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Home My WebLink About12538-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. Z~9~3 Date September 26 83 THIS CERTIFIES that the building . .~.l.~.o.~ .~ .~.i. qr~ .................................. Location of Property .... 7.25...?~ .e.5.~.5. 0..B.~.~9 ~.~. ........... ~..~. ~ .~.~.~.u. 9.k .............. House IVo. Street Hamlet County Tax Map No. 1000 Section ... ~.~.q ...... Block ...... Q~ ....... Lot ...... 0d ~ ....~. ~ ?~ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~Ug~$~. ~. ....... ,19~. pursuant to which Building Permit No... fi.~55.~.~ ........... dated .... ~..l~.~.u.8.~.. ? ............... 19.85,.. 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 ......... for ~lterations to existing building The certificate is issued to . ED.W.g. RD. &T21~g~ .SI&GA .... ................ (ownor, lessee or t~nant) .............. of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 I~P-M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~'nON OF THE WORK ^UTHOR~ZE~) ~.~ ~.~. 3 .., 1253~ Z ~ot. ............... 4 .......................... I Permission is hereby granted to: //~ '~ ~ . .......... .......... _ ~.~.£ ........... :l..~ ................ ,. ot premises located at ......................................... ~.. ....................................... .~ ............ T ...... County Tax Map No. 1000 Section. ........ i q.............../ Block ....... ..0....~/........ Lot No ...... ?3.}.....Z::.. ...... Building Inspector. Fee $...~...~.: ..'~.. .......... Building InspeCtor Rev. 6/30/80 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 Ptanning 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 ~ ~/$ 2. Certificate of occupancy on pre-existing dwelling land use 3/ 5.00 3. Copy of certificate of occupancy $1.00 Date .~..~..... (~./. ~. ~. N .... u,,~,r,u .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property . ~.7cc ,5 .~.o._. . 5. c~. . . .~. . ~,/[ ¢~. "~'-~( .~ . . ~. T'.,.~. .(.-~. . . . County Tax Map No. 1000 Section I L~ / Block ..... (~).~ .... ) ~-- .................. Lot .... ¢~ ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.]~.-~ ~..-~... Date of Permit ?)~].~ ~...Applicant. ~f~. ~.¢~...~.4....~./.~..~.0 ........ Health Dept. Approval . /~)//~ .Labor Dept. Approval Underwriters Approval ..... ~../~ .............. Planning Board' Approval .... -..~.. ......... Request for Temporary Certificate ...... ~ ............ Final Certificate ~'~ Fee Submitted $...' ......................... Construction on above described building ar~rmit meets all applicable codes and regulations. Rev. 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....... ?).,~ ..... , 19~..~. Approved ....... ~.). ~ ......19~..~. Permit No. Received.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 19 Date ....... · ............ · · · INSTRUCTIONS a. This 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, ordinance~s_s .~_.b.~uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary m~pections. /) ff(Signaturfof__ --applicant' or name, t/a corporation) --/(Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (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... !. '.~-~ .~.~:. { .t?..~, .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .... ~.~-. ....................................... ..... ....... 7.. .: ......................... House Number Street Hamlet County Tax Map No. 1000 Section ...... /.ti/ ........ Block .... ~)..~. .......... 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 ..... :&2.d.~.. .~. ~ .~.. .... ................ ,, ........................ b. Intended use and occupancy .... C.~. ~:.t.;. .~. J J, .~.~;~' / .... (.~.'.1.~. .~ ~ .... ~. : .'.'~./~').,:5£. [¥': ~ .................... 3. Nature ofwork.(check which applicable): New Building .......... Addition .......... Alteration Repair .... J~. ........ Remoyal .............. Demolition .............. Other Work ............... :.,'(.~'~'"tP9 i ~~.~r4.. (Description) 4. Estimated Cost ..... ~..qP. ...................... Fee ...... ~5 .~ ....................... (to be paid on filing this application) ~ "If dwelling-, n~t!mber of dwelhng ttnits /. Number of dwelling units ',' . ............. on each floor ................ ''Jif garage; n~n~ber of cars 6. If business, commercial or mixed, occupancy, specffy nature and extent of each type of use .................... 7. Dimensions of existing structureg, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure wffh alterations or additions: Front ................. Rear ................. Depth .................... ;. Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth .............. Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ........... ' ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... , .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violMe any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded .......... : ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect ............................ Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 ~OUNTY OF. above named. He is the ..................... of said owner or owners, and is du application; that all statements conl iS.S .~.~ ............... being duly sworn, deposes and says that he is the applicant ing contract) (Contractor, agent, corporate officer, etc.) [y authorized to perform or have performed the said work and to make and file this ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...................... :,.day~, _ ~'~~"19 Notary Public ,~ · .~. · · ·' '- · .~.~.~.~.~.~.~.~.~. · ~~Countv f'--'x f) ..... i ~No..s2-.oa4~.96a 8u~o ~,,~ ~ ~ f (SignOre of apphcant) ~mm~ss~on Expires ~arc' ~'&~ BUILDI['[G DEP:ZRT2~tENT TO%'~I OF SOUTHOLD, N. Y. Location Subdivision HOUSI~ CODE I[,~PECTIOH REPORT 725 Pacific Street Mattituck [numoer & s~ree~) ([,iunlclpali~y) X Map No. X Lot(s) X Name of Owner(s) James Mason & wife Occupancy R-1 (~ype) A~mitted by: self Key available_....Griffin gar~ge~ Source of request Richard F. unoccupied (owner-senan~) .... Of!~p %hrli e ~ Dy; Suffolk Co. Tax No. 141-6-12 Lar~,'Esq. Date. Mar. 31, 1983 D~LLI~: Type of construction Foundation brick Total rooms, 1st. F1 3 Bathroom(s) 1--first floor Porch, tSrpe wood, roof ove~eck, type Breezeway Type Heat oil fired Fireplace(s) Domestic hotwater Other wood framed #stories 2 Cellar full Crawl space 2nd. F1 2. 3rd. F1 Toilet room(s) t--second floor Patio, type Utility room Hotwater Airconditioning yes Type heater .gas Garage. Warm Air X No. ~its 2 ACCESSORY STRUCTURES: Garage, type const. Swim. ming pool Other NONE Storage, typs const. Guest, type const. V__IOLATIOMS: Location _kitchen ·bedroom(down bathroom stairs Housing Code, Chapter 52 Descriotion floor needs repairs badly large rotten spot in floor floor~ walls, fixtures need repairing Sec. I III 152-32-A ...ITM 15 ~- .3..2- A - ~ III {52-32-A~C,D I I,I 152-27-A & B V 152-50-A III 152-32_B 52-31-B 52-27-A & B 52-31-A & B rails missing and broken lower floor ~ heater grills in floor broken windows & doprs some broken, ali need repairing outside " cellar o~t~ide, chimney falling away from wood shingles missing house cellar steps broken and no rail porches need repairing THIS DWELLING IS NON-HA~BITABLE UNTIL REPAIRS Remarks: AND APPROVED BY THE BUI[,DING DEPARTMENT. Curtis W. Hor~'on 'Time start 10:45 end 11125 ARE MADE