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Home My WebLink About12164-z FORM NO. 4 TOWN OF SouTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall $outhold, N.Y. Certificate Of OCcupancy Date THIS CERTIFIES that the bulldog ~DIT~.ON, ~. AqTEF.~T~gF.~ 16/~5 WESTPHALIA RD. MATTITUCK Location of Property ............................................................... Hous~ No, Street Hamlet County Tax Map No, 1000 Section 16 1 ..... Block 1 . ,Lot ,6 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office datod FEBRUARY 28 19Bfi. hicl B ildi gP itN 1216~.Z ..................... , . pursuant to w I u n erin o ..................... · dated............................FEBRUARY 2~ 19 .8.6. , was issued; and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...~:qa., ?.U.,/t. pp.I.T I. 9.~..4~P. A~ T.~?.n.~..I 9.~.s..Tg..~fi...~.x.I.S.T.I.~.E , .0.lq~..~ .n.~.i.~?. ......... DWELLING The certificate is issued to . . C.,~.O.R.C.,E.....~/~ ¥.L.O.F~ .~..W.~ .............................. (ownor, lesse~ or tenant) of the aforesaid building. Suffolk County Department of Health Approval ,., ~,/~. .................................. UNDERWRITERS CERTIFICATE NO.. fi. 6. ! ,~ :5.1.7. ....................................... Rev, 1/81 BUILDIN (THIS PEP, MI'J' MUST BE ~EPT ON;~ ~HE I~R ~ES UNTII~ FULL C~PL~ION O THE WQ AUTHOR ZED N? 12164 Z ~issibn is hereby grant~_ to:~:O D ~ ~n~ Tax Map No. lO00 Section NO}.. ....................... ~u u0nt to application dat~ ,~.~;:.~ ' and appr~ by the 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. B, 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" lend uses: 1. Accurate survey of peoperty 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 ~ $5.0.Q/' ~/ 2. Certificate of occupancy on p~-~x~sting dwellingf land use -- ]~z~e-~× ls t. ln~ C. 0. $15.00 3. Copy of certificate of occupancy $1.00 Vacant land C.O. $ 5.00 Date .......................... New Building ............. Old or Pre-existing Building z/ Vacant Land Location of Property J..~.. '/.~. ~,~ ,~/. House No, ~ ~ ~~- I~ ~ Strut ~ ~am~er Owner or Owners of Property ,/~'~.~ · ~ .................. t ......... County Tax Map No. 1000 Section .../~/~~BIock. J ............ Lot... ~ ........... Subdivision ....... Permit No. ~.). ~¢~.. Date of Perrit .~.~.Applicant .~~. ~.~;~ ........ Health Dept. Approval ..... ~'. ......... Labor Dept. Approval ....... ~ ........... .~..G. ~J ~.~ ~ ......... Planning Board' Approval ..... .~ .......... Unde~riters Approval.. Request for Temporary Certificate ..................... Final Certificate .................... Fee Submitted $. ...... Construction on above described building an¢ permit meets all applicable codes and regulations. /, ~ Applicant .~~. · ~..~~ ........... ~ ............ COMMENTS · F ~E L.D"~© FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING ADDITIONAL COMMENTS: INSULATION FER N. Y. STATE ENERGY q,ODE FINAL (D -[ FOUNDATION (~st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~ODE FINAL ADDITIONAL COMMENTS: lOOO6 ; THE NEW YORK BOARD OF F!!RE UNDERWRITERS BUREAU OF ELEGTRIC~IT~ ~' 85 JOHN STREET, NEW YORK, NEW ~ORK N 611517 THIS CERTIFIE~ THAT only the electrical equipment ~ descrtb~ below and introduced by t~ applicant hated on the above application number in the prem~ses of ~r~ Taylor, W~ Phal:la 1~ ~].6~, M~ttit~, N.Y. in the following location; ~ Basement ~ i st FL was examined on FIXTURE OUTLETS 10 DRYERS [~ 2nd FI. Section Block Lot and found to be tn comi~har~ce wtth the requirements of tkis Board. FIXTURES SWITCHES INCANDESCENT FLUORESCENT VA~O~ 6 7 10 FURNACE MOTORS APPLIANCE FEEDERS RANGES OVENS DISH WASHERS EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT APPARATUS: $ E NO. Oi~ERCCffCOND. R AWG OF CC, COND I C E NO OF NEUTRALS A W G OF HbtEG OF NEUTRAL Glennr{, Bradley Horton avenue PWD 169 ~att~.tuak, NoY. 11952 This certificate must not be altered in any manner; return to the office of the Board if $ DEPAFITMENT. THIS COPY OF CI may be ED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-111013 Examined ........ ~.'.~.., 19..~. Approved ....... .~./.~. ~..; 1 .~.~. Permit No.. (..~..( .~..~;-7~ Disapproved a/c ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. f~ ( ~ V INSTRUCTIONS 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 co~nply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ij~spections. · ................... (Signa4~ure of applican5/, or name, if a corporation) (Mailing address of applicant0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~:~.~.'~. ?~.-. ¢?..¢,_L. ~M ..... . .................................... /~ (as on t~tax Tull or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... O.'r~. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l. Location of land on which proposed work will be ~one..t~q/.-¢~*. 1~,¢/¢?-m.< .c~?.-. .... :-...- ................ ~ ..... / .............. .¢.. ?. . . ................... . ?, . : .:;:2. .. . .::. . ,/ : . .... Itouse Number Street Hamlet /( / cf/ County Tax Map No. ]000 Section .................. Block ..... ...... ( ...... Lot .... ¢ ............. Subdivision ................. -. .................. Filed Map NO .... ~'. ........ Lot . .---~. ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy :/.~. {.~:[(.'~ .. ....... , .................. 4' ' ': ' ' ' [ ........................ Existing b. Intended use and occupancy ~.:~.~.'~(.~..~., 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration . Repair .............. Remgval .............. Demolition .............. Other Work ............... 4. Estimated Co · ·, ...... Fee ..................................... ! (to be paid on filing this application) 5. If dwe!ling, number of dwelling iunits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixe~ 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 constmction: 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 pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................... .t.~ ....... Will lot be regraded ........ ! ................... Will excess fill be removed from premises: No 14. Name of Owner of premises ...I ................. Address ................... Phone No ................ Name of Architect : .... Address ................... Phone No ................ Name of Contractor ' Address Phone No. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF N.F/yV Y.o,P).K~ .~, S S COU];gr~Y O~ .... , ' ./. ~d~ .' ~,~../~.. / .~.(.~..~ ................... being duly sworn, deposes ~d says that he is the applicant ~ame of individ~l si~ng contract) above named. He is the .................. ~~7~ ............................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ authorized to perform or have perfo~ed the said work and to m~e ~d file this application; that ~1 statements contained h th~s application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ne[ set forth m the application filed therewith. Sworn to before me this ' · · · · - . County ' r . [ ,~,,, ,~,,,, ~.~,~ ao, ~ ~ (Signature of applicant)