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Home My WebLink About11245-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou/hold, N.Y. Certificate Of Occupancy No...Z,1.2.1..0.0 ......... Date November 30 ., 19.8.3. THIS CERTIFIES that the building a Far.m Sta. nd Location of Property 4140 BREAKWATER RD. MATTITUCK ~l~e ~o: ........................................................ Street Hem/er County Tax Map No. 1000 Section 105 .Block 09 .Lot 002.1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to tr,,~ Application for Building Permit heretofore tided in this office dated .... .~.u.n..e...2.5. ....... ,1~.1. . pursuant to which Building Permit No. 11245z dated . .49.13'. .~. ................... 19 .83. } 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 ......... .... · .or. v..~'arm .~ ~cl ........................................................ The certificate is issued to . .l~0]Jfil~/~..fi, .. COOPER ....... io¥,,'*;, 't~ 6io' dr't~idn'tj ...................... of the aforesaid building. Suffolk County Department of Health Approval ...hi/P~ .................................... UNDERWRITERS CERTIFICATE NO ........... hi/P~ .................................... Building Inspector Re~. 1/81 BU BUILDING (THIS PEP, MiT fAUST BE KEP¥ ON TBE COMPLETION O~ THE WORK AUTHORIZED): Permission is hereby granted to: UNTIl F~JLL ~ot~ ...., ~,7....;~.,, .................... , ~9.. C~urjty Ta~< Map No. 1000 Section p0r%ant tb application :dated B~ ~ln0 I~spector. ~e ?./.~.~ ......... : ..... R~v 6/30/80 N~, ~.~:-../. .... and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Sonthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in wpewriter OR ink, a~ld submitted in duplicate to tbe 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 Reside,nces 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pre-existing"_ land uses: 1. Accurate surYey of peoperty showing ail property lines, streets, buildings and unusual na[ural 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 .--Fr, e-Existing C.O. $15.00 Vacant land C.0. % 5.00 Datc.~.~.~?:~-?.~i~, ........ ~?.~?... New Building .... ~ ....... Old or Pre-existing Building ........... % Vacant Land /P -/? .- ' ~ . St~'ee t Hamlet Ho,,. No. '~ It) W /( Owner or Owners of Prope~ ....... ~/ .............. ~ .................................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. !~ .?. ~...~ Date of Permit . .. Hea~th Dept. Approval ......... ~ .............. Labor Dept. Approval ., itersApproval '~- '~ PI nni gBoadApp oval Underwr ........... ' ............. a n r r Request for Temporary Certificate ..................... Final Certificate ,, Fee Subrrritted $ ............................. Construction on above described building and..p~'mit meets all 8pplicab!e~cpdesAnd regulations. (-' (: " ' FIELD INSPECTION FOUNDATION ( FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY C,ODE FINAL DATE COMMENTS 1st) 2nd ) ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ ~ TEL.: 765-1803 Examined Z[d.~..~. ...... ,19... Approv/~. 6/ , 1 ~.. P~ermit No [red a/c . ' .......... ..... ' ......... .......... Disappro e a/c ....... ~. ..... i . . . .~ ..~ Y / .................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No././.d..~.77 ...... 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 promises 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 the applicant. Such pen~ 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 necessa~ iuspections. , (S~g,~.)~,rure et appucant, or name, z[ a corporauon) / ¢ c ........ (Mailing address of applicantK State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild, Name' of owner of premises.. ~ % .~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 9f land on which proposed work will be done ................................................ ............ .; House Number Street Hamlet County Tax Map No. 1000 Section ... ~ .( ......... Block ... ~.~ ........... Lot ~:.~ ....... Subdivision ............. ; ....................... Filed ~.-~,,a~ No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and ?¢upancy of proposed construction: a. Existing use and occupancy.............,.,,.. · .......... b Intended use and occupancy Nature of work (check which applicable): New Ripair .............. Rem( ~al ... Estimated Cost....~...~..O..O, ..... If dwelling, number of dwellin ¢nits ..... Building .,~ ....... Addition... ...... Demolition ............ ...... Alteration .......... · Other Work ............... (Description) .............. Fee .~..].~... ................. ¢. .......... (to be paid on filing this application) ........ Number of dwelling units on each floor ................ If garage, number of cars ....................................................................... If business, commercial or mixed occupancy, specify ~iature and extent of each type of use . .,~,4t-t...-?T-o. O~. .... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ...................... Number of Stories ............ z ........ Dimensions of entire new construction· Front ~. ". . Rear . ~. ~ ....... Depth ...~ Height .../. ~2~.~ ........ Number of Stories ........................................................ Size of lot: Front .../.;~t..C_.>O..".I ........... Rear ...................... Depth ...................... Date 6f Purchase ........... : .................. Nfime of Former Owner ............................. Zone or use district in which pre:raises are situated.......... ...................... . '~' ................ Does proposed construction violate' any zoning law, ordinance or regulation: . .~..o. ........................... Will lot be regraded .../~.O. ....... ir/ ............ Will excess fill be removed from premises: Yes No Name of Owner of premises . ~.*. ~t ~'/ .... (-~.,~(~ddress ~.o.J(...~...~.~..~/.~?.~.(.. Phone No..~?.~'...~?.~. .... Name of Architect ........ : ................. Address ................... Phone No ................ Name of Contractor ..................... Address ................... Phone No ................ PLOT DIAG RAM Locate clearly and distinctly all~ buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty l~nes. Give street and block ~umber or description according to deed, and show street names and indicate whether ~ter~or or corner lot. L f o ,. erP rATE OF NnW / is s ................ being duly sworn, deposes and says that he is the applicant ~ (Name of iff, dividual signing contract) ! )ove named. .e is the ................. "l~...~-; .~.. ~ ~'Contractor, ~t~ent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plicationl that all,statements conthiued in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. ~vorn to before me this .o]~q~bl?, ;, '2_:A2//'' ~ ...... ~County ~ // ...... (SignatUre of applicant) Z"X 6, R IDSE. CORRUGSTED P,,O01~ I N 6- £~/",x' 10' ,SHEETS sI~'F--- z'xq' R~FTE RS ×~' ,TOtSTS 8'o.c. ........... F_[~ONT._ ELE V ^TIO~'~ CORRUG/tTED GA LVAN STE~.~. ROOFING GRADE ,~,~ , TREATED ~ELOW j ZED 2zt/ FT R/~FTER~ c.c. ,L ~" - ~. Foot