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HomeMy WebLinkAbout11283-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy No..!.109S ......... Date .............. .29..J.u.[y ............ 19.82. THIS CERTIFIES that the building ................................................ Location of Property ... 1145, Donna. Drive,. Mat:tituck.,,. .......................... :.. -: · House No. street Marmot County Tax Map No 1000 Section .. 115 ....... Block .. 16 ........... Lot .. 0ll. ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for B~ilding Permit heretofore filed in this office dated ........... ,luly .il.., 19 g.[. pursuant to which Building Permit No.. 11283 ............... dated ........... July. 15 ..... 19 B2., was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ......... · . .Const;xuat .a .deck .addit;ion. to .existing .one · family, dwellimg .................... The certificate is issued to . .Douglas .& .Mary .Moore ..................................... (owner,/eseee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~I/t .................................. UNDERWRITERS CERTIFICATE NO .... ~I/.~ .......................................... / Building Inspector Rev 1/81 FOE~ NO. ~ TOWN OF $OUTH01.(D BUILDING DEPARTM~N' TOWN HALL SOUTHOLD, N~ Y.- BUILDING FERMI? (THIS PERMIT MUST BE KEPT ON THE PP, E~IS~Es UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~, x'- 2.1 N~ 11283 Z Dote .... ------~"~Z"~ ....... : ........ ~ ................ ,,9. Permission is hereby granted< t~: / ...~..,.~_~,~....~,,: ............. .................... ,o ............. ~.~.~.~....~....~...."~4~.~...:z~: .................... ..... ~.~....~....~&. ...~Z~..~ ...................................... I~ate~at · ...d...,~/ ~ ' ~ t / Coun~ Tax Map No. 1000 Sechon ..... ............... Block ;,...~ .................. ~L°t No ................ ,~ff~ ..................................... t..... ~ , ond Building Inspector. Fee $ ............ Rev., 6130/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application 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 ail 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 certffmate 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 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 buildings or premises, or other pertinent informa- tmn 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 . .~. ;/.¢.;~.\ ./..0./..]..~. ~ ./ ..... New Building ............. Old or Pre-existing Building . .7~ ...... Vacant Land ............. House No. Street Ham/et Owner or Owners of Prope~CD ~cb W.~ % k/~C:~2L( t axMa 1.0 ..... ; ;~'~' .......... --"; ............. ~'~';; ....... Coun y T p No. 00 Sect'on ............... Block .... ..~. ........ Lot ............... Subdivision)...~..~...~. !¢-;..~....(~¢-¢-~- '~ !('~..~.--~. ~..J~. ?.: .~...Filed Map No ........... Lot No. ~.'~.-. ....... ' ~.~ ~ ~ r'/11?~'/~l Applicant .-~,. O¥~c ~ ??- ~,~o Permit ,o. [.t. ....... Date of Permit .............. ~ ........ 't ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... d ............... Fee Submitted $ ~O© ..~. Construction on above describedAppbUildingcant and~...k~.permit meets all~.~app~ca~ble~codes and regulations. FIELD IN~SPEg~ION 1. FOUNDATION (lst) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpD~ FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved..d. ':.¥ ......... , ee=it Disapproved a/c ................. ...... ( g P ) APPLICATION FOR BUILDING PERMIT Application No.///~.d .~..~.~ ........ Date ....... ¢//. ....... , 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 Permit. d. Upon approval of this application, the Building Inspector will issue a Budding 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.~i The~applicant agrees to comply with all applicable laws, ordinances, build,,gi~ode, ~gusing .code, and .regulations, and to adlllit authorized inspectors on premises and in buildings for necessary i~ct~ns.~j/,~,-~' . (Si~:dor~ ;corporation) (Marling address f applica t) 1/ State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .O. ............................................................................... Name of owner of premises .