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Home My WebLink About12434-zFORM NO o 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-12555 Date JUNE 14, 1984 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property. 1735 ~q~STPHALIAROAD MATTIT~CK, ~.Y. House No. Street Hamlet County Tax Map No. 1000 Section 141 Block 1 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 6, 1983 pursuant to which Building Permit No. 12434-Z dated JULY 20~ 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 ADDITION & DECK ADDITION & ALTERATION TO EXISTING DW~-LT.IN~ The certificate is issued to (owners) of the aforesaid building. SUFFOLK COBNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ROBERT & KATHLEEN REYER #630963 - JANUARY 20~ 1984 Building Inspector Rev. 1/81 lrOll~ NO. ~1 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? 12434 Z Permission is hereby granted to: ...... ............. ....... ....... , ........ t...~...~..~......,...../~. .................... ,o ........ ~.~__~...~.~..-/~..~.~.~,O.....2,.....~.~.r~..~.~.~.........~..~ ................. ........... ~c~.'~.~.~..-~ ....... .~..~...~,.t~...~.- ..................................................................... o, premises located at ....J...~.5..~.~......~..~..~,,~..i~./2~ .~.-~,~1..~..,.~. ....... .L.~.~,~., ,~., ..................... ....................................................................................................... /~..~..~:~...k~...~..L.r.~.~.../ County Tax Map No. 1000 Section ....J....~..! ........... Block ......~.,.I ........... Lot No....~).(~..~. ...... pursuant to application dated ............ Z.Q~.~.~--.~......J.~. ............ , 19..~...'.~., and approved by the Building Inspector. Fee $..~.~.....~,.. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted--i~=ctupl~cct= 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-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. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property .~t.~.'[.. ~..~.s?.~./~,z~...~ , ..~..~.~ ....................... House No. Street Nam/et Owner or Owners of Property ...,~. ~ .~.~.~. ~..~..,,.~./~-..~..~.z,~-..~.~....~.E..~.~...~_~,. ...................... County Tax Map No. 1000 Section / 5// Block / Lot Subdivision ......... ~. ....................... Filed Map No .... T ...... Lot No. - Permit No../?. ?.~. ?..~'. Date of Permit ,~/..~o/~.~...Applicant.. ~'.'~.¢..~. ~....~'~,~'.~.'.-~-. ............ 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. Applicant..~--_~.~..~ ....................... ,.v.,0-,0-,a THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN BTREET, NEW YORK, NEW YORK 10038 ~4~ N 6309~3 THIS CERTIFIES THAT was exarniaed o~ J~ ~ ~ ~ and fou~d to be i~ co~pllance wlth ~he requireo~ents of thls Board. DRYERS SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS E R NO, OF CC COND, PER,O' V I C NO OF HI-LEG OF HI-LEG AWG. OF NEUTRAL OTHER APPARATUS: 1-43.F.I. 1-~oke detc~g~or 17~ Westpha~a Rd. ~ttituoE~ ~.Y. 11952 GENERAL ~ANAGEn~ ~ 11 ; This certificate m~st not be aJtered in any manner; return ~o the o~fice o~ the Board if ~pcorrect. Jnspecto(~ may be ~dentified by their credentiah COPY FOR BUILDING DEPARTMENT, THIS COPY ~ ~AN~ MANNER. ~IELD~INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY Q,ODE FINAL ADDITIONAL COMMENTS: BUILDING DEPT.. INSprECTION []FOUNDATION 1ST []ROUGH PLBG. []FOUNDATION 2ND [ LAT ON []FRAMING []FINAL : REMARKS: DATE ........ INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c ....................... ~ _~ ~ [Building Inspector) APPLICATION FOR BUILDING PERMIT 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 a~cording to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining ~ .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 applicaaL 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 L~ws. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as berein described. The applicant agrees to comply with all applicable laws, ordinances, bulld~'mg code, ho~m~g code, and l~gul~.tio _ns~ and to admit authorized inspectors on premises and in building for neeessary ~s.. /~/~ (Marling address of applicant) //~L~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .~..~ .............. Plumbers L~cense No....~. .... 1.~r~ ..... Electrician's License No .... .'.~~... . ~. - Other Trade's License No. ....... ~ ...... I. Location of land on which proposed work will be d~ ........ :: ........................................ ·/. z~. ....... ~..~..~..~p..d..~. ~z..~.....~.~.~.~. ....... .. ..... . ./~.~...~...,2/~. ~ ........ i ......... House Number Street Hamlet County Tax Map No. 1000 Section .../..g//. ......... Block ..... ./. ........... Lot...C ............. Subdivision ..................................... Filed Map No ............... Lot ................ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~.~.¢..t ~)~..C_~. ..................... b. Intended use and occupancy ~ ! 1>~;~¢~-- ~o'Ct~. h .~'~.'~-~"~' ~'~ ' - Nature of work (check which applicable): New Building .......... Addition ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work. zz[ , .- .~ ~-- .... ...,// (...D,,escription) 4. Estimated Cost ~/.~./.~.~. ~ . Fee ~a~"l~m'~' t~'~ ' (to be paid on filing this application) $. If dwelling, number of dwelling ~nits ...... [ ........ Number of dwelling units on each floor .... If garage, number of cars . :-7. ................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... 7-- ............... 7. Dzmens~ons of ex~stmg structures, ~f any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wiih alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .................................................. 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ........... i ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ............................. 12. Does proposed construction violdte any zoning law, ordinance or regulation: ...... ~.0 .... 13. Will lot be regraded ...... ~..i.. '.2 .............. Will excess fill be removed fr~o,_~.remises: ~*~es~ No 14. Name of Owner of premises .T~,~.~..,...4~.~y~,~. .... Address&d4~..~../~-~..c:~....4~?:~:'~one No.. ,x.~. ~...................~.~.~./... Name of Architect ~' ~:~x'r'~°d~,~. AddressT~ ~,~ 2)~ .~.~.,~ Phone No f Co 4~ O~ ~r~ Add " e No Name o ntractor ~. ~ ~ tess ....~: ......... Phon ........... PLOT DIAGRAM Locate clearly and distinctly all 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 NEW YORK. ' S S COUNTY 0]~...~. C4. ,~.~..O.L..~.. · ........ ~¢fO-- ~ .... ~ ~ ................. being duly ~worn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the ......................... ~ ............................................... . ................ ~ XCont~actor, age, t5 corporate officer, etc.). of said owner or owners, and is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained~ this application are true to the best of his knowledge and belief; and that the work will be performed in the m~ner set forth in the application filed therewith. Sworn to before me this /.q r 19~ . . ~ . .dayo.?...? ............ , $ota, Public~~. LINDA r. KOWALS~ "~ NOTARY PUBLIC, $tat~ of qualRi~d tn Suflo)~ Coun~ ~o~i=siofl Expires March 30~ 198,~ -~1 coppe~ ~ubi~,g is water distributing system; piping of types K or APPROVED AS NOTED B,P. 765-1802 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO FOR POURED CONCRETE' 2. ROUGH 3. INSULATION 4. FINAL - CONSTRUCTION BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL THE REQUIREMENTS OF THE SI'ATE CONSTRUCTION & CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION lNG