The URL can be used to link to this page

Home My WebLink About12177-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No .... g.q.q.799 ....... Date ................ July..2q ......... 1985. THIS CERTIFIES that the building ADDI~JEON ...................................... Location of Property fl~500 Main road Mattituck Houso No, Street Hamlet County Tax Map No, 1000 Section ....'1.q/4 ..... Block ..... .9 ......... Lot .... ~. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ?.e.b.r..~.a?.y.. ? .6 ........ 19 f} .3pursuant to which Building Permit No.. fl 2.q.7. TZ ............. dated ....H.a.r. 9.h..7. ................ 158.5.., 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 ......... ~or a rear house addition to a one family dwelling The certificate is issued to .. La.w;~enc~ .Mn.:pdoek: J~o .,. ......... , ...................... of the aforesaid building. Suffolk County Department of Health Approval .N./..A ...................................... UNDERWRITERS CERTIFICATE NO. 1'~ 609802 Building Inspector Rev. 1/81 NO. ~ TOWN OF $OUTHOL, D BUILDING DEPARTMENT TOWN HALL SOUTHOI~D, N. Y. BUILDING PEP. MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12177 Z Permission is hereby granted to: ..... · ....~.... .~~. ~../..~.~....~.//¢~- of premises located at ..... ~. .......................................................... .................................... ~.~1.+...~.~., ...... /./...~~.. ................. ~oun,,, Ta,, Map No. I000 ~ec,,on ..... Z./...~ ........ B,oc,, .~....~ ........... Lot No ...... ~ .............. pursuant to application dated .l~.....L~.. ................ i....:...., 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 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 featu res. 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. §. Submit Planning 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 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 ~-/e 2. Certificate of occupancy on pre-existing dwelling q/r land use ~'/~1,~5.00 3. Copy of certificate of occupancy $1.00 f ~ ~'~'5'~ Date. (~ . ,~-, ./. ~..f. ?,?.~,... New Building ...... Otd-~r pr..ov;~,;.= Bu!!d.~g ~ Vacant Land Location of Property . .~ .c/,, ,~,, ,~, .... ~, ,~. ,/,/~,,,, i ,~,,, ,O' ,~. ~ .~, ......... , ,~ .~,j-,~., ,~, ...... House No. Street Hamlet Owner or Owners of Property . 4.)~- ,/~) ~-~C/~ ..../~. ~.~...~...~..~ .~...~.~..,.. i County Tax Map No. 1000 Section ..... l .//.~,' ...... Block ...... .~ ....... Lot... ~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Perm it Nc~..}.~. ?.~ .~ .'~ate of Permit .~) ?.]~. ~..Applicant, ~. ~.~:~. ~ ~.~9~.~. ~ ~, Health Dept. Approval ................. Labor Dept. Approval ........................ Unde~riters Approval .. . ~ ~ Plannin oard royal ...... Bequest for Temporarg Gertificato .......... Final Gorfificate .................. ...... ..... **" ................... ~er fublng i~ usec~ for wate~ distributing ~..o[ types K or L only t! THE NEW YORK BOARD OF FIRI _ UNDERWRITERS SUREAU OF ELECTRIC~IT~ ,j[/].,~ ~ ~[~ 85 JOHN ~TREET, NEW YORK, NEW ~ORK 1003e THIS CERTIFIES THAT only the el~trical equipment ~ described below and introduc~ by the applicant Oam ed on the able application namber in the premises of L. ~, ~n ~ ~uth Bi~, 1~/0 ~we Ave,, ~ti~, N.X, in the following location; [] Basement July 14, 1983 [~ 1st Fl. FIXTURE FIXTURES OUTLETS SWITCHES INCANDESCENT PLUORE$CENT [] 2nd FI. ~ld floor Section Block Lot and found to be in compliance with the requireraents of this Board, RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS s E R : iV ~ C OTHER APPARATUS: AWG OF HI-LEG OF NEUTRAL Daniel A. Fo~v~ty, JT. ~3ox 1~30 ~ound Avenue [~ttitu<~, N.Y, 11952 This certificate must not be altered in any manner; return to the office of the Board if inc&rect nspect~ may be dentified edent a s ~ ~ COPYFORI~U LD NG DEPARTMENT TH SCOPYOFCERTIFICATEMU$~,N(7~BEALTERED NANY MANNER ~; ~N ER ~o#773. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Application No.../. o~-/..'7..~..-~---. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19 .~..