HomeMy WebLinkAbout12401-zFORM l~O. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-17968 Date APRIL 25~ 1989
THIS CERTIFIES that the buildin~ ADDITION
Location of Property 275 CARDINAL DRIVE MATTITUCK~ NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 115 Block 06 Lot 010
Subdivision MATTITUCK ESTS. Filed Map No. 4453 Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 24~ 1983 pursuant to which
Building Permit No. 12401-Z dated JULY 5, 1983
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 SOI~AR GREENHOUSE ADDITION ON AN EXISTING PATIO
The certificate is issued to MARY R. RAYNOR
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N-067267 - APRIL 17~ 1989
Inspector
TOWN OF ~OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 12401 Z
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c,,,~ T,~ M,p N,. moo S,~,, ..... L~ ....... B~k ...~. ......... L,~ N,. ...~.~ ........
Building Inspector.
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUP
Instructions
This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of' Fire Underwriters.
4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topogrcptqc features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3, Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion requ ,red to prepare a certificate,
C. Fees:
,1. Cert f cate of occupancy New Dwelling,S25.00, Accessory i$t0.O0 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $~0.00
4.Vacant Land C.O. $ 20.00 t/''~"'~"~'
5.Updated C.O. $ 50.00 Date ....... .~. .............
Ne ...... Old or Pre-existing Building ............ Vacant Land .............
Hou~ No, Street Ham/et
o, .... .........................
County Tax Map No 1000 Section ...... cc ............
Subdivision. % .... ~ . .Filed Map No ........... Lot No ..............
PermitNo.[a~J.L~.DateofPermit ~(4~ZApp,,ca.t...~:.~: .....................
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 permit meets all applicable codes and regulations.
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~-- 85 JOHN STREET. NEW YORK, NEW YORK 1003B
~PR1L ~7,~989
D~te ~pplieation No. on file
THIS CE~IFIES THAT
o~y ~ ~t~ ~u~nt ~ ~ ~ a~ int~ ~y t~ ~nt ~ on the a~ ~ numar ~ t~ p~m~ o~
iE~Y ~A~NO~, CARDINAL l)Rlv~, HA'I'T[TIICK, N.Y.
~ exami~ on and found to be in compliance with the r~uirementn of this B~rd.
DRYERS FURNACE MOTORS FUTURE APFUAHCE FEEDERS TIME CLOCKS
MULTI.OUTLET
SYSTIMS
PElT
SERVIrI DISCONNECT
,RAbE LL(,Hq]NG. 4
C
GOODALE ,,l,l',t. F~ U.,
7355 MAIN EOAi~
MATTITUCK, HY, ?''' 2
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST HOT BE ALTERED IN ANY MAI~ER.
~,_i~i~NSPECTiON COMMENTS
FOUNDATION
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
FINAL
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
ILO. BOX 1179
TOWN IIALL
SOUTIIOLD, N.Y. 11971
Narch 2, 1989
TEL. 765-1 $0,2
Nr. Henry g. Raynor, Jr.
R.R. fl Box 275 Cardinal Drive
14attituck, New York ll952
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/_--/ An application for Certificate of Occupancy
is not on file.
/X_--/ No Underwriters Certificate on file.
/~/ No Hea].~h Dept. Approval on
/-~/ No final inspection has been made.
Please contact ()ur office on this matter.
Z
Thank you for your cooperation.
lluilding Permit f~ I 2 4 0 I
Building Dept.
***/--/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
$OUTHOLD, N.Y~ 11971
TEL. 765-1802
FEB - 6 1981
This is to advise you that the job under building
permit no. 12401Z issued to H. E. Raynor
on 7/5/83 for Addition is completed and
a final inspection has ( ) has not ( X ) been done.
In order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a check
for $25.00 payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an inspection date
Occupancy or use is unlawful without a Certificate of
Occupancy. Please help us to clear up this matter so that
legal action does not have to be taken.
Thank you for your prompt attention.
Very truly~,
Victor Lessard
Executive Administrator
VL:gar
encl.
VICTOR LESSARD
PRINCIPAL BUILDING INSPECTOR
(516) 765-1802
FAX (516) 765-1823
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
ADDRESS:
DATE:
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
RE: BUILDING PERMIT # %~qo~
SEC. tl~ BLOCK ~ LOT (O
This Building Permit has expired. You are now in
violation of the Town of Southold Zoning Code.
Please contact our office, this matter must be
corrected.
Yours truly,
Victor G. Lessard
Principal Inspector
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ~INAL
REMARKS: ,/~ ~-~/~--~
//
DATE INSPECTOR
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180:3
Examined..'7/.ff ......... , 19~.
Approved .Z/ff. ........ ,1~..~. Permit No. · .t(. .~- · .Sf..O. .~''~-~
Disapproved a/c ........ '7~ ........... .X/, / (~' ' '/
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No./-o~..<tP'..O. ·/. ........
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 ail applicable laws, ordinances, l~uilding cod,e, housing code, and regulations, and to
admit authorized inspectors on premises and in building for nece~ctio~f~ M//~ ~
· ....
~ [~lgfn~t~ pp _
(Mailing address of b, pplicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .... O (a~/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 .... '~. · ~ [) ................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
House Number %~ Street
k. Hamlet
County Tax Map No. 1000 Section ........... Block .............. Lot ...............
.,,~..~ ~...~~.. Filed/vlapSo. ~k~.~.~,.~ Lot,..:'-~.. I./~.C
Subdivision ' (Name) ...............
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: *2/::2
a. Existing use and occupancy ........ ~L4~:v~..-w~..~3,~-.~_. .......................................
b. Intended use and occupancy ......... e'~~. · .~'/~....t~qdr .L .-~.~ .flS.~z.~O-~0....~. ~ ....
10.
11.
12.
13.
14.
Nature of work (check which applicable): New Building .......... Addition . .~b~.. ..... Alteration ..........
Repair .............. Removal ............ Demolition .............. Other Work ...............
Estimated Cost .... .O..'9... ...................... Fee ...e .............................
! i (to be paid on filing this application)
If dwelling, number of dwelling iunits ............. Number of dwelling units on each floor ................
If garage number of cars '
If business, commercial or mixed occupancy, specify nature and extent of each type of use ....................
I)imensions of existing structures, if any: Front ............... Rear .............. Depth ..............
Height ............... Number of Stories .......................................................
Dimensions of same structure w.ith alterations or additions: Front ................. Rear .................
Depth ................... ;.. Height ...................... Number of Stories .....................
Dimensions of entire new construction: Front ............... Rear ............... Depth ..............
tteight ............... Number of Stories ........................................................
Size of lot'. Front ' Rear Depth
Date Of Purchase ' Name of Former Owner
Zone or use district in which pr~mises are situated .....................................................
Does proposed construction violate any zoning law,, ordinance or regulation: ................................
Will lot be regraded ............................ Will excess fill be removed from premises: Yes No
fp ~
Na~ne of Owner o remises .. ~ ................. Address ................... Phone No ................
Name of Architect ........................... Address ................... Phone No ................
Name ~of Contractor . Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from
lllx~t~rty lines. Give street and block' number
STATE OF NF4ff, Y, ,t S
COUN~FY 0F~ ..... iL'
................... ana
V(Name of ifidividual ~gning contract)
above named.
He is the ................. ~.
(c
ontractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file ~is
application; that all statements conthined ~ this application are true to the.,best of his knowledge and belief; and that the
work will be perfo~ed in the m~ner set forth in the application filed therewith.
Sworn to before me this
Notary Public, ~~"~~...~ ...... County fl ~__ .~,~~~i~.