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HomeMy WebLinkAbout12548-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14708 Date July 25 86 ......................................... : ........ 19... THIS CERTIFIES that the building Pool Location of Property ..... 2.Q .5. ~NOLLWOOD LANE MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 10 7 .Block 6 .Lot 11 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A..ug....1. t . .1.9. 8. .3 .... 19... pursuant to which Building Permit No....1.~ ~.z ............ dated .. p, qcj ,..6. ,...19.8.3. ........... 19..., 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 ......... I~r. Qu~.d.p. Qol ~ fence and deck. The certificate isissued to Sharon & Richard Brooks (owner,~pXCJ~,~ of the aforesaid building. Suffolk County Department of Health Approval .... .N./.A. .................................. UNDERWRITERS CERTIFICATE NO ............ lq.~ ]~ ~ ~2.~ ............................. Rev. 1/81 Building Inspector FORM NO. 9 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) 12548 Z Dote .... ~...~........$.. ............ , ~..~.~ Permission is hereby granted to: . ..... ............ .Cii~.~.~....~.~..~ ............................................. ~~ , .~. ~.. ~ .~ ~..~- ro ..... ~)..;].,~..~. ...... ~! .............. ~ .............. at premises located at .s:~...O..~;3~......~..~2g..~~...~-.-~.....~H~........~....~ ......... County Tax Map No. 1000 Section ....~.~..~ ........ Block .......... ~. ........ Lot No. J ( pursuant to application dated ............ ~.,~q....~...../ .......... , 19.'~..?.., and approved 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 Instructions A. This application must be filled in typewriter 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. Approva~ 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. §, 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:Coperty 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 ~m~'f~~ on~-p re--~-e"-~ mt~ n~g d--~velling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date..~. ~.g-.~./~..-t~... J>..~i .... NewCons %z~uction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.. ~.~.-.5.~. i .......... House No, Street Ham/et Owner or Owners of Property ....~.:../~..:...: ./~-.....~.'..~.:....~..,~...O?..~.~f ................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .... /.~./~..~.+.~..C~..O?..~....~...z?~.. ..... Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval Underwriters Approval ......... .~. ............. Planning Board Approval .................. Request for Temporary Certificate ...... .~..~. ...... Final Certificate ...... .~..~, ~ ............ Fee Submitted $ ..... ..~..-~... Rev, 10~10-78 Construction on above described building and permit_meet%~ll applicable codes and regulations. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY G,ODE FINAL COMMENTS /11 J , ' ,---~. ADDITIONAL COMMENTS: L-AblE .,V. 7f °4-7"0o'~''. ~7~0' ' W, ~'I, - 5. 7/ U 765.1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION IST [ ] ROUGH pLBG, [ ] FRAMING REMARKS: FOUNDATION 2ND [ ] INSULATION [~FINAL INSPECTOR, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~I'r~ ~51~.~'1~ ',J~, ~85 JOHN STREET, NEW YORK, NE~ ~RK 10038 THIS CERTIFIES THAT only the electrical equipment ~ deserlbed beJo~ a~ introduc~ by the applicant named on the above application number in the premises of in the follo~ng location; ~ B~ememt ~ 1st FI. ~ 2nd FI. ~Si~ Secglon Block Log was examined on ~ l~ ~ 1~ and found to be in complia~ce with ~he r~q~irements of thls Board. FIXTURE i FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS i SWITCHES OUTLETS FLUORESCENT l DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E OTHER APPARATUS: C E ow~m~ng t,oo1~ 'II,is c~rtificate covers c~npli~nce at ~b~, d~te of inspection, ~i~ecau~o of unusual enviro:~n~ts it is advisable 'co h~ve fr~tuent ~ and/oi, ~p~irs nu~de by a quali~fied Ol~ Bradley Ma~ti~zk, N.Yo llgv;~ Lig#12E7 This certificate must not be altered ~n any manner; return to the office of the Board if GENERAL MANAGER may be identified by their credentials. Y MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. ~(~~..~.., 19~.g. Approved .% ~.W'...~., 19~.~. Permit No..~ ~-. ~.. ~ ~.-~.. · Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application NO .... )..)w, ,~, ·~, ?, ..... 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 regulatious~, and to admit authorized inspectors on premises and in building for necessary inspections. ......... ~.../'~.-. Zz~ .z'., t. £~..~ ~..~.~-. .... (Signature of applicant, or name, if a corporation) ... z~ .o..~... ,/J.~...~,~:r-_~./:m~.k..z:....[.~/X. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... C,~.,/z-~,~.t,... ¢.~..~.r~.~r~..~ ...................................................... Name of owner of premises ..... .~.~..~..~..~...&. .... ~J~.~.J~D~/ .... ~t~(~)l~c' ........................... (as on the tax roll or latest deed) If ~5~ant is a co~ora~o~igna~xe o f duly authorized officer. · :... ........ / (Name and title oi' c6-rporate officer) 5~. (o . 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 .................................................. .... g.9~. ................... j?~. .~.~o.o.~ .~. ............. /¢sz'/:.z. .~. ........... .~. . . .. House Number Street Hamlet County Tax Map No. 1000 Section ...... ./.0..? ....... Block ...... 6 .......... Lot ....... //.......... Subdivision ........ ~.1~...~. ...................... 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 ~ I~ .~/...T,//~" ......................... b. Intended use and occupancy ......... ~..~../../~ .~...Tf..~.-. ............................... ; .......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other W~k,~7~..~./.~.~. 4. Estimated Cost ....... /.~.~. ......................... Fee ................... .~.~..t.~.~. ............ (to be paid on f'ding this application) 5. If dwelling, number of dwelling units ............... 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 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 ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ............................ ~Fh ...................... q12. Does proposed ¢o,nstruction violate anY zoning law, °rdinance or regulation: ...... lY.¥ ....... h~3. Will lot be regraded . ........................... Will excess fill be removed ,fr~ojn premises:"'~'q~''"'Q~ 14. Name of Owner Of premises .. I/.I.~ .t~. ~0.. t~t~..o/~.. Address . ~/tJ.T.. ! Y~,~tl~'. ~ ~. Phone No ................ Name of Architect .... . ...................... Address ................... Phone No ................ Name of Contractor .~.. ~.t:.(7 ~. ~.. ~'2 .~... .... Address ..Jh .~"K.t..~42-/~.... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names arid indicate whether interior or comer lot. / STATE OF NEVJ/~YOg[, ~a ~ ~ .~ .t~. ~. -~.. J~'...~_____ .................. being duly sworn, deposes and says that he is the applicant (Name o~'i~tiv~t~al fi/gning con~act) above nmed. He is the ............ ~~ .................................................. · ~ .......... , (Con,actor, ag~t, co,orate officer, etc.) of said owner or owne~, ~d ~ duly auto,ed to peffom or have peffomed application; that ~ statements contmed ~ ~ application ~ tree,lo ~e best of ~s ~owledge ~d belief; ~d that ~e work will be p~ff°~ed in the m~ner set f~ Sworn to before me th~ Nota~ Public, ~ .~~,.~oo,,.. Coun~ ' .... ................