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Home My WebLink About10756-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N,Y. Certificate Of Occupancy No. ~.!0..'t .~ ....... Date ...8.~.p~in.b.e.r...'17 ................. 19 .I~..0 THIS CERTIFIES that the building ............................................... 300 Deep Hole Drive, Mattttuck Location of Property .............................. 'S't/e~i ...................... fl~r~/e{ House No. County Tax Map No. 1000 Section .... .'1.'1.~. .... Block '12 .Lot 00L~ Subdivision .............................. Filed Map No ......... Lot No. ' conforms substantially to the Apphcat~on for Building Permit heretofore filed in this office dated ....ff...u13.~' ?.6.~ ........ ,19 ?.0. pursuant to which Building Permit No. '10756 Z dated .... .~.~?..o..2.?~ .............. 19~.0. ,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 ......... ....... 9.r,.e. :¥..m%..~y. ~..e.l.~.~.n.g..(?.4..4.~.9.n) .................................... MarJory T. Kalk The certificate is issued to ..................... [o~n'e'r,'~s~'lf~dX~X .................. of the aforesaid buildmg. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. R¢~ 4/79 Building Inspector FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10756 Z Permission is hereby granted to: ~o. z~.--.~. ~... ~ ~:'~.z~-o~...Co.- /,/z:..czJ...,.2.o. .~. -.oZ.~,,~.... ./..l~. .......... , to ...(,2o.~.~z:.z.~,~'zT..........~-..~. .~........~.~.z.~.z..T..z6.~.......:.Z...~....~.~.r.~Kc~.c..2 .......... ....................................... 0t premi~e~ ~o~0~ed at.~..~...O. ........ .-~Z~. Z-.~Z~. ,0~..z. .~,~.~....0...:.~'. Building Inspector. ' I~ilding Inspector 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 Wpewriter 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. Approva~ of e~ectrica{ 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 lines, streets, buildings and unusua~ 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. 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 Date .A..t~.s% 11, lcJ80 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . 300 .~. ~o .~.e.~e..~..~.~.e .. ]~[a%t:[%uek~ House No. Street Hamlet County Tax Map No. 1000 Section l'l.~ Block 1.~ Lot. Subdivision ................................ Fded Map No ........... Lot No .............. Permit No. 10756Z Date of Permit 6/2?/80 .Applicant E[et, t, en Ce.~'~tz'ttet i~n Co, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approva~ ...................... Request for Temporary Certificate ..................... Final Certificate ., XX Fee Submitted $. ~,' .0.0 ........................ Construction on above described building ~,d p~rmit meets all applicable codes and regulations. Rev 10~10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOV~N HALL SOUTHOLD, N. Y. 11971 T~L. 765-1802 August 11, 1980 Horton Construction Co. Gerry G. Horton Mew Suffolk, N.Y. Dear Mr. Horton: : This is to advise you that the job under Building Permit No. 107~6Z issued to Harry Kalk on June 27~ 19~0 for dedE ammi~xon appears to be completed as of our last inspection. Bef6re you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very t~uly yours, GEORGE H. FISKER Sr. Building Inspector encl. FIEL~ INSPECTION 1. COMMENTS 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 / Disapproved a/c ..... ~.'-; T... '~ .......... ~7 .......... / APPLICATION FOR BUILDING PERMIT Dater, S. .~. 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 [oc~ion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a dethiled~escfiption of layout of property must be drawn on the diagram which ~ part of this appli- cation. '~ c. The work covered by this aPPlication may not be commenced before issuance of Building Pe~it. d. Upon approv~ of this application, the Buildifig Inspector will issue a Building Pe~it to the applicant. Such befit sh~l be kept on the premises avafl~ble'~0r inspection throughout the work. e. No building shall be occ~ o~ used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Bu~g inspector. ~PLICATION IS HEREBY MA~.~o the Building Department for the issuance of a Building Pe~it pursuant to the Building Zone Ordinance of the To~ ?outhold, Suffolk County, New York, and other applicable Laws, Ordinances or Re.latins, for the construction of'bfli~i~gs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all h~pticfible laws, ordinances, building code, housing code, and regulations, ~d to admit authorized inspectors on premises and~n'~ buildings for ~eces~ in~ections. ~ : ~;[,~:t~ ............... ~, ,~r,, j (Signature ~plicant, or name, if a corporation) ........... ~ ~ ~ (Mailing address of applicant~ State whether applicant is owner, lessee, agent, architect, engineer, gener~ contractor, electrician, plumber or builder. . ~e~e~k ...... c~~ .....~ ................ ~ ........ ~.~o~. ................ ;m~f owner of premises..~f .... ~ ~ ............ ~g~ ~.~L .......... ' (as on the tax rol[ or latest ~) If applicant isa corporation, signature of duly authorized officer. ~' ~~: .............................. ~O~l~x~ '9 k'h~rCXtO' (Name and title of co. or te officer) ~ASA~VJ,.~,G' ~t,~>'" "~NqO ~' - - Builder's License No ....... ~ ................. i ~O~V},O /¢~D.~[~G - OuGv~ ' 0~4 .~ C,x~O~ "' Plumbe~ s ~zcense No ......................... ~ ~ .o,L~~¥ ; ~qS~ ,' j' - ~ -~ ~ ~ >u. Electrician's License No ....................... ' ~. F'~'.~P?7~7~ Other Trade's License No ...................... ' ~Lk~ ~¢QkSkP';2?~(3d~O~'~B x¢y&' co~'~g~' ~s?y2]n~ ta~'- ' 1. Location of land on which proposed work will be done ............... S~7c .... ~}~{9~g~q ~ [Z ............ . C9q;~ ...... ............... ..................... Hous~nber Street Ha let County Tax Map No. 1000 Section .... 4ff~ ......... Block ..... 4.~ ......... Lot...Q~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. ,~..ItX-~L .... '~' '~' "' X "l't~' ~'}' ~ ....... ;:-~' '-' ................... :~. Intended use and occupancy ...~..~C.ddA.....6~x~dc~. z&d-./-<d:-~ ............... 4 -9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition ..... Alteration .......... Repair .............. Removal .............. D~molition ............ Other Work ............... Estimated Cost ..... '. .).. ................ Fee ................................ (to be paid on filing this application) If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor...: ............ If garage number of cars ' If bus~ness, commercml or mixed occupancy, specify nature and extent of each type of use Dimensions of ex~stmg structures, ~f any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ,.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Sleight ............... Number of Stories ........................................................ Size of lot: Front . Rear Depth [)ate of Purchase ......... : .......... ' ..... Name of Former Owner . Zone or use district in which pr~mises are situated..v~. ?. ~ ........................................... Does proposed constructioit violate any zoning law ordinance or regulation: .... 1~.~ ........................ Will lot be regraded .... gdO.., ................... Will excess fill be removed from premises: Yes No Name of Owner of premises. J-~:l~ .~J...~k~.k,.... Address ................... Phone No ................ Name of Architect .......... ~ ................. 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 block,number or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPanCY OR COUNTY OF j S. ......... '..G~*~ · .~Q~0~ ............... 'g y sworn, deposes and says that he is the :pplicant ' (Name of individual sig~ing contract) above named. Heisthe ....... ~~~......... ........................................................... . (Contractor, agent, corporate officer, etc.) of s~d owner or owne~, ~d is duly au~or~ed to perform or have perfomed the said work and to m~e and file this application; that all statements conthined ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ............. day o ........... ,19. $o~ry rubhc,' ..... ~ ...... ~.~' ....... ~o unty~ l~m EXpL~eS March 30, ~ ',