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Home My WebLink About10884-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buitdin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10642 Date August 21 THIS CERTIFIES that the building ................................................ Location of Property 2645 gliSa~'s Lane, Mattituck, New York House glo. Street Hamlet County Tax Map No. 1000 Section .... 1.0.8. ..... Block 04 . .Lot 007.015 Eltjah's Lane Estates Sec~..1, 6065 12 Subdivision ............................... rhea Map No ......... Lot No .............. conforms substantially to the Applicatmn for Building Permit heretofore filed in this office dated September' 17 19f! .0. pursuant to which Building Permit No. 10884 Z 80 dated....Se ....... ptembe¢. ......... 24, . ...... 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 is ......... ............. .......................................... William A. Schmitz The certificate is issued to ..................... ~o*~n~/~.~,~k .................... of the aforesaid building. Suffolk County Department of Health Approval iq /R UNDERWRITERS CERTIFICATE NO.. N/R Rev. 1/81 TOWN OF :~OUT~D ~ BUILDING ~DEPARTMI~N~ TOWN ~-HALI- ! SOUTI-I'O[D,'N,. Y~ i~ BUILDING; P,ERMI~ (THIS PERMIT MuST BE KEPT ON 'PILE PRE/~IS~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZ£D) i Permission is hereby gra~ted t~ , . /7 ~ ~ ....... ; ................................ , ....... : ....... ,.:;.~ ................ ............ :d~2T~....~. ........ ,..., g ................ t ............... ; .......... ~ ................................... , ................ , ....... ,; ..................................................................., , ~:: ..... ~.~z~~ ....................... (~ ~,7~: ~.~ ~ ,~ ....... .............................. COun~ lax gop ~o. 1000 Section ............. BIo~k,~'..,,~ ................ ~kot ~o ......................... Building InSpector. Fee $.../.......i ............ Rey; 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Ti~is application must be filled m 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 certihcate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te 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 buddings 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 or land use 3 Copy of certificate of occupancy $1.00 $5.00 Date .~.~¢44¢.,. ~..~':../?..~. ........ New Budding ........... Old or Pre-existing Building / Vacant Land Location of Property . .?-~. T./4/...o~....~, ./-/.d.'~,?¢- .~?.~.. ~i ,/~,'/'P.Z. ............. .~..//:./.'~.~.-~ 77..cf,~./.~' ........ House No, Street Ham/et Owner or Owners of Property f..~[Z-L/i'¢~ ~L. -~ ,..J.o.,o,o,o,o,o,o,o,o~..,~.. County Tax Map No. 1000 Section /.~..~'.,..~..c~ .... Block . ,~).'~t...d~..~. .... Lot .~.O..~.~.:..~. ,/, .o~.. Subdivision ~'~"'~/1~r5 .~'./¢..'~.~..~. '.5'/,~../.Z.'5., ?..~.c. ~.~Filed Map No. (,.~ .O(_o,~ .Lot No. Permit No/.O.~F.~.~.. , .~Date of Permit .~'T?r.4/,"..~..Applicant . .fr~../.g../-/?J~'!.... /'~.-. ~'../f-..~. Health Dept. Approval ...... /~.. -~ ............ Labor Dept. Approval ..................... I~'' ~71__ Underwriters Approval .... ~.I./'~. ............. Planning Board Approval ................. Re uest for Tern orar Certificate Final Certificate ~ ~ '~"\ q P Y,~_~ .................................... Construction on above described building and permit meets all applicable c,,ode/s-a~ regulations. Applicant . . ~.. (~. ~¢¢.%, ._: , y~c~/)~,~ ..................... Rev. 10-10-78 FIELD INSPECTION 1 DATE COMMENTS,,, FOUNDATION (1st) ROUGH F~E & PL~BING INS~ATION P~ N.Y. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ~).~.Z..'.~..~. ., 19... Permit No/.~.~. ~ffi.~. V.~ / Disapproveda/c .................. - ................. J' ~ (Btflldmg Inspector) APPLICATION FOR BUILDING PERMIT Application N o../.~.. · .~( ..~'~. · ....... Date~./. 7 ....... 19~.. 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 Pennit. 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 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 w~th 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 ~/ame, if a o p rati ) · ~....g.o .X...