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HomeMy WebLinkAbout10457-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z-15!.7! Date January 6, 1986 19 Garage & Breezeway Addition THIS CERTIFIES that the building ................................ ... ... .. . .. .... Location of Proper 1950 Deep Hole Drive, Mattituck, New York l/d ........................................................ Street Ham/er County Tax Map No. 1000 Section ....1.2.3. ..... Block ...0..4 ..... Lot 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 24, 79 10457Z ..................... ,19 ·.. pursuant to which Building Permit No ...................... October 26, 79 dated ........ _ .................... 19..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued i~ ......... Garage & Breezeway addition to existing one family dwelling ELAINE T. VILLANO The certificate is issued to ................................................ fowner, 'l~e~ ~t~ ~ :~ of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... 1N740463 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 FORI~ NO. 2 ?OWN OF $O~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10457 Z ,/ Permission is hereby granted to: , ~ .... __~.~.~.~..~//~. ~. ....... /..~....~.~.~x.x.~.~ ....... ~/.Z~ ................... :~: ............................................ at premises located at ...[..~.~......~~....~./~L...~/~ ......................... ......................... ~ .................................................................... ~~~_....~...~.. ......... the Building inspector. ¢~'~' ' /~l~diPig Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Bo 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 Res, idences 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. 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 nforma- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.OO Date ... ~ ..... × New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... l~SQ .D,~_~ ~,:k~ ................. ~.~.~.U~ ................. House No, Street Ham/et ELAINE, T. ~ VILLANO Owner or Owners of Property ............................................................ CountyTax Map No. 1000Section ..1~I~.3 ....... Block ..,~. .......... Lot. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 10457 Z Date of Permit 10/26/79 .Applicant AN?~[ONY R. VILT~NO Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval..7.~0 .I~. I~. ~ ........ Planning Board'Approval ...................... × Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev, 10-10-78 FIELD INSF~CTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME& PLUMBING (an~) INSULATION PER N.Y. STATE ENERGY co~ THE NEW YORK BOARD OF F.RE UNDERWRITERS ~, BUREAU OF ELECTR q~ITY~ ~ ©~¢~ 85 JOHN STREET, NEW YORK, NEW~lj~38 in the following [ocotlo~t; ~ Baseo~e~t ~ 1st FL ~ 2nd FI. Section Block Lot was examined on ~('?~ j ~ ~ ~ and found to be in co~npliance with the rdqulre.tents of this Board. FIXTURES RANGES OVENS EXHAUST FANS FIXTURE DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEf~AS NO OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R :V I C E NO O~ CC COND A W G '].950 ,I~¢~zp )i',)"l.e 'Drtv~.~ Th~s cert ficate must not be o tered n any manner return to the office of the Board if n~o~rect nspectors may be dent f ed by the r credent Y;OS.B ILD NGDE R ENT,.~HS _ p ......... ..... D N ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hal~ ,~outhold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~p!ic;tc 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. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "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 ...... ~.. ~. (~. (~.L.:~ .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ocation of P House No. ~ Street Ham/et Owner or Owners of p roperty ./t~.. ~--~/30 .~.~/ '~..~.~...(.. ~'~ .~...~.~.~ ~-.~. ~ .......... 0o0. .gl: ......... .. ....... .... ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, . .~. .... Date of Permit . . Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable co,les and regulations. Applicant ........................... Rev. 10-10-78 ~ ~(~ ~JL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 .... , Application No~.O. ¢:5.2). '7 ....... Approved~. ~ ~..., Permit Disapproved a/c . . ~_~.- ........ '7 .................. APPLICATION FOR BUILDING PERMIT D ate .... /..(J/.~. 5(. ....... 19 '~ INSTRUCTIONS a. This application must be completely filled m by typewriter or in ink and submitted in triplicate 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 th~s application may not be commenced before issuance o? Building Permit. d. Upon approval of this application, the Building Inspector will issue 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 m 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 apphcable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized~inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or naine, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ..................................................................... ' Name ofowner~(ofpremises .~.g-CClt~/.6:'. .. .~d.4/O .... ~...~.¢.7~....~. ((-.{/:¢/tg. O. ............... (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. ~.~..~.' .............. Plumber's License No ......................... Electrician's License No. ""~'~--~ ~ Other Trade's License No ..................... 1. Location of land on which proposed work will be done../~7'..O....~...~-;';';';';';';'~, .~.: ~ .~.~='....~ ................ House Number Street Hamlet County Tax Map No. 1000 Section .../..~. ~.~. .......... Block .... .~..~. ......... Lot... ?Q. · .~. .......... Subdivision .................................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupan~cy of pried construction: ' ' n n ~¢'~ ~ O..~.~.~ v~t'r~' ./~.~¢~'~ a. Existing use a d occupa cy ...................... ~. ...... .~ .................... b. Intended use and occupancy ...... . .~...~..¢2.~... t~...d~..~.././. [.O.~. ................................ 3. Nature of work (check which applicable): New Building )f Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... .~..~w ~Ot~I .~Z/_.~ (Description) 4. Estimated Cost ............ ....................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............. Number of dwelling un, its on each floor ................ If ~.~.~e, number of cars 6. If business .... commercial or mixed occupancy,, specify n~ture, and, er extent of each. ttype et°fuse ....... ;:,~ ;~;,} ..... 7. Dnnensmns of ex~stmg structures, ffany: Front· ..3.6....~ ....... Rear .'.~..6...~ ...... Depth .~. ............ · t~2. ! . Hmght ............... Number of Stones ............................................ , .... , ........ Dnuens~ons of same structure w~th alterahons or add~t,ons: Front ,3.. t~.. ~. .......... Rear .................. ! # , , Depth .... ~.2-...~ ......... ,.. Height ..... / ...., ............ Number of. Stones ............. ;., ....... 8. Dimensions of entire new constrUctiog: Front ..../~..'..., ..... Rear ..... ./.~.. '. ..... Depth ...F-, ~..' ....... 10.; :::: . :: S ...... :: .... 1t,. Zone or use district in which premises are situated ...... ./MJ~.~. ;'7. l .F:&'¢/.~. ................................ 1~.' Does proposed construction violg_te any zoning law, ordinance or regulation: . ./~...O .......................... 13. Will lot be regraded ...... ./k/..~. .................. Will excess fill be rempved from premises: Yes No 14. Name of Owner of premises ~'.4 .~./.4/.~... ?.((-..1~· .'q. qAddress [.g~J~,._..~. · .~%-~y.....~.: Phone No. ~,?.~.'. ?./..~.4 .~.. Name of ArcMtect ........................... Address ................... Phone ............ Name of Contractor ......... ' ................. Address ................... Ph, one No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF ~qEW YORK, ,COUNTY OF .Suf.golk ........ : p~,opoS~D ·. 77.-.-~77.-.A.N.T..HQ.N.Y' . .R:..V.I..L.L~.N.Q..-.-.-TrT.-.Z~;-..-.-.-.-. being duly sworn, deposes and says that he is the applicant (Name of individual sign.lng contract) above named· .~ ~ ,. ,; ~, Heis the ' ' (ContractoL agent, corporate officer, etc.) of said owner or owners, and is du!y 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 perfornred in the mannir set forth in the application filed therewith. Sworn to before me this