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Home My WebLink About12215-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...$~.5.~8 ........ Date June 8 1984 THIS CERTIFIES that the building --addition & alteration to dwelling. Location of Property 4400 Luthers Rd. (Breakwater Rd. ) Mattituck County Tax Map No. 1000 Section ....0.9.9. ..... Block 05 ..... Lot 003 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.rg.h' .1..4 ........ ,19.8..3pursuant to which Building Permit No. 12215 Z dated ....... .M.a.r.c..h..2.8. ........... 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.q ~.d~J,~on ~ ~lteration to existin~ seasonal cottage. The certificate isissued to ...... F..R~..N.t~ HUSAK JR. & kNNA HUSAK ......... ?o¥,,'0;, ...................... of the aforesaid building. Suffolk County Department of Health Approval ... N/.A. ................................... UNDERWRITERS CERTIFICATE NO ........... p.e. qqtiDg .............................. Rev. 1/81 Building Inspector souTHo~D, H~ y. (THIS PER/v~IT MUST BE KEPT ON THE COMPLETION OF THE WORK ^UTH~RIZED) permissioh is hereby granted !ULL at p~emises located at C~hty Tcix Mop No 1000-Section p~ont to epplicotlon oot~ ................ B~il~lng Ihspector. 6/30/80 - · · ~i ,,.......,.~.,~aOt NO.: .................. ...~,, 19 .~.., and approved by the FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,%uthold, 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 Underwr~iters. 4. Commercial buildings, Industrial buildings, Multiple Residences and sit, ilar 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. For existing buildings {prior to Apri~ 1957), Nomconforming uses, or 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, 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3, Copy of certificate of occupancy $1,00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 - Date..t~..~(~.~ &~ ......... New Building . .y,.;:, ~ .. .... Old or Pre-existing Building .......... Vacant Land ............. Location of Property . House No. Street Hamlet Owner or Owners of Property .~./.~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~.~./,~...~. Date of Permit ~/.Z.~../t.~.~. .Applicant...~,~..~../V. ,/~ .... ~..~. ~/~,,'...~.~.~,...... Underwriters Approval .-~.,.~L;t;t~! ...... 5,~L~, .~-.~..Planning Board Appr0val '" II~ i I Request for Temporary Certificate ..................... Final Certificate .... L~J_~: ';L~D'; ;E Fee Submitted $ . . . .~.~.. '~'~' ...~ ....~-~ { ~.~ . .... .. , TOWN pF ~OUTHOLO Construction on above described building and permit meets all applicable codes and regulations. Applicant. ,,~.~ .~.-~ · ,~- · ....................... FIEC~ II~PECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved 19 rmit No.. . Disapproved a/c ..... J ~-Y~ .................. I./. ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections.. ~ ...... ..... .............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) /! ?6-,R State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ....... .3 o. :7. ................................................................ Name of owner of premises . .~./.~..~..t~./.~.. ~..~/.4./.~.~. ..... ~5/?..~..~./.q. ..................................... (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~.~,~.~. ~/~.~.~c~..~. .... Plumber's License No ..... /.~.. ~.~...,_'7..~ Electrician's License No. ~..~.~.7'..~.~.... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... ~ .~. ?. ~/. ~7'.~.~. ./%..,~ .~./.'..~: .................. ~.~?.. ~.o~ ................ .Z..,/..r(~.~.~...~.o.~ ........... ~.*..~. rt. ~..W.~..~/<.. 1/.¢.~:. ~ .... House Numbe~/ ~/~C20 Street Hamlet County Tax Map No. 1000 Section .... .0.7.7 ......... Block ...... .t~..~.. ...... '. Lot...~. ~.~.