The URL can be used to link to this page

Home My WebLink About10918-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.l.J.}}.8 .......... Date .............. .&ug.u.s.t..17 .......... 19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property .... 155 Woodclxff, Drive~. Mattituck ............................. House No. Street Hamlet County Tax Map No. 1000 Section .... 107 ..... Block .. 0~ ........... Lot. 02.7 ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantmlly to the Application for Building Permit heretofore Cried in this office dated ...... 0c~ober. ~_.4 ...... 198.q. pursuant to which Building Permit No...1.0.9.1.8 ............... dated .......... October. ~.4 ........ 19.8.q, 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 ......... ........ construct, mud, room. addition, to. exi~l:ing, one. farn~J-7. ~t~.1~Bg ............. The certificate is issued to .... Michael. To. Burke ....................................... (owner, lessee or tenant) of the aforesaid building, Suffolk County Department of Health Approval ... N/R .................................... UNDERWRITERS CERTIFICATE NO... 1,1/R ............................................ Rev. 1/81 Building Inspector FOEM' ~0, 2 TOWN 01~ ~OUTHO~, ~ TOWN HALL SOUTHOLD, N~ Y, BUILDING P, ER/~!T~ (TH S PERMIT MUST BE KEPT ON THE PREh~ S~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~ N? 10918 Z Dote ... ~:r..~,,.../...: ......... ~9..~ Permission is hereby granted to: ~. . ~.~'~...z=...Z~~... ..~..~z ..~.&....~ ~ ~. .....~.~..~.~.~.~.~,,.......~....~./~......~.~.,,~.....x...~~ ....... : .............. ~.~rz~ ...... .~......~z~.~,..~¢Z~...;~ ........................................ ~ ~o~,~, ,o~ ~r~.x ....... ~~2~.~....~.~ ....................................... Coun~ Tox Mop No. 1000 S.ct on ....~..~ ..... :. "~k ~ ~ ~.~ ....... kot N~ .......... pUrsuont to opplic*tion dotod ..~.t~.....~.~. ..... ....., 1¢ ~nd ~prov*d by the Building Inspector. ,.. ~ ~~;~;;; ......................... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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 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 tines, 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building .... Old or Pre-existing Budding(X) ...................... -.. ....................... Hou~ No, Street ................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No ...... ., ....... Permit No./~.~.~.~/~.... Date of Permlt .~.. ?/..~.'.~..4~.Applicant. ~"_~[.: .......... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ................. * Fee Submitted $ .... 5,...~. ................... Construction on above described building and permit',meets all appl~cable~,odes and regulations. TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under Building Permit No. ~o~/~ issued to ~ ~v~a~L on ~o]/q]Ro for ~r~?~,~ ~~, is completed and a fiHal'inspection has/--7 has not/~--~ been done. In order to complete th~s fzle, it is necessary that a Certificate of Occupancy be ~ssued. Please fill out the enclosed form(s), return same to the above office wmth a check for $5.00 payable to the Town of Southold. Please · ndicate to whom the Certmfmcate of Occupancy ~s to be mailed, and arrange with this offzce for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Admznistrator VL:ec Enclosures FIELD INSPECTION FOUNDATION (Is~) C0~¥~ENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ../..~...., 19 . Approved ... ---..., 19 Permit No. ,.-; ...... Disapproved a/c . ~~".'~. .......... (.~. .... (Building Inspector) /c. 7// Application No ............... APPLICATION FOR BUILDING PERMIT Date . .~(?.~.../.?. ...... , 19 .~.O. 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 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 heroin 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. ~ ~ - (S~nature of applicant, oPqSame, if a corp ration) / ~vlailing address of applicant) F'f'?~5~,O.. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises /~ ~ t~Vdg/e/- (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 ..... .~,..~d. ~-. ............ Plumber's License No ...... ~-). ~). ~)~'. ........ Electrician's License No .... /~. ~2 )O. ~ .......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................. .... ......... ....................... House Number Street Hamlet County Tax Map No, 1000 Section . . .L~~. .~. ........ 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 ........ / .,~.~. . .,~. /. .L: 3.5'. ..... .~'~. ./. .;.;.;.;~. .;.~/'4,./.~;r,.?.~,,f~. . ...................... b. Intended use and occupancy .................................................................... 10. 11. 12. 13. 14. Nature 9fwork (check which applicable): New Building .......... Addition . .~.. ..... Alteration .......... Repair .............. Removal ........... .... Demolition .............. Other Work ............... (Description) . Q: z Estimated Cost ............................ Fee ................................. (to be paid on filing this application) If dwelling number of dwelling units '--' Number of dwelling units on each floor If garage number of cars ~ -- If business commercial or mixed occupancy specify nature and extent of each type of use Dimensions of existing stmcture~, if any: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... i. · Height ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ....... . ............... Rear ...................... D.e~th ........... Date of Purchase .............................. Name of Former Owner . )P;JPB .~.%'~75..; ;'.~.,,~..~.~.'v.~.: ...... Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ....~.0 ...................... Will lot be regraded ...... .~..~. ......... .~ ........ Will excess fill ~e removed from premises: Yes Name of Owner of premises ,(~4~.~'~.4..~-.. ~'..,~'.c4e~Address /44..e:~e~¥.~f..~.. Phone No.~'.~...~..q(~ ..... Name of Architect , Address Phone No Name of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly ail lbuildings, whether existing or proposed, and. indicate ail set-back dimensions from property tines. Give street and block pumber or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NEW~ORK, -- ....~. ].~ff .'f.~... · .~'....~..q .~<~.~. .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... ~ ................................................................... I (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 confained iff 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 ' I~OTAR¥ pUBLIC, State of New./'r~'[a~K / . : qua,he ~n su,a~ co,[w/(.~ ,~ i (Signature of applicant) Oomml-smn