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Home My WebLink About12575-zFO RM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.q2.93.~. ......... Date ....... .l~p~e.~.e.~..2 .............. 19.83 THIS CERTIFIES that the building .. ~..D.Z.~.~0.~ .................................... Location of Property ..'J .'1~.~.~. ~.o.u;gql. Av..~, .... lvia ~q~;~-~;~ck ............ House No. Street Hamlet County Tax Map No. 1000 Section ....~ ...... Block ...Q3 .......... Lot ..... Subdivision ............................... Filed Map No ......... Lot Bio .............. conforms substantially to the Application for Building Permit heretofore Flied in this office dated ..... ~Ol>~'0e~..~. .... 19 .E[~ pursuant to which Building Permit No....q 2.~7.~Z ............ dated ... S~.~era~o.e~: ¢ ............ 19 S.~, 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 ......... Rot..a. deck. ~ dct,5.~ ±or~ .~o. an. ex;La g~_r~, o~e..~m~Z7. dwa5l~_r~ ............... The certificate is issued to GENEVIEVE FIYALKOWSKI ..................... io~n'e'r, 'l;~;e'dr't~a'n'O ...................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ........... ~../..A .................................... Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12575 Z Dote ...~ ......................................... , Permission is hereby granted to: ..... ..................... at premises located at ....J..I..~. ............. .~.~.d(~......~.....~..~ ...... ~'...~..)...o~ Count~ To× Map No. 1000 Section/~....~...~..J. ........ B~ock ...... ~).~ ....... Lot No ...... ..~..?~. .......... ~ ~...~. , 19~.~., and by the pursuant to application dated ....... ~.'~... ..................... approved Building Inspector. Building Inspector FORM NO, 6 'TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 A~PLICATION 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: I. 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 end 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 peoperty showing all property lines, streets, buildings and unusual natural or topograph ie featu res. 2. Sworn statement of owner or previous owner a~ to use, occupancy and condition of buildings, 3. Date of any housing code or safeW inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 ~ use H/~/$5.00 2. Certificate of occupancy on pre-existing dwelling v, land 3. Copy of certificate of occupancy $1,00 Date ......... , .....t ........... New Building .~...0,-~.-~<... Old or Pre-existing Building .... .~ ....... Vacant Land ............. Location of Property 11485 Sound Avenue Mattituck, LI, NY House No, Street Hamlet Owner or Owners of Property Coney±eve County Tax Map No. 1000 Section ...Z. 4.1 ......... Block 03 Lot....0,9, Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, .1.2.5.7.5...~.. Date of Permit., .9/.6./..8.3.Applicant Health Dept. Approval ....~P.% .~¢9.u.J,~¢¢ ....... Labor Dept. Approval . .NO.%..~qp;L,z:¢d ........ Underwriters Approval .,. b.~p~ .~.i¥~¢ ....... Planning Board Approval ,, NP, t, ~,:(¢¢~,uir¢¢, ..... Request for Temporary Certificate ..................... Final Certificate ........ ./. ............ Fee Submitted $...~.~,'..(.?.C?. , V/ Construction on above described building and permit. ~eels,¢ '":~, 'all adp, icab e~codes and, ragu. at OhS Applicant--~/vt£ ~.~.~¢L :'~'.. ~ .... Z~ ..................... FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE COMMENTS · FINAL ADDITIONAL COMMENTS: BU!LDIN~ ~EPT. INsPE TION ; [ ] FRAMING REMARKS:, [ ] FOUNDATION'IST i ~;R°UGH Pi;BO- [ ] FouNDATION '2ND [ !]' ~ ~ INSUlaTION '[~AL DATE FORM NO. 1 TOWN OF SOUTHOLD: BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 1197t TEL.: 765-1802 Approved .... --,..~tT....[e.., 19~.~. Permit No. Disapproved a/c ..................................... (BuilcTing hlspector) APPLICATION FOF1 BUILDING PERMIT Eeceived .......... ,19... :Dat .~,.ct{,L~(:.%-)..I.., 19 .'~ INSTRUCTIONS a. Tlfis application nmst 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 sckedule. 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 applinant. Such permit 4tall 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 'dmll have been granted by the Building Inspector APPLICATION IS ItEREBY MADE to the Building Department for the issuance of a Building Permit pursnant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordhmnces or Regulations, for the coustructJon 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 regulation5, and to admit authorized inspectors on promises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) q!ate whether applical~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . .QI,,.N.E.V.t.