FOR THB iNSPECTIONS: FOLLOWING ~EQUIRE~ L FouNnATION - TWO FOR pOURED CONCR~E 2, ROUGH - FRAMING & DLUMBING 4. FIN~L - c~NSTRUCTION MUS~ BE C-'~tp~'~E FOR C, O. ALL CONSTRUCTION SHALL MEE~ THE REQUIREMENTS OF THE N.Y. ~ATE CON~RU~ION & ENERG~ ~DES. NOT RESPONSIBLE FO~ DESIGN OR CO~~ ~ i' l 1