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HomeMy WebLinkAbout11241-zFORM NO. 4 TOWN OF SOUT~,IOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16698 Date March 9, 1988 THIS CERTIFIES that the building A C C E S S 0 RY Location of Property 11155 Main Road/50 Legion Ave. Mattituck t:t~t~s'e 'No: ....................... Street Hamlet County Tax Map No. 1000 Section . . ! 4. .2- ....... Block . .0. 2. ........... Lot 22 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...J.u?..e..8.,...1.9.8. 1.... pursuant to which Building Permit No, . .1.1.2.4. ! .Z ............. dated...Ju 1 y 2.., ........ I 98 I . ........ . 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 ......... ... ~le t a2..acc.e, as ory..btj ~_.l.d.i..ng.. ............................................... The certificate isissued to RAYMOND & JOAN PLUSCHAU ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval N /A UNDERWRITERS CERTIFICATE NO... N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TO~i'~ I~ALL SOUTHO~D, H~ Y~ BUILDIHG~,ERMIT !: (TH S PERM T MUST BE KEPT ON ~T~,E PRE~IS[ UNTIL F~LL COMPLETION OF THE WORK AUTH©~IZED)! Pe~miss on~ s hereby granted to: o{ p~emises located at .. , ..... , .-~ ....... ~ .......................... C~.Q~ To~ Mop No. 1~00 ~S~ction ...... ~ ......... pu~nt ~o ~ppllc~tion d~t~d ~pproved by the ................. TOWN OF SOUTHOLD FORM NO. 6 TOWN OF Sou'rHOLD Bu ildlng Department Town Hall Southold, N,Y. 11971 765 - 1802 APPLICATION FOR CERTIFICA.rE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ 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.Appro,~al 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. §.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 property 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Cartificate of occupancy New Dwelling $25.00, Accessory *$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.0/0 / 4.Vacant Land C.O. $ 20.00 x~/~ /~.~' 5.Updated C.O. $ 50.00 ~uate ...../// u ~/ .................... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..~/¢//v' ~ ~ ~' ~- /0/0 '-~ 7%'. ,k']~/'Z'~7~7'-u ~ J~ Hous~ No. Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section ............... Block ............... Lot ................ 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 $../..C?., ....................... Construction on above described building and permit I appl b e c Applica ., % ...................................... 76S~1802 BUILDING DEPT~ INSPECTION FOUNDATION 1ST [ ] ROUGH!PLBG. FOUNDATION /ND [ ] INSuLAtiON FRAMING [ ~FINAL ~ REMARKS "AT" 75 .OO MA I N P..OA, D GUAf;2.ANT,EED lB 'rl4E HOM~ VIGION 3CHIO~F~ TI'I'LE VAN TUYL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL: 765-1802 .............................. '..::::: : (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre( or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl;' 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 thc applicant. Such peru 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary... ~ '~'~'' ~'' '~"-'~i~°ns' .. ,,~D.~ .~:~'-~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ............... ................................................................... Name of owner of premises ............ .~, ,~1. ,/~, , ./~, ,~.~, , ~ , , .~. , ,. ..... ,~. . .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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done... Jr~OA°~'~/ /~'~"~"'~ '~/~'~'~- ~ House Number Street Hamlet County Tax Map No. 1000 Section .... .//dr ........ Block ..... ......Lot .... ...... Subdivision ..................................... Filed MapNo ............... Lot .............. (Nmne) r : State existing use and occupancy of premises and intended use and ocdupancy of proposed construction: a. Existing use and occupancy............ ..................................................... b. Intended use and occupancy .................................................................. Nature of work (check which ap41icable): New Building'.. i ....... Addition .......... Altera~5)n ...~ ..... Repair .............. Removal ............ ;. Demolition ..... ~.,., ....... Other Estimated Cost ............. ; ...................... Fee ............. (to b~ paid on filing this application) If dwdling, number of dwelling ~nits ............. Number of dwdling units on ~a~h floor ................ If garage, number of ~s ...................................................................... If business, ~omm~rclal or mixed occupancy, sp~Ey nature and extent of ~aeh typ~ of us~ . ~~ ...... D~ansions of ~xisting stratumS, if any: Front ............... R~ar .............. D~pth .............. Height ............... Number of Stories ....................................................... D~nsio~s of sam~ st~ctur~ wit~ alterations or additions: Fro~t ................. R~ar ................. pth ' 'ght o[St ' D~ ...................... H~l ........... /Z .......... Number ones ......... .~ ........... Siz~ of lot: Front .... 1..~..~ ........... Rear ...................... D~pth .... ~ .................. 9o~s proposed ~onstruction viollt~ any zoning law, N~e of Architect .'. . Address ..... Phon~ No. N~e of Contractor ......... ~ ................. Addrem ................... Phone No ................ PL~T DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether ;operty lines. Give street and block ~ ,terior or corner lot. rATE OF NEW / / S.S OUNTY OF ~~ .... "- //q // ' ' (~'~signing c Jove named. being duly sworn, deposes and says that he is the applicant eisthe ..................... ~~ ~..~w.~: ........ ;~ ................................................. f said owner or owners, and is dkly authorize--~- ot~erform or have performed the said work and to make and file this >plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the m the manner set forth in the applicafion..filed therewith. ork will be performed ' worn to before rne this ......... ~/,~ .... day0f .... c/ li°~~ff~[~ .sc~ ...... '~/' ' ' (Si§nature o f applicant)