~#~... m~/7. v.,c ~', ..~./~',. '/. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pre~nises ...G J/..ck<.~. ..... ~ .,....OT.e.4/.m.. < .7..~. .... .~...~.~../7..,Z...~., ............... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nmne and title of corporate officer) Builder's License No ........................ Ptumber'sLicenseNo ......................... Electrician's License No ...... ~ .--'~..¢~.-: C7.: ...... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................. ~ ' '~--' 7-'~ e... · . 3.4 '43- d~z/J,4.~.~ /~/.*. ?.~/. < q ~ .......... House Number Street Hamlet Lot' ~ ~ ~ County Tax Map No. 1000 Section ../~. ~'. ~ ~ .... Block . ~.~?. ~ ........... Z ~..~? ..... ~ , ~ ~,/ ~,~ ,_~ Subdiwsion ~L/~f ~ ~S/~ ~5 ~i~a Map No. .~ .... ~.~ .r. Lot .~ ~ ........... (~'a~i) ............. ~o ~Y 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: . ~ lz ~ ....... a. Existing use and occupancy .. ~f.~4~ .. ~ ....... ~ .... /~.~ ........................... b. Intended use and occupancy ............. ~.~ ~-.. ~ .~[4 [~g~ .(~'~..7..~¢~J& .... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...t,,-~'. ..... Repair .............. Removal .............. Demolition .............. Other Work ............... i e .~/~..~.. (Description) 4. Estimated Cost ..................................... Fe .............................. i (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ..... /. ........ Number of dwelling units on each floor ..... .-~ ......... If garage, number of cars ---- 6. If business, commercial or mixed'occupancy, specify nathre and extent of each type of use ...... -':'. ............. 7. Dimensions of existing structures~ if any: Front...3~..~q .~. ~. ...... Rear . ..'?~? .ql-. t. ....Depth . .K.~. ~ .'.L.' ...... Height ..... /.(~. ~. .....Number of Stories .... ?' "'?'~- ............... t .................... '-' > ........ Dimensions of same~ structure with alterations or additions: Front . ,,c' .,~...~. .......... Rear .~"~r. ~. .......... Depth ...~...c~ .Z,. ............ i' Height ...[.6..t ............... Number of Stories ....O..~/.~,... 8. Dimensions of entire new construction: Front ~-~ Rear .-7.. Depth ? ............ Height .... T .......... Number of Stories ........ .~: .............................. : ............... 9. S~ze of lot: Front ..... /.~... ~. ........... Rear ../.~.~..(D.~. ......... Depth . .~-.~f'~'.6. ,.~fo.~ ........ 10. Date of Purchase .... .~..X(7~ ................. Nameqcf Former Owner .(-M..'~-'.4~. f. ~..~t~/'~¢.T~.~.~t.~.~. ~.1. 1 1. ~ Zone or use district in which premises are situated ........ './. ................. : ~ ......................... 12, 1 Does proposed construction ~(iolate any zoning law, ordinance or regulation: ..... Y~.O ....................... 13. Will lot be regraded ..... .24.0. i .................. Will excess fill be ~movqd from premises: Yes No 14. ' Name of Owner of premises .~q.t.6~t.~.~...~.c.~?. :T.~-. Address .Z~.qt./~..~./-.(~.~. ~.~.t-..~?..~Phone No..~.~.~-7 .'-?/..~7. .... Name of Architect ~- Address Phone No Name of Contractor ..... .,5:~..~:~.~ .............. 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 block umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW, gKORK, ........ ... t~~..~..'.~~ ................... being duly sworn, deposes and says that he is the applicant (Name 6f individual sf~ning contract) above named. He is the ~.~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ anthodzed to perform or have peffo~ed the said work and to m~e ~d file this application;'that ~1 statements cont~ned~ ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed m the m~ner set forth m the apphcat~on filed therewith. Sworn to before me this ........ ..... Nota~ Public, ~% ~Y~; ........... County . sr~r[ 0~ s~' ~a~ ~ ..... ~(Signature of applic~t) I No. 52~4637~,7~ !' , , \\ = MONI/M~ OF THH ~[ RK OFSUFFc~i. K ~U~ TY O~ YOUNO ~ ~0~ INLAND HONIES INC. LOT NO. 12, LL J~H S LANE ESTAT~,~q.~x'~3~x, - r o e I I I = 40 ~ SEP1.~8,1973 ~'"73'~99