~ 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 promises 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 Couct~,-Nm{r York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alter/htions, o~[ for removal o/Bdemolition, as hereir~ described. The applicant agrees to comply with all applicable laws, ordinances, builsling code, hp~i~/ng code, add rej~ul~ons, and to admit authorized inspectors on premises and in building for ne~ ;.~~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~. &v-o .r:. e.~,,e-.,e .... .~/~.~&o.c-.K t .~.P., .................................. (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. O co Plumber's License No ....... .~.~..-r.~.-F5 .... Electrician's License No. F-O ~ f5 ~ Other Trade's License No ...................... 1. Location of lafid on which proposed work will be done ............. .... ~l '1~ ............................. ..... ...........i.% .4 ..................... House Number Street Hamlet // County Tax Map No. 1000 Section. / ././~. .......... Block .... ~ ........... Lot ...... ./'~. ·. ......... Subdivision .... i~ t..~ ~O. ~.('~ .......................... Filed Map No ............... Lot ............... (Name) 2. State existlng use and occupancy of premises and intended use and oocupancy of proposed construction: a. Existing use and occupancy .... .~.~..e. ¢. , .......................................................... b. Intended use and occupancy .... .e; .~...... ~gv..[ :(~b.~... ~.t~.. :~?.\.c.~'~..~0¥.: ............................. of wofk~.~heck which applicable): New Building .......... Addition .......... Alteration . ....t~ff.. ']., 3. Nature Repair .... .~ ......... Removal .............. Demolition .............. Other Work ............. ,v/r~ ,,... ~ (Description) 4. Estimated Cost ..... ~.2f.t~. ,' , ~ .. ....... ................. Fee ...................................... (to be paid on f'fling this application) , / 5. If dwelling, number of dwelling Junits .............. 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 w!th alterations or additions: Front ................. Rear .................. Depth ................... i · · Height... ............ ! ..... Number of Stories ........ ' ' ' ' ' ~i.~.V.. Rear../.. ~.~ ....... Depth . ~ff'a ......... 8. Dimensions of entire new construction: Front . ~' * ...... ; ....... Height .......... .. Number of Stories .... ¢:~ .................. 9. Size oflor Front .~./.0 ~. / Rear /~' ~ ant ~6'~,,5~q .......... ; ...................... ...~. ...... D_ ,h ........ , ............ 10. !)ate of Purchase .... ................ of Former Owner ............ 11. Zone or use district in which ~remises are situated .... i~.~..~.: ................. ~. ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~..Q ........................ 13. Will lot be regraded ..... . .NL-,.i~. ................. Will excess flu be removed from premises: .Yes No 14. Name of Owner of premises .rY~t~..~.D. 9.~.~,... Address ."~...~ ~..l/f, .~L~fi.%~:Phone No. 7.~..~..6-]/.~ c~ Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... ; ................. Address .............. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block inumber or descfi interior or corner lot. ' ~tion according to deed, and show street names and indicate whether 765-1802 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS: l. FOUNDATION ~ TWO REQUIRED FOR PO[JR[D CONCRETE 2. ROUGH _ FRAMING & PLUMBING 3. INSULATION 4, FINAL _ CONSTRUCTION MUST BE C~MPL[TE FOR C. O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF TH~ N. Y, STAT~ CONSTRUCTION & CODES, NOT R~SPONSfBLE POR DESIGN OR CONSTRUCTION .q7 STATE OF NE~~'"~"'~ COUNTY ~t .[ ~;~//\ 'Z/ ~ ..... ~.~. ~_2~ ~tz'.r:.~ ,~ .... ~ ~,~...~ being duly sworn, deposes and says that he is the applicant (Name ot individual signing contract) above named. ~ He is the ................. ~ .~. ~; ............................................................ (Contractor, agent, corporate officer, etc.) of s~d 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 all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the manner set for~ in the application filed therewith. Sworn to before me this , ......... /.~ ...... day of(..~..~~. ~ ~