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Home My WebLink About11852-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g.l.q. 4.55 .......... Date ..... ,7..a..n.u.a. Ky..2.6 ................. 198..3. THIS CERTIFIES that the building ................................................ Location of Property .7.5. ............ .W. qqd.c.liff p. rive Mattituck Ho,,se No; ...... 'S'tle3i ....................... County Tax Map No. 1000 Section .. 1. 0. 7 ....... Block . .q 7. ........... Lot ....0 .2.8 ........... Subdivision...X. ........................... Filed Map No...X. ..... Lot No...~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...A.u..c[u..s.t, .6. ......... 19 J3.2. pursuant to which Building Permit No .... .1.1.8..5~..g. ......... dated ....... A.u. 93&s.t...1.0 ........... 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 ......... ...... a.n.. .a~.q~.s.s.o.r.y. .t.w.o..-.c~.r. .9.a?.a. cj .o.. ......................................... The certificate is issued to ........... .J.A.~.E..S..B.....~..C. yN.. T.H.I.A., .G....K. ,A .M.I.N. S. !< .Y ............ {owner, I~ ~t-i~rmrtt-P of the aforesaid building. Suffolk County Department of Health Approval .... O./j~ ................................... UNDERWRITERS CERTIFICATE NO ............ O/'.a ................................... Building Inspector Rev. 1/81 TOWNOF ~OUTHO~D, BUILDING DEPARTMEN~ TOWN HALL SOUTHOLD; N. Y. BUILDING PERMIT (THIS PERMI~ MUST BE KEPT ON TH:E PP, E~IS~ES COMPLETION OF THE WORK AUTHORIZED) ' UNTIL ~ULL Permissioh is hereby granted to:~..~ / ~ , ~ .......... Building Ihspector. F~e ~..~/~.. ............. '., ; ' lUllalng inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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 llne~, 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 simiiar 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-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-existin9 dwelling or land usa 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... , .. New Building ..... ~( ...... Old or Pre-existing Building(~) ......... = ZVacant Land ' . ...... Location of Property . ...~. -~-~, .J~),~J~ .' C',~,L~J .l~ JCl, ,~DJ~ j ~.~_~ ~:... . J~Jo/~ .T..~. J .T. ~,' j~ ...... House No, Street Ham/et .... County Tax Map No. 1000 Section ../.(~)~'Z ........ Block ..... (?, .-].. v ..... Lot ...... ~. ~ ....... Subdivision ..... ~ ........................... Filed Map No.., :~.. ..... Lot No... ~.' ......... ......... ........... ...... .......... ,.. Health Request for Temporary Certificate ..................... Final Certificate ... Fee Submitted $..; . .,_~.. ~ ~i~. ................. Rev, 10-10-78 Construction on above described building and permit"meets all appJ~cable~codes and regulations. Applicant . .. · . '.. ~ ' . .................. FIEL~ INgPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. ADDITIONAL COMMENTS STATE ENERGY FINAL FORM NO. 1 TOWN CF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 Disapproveda/c ....... :.-....~.....~. ..... ..~. ..... ../ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplioate to the Btdld_ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordiug to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining p~=mises or public stre or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part offthis ap' cation. c. The work covered by this application may uot be commenced before issuance of Building Pe~it. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such pen shall be kept on the premises available for inspection ~hroughout the work. e. No building shaI] be occupied or used in whole or in pad for any purpose whatcver unt~ a C~rtificate of Ocmapar shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance of a Building Pe~it pursuant to Building Zone Ordinance of tlm Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinance5 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing cod~, ~d regulations, and admit authorized inspectors on premises and in buildings for necessaw inspections. (~gnature of applicant, or name, if a ~rporation) : u~aidn= address o~ appdcant)~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ~_~. (as on the tax roll or latest deed) U ' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Bnilder's, License N~ .................. Plumber s Licens~ No ............. /. ........... El::ctrician's License No.' ...................... Other Trade's License No ...................... I. l.,ocation of land on which proposed work will be done ................................................ House Number Street Hamlet Coun, T= No. ,0oo S c,io .... ~aZ ........ : ........... ............... SubdM~on ..................................... Filed Map No ............... Lot ............. (Name) 2. State existiug use and occupancy of premises and intende~ us~ and Occupancy 0f proposed construction a. Existing. use and occupancy ( ~~~ ~ .:..;j, . Intended use ~d occupancy ...; .... :-....~. ~., }~~..' .... ~..*~ ., 4 5. Repair .............. Estimated Cost .... .~: ~rO.O.O. . 3. Nat~:re of work (cheek whc!, appl cable) New Building .......... Addition .......... Alteration ........ Demolition Oti~er Work ' ................... Fee~/ ~.~ (Description) (to be paid on filing this application) If dwelling, number of dwellii~g units ..... 0 ........ Number of dwelling units on each floor .... ~ ......... If garage, number of cars ..; ....... ~:~ .......................................................... fi. If business, commercial or talked occupancy, specify ~,ature and extent of each type of use ................... 7. Dimensions of existing strnctflres, if any: Front ..... .' ......... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same stmcturff with alterations or additions: Front ................. Rear ................ Depth .................. : ....I'tei~t ....................... Number of Stories ........... el. Dimensions of entire new c. on'struct on' Front ..04 t. ~,,~, .oq-" ri,nth ..~t4 I ~ Height . o.. '7._ ..fpq'oo:~~f S tot/es .' ..... J. . ................... ' ........................ {l. c'tin I~ /si 12. Doe~ proposed construction violate any zoning law, ordinance or regulation: .... ,.e~,.O ........ /3. Wi lot be re',raded . ' · . · ' : = · · r~:c_'m: '.,, ........ :~,......~. Will excess f, ll be removed from erem~ses: Yes . ~ (4. Name of Owner of prelnisesr~./7/TJ~.(.~.,ffI'a.~ress ~..5t..dt!~.c~./~ ~/t...~'~ x,~ 4ap _d~o'a / ~ ~'~ame o, -krc tcc .... '.. A~ffdress v~, ,,,_ .......................4,_t...~, ~.~ ....... Address mono mo .~ ...... Nam,e ct Contractor~.-r~.~4,~.e~g]...... ................... Phone No/.~t..,~$~.-.~0./~,.. Locate c/early ,.nd distinctly 4dl m 'ldmgs, whc property lines. Give street and blodk nun',her or descr ;t~tcr/or or corner lot. ~'TATEOFNE1VY~RK.v / . .~' cou,', rY s (Nanie ofindMdual sigBing contract) above named. LOT DIAGRAM '~' ~er existing or proposed, and. indicate all set-back dimensions fro~ ~tJon according to deed, and show street names and indicate wheth( ...... being duly sworn, deposes and s,ays that he is the applic:!n t-lc is the ..... ' . ........ ' ......[ , (ContracTor, agent, c;rp;~ate officer, et~.') o'f said Owner or own'ers, and is dui> authorized to perform,, or have performed tile said work and to make and file thi r~pplication.; that all statements coniained in this application are true to the best of his knowledge and belief; and that th~ .~7ork will be performed in the manni2r set forth fix tile application filed tl, erewith. · .Sworn to before me this ............. : :": '.ua,, ..... o -' ..... ,:.. - '"Jotazs' Public, .~__.<~<"C--,'C~ ~~i" '