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Home My WebLink About12203-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.z. ! ! 7.3.7. .......... Date ..... .~.u.n.e...2.2 .................... 19 THIS CERTIFIES that the building ................................................ Location of Property 920 Naugles Drive Mattituck 121[~s'e )~o: ............. Street Hamlet County Tax Map No. 1000 Section ...0.9. 9 ...... Block ...0.5. .......... Lot .... (3.1. .3 .......... Subdivision ...... X. ........................ Filed Map No...X ...... Lot No..X. ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated .M.a. ~..c.h..4. ............. 19 .8.3. pursuant to which Building Permit No. 1 2 2 0 3 Z dated .... ~.a?.qh...2.3 ............... 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 ......... addition to second floor of existing one-family dwelling. DONALD A ROBINSON The certificate is issued to ..................... [t;~,n'e'r,;¢~e;~r't66~t') ...................... of the aforesaid building. Suffolk County Department of Health Approval n / a ........... UNDERWRITERS CERTIFICATE NO ............. 1,1...6 9.6.2. 9. .5 ............................ Building Inspector Rev. 1/81 $.o BUILDING D~PARTMI~I TOWH'H:4LL i SOUTHOliD, (l'HmS pi:miT MUST BE KEPT ON THE COMPL~ION OF THE WORK AuTHoR~ZED~ ~ 12203 Z bate permission is hereby granted to:~" ,, .... tO ~, ........................ ' , , . . ... of p~mise~ I~ated at ...... ~ ......... ~ ................................................................. "5'"'? ......... ~ ............................. ."", ....... ~'~ ....... COUS~ Tox Mop No. 1000 Section ........ pu~,pont to opplicotlon dot~ . ............... j; ......... ..,~ ........... i ...... Buih ring Ihsp~or. F~e ................... : .... ." :, 19 ~ and approved 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 irequirements where applicable. B. For existing buildings (prior to April t957), Non-confbrr~irtg usea, ar buildings and ~'pre~existing" land uses: - 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occ[~pancy 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 u~e 3. Copy of certificate of occupancy $1.00 Date .,~-~,¢-. )-t ) ~q'%% .. New Building ..... .~..,... Old or Pre-existing Building(Z) ........... ~ tVacant Land Location of Property...~. ~_,,O. ............... .~~ ~..~1 ..... ~ ...... .~~ House No. Owner or Owners of Property... ~'~. ~ .~.~. ~ //'.~:~ .................. County Tax Map No. 1000 Section ..... ¢ '7' ..... Block...~, .......... Lot.../.?. ......... Subdivision ................................. Filed Map No ........... Lot No ............... Permit No./,~L.~, 1~..~2, Date of Permit~,~/.~/~..Applicant ~)~I~,.../~~ .... Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ........... Planning Board Approval .................. Bequest for Temporary Certificate .~. .................. Final Certificate' ....~...-. ........ * · Fee Submitted $ .... ~.~-¢{~. .................. Construction on above described building an,C'lS~ermFCmee~s ¢J app4~d;a~de~, and regulations. Applicant .~ ._~.~. ~. ,~ ~(~.. '.~.. ........................ FIELD INSFECTION ~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS': Memorandum from.... ¢! BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, ~N'. Y. 11971 765-1802 Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTttOLD Town I-ISLE, flOXa'raOL~., N. Y. 11971 765-1802 THE 1000062 '~,,,e ,Tune 16, 1983 pp~c.tonWo ony~e ' 212666/83 ' ',/ I!~ ~ ~ ~nal ~bzn~n, Naples Drzve, of~ A~halt T~,. Mattituck. N.Y," ' ~l ~(~,~.,~t~ m thefollow.,g loc~tmn; ~ Baseo,ent ~ lst ~l ~ 2nd ~l. ~ Section' ~ ,BlOck~ h~ XdLot ~ ~ 9xamtt~ea on and found to be in compliance ~ith th9 {equirgt~ent~ of fhia Board+ ' ,H OVENS DISH WASNEES EXHAUST 7 ~, 1,227 E. Breakwater P~ad ' '' : k I Matt:Ltuck, N.Y. 11952 certificate must not be altered in any manner; return to the Office of the Board I~ incorrect, Inspectors may be 3. Nature of work (check which applicable): New Building .......... Addition .... .X ..... Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .... ....C>.~.'.°.9 ....................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ~ ......... Number of dwelling units on each floor...~.~. ........... If garage, number of cars .... '2. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ..... Q.G ........ Rear ...9. .6. ........ Depth.. :'.~.. ......... Height ....... c/. ....... Number of Stories ...! ....... Dimensions of same structure with alterations or additions: Front .... ,~.'~.~.' ~ ~i ...... l{;~r' '-~,~'~'~ ~' ......... Depth ...................... Height ..... .Q,-(~ ............. Number of Stories ...................... 8. Dimensions of entire new construction: Front . .2..~. ......... Rear ...~.(4. ......... Depth .'2_~ ..... Height .../~. ..... Nu~mber of Stories / , . 9. Sizeoflot:Uront ..~....~.%. ............ Rear,.iiii~.~'iiiiiiiiiiiiii'l~;~[t~'ii~.'4~.iiiiiiiiiiiill 10. Date of Purchase . .~. ~'~.~..... [.c?fT'~ .............. Name of Former Owner .. ~/.(¢rq~-~ ............. j .... 11. Zone or use district in which premises are situated ............... , ..................................... 12. Does proposed construction violate any zoning law, ordinance or rogulation: ... ?,.).O. 13. Wilt lot be regraded .... ?~.~.¢ .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises/~..a.~./J~5. /~. ~d~gt~).~O~d. Address A)~l~).&.t'~q .~. ....... Phone No.~..(4.g:.~.? ~.~ ..... Name of Architect ........................... Address ................... Phone No...~r¢~% +?.t..q.q.,([,(~: Name of Contractor .......................... Address ................... Phone No~ .'...~. (n .c?. ~. I PLOTDIAGRAM ~ '~ ~ ~ ~ Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWYt(J'RK,z t ! - - C ~NTYO .. . .. ~'~ ~i. ~..-~& .................... being duly sworn, deposes (Name of individual signing contract) above named. and says that he is the applicant He is the .................... . .g2~-..~;-; .~m.'~ ................................................... (Contractor agent corporate Officer etc ) of said owner or owners, and is duly authorized to perform or have porfOrmed the 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 manner set forth in the application filed therewith. Sworn to before me this .......... .... Nota~Publi,c, . ........... ! o k County ..... q~. ~.~l~a.~.0.. s.u ~ ~c~u~z / (Signature of applicant) FORM NO. 1 TOWN OF SOUTHOLD ! ;,~,/~: ::~; '. ;'BU I,L DING DEPARTMENT 7 ,"~ TOWN HALL . . :'J "~.,~:%?~" ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ........................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wiih 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 publio st/~ets or iareas, and giving a detailed description of layout of property must be drawn On the diagram which is part of this appli- cation. - i :.. ' i c. The work covered by this application may not be commenced before issuance of Building Permit. [ d. Upon approval of this applicat!on, the Building Inspector will issued a Building permit to the applicant. Such permit shrill be kept'on the premises available[for inspection throughout the work. , e. No building shall be ocoupiedi 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 Towfi 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. Th~ 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 necessar~spectioj)s./3 z~,~// . , : : ............... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~dneer, general contractor, electrician, plumber or builder. Name of owner of premises L ,, ~ O (as on the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer. (Name and title of corporale officer) , Builder's License No ......... .~..~5 ....... Plumber's License No ........................ Electrician's License No~/~.. Other Trade's License No .................... .:. 1 Location'oflandonwhichpropos~dworkwillbedone.~(S ~ ~(~O' ~ o(-o't'~JF-~- House Number i Street Hamlet County Tax Map No. 1000 Section 9~ Block ~ Lot Subdivision ............. .~...; ................... Filed Map No ...... .~. ....... Lot .... X. .......... (Name) 2. Stat~ existing use and occupancy Of premises and intended use and occupancy of proposed construction: a. L ~st~ng use and occupancy .., t ~_.o~ ~ L ............ , .............. : ........ L, b. [~tcnded use and occupancy . !...~.x. f~q ,or, rE'& t~, ~oC~. ~.P.~ O_.~. ............................ N fxO 6 c-~ & i"/,kT'T ~ TO r J,4 TO'WN OF SOOTHOLD, 5(_AL E- 50bi'' k]-~ M Ok} gM ENT ~_ Sd RV EYE6 .~CC. ~0,I971 VAN TO'( L'~ 5ON t t 765-1802 9 AM TO 4 p~/FOR TlqgE FOLLOWING JNSpE~IONS: / 1. FOUNUATION - ~O BEQUIREU ~ 2. ROL OH - FP. AMING & pLUMBING~ THE R~QUIRrMENTS OF TPIE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS //'// /