HomeMy WebLinkAbout11137-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Bui[din§ Inspector
Town Hall
Southold, N.Y.
Cerlificate Of Occupancy
No .... ~ J.0.480 ....... Date .... da.¥. fi 19~J.
THIS CERTIFIES that the building ................................................
500 Azalia Road, Mattituck, New Yol-k
Location of Property ~$$~ Ho ........................
· Street' ........................... ~r~ie~'
County Tax Map No. 1000 Section ..... 'L l 5 .... Block .... 0.6 ........ Lot ...... l 3 .........
Subdivision..Mag.l~ituck .E~gates ......... Filed Map No. 4653 .... Lot No .... ] 3 ........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... May..l .......... , 19.8 ~ pursuant to which Building Permit No .... 1.l 137.~ ...........
dated .../,lay. 6 ................... 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 .........
One Fam.i.ly Dw~ll. ing !A.ddition)
The certificate is issued to . . Ela.:kJ, y. [t.i.],~ky ...........................................
fowner, 4es~ee,or
of the aforesaid building.
Suffolk County Department of Health Approval ... ~I/.'r~ .................. ),. ...............
/
UNDERWRITERS CERTIFICATE NO ..... ~q/.R .................. . . , .,/. .................
/
Building Inspector
Rev. 1/81
TOWN 0F~!
BUILDING
'row
SOUT,O . ,
BUILDING~ PER~I~
(TH S PER/v~IT MUST BE KEPT ON ~H,E PRE~IS~S UNTIL FbLL
COMPLETION OF THE WORK AUTHORIZED) i
at premises located at ...,~.~...~?....,.:.
County Tax Map No. 1~00 Section ...../. ,/./~, .......
, i' ~ 19t...,~..,, and approved by the
pursuant tO application idatod .....................................
Building Inspector.
.-
Rev 6/30/80
· ~ o
.~.. ...... Lot N ,. ~/.~...~... .........
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Bo
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 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 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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ~y.. ,~...~.~, ·
New Building ............. Old or Pre-existing Building ............ _ Vacant Land .. ,~ .......
Location of Property. ....... ......
House No, Street Hamlet
Owner or Owners of Property .... ~. '.~,/~, ¢'./-~.~/~. ...... 2./ .........................
County Tax Map No. 1000 Section .............. Block ..... ~7 ....... Lot....~ .........
~-"~'7 ~- ~-~ ' .~..~.~?.~.~..Lot No... ~..~.~.
Subd,vision...~.~'4~.~ .¢ / (~¢~(.~-...~?-~¢~..~.... F,led Map No .......
Permit No..[?./..~: ~/~..~Date of Permit .~.~.~..~ ~...Applicant ~)~'Z~'..ZJ.O.~..~.~..~.4 ~..~ .~.~.: ....
Health Dept Approval. ,~..~.'/.~; Labor Dept. Approval ~..~.~.~ . .
Underwriters Approval .... ~.~'?.~.~..~-~ .~ ............ Planning Board Approval /.~ ¢'2 .~./~~. .........
Request for Temporary Certificate ..................... Final Certificate . ~ ..................
Fee Submitted $ .............................
Construction on above described building and ~it m~els a~ap~plicable codes and regulations. ,~
FIELD IN~CbC'I ±ON
1.
FOUNDATION
FOUNDATION (2nd)
ROUGH FRAME &
?LUMBING
INSULATION PER N.
STATE ENERGY
qODE
FINAL
ADDITIONAL COMMENTS:
YOUNG & YOUNG
400 OSTRANDE~ AVEHUE Rt~ERHEAD
NEW YORK
SURVEY FOR EDWARD ABITZ
LOT NO
"MATTITUCK ESTATES, INC."
MATTITUCK
TOWN OF SOUTHOLD BU,~RANTEED
SUFF. CO, N Y.
SCALE I" = 40'
AUG. '6,'972
AUG 2.4,1972 OFESSIO_N'~/ENGI~I~r~R ANb
LAND SURVEYOR, N.Y.S-LiC.NO.I~B45
~ RIVERHEAD, N.Y
S . 88o;~5, 30,,E ! ,
I0.00'~-~ ~
o
56'
N.86°27', ~.
