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Home My WebLink About11082-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Nog10857 . Date January 18 .................................................. 19.82.. THIS CERTIFIES that the. building ................................................ Location of Property 1.90.0 ..... W. 9.s.tp.h..alis Road Matti~uck House No. 's'tio;i ........... h$~iei County Tax Map No. 1000 Section .1.1.4. ........ Block . .Off. ........... Lot 0 12 Subdivision...X. ........................... Filed Map No. X .Lot No. conforms subst~ally to the Application for Building Permit heretofore fried in this office dated ...I?l.a.r.q .h..2.6.'~ .......... 19 8fi. pursuant to which Building Permit No.. ! ! .0.8.2...Z ............ - dated . .l~I~a?.ci~..2.7 ................ 19 .8.1. , 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 ......... a private one-family dwelling. The certificate is~ssuedto Estate of Ruth L. Satterly~..c/.o. Mary W. MacNish ..................... io¥.'o;, ..................... of the aforesaid building. Suffolk County Department of Health Approval .1.1. -..S.O.-. 1. 9.,..1/. ~' ./.8.2. ,...R .o.b.e. P..[. ?. :..V ,i.l.l.a. !. F.E. UNDERWRITERS CERTIFICATE NO. pendin~ ~. 55 V Rev. 1/81 Building Inspector FOI~M TOWN O~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.. Y. BUILDING P,ERMIT~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N©. 11082 z Permission is hereby granted to: ........... ............ ...... X,,.a,. AZ' ...Z~xz~ :~a~.~.=:~..~.~.; ................. ~o ...... &-.2~.~....~.~ ............ ~ZZzz ............................. County Tax Map No. ]000 Section ... ,//..,~,.. .......... Block '""~"'7' ........ /Lot No....(.J,/,~: ..... pursuant to application dated ,~.~,~C~,,,,,,,. ~.. ............. 'ii"'", 19~"~', and approved by the Building Inspector. ~/ Building: Inspector Rev. 6/30/80 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 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. Approval of electrmal 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 land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... .~ .'~-[... J ,'~. .... !d.(~. ,~- New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... Z, .C2, (~.~.. .......~ ~ '~' P ,~ ~,C:, ~ ~k ~.~, House N~i~ Street Ham/et County Tax Map No. 1000Section ...[..[..~f. ....... Block .. r7 Lot Subdiwsion ................................. Filed Map No ........... Lot No .............. Permit No. [!..~).~. ?r, .~. Date of Permit .~../.~.?l~.J.Applicant...--, .~¥.72..~....~.....L,~=.-~..~'.'..~. ,~ ..... Health Dept. Approval...........ll-$°-Iqo ....~ 1 . aborDept, reval ......... ............... Underwriters Approval ...~..~.O..,.~. ~ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ ................ Fee Submitted $. , ...~'.'....C?. ¢~. .............. Construction on above described building and p~-m-~ets all ap~,~es an~regulations. Applicant ......... 7~~ .... . .~... Rev. 10-10-7a ]1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY' 8S JOHN STREET, NEW YORK, NEW YORK 10038 ..t. Jm'~ 15, 1982 ~ 129123~81 ,,,,,,c,,t,o,, No. o,, fi,e N$47854 THIS C~RTIFIES THAT only the electf~ ~O~,~scri~ed belo~ and4ntroduced by~ ~a~li~.name~ on ~e able ap~licatiot~ nu in the remises FIXTURE OUTLETE z4 RECEPTACLES SWITCHES FIXTURES INCANDESCENT FtUORESCENT 19 24 [] 2nd FI. Section Block Lot attd found to be in cotnpltanee wtth the requiretnents of this Board RANGES COOK NGDECKS OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS. 1-G.FoC.I. 1 ~Sa~ke D~tector 1-4.b~z H.WolL E R V I C 1 2/0 Motor~: l-lhp r, lec. Co., P.O. ~ t43, ii 55 //1 ~/ Per-- __~ ~ j _ ~hls cerh~c~e mus~ ~o~ be ~[tered m ~ny manner, te~um ~ ~h~ off~ce o~ ~h~ Board ff incotred. Inspedo~s moy be identified by ~helr credenhgE. [ ~ cOPY FO~ BUJ~DIN~ DEPARTMENT. THIS COPy OF C~RTI~I.~Tj M~S ~ ~07 B" ~ TE"ED IN ANY MANNER. ~, FIE~D INSPECTI0~ '~ COMMENTS FOUNDATION (1st) FOUK~ATION (2nd) ROUGHFRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDIT COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ~Y ~ 19 .~.. Permit No. ,//. 6/0~° .... .... z v ~,~/¢ V ' ....... (~dii~;g Inspect;r) ~~ - · .............. - ~1/~:~ ..