~ .......... Subdivision ..................................... Filed Map NO ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...., .,-~.V .,W.v~. ~/.~ .... .~.~.~. ~./. (ff......x~..~:~...,'?.-¢74Z... E~. t(....((.~.~..~ ........... b. Intended use and occupancy ....,~.~.~q...~...~./.z. .... .~.~..~. (.2~. ....'.~5.../~..,~.q. tS(.G(.r..~-~.O.7.7/.~...' ............. 3. Nature of work (check which applicable): New Building .......... Addition... X .... Alteration .......... Repair .............. Remotal ............ Demolition .............. Other Work ............... t (.'~. ~. ¢.'.4 ; ~.~?~.~ ~.... (Description) 4 Estimated Cos .... i ..................... 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 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 . ~'Y.' .......... Depth . .~..0. .......... Height . . ./.;z. ~ .... Number of Stories .co. f,,(. -~.. g.¥. .... Dimensions of same structure with alterations or additions: Front .. ~. 9'. ......... Rear . ' r Depth..~.D../. .............. · ! ........... Height .../~. ................ Number of Stories ..... .¢..Q'¢.7 ........... 8. Dimensions of entire new construction: Front ... ¢..¢... . Rear ...~..¢. ......... .D. epth . ¢~.0..' ......... Height .../..z-r ........ Number of Stories ~ ~/~-~ .............................. 9. Sizeoflot Front. .~..o.0..,.7.~ ......... Rear..~..~..~..:~.~g ...... D. epth ....?.,,?.~:'7,'.6.°. .......... 10. Date of Purchase ...~. ~./. ~..,~. ~7 ............. Name of Former Owner ?¢.q (¢..,~../5.',../4;'~2..~'~'./e~- ...... 11. Zone or use district m winch prermses are muated ....... /~.,..~ ~ ....................................... 12. D~es proposed construction violate any zoning law, ordinance or regulation: ../V? ........................... 13. Will lot be regraded .... .,9./P.. ! ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ,A~.q%¢. ~/~ ~q~.~g~ldress ~¢z~o~-~ /-~.~r~'~ Phone No. ~..~..,~.'; .'fi/.~. ~.~.. .... .~r~' · ' .:~',,la 7'~"r,r ~'c~r... Name of Architect ' . ........ Address ................... Phone No ................ Name of Contractor . .~.~#.~F.%. ]./(~.,~ ~.~. ........ Address .~.e .~. ~.~..~.4t..a.°~!4..a.~-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 humber or description according to deed, and show street names and indicat~ whether interior or conter lot. STATE"OF NEW(Y(~RK ,, ~ COUNTY OF. ~.' . ; (Name of individuhl signing contract above named. being duly sworn, deposes and says that he is the applicant He is the ............... ¢~¢-~m~¢~_,. .............................................................. : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfOrm or have performed 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 manne~ set forth in the application filed therewith. Sworn to before me this ............. ]...ZJ-~,~...day oi ........ ~-r~-~A~..., Notary County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~ITY~ ~J~ 85 JOHN STREET, NEW YORK, NE~V ~bRK 10038 Date /Ipplication No. orE file ' ~/83 N 647294 THIS CERTIFIEs THAT only the electrical equipment as described below and introduced by the applicant ~a~d on the above application nu~nber irt the premises of Frank Husack~ Breakwater }k~, Nattit0~k~ in the fotlowing location; ~] Basement [] 1st FI. Ju~e 0~, 198~ [] 2nd Fl. ! ~ Section Block and found Eo be in coml~liar~e with the requirements of this Board, FIXTURE FIXTURES RANGES OVENS EXHAUST FANS Lot DRYERS FURNACE FUTURE APPLIANCE FEEDER~ UNIT HEATERS MULTI-OUTLE1 SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT t-G,F.Io S E R NO. OF~E~C~COND, OF CC. coJ~o C A. W. G NO. OF NEUTRALS A, W G OF HI-LEG O~ NEUTRAL Gus Bartra 227 E. Bre~kwater Rd. ~[%tti'~tck, N.Y. 11952 This certificate mvst not be altered , manner; return to the office of,the Bo, CO~Y F dG DEP~ARTMEI GENERAL MANAGER Inspector may be identified by their 'P i-o '~>..~'r-- C z vj &"T - L/v/;';/6 ld~-¢a I