Lot 17
NOTE:
· = MONUMENT
MAP OF SUBDIVISION FILED IN THE
OFFICE OF THE CLERK OF SUFF, CO.
ON SEPT. 8~ 1965 AS MAP N0.4455.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined../."~.~¢f..G./. .... ,19 ..~/
Approved. ,/'.~.~..~...(. .... ,19 ?/. Permit No..../~. (..~..~. r:~
Disapproved a/c ..... :..~-:~ .~..---~.: ......................
................................. &/':/' '55 _i ,/_.
;~:r'~'( BJtildi~g Inspector)
APPLICATION FOR BUILDING PERMIT
Application No...(,/./. ~.. 7 ......
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 ap[:
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 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 Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buddings, 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 aud in buildings for necessar~pecJ4qns,h
.......
(~ig;,ature..of appli;a~t, ~; ~e', 'i; ~ c[rporation)
(Mailing address of applicant) ]1 l'~
State whether applicant is owner, lessee~agent, ~'~hitect, engineer, general
contractor,
electrician,
plumber
or
build,
Name of owner of premises .... /. ..... m. ..........................................
(as on'the tax roll or latest deed)
If applicant is a co;poration, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No....~l.O~/.z~. ~.~. ~___~ ./~'..~...
Plumber's License No ..... .~.r7 .Z~..~ ............
Electrician's License No .... .Ad..oA-'..~.--~. ...........
Other Trade's License No ......................
1. Location of land on which proposed work will be done ................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ................. Block .............. Lot .............
Subdivision...~..x'/.~ )!:~4..<-.~... ~ ~..d'2..~7~.-~. · .... Filed IVlap No ..... Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
E×isting and occupancy .... ':':'"":'/" ' ........................:
Nature of work (check which applicable): New Building .......... Addition'~.4~... Alteration ..........
Repair .............. Removal .............. Detnolition .............. Other Work ...............
/.0' .O. ~ -- /~/D--~ (Description)_
Estimated Cost Fee. . . . . '
: (to be paid on filing this application)
If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
If garage, number of cars .......................................................................
If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... ; ........
Dimensious of existing structures, if any: Front ............... Rear .............. Depth ..............
Height ............... Number of Stories .......................................................
Dimensions of same structure wi.th alterations or additions: Front ................. Rear .................
Depth .................... :.. Height ...................... Number of Stories .....................
Dimensions of. entire new construction: Front ............... Rear ............... Depth ..............
Height.......... .~... NurSer of Storigs .......................................................
Size of lot: Front . .~.~...J'~.~.~7.~..%./... Rear ...................... Depth ..................
Date of Purchase ................. / ....... ~ ...... Nmne ~o f/~Fonne!:J~wne,r ................... i ........
Zone or use district in which premises are situated ~ .~ ././--~.~.
Does proposed construction violate any zoning law, ordinance or regulation: ............................
Will lot beregraded ......... :.................. . Will excess fill be removed from premises:Yes ~
Name of Owner of premises ..................... Address ................... Phone No ................
Name of Architect .......... : ................. Address ................... Phone No ................
Nmne of Contractor ......... ' ................. Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly alli buildil'lgs, whether existing or proposed, and, indicate all set-back dimensions f¥om
:operty lines, Give street and block humber or description according to deed, and show street names and indicate whether
~terior or corner lot. ~
rATE OF NEWYORK, ~ ,
OUNTY OF...~.t~.,~i.(.).Y,,t~.... S.S
......... ]k~o~[.q ..... .~.6..R.~...~.~.~'.¢.~. ~"~ ............ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
'~ove named.
e is the ..................... ; ...................................................................
' (Contractor, agent, corporate officer, etc.)
C sakl owner or owners, and is duIy authorized to perform or have performed the said work and to make and file this
pplication; that all statements conthined in this application am true to thb best of his kmowledge and belief; and that the
'ork will be perfomned in the manner set forth in the application filed therewith.
worn to before me th~s, ~
............. .~. ........ dayof .... ~ .........
i NOTARY pUBLiC, S~.te ~...~
No 52.4526771 ...................................
Quahfmd m Suffolk O0untY . 0 ~Signature of applicant)
Commmm0a Expires March 30,~