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Home My WebLink About12663-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17815 Date MARCH 3, 1989 THIS CERTIFIES that the buildin~ Location of Propert~ 770 PIKE STREET House No. County Tax Map No. 1000 Section 140 Subdivision ACCESSORY MATTITUCK Street Block 03 Lot 06 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 30, 1983 pursuant to which Building Permit No. 12663Z dated OCT. 1~ 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 ACCESSORY BUILDING IN BACK YARD. The certificate is issued to GERALDINE M. (CULLEN) SCHAAFF (owner, - ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROV~L UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 · / Building Inspector I~OBM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 12663 Z Permission is hereby granted ~: · ~- ~- ..... ....... ............... ~ ~.~.,.~.:~/.,.....~.~.~.:~.~. ,o ..~.~.....~~.~...~~...~.....~.~...~.~.~. ....... ~.....~~ ~.~ ..~:_~ .... ~ , .~_.....~..._;_ County Tax Map No. 1000 Section ........ !...~....0. ....... Block ...... ..O,...~. ....... Lot No .......... .~ ........... pursuant to application dated ....... ...~...~.b.~,...~ ......... , 19.~..~..., and approved by the Building Inspector. 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 Instructions This application must be filled in tVpewriter OR ink, and submitted ,- a~m.asm 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 unu~al natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal-(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 Coda 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: 1. Accurate survey of property showing all properW 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 inspectior~ of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: New Dwelling. S25.00, Accesaor? ..$10.00 Buaines.~ $50.00 1. Certificate of occupancy 2. Certificate of occupancy on pre-existing dwelling $ $ 0.00 3. Copy of cer%ificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5,Uudated C.O. $ 50.00 Oate .......................... 6. hlteration $25.00 NewCons t~uct,ion ...... Old or Pre-existing Building ............ Vacant Land ............. Locatio~ of Proparty ................................................. House No. Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section .... / .~.~. ...... Block ..... ~.. ........ Lot....~ ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. (z~.~.4,~..~.' Date of Perm!t , ./~.~./~..~'~,..Applicant...,~.,;~./~..~'..~(./.'~. · .//~.~ .'~... ........... Health Dept Approval '"'- Labor Dept Approval '-"--- Underwriters Approval .............. ~ ....... Planning Board Approval ...................... Temporary Certificate ~-----' Final Certificate Request for ............................................ Fee Submitted $../.q: ........................ Construction on above described building and perm!t meets all applicable codes and regulations. c,O,z COMMENTS FIE%D %NSPECTION 1. FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .O.c~ ........ , 19'~.g... Approved . . .~.'..?~...). ...... 19'~. Permit No.j. .2..b.~..~..-~... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Tins 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 tins 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. ,~ ~ _ ....... (Signature of applicant, or name, if a corporation) · .z?~.../././.<~..~..//..d/.& ./-/7. x~. ~.c/<..~:~/l.¢..-.~_. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name or owner of premises . .a~.~ .-~-../~..//.L..D./..'5/.. ~. ~... /'¢7.- (/.. d~ ~?/..z~'...)...~ Z. ~..-"/./7/ff. (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 ...................... 1. Location of land on which proposed work will be done .................................................. · ~, .~. ......................... ,,~././.c.~..0-.../7. ............. ~./4 ./-.~7..//.--. e:.c/~ .................. House Number Street Hamlet County Tax Map No. 1000 Section ...... /.~?. ........ Block g' Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~..'~?-~.../~..."~.~./...~.yS. .............. ~iti$~ ~3~,.{~i~'~, ~f~'/6~ ....... b. Intended use and occupancy ................................... "f~q',,',lqf}"lhlt~l~klf~ i~l i ;.Y'~'~ ~A.~.% ......... 3. Nature of work (check which applicable): New Building .---:~.(P....~75.. Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost ...... tg:c).,. O. 0. .................... Fee ...................................... (to be paid on filing this application) 5 If dwelling number of dwelling'umts Number of dwelling units on each floor If garage, number of cars .... ~ ................................................................... 6. If busipess, 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 ........................................................ Dimensions of same structure With alterations or additions: Front Rear Depth ................... i ·, Height ...................... Number of Stories ..................... 8. Dimensions of entire new constrUction: Front 5~..~.///~/r ... Rear..~.( .~f/.Z.~ ..... Depth c~. ?.~')~./. Height ............... Number of Stories ........................................................ 9. Sizeoflot Front .~.~4.~.ff ~ . Rear oc~/)?.. .... De,~h f0. !)ate of Purchase .. ~'. ~ ./..~i$ ................. Name of Former Owner '2~.ac~:~.W. I 1. Zone or use district in which prs~i',}ses ale situated. 2~. ............................................... 12. I)oes proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........................... Will excess fill be .re~_~moved from premises: Yes No 14. Name of Owner of premises~ ~-.~?)./.,~.~ ~,a~c ?/~-z' ,~ ,e'-'. ~.~ ~ ............... Address ~,,qtg..~.... / ......... Phone No.. ?. ....... ~..... Na~ne 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 property lines. Give street and block] number or description according to deed, and show street names and indicate whether interior or corner lot. Pre~ - --~o_~. t/~9 q.~ ~ STATE OF NEW YORK, ~S.S COUNTY OF ................. ..... ~ ................... being duly sworn, deposes and says that he is the applicant (Name oFin~ualS~ning contract) above named. He is the .......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, md is'duly authorized to perform or have performed the said work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this Notary Public ...... ~ .......... County · a · .... . · · .