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Home My WebLink About11342-zFORM NO. 4 TOWN OF SOUTHOLD Office of the Building Impe~tor Town Hall Southold, N.Y. Certificate Of Occupancy No.~.1.0.9~9: ' - Date.......~pr~l.6 ...........': ....... 19,~ THIS CERTIFIES that the building ..................................... .......... . Location of Pro · 4235 Cam~ Mtneola Road . MattltuCk p rt~/~,~& ~o~ ...................... ~-~ ...................... County Tax Map No. 1000 Section 12 3 Block .0.5. Lot 0.2. ~ Sug'division. × Fil d Map No X Lot No X. conforms substantially to the Application for Building .Permit heretofore ~ed in this office dated June 3 1.134.2..Z. ..................... ,19.../31 pursuant to which Buildi~ Permit No ................. · dated ....l .u~u. ~. ~..1.9. .............. 19 .8.1., was issued, and conforms to all of the recluiremmlt$ of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... addition to an existing accesSorY structure. The certificate is issued to Jo.hn R. & Judii;h E. Lynch of the aforesaid building. Suffolk County Department of Health Approval ...n./..~ .................................... UNDERWRITERS CERTIFICATE NO ........... n./..~ ................................... . Building Inspector FO~tM TOW. Or BUILI~ING TOWN HALL SOUTHOLD, BUILDING P, ERMIT~ CTHIS PERMIT MUST BE KEPT ON THE PREM, IS~S UNTIL I~ULL COMPLETION OF THE WORK AUTHORIZED) 11342 Z Date .~ Permission is hereby granted ........ ~.d/./.~ _~, ,-~,~,,.. ~-~. . . , , ~ ~ . .~ .................... at premises located at ......~..~...~.~...~. .......... -.~m'.~....~...~.[~....~ .......... ~ .~./Z~.~-.~.t~.~. ~ co~ ,o~ ~,p ~o. ~00o so~t~o~ ..Z~ .......... ~o~ .N .............. [o~ ~o. ~ pursuant to application dated ~. ~ } ...................... ~....~....., 19. , and approv~ by the Building Inspector. Fee $.../.~:........~.i .... 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 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. 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- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or ~and use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. ~ .. New Building .. t.//. ........ Old or Pre-existing Building(X); ........ ~/Vacant Land .... ~, ~.. ~. , ~, uecauon o~ ~roperty . ..z .......................................... ~ ...... ~+. ......... Hou~ No. Stree~ Hamlet Owner or Owners of Property ~ ~ ~ ~ ~ County Tax Map No. 1000 Section f ~ ~ Block ~ ~ Lot, ,. ® ~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit ..4./.l....Applicant ................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate .... FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBZNG INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILOING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined F '~.~?.. t/.~ .... , 19~J51 Approved/C,57../. ~...., 19.~t/. Permit No. Disapproved a/c ......................... (Build}fig Inspector) APPLICATION FOR BUILDING PERMIT Application No.. ~./~'~/~..~. ...... 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 th,s application, the Building Inspector will issue a Building Permit to the 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 Buildh~g 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, a5 herein describt The applicant agrees to comply with all applicatflc laws, ordinances, building code, housing code, and regulations, and admit authorized ~nspectors or, premises and in buildings for necessary inspecs~ons. e.~...~..O.'.~... · .~. ~. ·~.(Sigfiature-- --"-'of applicant, or .~.~....~..~..~.O.....~....~,~ name, i.f ~, cor. poration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builO Name of owner of premises ......................... (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 .... .~.~'.I~._:4/...~.... ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... . .~.