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Home My WebLink About11787-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23722 Date JUNE 21, 1995 THIS CERTIFIES that the building Location of Property 1560 PIKE STREET House NO. County Tax Map No. 1000 Section 140 Subdivision ADDITION MATTITUCK, N.Y. Street Hamlet Block 3 Lot 17 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 1, 1982 pursuant to which Building Permit No. 11787-Z dated JULY 8, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to GEoFFrEy HALLENBECE & WF. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 $ouTHo~D, N~. Y. BUILDING~ PERMI'I (THIS PERMIT MUST BE KEPT ON ~H,E PEEl N? 1757 P~ermisslon is hereby granted to: dS S'UNTIL' ULIL COMPLETION OF THE WORK AOTHORIZEDi et premises located at . .~..' ........... ector. Rev. 6/30/80 and ~pproved by the TONN OF SOUTIIOLD BUILDING DEP/XRTNENT TOWN UALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 from H~lth Dept. of water supply and sewerage-disposal(s_9 form). 3. Approval of electricml installation from Board of Fire Underwriters. 4. Sworn statement from~plumber certifying that the solder used in system contairs less than 2/10 of I% lead. 6. Submit Planning Board Approval of completed site plan requirements. B. F~r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-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 Inspec~-~or shall state the reasons therefor in writing to the applicant. G. Fees 1. Certificate of Occupancy - New dwelling $25.00, 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~ Occffpancy $20.00 ~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.O0' New Construction ........... Old Or Pre-existing Building ................. ' ...... Location of Property ........... ~ ~ House Ho. Street Hamlet Permit No ................................ Filed Map ............ Lot ...................... Subdivision .... ilealth Dept Approval Underwriters Approval Planning Board Approval .................. lequest for: Tcmporary Certificate ........... Final Certicate ........ ~ee Submitted: $ ............................ FIELD II~'S ?EC~ I ON 1. FOUNDATION FOUNDATION 2. DATE COMMENTS ADDITIONAL COMMENTS: (1st) (~nd) Y. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING [ ] ROUGH PLBG. [ ]INSULATION ~I~INAL ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR.~..~~/ FORM NO. 1 ?' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. . . .... , l V. Approved '¥:'/r'"Z .... Permit No..././..7. ¢.e:Z Disapproved a/c ............ : :":'.. · · .~-'~. .... fi~? ......... / (Builaing Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS -Application No./..f.?.~.'.~. ......... 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 issue a Building Permit to the applicant. Such permit shall be kept on the promises available for inspection throughout the worl~. 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, buiJding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaCy inspections. / (S/~n~iture of)/f!~licant, or name, if a corporation) , ?(Maiting address ox applic/nt]~-/~/~-<~.. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premise // / (as on the tax roll or ~a~est deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... .~..f Plumber's License No ......................... Electrician's License No ....................... Other Trade's License Nq ...................... 1. Location of land on which proposed work )~i~l be. done ................................................... ..................... ............ ............... House Number Street Hamlet County Tax Map No. 1000 Section .../..~.~. ........ Block .... c/~'. ......... Lot... f~.../f..j~./. ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy offf~mises and intended use and 'occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition .......... Altmti0n....... .~. Repair .............. Rem?al .............. Demolition .~ ......... Other Work ....... ~... ..... 4. Estimated Cost ...... ~.~.....'~. .................. : me..../.~.. .... (to be paid on filing this application) 5. If dwelling, number of dwelling ¢nits ............... 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 .......... t ............................................. Dimensions of same structure wSth alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front . .~..~..)(~c,~Rear .............. . Depth ............... Height Number of Stories ' Size of lot: Front ........... i ........... Rear ...................... Depth ...................... [)ate of Purchase ........... ................... Name of Former Owner ............................. Zone 6r use district in which premises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... /2..i .................... Wil]t~.xcess fill bl~ l;em~ved fro, gm premises:Yes , ._,No 14. Name Owner of ;Z hone Name of Architect ........ f.q... / ............ Address ................... Phone No ................ Name Of Contractor ........................... Address ................... Phone No ................ 10. 11. PLOT DIAGRAM Locate clearly and distinctly alli buildings, 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. ~ STATE OF NE'{ ~RK,//.~/,/ ,~ ~ · . being duly sworn, deposes and says t e is the applicant (Name of individual ~igning contract) above named. ; ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this apphcatxon; that all statements contained m this apphcation are true to the best of fils-knowledge and belief; and that the work will be performed in the mannqr set forth in the application filed therewith Sworu to before me this : ........... ...... ..... ...... Notary Public .............. ""~'.. ~\ County ~, ~'-Sl2SS§O, $t~O#l r~rm ~ires Msroh 30,19~/''''