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Home My WebLink About12295-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No.. zl.4635 ......... Date ......... G..g.ly' .1..4, ............... 19 .8.6. THIS CERTIFIES that the building ...d~.c.k...~.d.~.~.~. ~_9.n. .............................. Location of Property .3.2.0.0...B.u.n..qg.lp.w..' ~.9.n.e. .... Mattituck, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section .... 1.2. ,3 ..... Block 08 ..... Lot 29 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .Ap.r.~ .i..1.2.~ ...... ,19 .8.3. pursuant to which Building Permit No .... 1.2..2.9.5.g. ........... dated ..... .M.ax..4 ~ ................ 19..8 .3, 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 Mrs. George L. Penny, III ..................... [o¥,;o;, ..................... of the aforesaid building. Suffolk County Department of Health Approval .... N/A UNDERWRITERS CERTIFICATE NO.. N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD 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? 12395 Z Building Inspector. fee ,..~ ......... Rev. 6~30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted m'=--,---~ 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 p~"operty 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 .~. 5 .Updated C.O. $15.00 Date .... ~,¢~3-~..~'~./.?.~..~.. New Building ..... ' ......Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~.;~.°..o... ~ ?..~.~, .~. ~.o..~....),r.~. ?..~. ..... ~ ?.~u.~ ............. House No, Street Ham/et Owner or Owners of Property . .~/..~[%.., .~..~. · .~.~..~..~:../'? .~.. ?..~.. ~ ..................... County Tax Map No. 1000 Section ,.../.t~.~. ...... Block ... ,O..'~. ........ Lot...'~..~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo./.;~R~/.~-.~... Date of Permit ~/~j25 Applicant (~'~,~-/.-"~'>~t/~ .;..~.0~;... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~.; .D..o ...................... I~licable co ulations. Construction on above described building and permit meCCa de~ .................. Rev. 10-10-7S FIEL~ INSPECTION ~ - COMMENTS FOUNDATION (1st) F, OUNDATION [2nd) ~OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C?DE FINAL ADDITIONAL COMMENTS: N£W YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMIT PERMIT NO. 10-82-0621 ARTICLE 24, (Freshw'ater Wellands) [] ARTICLE 36, (Construction in Flood Hazard Areas) George L. Penny IV ____~05 Soundview Ave. ~ Southold~ N. Y. 11971 L~TION OF PROJECT (Section of stream, tidal wetland, dam, building) Deep Hole Creek at the end of Bungalow P~ad. Construct a 12' x g~' deck~ approximately 63' landward from the tidal wetlands as depicted in the Survey entitled "Map of Property of Mrs. George L. Penny III at Mattituck and dated July 20~ 19~2. COMMUNITY NAME (City~ Town~ Village) TOWN Mattituck Southold COUNTY FIA COMMUNITY NO. DAM NO. pERMIT EXPIRATION DATE Su £olk J .12/31/ GENERAL t. The permittee shall file in the office of the appropriate Regional Permit Administrator, a notice of intention to commence work at least 48 hours in advance of the lime of commencement and shall also notify him promptly in writing of the completion of the work. CONDITIONS 8. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to 9. That ~f the display of lights and signals on any work hereby authorized is not otherwise provided for by Jaw, such lights and signals as may be pre- scribed by the United States Coast Guard shall be installed and rnainta~ned 10. All work carried out under this permit shall be performed in accor- 95.)o:4 (':.,/75) ' (SEE REVERSE SLOE) PERMIT SIGN No,. 10-82-O621 has been issued to: oEORG~, ~. p~ iv address: ~. -- ,, ~ oour~ew Ave.~ Southold, N. Y. 11971 ~z~titled "Map of Property of Mrs. George L. ~enny III at Mattitu~'k unde" tf 'e':'Ei :/i 6'ns ( iital Conservation Law, Article 15, [Protection of Water)_ Article 24, [Freshwater Wetlands] Article 25, (Tidal Wetlands) Article 36, [Construction in Flood Hazard Areas] '".,:~ -~ ]2' x ~' deck~ approximately 63' landward from the tidal wetlands as depicted in the and dated July 20, 19~2. *ew York State ~artment of Environmental Conservation Perm!~ Admil~tr~,tbf ..... ~ O~,t. ~9:~2 Date Issued Dec. 31: ]9~ Expiration Date FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined, . · .... Approved/:.,.,+... .., (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No../.?.~. ~...~. ~ ..... 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections· ~, ...,3.~'~.~'"-.7 ..... ~~.r..o.'v....-':: .... .~...y (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~ ..~..~..'... ~ ?.-~... ~ .().r~ZT..../_,-.,.. ~..~. ~..~..~ ....... · ...... (as 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 ...................... l. Location of lane1 on which p3oposed.w.o~k will be done .... ~~---~Oj-j~.~%, > .~..(~ ./.~.' t .'~2. C(~ 3~0~ ~~ ~~ _. ~- '~' ~"~Y ........ . ~.~ ?. ~... ~::-:~ .~ ~~~:'7:~:~.~. ~ .~:(~.~ .......... ttouse Number Street Hamlet co.,~y r~x Uap ~o. ~000 Sec~io. ..... t..k: ....... ~o~k ......... .~ ...... lot ..... ~.~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of prop,osed construction: a. Existing use and occupancy ... /.. · .J...~....~?,../. ................. b. Intended u se and occupancy .. 1.../.?.'~.../¢3~. ). ¼ ~/(.. ~..'1.~... tetra(_. {. 14l .(_'.) .... ,~.....b..['%-.C.._. ]. '.Q:., ..... Nature of work (check,which applicable): New Repair .............. Rem6val ....... Estimated Cost ' Building .......... Additio ..... Alteration .......... ..... Demolition .............. Other Work ............... r~-~ (Description) ............. Fee .~.. ¢~.~ ............................... : (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 ......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur6s, if any: Front. ~ .~.. ...... Rear ...'~.¥[ ........ Depth..k:.[ ..~] ......... Height ...... Number of Stories . ~ . . r)imensions of s~tme structure with alterations or additions: Front ...~ ........... Rear ... ~.lc~ .......... Bepth....~ ..~ ............ .. Height ....... . ............... Number of Stories ....... ~,- ............ 8. r)imensions of entire new construction: Front ..... .~..[P ...... Rear ..... ~[. ~. ...... Depth ...t.[ .[, ......... 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 pr~mises are situated ..................................................... 12. r)oes proposed construction vio!'ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...' ................. Address ................... PhoneNo ................ Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. c_tk STATE OF ~YORK, ~SS COUNTY OF. ~ ~q ~ , ' ........ ~ ~) .t~...~,. ~.~, ~..~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ above named. He is the ............... {.. ~ ............................................................ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dulg authored to perfom or have perfomed the said work and to m~e and file this application; that ail statements contained ~ this application are true to the best of his ~owledgo and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ......... Z4. .... LINDA F. KOWALSKI . ..... .~ · ~,. NOTARY PUDLtC, State of Hew YO~ ............ .h ',-r ,r f ,/0,7,