~ .~.~.. . .~.,4.. '.'~: .,.~.. I. Location of land on which proposed,work will be done., v ..... .~..~..~5.'~: .... House Num beL.~ qoq~'~ Street Itamlet County Tax Map No. 1000 Section ...... ./.~'. ~. .......Block ..... .o...~. ......... Lot .... .o. ~. ....... Subdivision ................................ Filed Map No ............... Lot .............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ ......... :. ~ ................ ~. ..................... - ..... b. Intended use and occupancy . ./..'.~.~..~f.~. &...~....~..':'-~. ~ · .'~.72~.~. ·h.~?.~/:c.. .~/.' .'~. · .x'e?( ?..~....~..~..~7.~Of.. Nature of work (check wbicl* applicable): New Building .......... Addition.. i ........ Alteration .......... Repair .............. Removal .............. Demolition ........... ,.. Other Work ............... ' (Description) Estimated Cost.... .. ..................... Fee ........................ ~- ........... (to be Paid on filing this application) If dwelling number of dwelling units ' ' ' ................. Number of dwelhng uni~ o,n each, floor ................ If garage, number of cars ....... 4~ .c¢..¢'.."..~'.".~..-f4....,~.~?.. ~...¢..'¢.."~.~..~'.., .... &..,~...~7 .C~.. .................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .. Dimensions of existing structures, if any: Front .... .~.~? ....... Rear .. ~.¢¢.! ....... Depth..~-. ~ .......... Height ~.¢. ~ Number of Stories J ' Dimensions of same structure with alterations or additions: Front ... ~ .¢. ..... ! ..... Rear ....~ .O~. ........... Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .... ./.~...~. ..... Rear ...d.~¢..'' . . Depth .. 7.~'(. ~. Height .../.q .~ ...... Number of Stories ..... ] Size of lot: Front ...... .--~. ~. ............ Rear .-¢.~ ' ,Depth ~ .......... ; ......... Date of Purchase .................... Name of Fon~er Owl]er, . ."~. ::: .~..~.: .'¢¢..'¢~/. Zone or use district ~ tuated ..... ,,'&~. ~.~.~..~..'?..~7..'¢~..f..~.,IE. ~'. ......................... Does proposed construction viol_ate any zoning law, ordinance or regulation: ... ,~'. ,~. ..................... Will lot be regraded ...... .¢~..~. .................. Will excess, ffil he removed ,fro~remises: Yes Name of Owner of premises ..."(.;¥7!/..q ./-('. ..... Address .~;¢~.~.~,~.~ .~.~./f¢',¢... ~ne No..~'¢. r.~ 7.¢. 7 ..... ' No Name of Architect ........................... Address .............. ~ ....Phone ................ Nine of Contractor Address . Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street and block nmnber or description according to deed, and slmw street names and indicate whether :terior or corner lot. 'FATE OF NEW ~,ORI(~ ~ OUNTY OF...'~...~. ~. i .7~.~.F..~x. ·. S.S ~rC,'u' A~' ~2//~('/¢' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) 5eve named. e is the .............................................................................. (Contractor, agent, corporate officer, et~.) f said owner or owners, and is duly authorized to perform or have performed the:said work and to make and file this pplication; that all statements contained 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. worn to before me this ................... ,,...day of ..... 19 otary Public,~ ~, .,-~'...~-vS..' ..,~/.~..-.. y JUDITH T. TERRY Notary Public, State of New Yor~t ...................... '" r No ~2-03449fi3 Suffolk Ooun{~L,o df ,,~ (Signature of applicant) Commissio,n Exp,res March $0, J /? ~, ~Pi~OVED AS NOTED DATE: .......... B.P. ~,:/f · FEE: BY: NOTIFY; BUILDING DEPARTMENT' 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPSCTIONS: 1, FOUNDATION - TWO REQUIREB FOR POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBIN~ 3. INSULATION 4, FINAL - CON'STRU~TION MUS'I' BE COMPLFTF FOR C, O, ALL CONSTRUCTION SHALL M~I~' .._T~[ REOUIRFMENTS OF THE ~S~ATE CONSTRUCTION & g/;)DE$. NOT FLESPONSlBL~ I[SIG,N. O,, ~NS