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Home My WebLink About10179-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property . .~;90..I~ J..~.gl~ ! I1./a..~..o .............. Ho. Street Hamlet CounW Tax Map Ho. 1000 Section ..... 1.(~ .... Block .... ,~. ......... Lot ..... .~.: .8 ........ SubdJv~on... (}~q. el~!).~.~l..~..A.o.~..e.i ......... Eried Map No ......... Cot No...~. .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ...... Altair...1.~ ..... ,19'~9. pursuant to which Building Permit No .......... q.O. ~..7.9.~. ..... dated .....Aplv;LI, .1. {t ............... 19 .'~ .9, 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 ......... .................. ~.e.~..~. A4 .~..t.t..~.: .t;.o. ?..~.~y~t.e....~.e..~..m3.x.~.* .~..e.x.x.s..~,. ........ The certificate is issued to ......... ?.e.~.z,..e.n.o.~...~.,..&...R.e~[i..rig..B.:..}l.~.~.t.h..e.~.e. ........... (owner, of thc aforesaid building. Suffolk County Department of Health Approval ........... .~./.R. ........................... UNDERWRITERS CERTIFICATE NO ................... .~../1~. ........................... B~ding Inspector R~ 4/7S FORi~ NO, 2 TOWN OF SOUTHOLD BUILDllqG DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. BUILDING PERM;~T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10179 Z Permission is hereby granted to: ....... ........ :~..': .~,..:,~/?.>- , ~o ........ ~. -~. ~ ~~~. .~. . . . .~ ;,z,~. . . ~ . ~~ .... .¢.~,...,~.~./Z~..,.~..,,,,.~,~: ............................... .~. ..................................... , ....... ...... ,. ................................ .~ ................ : .......... ~_~. ................................. ;; ....... ,,. ................... : ....... . . .......... . . . . . . pursucan, ,o application doted ............ "~'""-~'"'/"7 ...................... , 197..~.:, and approved by the Fee $../~... ........... /' 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 buddings, 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: I. 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 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 /.¢ £o New Building ............. Old or Pre-existing Building . ~. ?.c./.~ .... Vacant Land ............. Location of Property. ~..?,q ....... · .'"~../..~.¢~..~o/~.....~..'?..~.~ ............... House No, Street Hamlet Owner or Owners of Property . .---~-.~,,~, 4...~..~...~.~-~...'~.'~.~. County Tax Map No. 1000 Section .../. ~ p? ....... Block .... .~. ......... Lot...~..'. ~, ....... Subdiwsion ................................. Filed Map No ........... Lot No .............. Permit No./.o. ~,~. ,?.~, Date of Permit z4'. ~./,~'.-.'7..~ .Applicant ../.;./~.~.~/..~.~'4'.~.-~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Boa~'d Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...-¢~. ................ Fee Submitted $. , ,~E'. ~ . ~ .................. Construction on above described building and permit meets all applicable c~,~g,u~tions. Applicant ~,,r,~-¢-,-~--~..~.'.....'~. '~-~¢~....~?~..'~.~ ........... Rev. 10-10-78 ~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 August 12, 1980 Terrance E. Matthews 590 EliJahs Lane Mattituck, N.Y. Dear Mr. Matthews: : This is to advise you that the job tmder Building Permit No. 10179Z issued to T. Matthews on April 1'8~ 1979 for deck addition appears to be completed as o£ our la'st inspection.' Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill the above office. of Occupancy out the enclosed form a~d return same to There is a fee of $5.00 for a Certificate Thank you for your prompt attention. Very truly yours, GEORGE H. Sr. Building Inspector encl. TION OR START FRA~ING Z~ 2. FRAMING ~ ------------ -- / 3. BEFORE COVERING P[~',ES OF ANY KIND 4. FINAL WHEN JOB COtAPLETED NOT RESPONSIBLE FOR DESIGN O~ CCNST=~CT;ON 5. ALL CONSTRUCTION MUST MEET REQU{EEMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING NOTIFY ~UILDIN~ D[PART/t~ENT AT 765~660 9AM fo 4PM FOR REQUIR- ED INSPE~iONS: 1. BEFORE BACKFILLING FOUNDA- ?2; I Examined .... .~...~./..~.~..., 1975/ Approved...~././. ~.. .... 197~/Perm,t No.. ~..~/~..~.~/ Disapproved a/c .............. FORM NO. 1 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN SOUTHOLD, N.Y. 11971 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in 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 this application may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, 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 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 Bui/ding 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 buildings for necessary inspections. .... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, g~neral contractor, electrlman, plumber or builder.~ Name of owner of premises .....~..~.<~.¢.~.c.¢.. ~ ...~...o~..~..~/~.t/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 ..... ~5-~.~. ............ Other Trade's License No ..... ~.. .............. 1. Location of land on which proposed work will be done .................................................. zS: ~ /~-?.//..o . .~.T./. ?..w..c/< .............. House Number Street Hamlet County Tax Map No. 1000 Section .... /..C>. ~. ....... Block ..... .~. .......... 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 .... ./Tlc. ~.*.v/4....,Y.~ ~/..~..e.<..c./ ......................................... b. Intended use and occupancy ..... ~.~.~.. ~ .c/~.e..o(.. ~.~'-4 c ..~.. 3. Nature of work (check which applicable): New Building .......... AdditionX .~.c,.~). Alteration .......... Repair RemOval Demolition Other Work ' ~ (Description) 4 EstimatedC st ~'7~D, c~o Fee ~.../..~...o~.. I (to be paid on filing this application) 5. If dwelling, number of dwellingi 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 .... G[ ~ .t ...... Rear .... ~.o..~ ...... Depth ... ~.~ ~ Height ............... Number of Stories ...... O.r/-q~ ............................................ Dimensions of sp,¢e structure with alterations or additions: Front ...S. xg.~. ~ ....... Rear ...$~'.~e~ ........ Depth .~.d.q/..~.'....~..~.~....~.q .~. Hel~at ........ Number of Stones ...................... 8. Dimensions o~entlre new const:ructlon Front . ..,~ a: ~ ...... Rear . .¢...-.~. ...... Depth . ./.ff ........... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ../.~..7:.~..°.~. ......... Rear .../. ~·~...~.o..~ ......... Depth . .o~'../.,~.*.9.°f. .......... 10. Date of Purchase ../x.,.,.,.,.,.,.,.,~. q .~ .~. ~ ./.?. ?~ ............ Name of Former Owner ...9,/~* ~.~-a.. ~ l~K.4 ........ 1 1. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .../xo~.q ......................... 1 3. Will lot be regraded .... . ./,~.~, .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .'~.,:.,:e~-c¢..~ fff~.,~/./e~esAddress 7F..~...~/...~.~..~."F~..fx~:'~P~aone No.~-.~:. ~'.4.,/ .... Name of Architect ......... 1 .................. 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 blocl: number or description according to deed, and show street names and indicate whether interior or 'corner lot. STATE OF NEW YORK, ·.. ~ .~7--'~. .... ~.. ~ .... being duly sworn, deposes and says that he is the applicant (Name of individual siglning contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements cor~tained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manfier set forth in the application filed therewith. Sworn to before me this ,o ~300 '~'~/ (Signature of applicant)