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Home My WebLink About12549-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12104 Date NOVEMBER 30 198.3. THIS CERTIFIES that the building ADDITION Location of Pronertv 1815 MARLENE DRIVE MATTI?UCK House No. Street Hamtet County Tax Map No. 1000 Section ....~.~.~ ...... Block .... ..3 ........ .l,ot ................ Subdivision .............................. Filed Map No ......... Lot No .............. conforms ,~uhstanti~]ly to the Application for Bui!dJng Permit heretofore fi[ed in this office dated · .~y, .~9 ......... 19.8..3. pursuant to which Building Permit No.. ~ .2.5.~..9. ~ ............. dated .,~UG.U.~T. ~ .................. 19 .8.3., was issued, and conforms to aU of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... For. a ba.tJl~'oola g~ D.ecl]~O~pl ~cJ.d.i.t.i. 9.n t.o..,ap..e..x.i.s, ting dwelling The certificate is issued to . .GEORGE. T....L/I]~.QI)~;o~ or tenant] of the aforesaid building. Suffolk County Department of Health Approval . .I~f/k ..................................... UNDERWRITERS CERTIFICATE NO ........ .N619D.7. D ................................. Building Inspector Rev. 1/81 FORM NO. 2 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) ~ z ~o,,...~..~ ...... .~ ............. , ,,..~...~ Permission is hereby gronted to: ...... ...... ~'~':~'"~'~"~~~~ ................. ~ii ...... i .................... ~o...~~.~ ....... ...c~.~..~......~......~.~.....$ ................................... premises Iocoted et ........ /....~. ...... : .................... County Tax Mop No. 1000 Section ...... k..~l...~ ........ Block ........ .~.~.. ......... Lot No .......... ..~. ........... Building Inspector. · Building InSOector Rev. 6/30/80 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- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property ~ines, 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-exist!rig" land uses: 1. Accurate survey of peoperty showing alt 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 ! //$5.00 2. Certificate of occupancy on pre-existing dwelling ~r land use $ 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building(X). ~.. ...... ~ ~Vacant Land '~ ........ Location of Property .... ~/~.~.~....7/~,~. '/¢..~..'~/,~', ,/~. ?....~ .~. ~... .... HouSe ~o. ~ / ,,dStreet Hamlet Owner or Owners of Property .... .~...-..' ~ ./z¢., .x~...-0._ ¢~. f-t- .................................. County Tax Map No, 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~ ?.~. ?..Z. Date of Permi¢ .¢¢: ~'¢~ .Applicant .'/v~.,../~.~. ~..~.~..~...~.~../?~.: .¢4/~J(~ Health Dept. Approval . ~. ,'~: ................ Labor Dept. Approval ...................... ,.. U nd e rw r itc rs AP P r °val/'~/~'//~'~' '~'/'~' ~' '~' ' ' I ' 'Planning B°ard Appr°val. .................. ~,.~ Request for Temporary Certificate ..................... Final Certificate ........ - ......... * - Fee Submitted $... .~. ................... Construction on above described building and pern~it'mee.ts all apt~i,cable~code¢ and regulations. ..................... Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY C ODE FINAL ADDITIONAL 765-'1802 BUILDING DEPT. I '~ N NSPECTIOr FOUNDATION 1ST [ ] ROUGH P~BG. FOUNDATION 2ND ['?SULAT!Ok FRAMING IQ FINAL 7G5~1802, ~ BUILDING ;DEPT~~ INSPECTION [, ] FOUNDATION 1ST [ ] ROUGH P~BG. ~<~ FOUNDATION 2ND ~j~,INSULATiON ~ FRAMING [ ~] FINAL' DATE, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIOIT~ SE JOHN STREET, NEW YORK, NEW ~?ORK 1OO3a 19E~3 tn the following location; ~ Basement [] 1st Fl. FIXTURE SWITCHES OUTLETS 10 7 DRYERS FIXTURES NCANDE$CENT FLUORESCENT ~ 2nd FI. Section Block Lot a~d found to be ir~ compJlence with the requirel~tents of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS OTHER APPARATUS: l~e E R V C NO, O~ERCC~COND, A, W, C; NO, OF NEUTRALS A- W G, OF HI-L~G OF NEUTRAL I~l~d ~l~ctric Oo. P.O~ Box 143 ~ttj~tuck~ N.Y, 11~52 COPY FOR ~BUILDjNG DEPARTMENT. THIS COPY O~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ×amined19 ^pproved ~,.~..t~.., l~.~ Permit No. Disapproved a/c ..................................... ................................ i .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.. ?. 77..~.~ff .~ ..... Date ................ 19 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 inspe.~ions. . ............~.~. ~..e /.g ./,~.~. ...... J.o. ~..~.../..A/. ~.~.. (Signature of applicatft, or name, if a corporation) ...... ~..~ ................... z:?.~.~.~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' Name of owner of premises ...~..~..O. ~.~..~....~.....~..~.. ~.. ~..'.~./~ .................................... (as on the tax roll or latest deed) If applica~nt is a corporation, signa, ture of duly authorized officer. .............. (Name and title of corpora~ officer) Builder's License No .... ~/..~. .................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Itouse Number Street Hamlet Filed MapNo. ..A~ ......... o ..~ .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration P, epair .............. RemOval .............. Demolition Other Work... , (Description) 4. Estimated Cost t5 ~ <9, o ~ .................................. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling!untls ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ..................... 7. Dnnens~ons of existing structures, if any: Front ............... Rear .............. Depth ............... Iteight ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ;.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new const[uction: Front ............... Rear .............. . Depth ............... I?ight ............... Number of Stories ..................................... "ge /'*-- i i ........ 9. a~ of lot: Front .......... i ........... Rear ........ /./...'~.. ...... Depth ....... . ........ 10. Date of Purchase .......... r .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ......................................... . ............ 12. Does proposed construction violate ,any zoning law, ordinance or regulation: ..... ~..0 ................... 13. Will lot be regraded ........ i ~ .Q,. :~' ;,'. 'z · ;, .... Will excess fill be removed from premises: Yes ~N0~ 14. Name of Owner of premises .~..77...~:../-/.(~.o...~..~... Address ./..~./.2[7. ~..~.z.ex,..~... Phone No ............. Name of Architect ......... i ................................ Address ................... Phone No. Name of Contractor . x~l.: .~ ~,,/../-.Z.~..~7. )Ya/-/.J'.. ~ ~' ~'- · Address .../~....,~'..~T. 77...,,~/y. Phone No ......... ~.'. ~..'~,__ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or ~orner lot. STATE OF,NJ~..~q~tj~,~/.4' 'S S COUNTY ~~ i ' . , ........ './~. O .,t~.4~.gg., ...... '..;~..~ ......... being duly sworn, deposes and says that he is the applicant (Name of ind' "' ~' 'ividual sign'ing contra~t) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed tim said work and to m~e and file this application ;~ that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ne]r set forth ~ the application filed therewith. Sworn to before me~ ........ ~,Z ........... day o~ ......... ~.., 19... No. 52.03~963~U~lk ~un ~ · .... t ................ Si' n ur ' ~' ...... ' i ~mm~lon Expires March $0, 1~ . ''' ~iin~;4;~; Ipphcant) 1~ copper tubing ,s useC~ for water distributing system; P pt.~ _:t F'~ APTm~"-~ AS NOTED