~/-:/ APPLICATION FOR BUILDING PERi, IT Date . ~.~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or ~n 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 bmldmgs 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 Braiding Inspector will issue a Building 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. The applicant agrees to comply with all applicable laws, ordinances, buildin~g~.c,ode, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in. split'phs. (S~grffiture of applicallf, or name, if a corporation) B~,..r.e:q ...... T.. j.r.~ ........ ff. I~ ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... .g~..~ (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 .................................................. ...... .0 ....... Vq.~-wp~nc~ P-c~, i~TT ~Tu~.k; ............................................................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~.1..~. ........ Block ...... i~ ........... Lot .... .~ .2. ............ Subdivision .................................... Fried Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .~..~.%.~. N..T. .... Lr.~..V. ...................................... b. Intended use and occupancy .......... .F>~. :V .~. 'Y.~. .... .ig..~.~.: .e?. ~.~. 9.~ ............................. 3. Nature of work (check which applicable): New Building ... ~ .... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... '~.~..5'., O..op. ,--' fiTS. ~ (Description) 4. Estimated Cost ............................. Fe ............................... (to be paid on filing this application) 5. If dwelling, number of dwelling units. I Number of dwelling units on each floor. ~. If garage, number of cars ..... ~ .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ..................... ' ................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new constraction: Front .... ~ i '~'1 .... R ar ..... O~J.~ ....... Depth . .'.~'.~'..T.~..~. [. Height .. [ ~.'~j J.' ....... Number of Stories i ~ 10. Date of Purchase ........... J.~ .~.q. ............ Name of Former Owner . . . .~Mr.¥.. I,,~..~OT.w. c7 ~..kl...~'.~. T, 11. Zone or use district in which premises are situated ............ ~.,~.-~..).~.~.~.T ~ ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ .kl.Q ..................... 13. Will lot be regraded ....... ~.~.~ ................. Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises .................... 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. STATE OF NEW.YORK. / COUNTY OF...~ ~"~..~F~... ........... ..~..~. 99 ~.. ,~,. .... 5.~ ~.%~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................. ~ ~&~ .... '. (Contractor, agent, c'orporate officer, etc.) of said owner or owners, md is du{y~authorized to perform or have perfomed the said work ~d to m~e and file this application; that all statements contOined ~ this application are true to the best ofhifi knowledge and belief; ~d that the work will be perfomed in the manner set forth in the application filed therewith. Sworn to before me this ............. ........ ~ / ' L I 'l lO'G" ' I~'~," -~. ' ................... 50,~0 t 0'0" O, q:O" J .--~ ii,J," ~ -% ~'aCT To H E,',TIL~TO~ FL,JE --'-" H E ~,'I' VEHT,' /I _ ti - I ,J r H~I.~ ~o,~ '~0' &' x '1 'Cc 6'1 ~'~.'T'l~ ~. FLUE T I I ! WI C" / t LI WI t,l~'~ 32:0" £8 '0 EL-~ ,'LTr~c ~l . ~.- Bo4(, vJ {t 3, o3 0.4.4 O.OSI I RODERICK VAN TUYL P.C. GREENPORT NEW YORK SUFFOLK CO. HEALTH D~PT. APPROVAL H.S, NO. STAT,EM~NT OF INTENT THE WATER SUPPLY AND SEWAGE DI~AL SYSTEMS FOR THIS RESIDENCE WILL CONFORM ~ THE STANDARDS OF THE LICANT ~FF~K COUNTY OE~. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTROCT O. NCy DATE: , 3~/~/ A~O~D: S~F~K CO. TAX MAP ~NATI~: i "-~¢. \ '9__'- ~ ~ '. . , . '. '~' ' '*" ~_ '*'"~--- ..... ~" -- .... ' -~ ' ...... '~'~':*: ....... ~ ~'~ec~ ~;~ ...... ~ /~ ........... STATEMENT ~ INTENT ~"~ ~ ~'~ ~ ~C ~ ~ I o .~ - -I~--' THE WATER SU~CY AND ~A~[ DI~L ~ ~ ~.t ~,~ . ; ~-~ [;~z, . ~"~. ~ . ~. / CONF~M TO THE STANDAR~ OF THE [ ~ ~ SERVICES -- FOR APPROVAL · _ ....... CO~T~UC~N ~ , '~ ~ / ~F~K ~. TAX MAP ~NATI~: -, ~ /(,' , R~ERIC~ VAN TUY~, P.C. LICEN~D LA~ SURVEY~S GREEN~RT ~W Y~K N755~4