$.VJ:,..P.. T~fAI{I~OW~.IO~ .............................................. (as on the tax roll or latest deed) If applicant is a cou)oration, signature of duly authorized officer. (Name and title of corporate officer) Buikler's License No....N. qr3e. .... Gfi..}': '.~. ....... Plumber's License No...N..o.n. p .................. Llcd c au s License No. N. qn..e .................. Other Tradc's License Nc), . .None .............. Location of land oil which proposed work will be done. $.ee. &t, tach.e~d .Dirxgre~m ......................... 1~ Sound Avenue Mat't~tq~,..hi,. R~ I louse Ntnn bcr Street Hamlet ' iqt (ou.ty Fax Map No. I000 Section ................ Block . ,'..: ~ Lot ..... SubdMsion ..................................... Filed Map No ............... Lot ............... (Name) State existing, use and occupancy of premises and illleltded rise and occupancy of proposed constructiOll: a. Exi~,thlg use and occupancy . . ~c:s:[O~.B tJ a3~ .Dwe3,1ing. ' £ame As Above b. hdcnded use and occupaucy ..,-...-...- ........................................................... =. Nature of work (check which applica!)l¢): New'Building .......... Addition · . D.e~k. · · Alteration Repair ..... Removal ......... Demolition .............. Other Work ......... ' ...... ......... ' .... (Description) ~one ~. Estimate~Cost. ~500.00 .................... Fee ............ ~ ................... i'; .... ...... ppli ....... (to be paid on filing this a cation of dwelbng umts on each ................ ~ If dwelling number of dwelling u~?i ........ If garage, nnmber of cars ........................................................................ ~. If business, commercial or mixed occupancy, spec t'y nature and extent of e~c~ ty~e 0f use .... [ ...... ~ ......... ~. Dinmnsions of existlqg structures, if any: Front ............... Rear .~.~ .~. · .] ..... Depth · .~.~ ......... .......... Nmnber of Stories ~ ...... '~ .............. ~ .......... Height .. · iterations or additions: Front ............. ,.[... Rear ....... ; ..... Dimensions? same structure with Height ...................... Nnmher of S~or es .................... Depth . ~. .............. . ..... .... construction: Front . .i&' ..... , ..... 8. Dm~ensmns of entxre new Rear .. 3.fi ~ j ..... Depth .~ ~ .... It,eight . . ~8.". · · · ................................ ~7' ' ' ....... Number of Stories .... N~A. ,. "' ' ~,,~ 401,25 & 390.5' . .. ~ ...... tqear .... · ......... l)cv~,, · · .'.' ........ ; ......... 9. &ze of lot: Front 55.50 -~ 70.. q..,.. 0 Date of Purchase ............................. Name of Former Owner . · { .......................... [ 1. Zone or use district in which premises are situated .......................... ~ .......................... Does proposed construction violate any zoning law, · 2. ordinance or regulation: · .~gg~ .' ........ ' ............. ~ 3. Will lot be regraded '...~9. ~'. ...... . ........... .... Will excess fill be removed from premises: Yes No ~4. Name of Owner of premises ~8~. Exy~kq~k.~ Address .307-95 ~ound ,h~ghone No 2.~ Name of Architect ~O~B. ............... Address ........ J... Phone No ............... ~one Address . Phone No ........... Name of Contractor ................................................... PLOT DIAGRAM Locate clearly ~d di;tinctly ~1 3u~dings, whether existing or proposed, and. ind cate all set-back dimensions from property lines. Give street and block nvmber or desc~ption according to deed, and show 'eel names and h~dicate whether interior or corner lot. See Plans STATE OF NEW YORK, S,S COUNTY OF ................ ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above nanled, t ; lleisthe .................................... ~' ' (Contractor, agent, corporate officer, et~.) of sakl owner or owners, and is duly attthorized to perform or have performed th~ said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;'and that the work will be performed in the mtmner set forth in the application filed therewith. Sworn to before me this ........................ day of ...................... 19... Notary Public, . ................................ County