The URL can be used to link to this page

Home My WebLink About12627-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. ZI5254 Date F.ebruary .6~. 1987 , THIS CERTIFIES th tiding d.d~ ~ at the bu A i t i o n. ,~ ...... ty ..2.5.2..5. Westphalia Rd. ...... Mattltuck Location of Proper House ~Vo. ' ................... Stro~[ ................ ' '''''''''''Hamlet County Tax Map No. 1000 Section 114 .Block 10 .Lot 022 Subdivision ................................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .S.e.p..t :..1.3. :..1.9.8. ,3 ' ,,. pursuant to which Building Permit No.. 12. 62.7 Z dated Sept. 22, 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 ......... Dqck. ad. diti. on. to e.x.istl.ng one family dwelling. The certificate is issued to BENJAMIN & RITA COX towner, ~eYe~ ~ ................... of the aforesaid building. Suffolk County Department of Health Approval ...... .N ./A ......... N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FORM NO. ~1 TOWN OF SOtJTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12627 Z Date .....,~u~.~ ................................. , Permission is hereby granted to: ~ .~.n-~.~_. ~.~.,.~.~......~.:~.....~.~. ....... ........................ ,,_~~;z...;~.~......~.....b....~ ....... ~.. '~ ................. ~ ...... '-'""'~""-"~;~ ........... '- ~ 4 at premises located at .....~....~.....-~...~. ....... L~...~...~-.~.....v........~.~~ ......... County Tax Map No. 1000 Section ....... J.!...~.. ........ Block ....... .J....~. ....... Lot No....,.~.,,~'v...~...~ .... pursuant tO application dated ..,'~.~ ...... .~....'~.. .......... , 19~.~, and opprov~ by the Building Inspector. Fee $ ~...~.~...,~ .... Building Inspector 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 FEB - 6 1987 Instructions A. This application must be filled in typewriter OR ink, and submitted mmmmmm 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~perty 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 occupancv New DweI1J. ng,$25,OO, Accessory ,.$10,00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50, OO 3, Copy of certificate of occupancy $ 5,00, over 5 years $10,00 4.Vacant Land C.O. $ 20.00 5.Uodated C.O. $ 50.00 Date .......................... 6. )~lteration $25.00 NewCons truc tion,, X,X,.. Old or Pre-existing Building ............ Vacant Land ............. 2525 WESTPH'ALIA RD Mattituck Location of Property ' ' House No. Street Hamlet Owner or Owners of Property BENJAMIN & RITA COX ,',', 022 County Tax Map No, 1000 Section ,,, ,I ,1,4, ....... Block .......... ],0,,,, Lot ................ Subdivision ................................ Filed Map No ........... Lot No .............. 12627Z ofPerm~t ,9/22/,,8~ Applicant Permit No ........... Date , ..................................... Health Dept Approval Labor Dept Approval . Underwriters Approval Planning Board Approval ...... Request for Temporary Certificate .................... Final Certificate ....................... Fee Submitted $ ............................ FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd } ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE Ol-: BUILDING INSPECTOR ILO. BOX 728 TOWN I/ALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 TbJs is to advise you that thc ~ob under building permit no, 12627Z issued to Ben COx on 9/22/83' for Addition is completed and ti fi~al ~nspection has ( ) has not ( X ) bee. do~e. Tn order to complete this file, it' is necessary that il CortJf~cate of Occupancy be issued. Please fill out enclosed form, return same to ~he above office with a check for $2'5.00 payable to tile Town of Southold, Please indicate to Whom tile Certificate of Occupancy is to be malted, and arrange with this office for an inspection date Occupancy or use is unlawful without s Certificate of Occupancy. P[ease. bc]p tls to clear up this, matter so thac legal action does not have to be taken. Thank you for your prompt attention° Vet! truly your , Victor Lessard Executive Administrator VL:gar encl . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 19~..~,. Exanfined ..... ~. ......... , Approved....~..~...:27. ?T..., 19~B'.. Permit No. ! .~r..~.~..~..~.. Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter 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 build~.l~ code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp,o~ltqns, t x. ,f<;y ' (Signature-- '~ r--"--of ltpplicant, or name~if a corporation) . L I ...... .?. .< . .... t ............ (Mailing address of applicafft) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ..... '.. .~ .7'(. ........................ " (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 ...................... Location of land on which proposed work will be done...~. ~k-'~. ~.. · .~.. [J. · .~. ~~.fff~*.~.. House Number Street Hamlet County Tax Map No. 1000 Section .... /./..~. .......... Block ..... /..O ........... Lot.. O ~ ~ t~/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 ....... (~:~...iT-.' '(/?-~' ('(7'..~...d~/ .................................... b. Intended use and occupancy...~..,'?~...~...~....'..~..~.~..~..~..~..~ ~...~../..~'7...~.. .... o o /lO. ll. 13. 14, Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... Estimated Cost.. .' .......... Fee ................ (to be paid on filing this application) If dwelling, number of dwelling units .............. Number o f 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 ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ,.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ....... ~ .~-~. ....... Rear ...................... De_I/t,l~ .~ ~...~ ........ Date of Purchase .... .,~.0..~ .............. Na~e of Former Owner ....~.~. ~;lr. t. t. (-~,0Tl~. ...... Zone or use district in which pf~mises are situated .... ,,~.: ............................................ Does proposed construction violate any zoning law, ordinance or regulation: .; .............................. Will lot be regraded ............ ,. .........,o ...... Will excess fill,bersentpyed from premises: Yes No · Address ~%e'~/z~.~..~:-..~Phone No..,:~..w~7.~. ~-.~C~..2:,7. N me of Owner of premises Name of Architect ............... ~' Address ................... Phone No ....... Name of Contractor ~ ...... : .~..-~.~. ~ i i i .....Address ................... Phone No.~C'...'77.:. '.........:"' 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 nq~b. er,or description according to deed, and show street names and indicate whether interior or corner lot. AI~?~J~/fS/C--~/;c~?~_~ _~, COUNTY OFFS.. S.~/Z,~ ~/ a~ ......... ~~.: .~r. ........... being duly sworn, deposes and says th e ~s the applicant ~(Name o~ndividual signing cofitract) above named. He is the ....................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfumed the said work and to m~e and file this application; that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfumed in the m~ner set forth in the application filed therewith. Swum to before me this Nota Pubii . Oount, ~o~a~ Public $ta~ o{ New *a'~ ~ ............ ~ ............ 2 ' ~ ~ ...... ~ .... ' -uffolk Count / (~ignature of apphc~t) Comm. Exo~ Ma~ 3.~ 1,~