~.q .~.l.a.~....~... ?....~./..CM'~....~. .... .~..O. 9 ?.q~. ................................. (~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 ...................... 1. Location of land on which proposed work will be done .................................................. House Nmnber Street Hamlet County Tax Map No. 1000 Section / / ~'' Block / ~ Lot.. Subdivision. P. tT~J.;., b{.o.{ t5..(.'1~3',e. .td'xZ.l.l~]T.~G .... 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 .... C..e.~'~ cXe,~ko~. ................................................. b. Intended use and occupancy ....~.~..~: .~.e:.~.~...c~,...~.. ~.C.~5.~. ~/~? .~.../,~:. .................... 3. Nature of work (check which applicable): New Building .......... Addition .., .~...'.. · Alteration Repair .............. Removal ............ Demolition .............. Other Work ............... Fe?/./. ~..~.' (Description) 4. Estimated Cost .......... ,. ....................................................... (to be p~d on filing this application) 5 If dwelling number of dwelling Units ~ Number of dwelling units on each floor ~ If garage, number of cars . Z .~~ ...................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . .~ ........ > ...... 7. D~mensmns of ex~stmg stmcture~, ~f any: Front... ~.~ ..... Rear . ~,.~ ...... Depth . ~..~ ....... Height . ~( ......... Number of Stories '~ ................... D~ensions of same structure wiih alterations or additions: Front .. 6-~. ~ ........ Rear ... ~ ........ Depth ..... ~.~.~ ........ [.. HeiSt .. ~.(.. i ........... Number of Stories...~ ................ 8. Dimensions of entire new construction: Frqnt ..... ~..., ...... Rear .... ] ~ ~ Depth / ¢ ( Height i~.~ ..... Number of Sto~es . 2. ~..) ..... ~ ........................................ Size of lot: Front ..... ~ ~.. ~ ..... Rear ~ De~th .~ ............. .. ¢::. :... :: ..... :: Zone or use district in which premises are situated... U~.~ ~ ~.~ ....... ,~: ................ 11. 12. Does proposed construction violate any zo~ng law, ordinance or regulation: ................................ t~ 13. Will lot be regraded ...~... .......... ' ......... Will excess fill be removed from ~remises: ~Ye~ ~ 14. Name of Owner of premise~O~/~ ~ ~.~ddress ]] M~7 .~o.n o~l~q~0~ No.~q.~v .~.A~ .... Name of Architect .......... ~ ................. Address .................. Phone No ................ Nme of Contractor ~.~. 0....~& n ...... Address .~. ~j .Oa ~... Phone No. ~ ~-7 ~.. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from r~tY lines. Give street and block humber or description according to deed, and show street names and indicate whether STATE OF NE~ YORK, ~S.S ~¢~,07/0~ I (Name of individual sign2ing contract) above nmed. (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is duly authored to perform or have perfomed the said work and to m~e ~d file this application that ~l statements conthined ~ this application am true to the best of his ~owledge and belief; and tha~ the work w~l be perfommd in the m~n~r set fo~h in the application filed therewith. Sworn to before me this /- '-7 --~AR~¢~BLtC, State o~ Ne~ York ...~ ......... (Signature of applicant) ,V IVEky SUFFOLK /? N 87~/8 182 O0' /_o/ - 8 2 SUBDIVISION MAP FILED/N THE OFFICE OF TH~ CLERK OF SUFFOLK COUNTY ON JAN 2B, 1~5 ~S FILE NO THELOCATION OF ~ELL , SEPTIC TAN~ ~ C~POOL5 SHOWN HEREON A~E FROM FIELD OBSERVATIONS AND 0~ DATA OBTAINED F~O~ OTHERS. YOUNG & YOU/ ALDEN '~,' YOUNL, SURVFY FOR DOUGLAS M MOORE 1~ LOT 63 "DEEP HOLE ~ MATTITUCK -,ow,~or SOUTHOLD SUr, O, V, CO N Y MARY D. MOORE CREEK ESTATES" FEB , AMERICAN TITLE INSURANCE C'O. I SOUTHOLB SAVINGS BANK --- NEW SUFFOLK . A VENUE Lo! 64 87°19 '20 "Vt. Lot ' ~2 182.00' 182. O0 ' % NOTE: · = MONUMENT ~ = STAKE THE LOC&TION OF WELL , SEPTIC TANK ,~ CESSJPO0£S SHOWN lJEE F~OM FIELD OBS£~VitI'IQNS AND Oi~ OATZ OBTAINED YOUNG & Y01~ 400 OSTRANDER AVENUE,' RIVERH ALDEN W. YOUNG SURVEY FOR: DOUGLAS M. MOORE ~ MARY D. M( LOT 63 "DEEP HOLE CREEK E~ ~ MATTI TUCK 4uc~ ~ow. o~ SOUIHOLD SUFFOLK CO., N.Y. aY~ ..... , ......." MOORE ;TATES" ~ TITLE IWSEtt~IVCE'CO.