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Home My WebLink About12190-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.1.1.5. 7.8 .......... Date ....... .M.a?.c.h., .3.0. ................ 19.83.. THIS CERTIFIES that the building 7 .-.d.e..c .k..q d..d .i.t.i. 9 .n .............................. Location of Property q 065 Marratooka Lane Mattituck h3~s'o ~iol ....................... 's't;~3i ....................... h3~iel County Tax Map No. 1000 Section ., q. ! .5 ....... Block 04 . .Lot 032 Subdivision...X. ........................... Filed Map No...X. ..... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... F.e..~ ?.u.a.v.y..2.8. .... I9.8.3. pursuant to which Building Permit No ..... 1.2. ] .9.0..Z. ......... dated .. ~ .a?.c.h.. ! .5 .................19 .8.3., 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 ......... a deck addition to existing dwelling. The certificate is issued to EUGENE H. HISKA ..................... ?o¥,'o;,4~'~3~'~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .... .n [.a. .................................. UNDERWRITERS CERTIFICATE NO ............ .n./,a. .................................. Building Inspector Rev. 1/81 ~TOWN $OUTHO~D, 12190 Z permission is hereby granted BUiLDiNG pER~i;i (THIS PERMIT MuST BE KEPT ON ~HE P:R~ COMPLETION OF 'I;HE woP~:AUTN~RizEI~) at o~m'~ ~se~s located at ~OU~hty Tax Map No. 1000 Sectio~ ......... ; ........ · p~!rS!ant ~o application dated Bb!l~lrig Ipspector. .;, 19....?~ ~nd i~pprow~l 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. 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 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 f 2. Certificate of occupancy on pre-existing dwelHng ~r land use 4~' 5,00 3. Copy of certificate of occupancy $t.00 / / f New Building ............. Old or Pre-existing Building(X~.' ....... .~ ZVaeant Land i ........... ooat on Property...1 - .............,.. ..... .. House No, Street Hamlet Owner or Owners of Property .......... ~'~O J,~.~.~.~. -".~..~.~. ~¢, .................... County Tax Map No. 1000 Section .... ~/..~.~L~ .... Block . .~o~..~.O. ..... Lot....~-~.~., Subdivision ................................. Filed Map No ........... Lot No. ' .......... Permit No. j~ [~0'Z Date of Permit .~'/~, .~..Applicant.. ;.~'k) .g~../~,J~. .J~J.~ Health Dept. Approval ........................ Labor Dept. ~,pproval ......................... Underwriters Approval ........................ Planning Board Approval .................. ~ ,. ~ Request for Temporary Certificate ..................... Final Certificate ............. * Fee Submitted $ ..... i ...................... Construction on above described building Applicant Rev, 10-10-78 FIELD INSFECTIO~ FOUNDATION (1st) FOUNDATION ___ (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY COMMENTS FINAL ADDITIONAL COMMENTS,: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved 19 Permit No. Dlsapprovea a/c ................ - ............. /7(~' '/ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No./~.~.~. ~..~. ....... 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, ml~tionship 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 i~cti~,:ons~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... 0. ........................................................................... Name of owner o f premises .... dT~ ~.- ~7. ~ t~:../~... J'P-~.~.~. [.~4~ ............................................ (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. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ............... . ............. . ................ House ~ber Street Hamlet County Tax Map No. 1000 Section ..... ].'/b.;.~.0 ...... Block ...~.~,.0.0 ......... Lot...t~.~.~, {9.0.¢ ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing nsc and occupancy .......... [..['~.~J~.~....l~.,{1~[~.1 .iJ.. (2,.., ........ . ........................ b. Intended use and occupancy ............... :.~.~.C.L.~ .~.~. ~tl 0.... .................. .t? ............. 4. Estimated 5. If dwelling, ~ If garage, nu 6, If business, c 7. Dimensions, Height ... Dimensions ~ Depth .... 8. Dimensions, ][{eight .... 9. Size of lot: 10. DateofPur~ ll. Zone or use 12. Does propos, 13. Will lot be re 14. Name of Ow Name of Arc Name of Cm Locate property lines. interior or corner Nature of~ )rk (check which applicable): New Building .......... Addition . .01:-,~.~.... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... ese on >st .................................. Fee .................................. ~ (to be paid on ~ing this application) lumber of dwelling iunits ............... Number o f dwelling units on each floor ................ nber of cars .... i ................................................................... ommercial or mixed occupancy, specify nature and extent of each. type of use ............ t ........ )f ex,sting structures, if any Front . ~.. ! ..... Rear ....~ ~? ....... Depth .... ~ . }f same structure with alterations or additions Front . . -j.~ t . Rear . .~/.~. ... ~[ ......... ~.. Height ......... ~ ~ ........... Number of Stories ........ ~ ............. ~f entire new construction: Front ............... Rear ............... Depth ............... ........... Number of Stories .................. 6 ..................................... Iront ......... ~3~ ~.0 ..... Rear ....... ~.~fi. ........ Depth ...... 16q, 13 .......... sase ........... .................. Name of Fomer Owner ............................. listrict in which premises are situated ..................................................... ~d construction violate afiF zoning law, ordinance or regulation: ......... ~O .................... graded ......... ~. · .~P.~ ............ Will excess fill be removed from premises: Yes aitect .......... ~ ................. Address ................... Phone No ................ tractor ......... ] .................. Address ................... Phone No ................ PLOT DIAG~ ~d ~distinctlg ~1] bulldogs, whe~er existing or proposed, and. indicate ~1 set-back dimensions from humber or deseflption accord~g to deed, ~d show street nines and ~dieato whether STATE, OF NEW '10RK, S.S COUN'FY OF .................. , (Nam~ ~f individual signing contract) above named. ~ being duly sworn, deposes and says that he is the applicant He is the . ~ (Contractor, agent, corporate officer, etc.) of said owner or application; that work will be petrol Sworn to before m Notary Public, . )wners, and is duls, authorized to perform or have performed the said work and to make and file this I statements contained in this application are true to the best of his knowledge and belief; and that the med in the manner set forth in the application filed therewith. this : .... x. .... ,19... ''~JONN ...... a~,¥":-~' '//t' 'k.j '" ...... County~'f'.. NOTARY PUBLIC, Stat~ of N~w Yor)~ ......................... Qualified in Suffolk Coqrfly 52-469322, Commission ~xp~ro~ ~?ch S0~ 10~-'2~ (Signature of applicant) AP~:~,;F.D AS NOTED *~ DATE ~ ~_~__~_B. P. !~ ~ FEE: ~(~ BY: ~ . NOTI~ BUILDING ~PARTMENT AT 765-1802 9 AM TO 4 PM ~R THE FOLLOWlN~ IN~E~IONS: 1. FOUNDATION - ~O REQUIRE~ FOR POURED CONCR~E 2. ROUGH - F~MING & PLU~I~ 3. INSULATION 4. ~L - CONSTRUCTION ~U~ BE C~AAP).ETE FOR C.O. ~ ALL CONSTRUCTION SHALE ME~ THE REOUJ~AE~S OF THE N. Y, STATE CONSTRUCTION & ENERGY CODES, NOT RE~ONSlBLE FOR DESIGN OR CONST~CTION ERR~ / / J