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Home My WebLink About13637-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1. ~ .33.5. ......... Date .... a. p..r.5.]_.. ! .6 .................... 19.8.5. THIS CERTIFIES that the building .... .D?.v.m.e. ¥ ..................................... Location of Property 17275 Main Road Mattituck House No. Street Hamlet County Tax Map No. ]000 Section . q..q .5 ........ Block ...... 2. ........ Lot .... .~. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0 c ~c.... l @ .........,198 t~. pursuant to which Building Permit No..q .3.6.3. 7..Z .............. dated ........ ~D.e. q,..q.8. ........... 19.8. 4., 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..~.~..d.o.r.m.e.r., .~p..e.x..~.s.~.~..nC..d.w.e..Z.Z.~.n. 5 ....................................... The certificate is issued to ..... 0.1. .k .v.e..E.:..G.q a..e .b ...................................... (owner, XoX, c~,~'X¢O~ X X of the aforesaid building. Suffolk County Department of Health Approval ...... iq/. g ................................. UNDERWRITERS CERTIFICATE NO .............. #. i~..6.8.5. ¢ .3.7 .......................... Building Inspector Rev. 1/81 FO~' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13637 Z Permission is hereby granted to: ..... /~~£.:.?/.~ ........ ...,~...~. ......... ~.~..._ ..Z...,...:~,~_z'. ........................... .......................................................... County Tax Map No. 1000 Section .... /.../..~.... ...... Block ..... ~ .......... Lot No....~....~....~... ....... pursuant tO application dated .... L...~.......~..../...~. ....................... , 19~..~., and approved by the Building Inspector. , Fee $ ......... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAN( TOWN OF 8OUTHOM) Instructions A. 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 p;Coperty 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 ~$5.0~ 2. Certificate of occupancy on pre-existing dwelling $15,0 0 3. Copy of certificate of occupancy $1.00 4.Woant Land c.o. $2.00 Date .......................... New Buildin~ ............ Old or Pre-existin~ guildin~ ............ Vacant kand ............. Location of Property ....... ¢ ~ ................... , ............................... House No. ~ Street Ham/et Owner or Owners of Property ......................................................... Subdivision ................................. Filed Map No .... :-7 .....Lot No. -- 13 57 Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ~ ,Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and~;z~ermit meets all ap/plicable codes and regulations. Applicant...~.~.".~:..~....~.:. 'x~./'-~.~..'-~'. ...................... Rev. 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~-*~CJ BUREAU OF ELECTRICITY ~%~.1 02~ ~[.585 85 JOHN STREET, NEW YORK, NEW YORK 1OO38 310303/85 ~'.,e -~,,-,,ca,o,, ~'o. o..~,,e N~ 685337 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application nu other irt the pre,nises of Olive Graeb, ~/S Route 25 Main Road, 200'~./0 Marratooka Lane, ~lattituck, ~Y in the followlng location; ~ Basement ~ 1st Fl. was examlned on ~aroh 28, 1988 FIXTURE OUTLETS 4 DRYERS [~ 2nd Fl. Section BIoch and found to be in compliance ~i~h the r~qulrements of this Board. RECEPTACLES SWITCHES FIXTURES INCANDESCENT FLUORESCENT VAPOR 7 5 4 FURNACE MOTORS FUTURE APPLIANCE reeue~S Lot RANGES OVENS DISH WASHERS EXHAUST FI TIME CLOCKS ~NIT HEATER MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: 1-G.F.Z. 1-Smoke 4erector S E R NO Oi~ERCC~COND. AW, G OF CC COND ,V I C OF HI-LEG NO. OF NEUTRALS AW, G OF NEUTRAL Ruland Electric Coo PoO. Box 143 Hattituck, NY 11952 Lta#242 This certificate must not be altered in any manner; return fo the office of the Board [f i0correct ¢01~ FOR 81 f GENiERA~,L MANAGER Per / 1 moX be by their credenfiols. FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY COMMENTS QODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ['~ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION It/I/FRAMING [ ] FINAL 'REMARKS: DATE INSPECTOR, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1803 .., 19~.~/~ermit No. [.~. ~..3 p.,7 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . .[~ .x {..P .......... 19 ?.~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 tiffs application may not be commenced before issuance of Building Permit· d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permil 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 fbr 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 thc Btdlding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ 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, building code, housing code, and regulations, and t¢ admit authorized inspectors on premises and in building tbr necessary ~. ~ections. ............... · (Signature of applicant, or nmne, if a corporation) · : .... ~..~.~ ....... ~ ~. ~ .~.·. ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ~ ~- '~ APPI~OVED AS ~OTED ........ -:' .................. Name of owner of premises ...~)..(-:tJ?.~ .... ~.,...(~. (~ .~.. ~..,... ..... .:. ~E.:~.~_.By ! · .~_~,'~ ...... [as on me tax roll oI~JJ~r,~ie~u.,~LDiNG If applicant is a corporation, signature of duly authorized officer. ¢65-1802 9 AM TO 4 PM FOR Tide - ~OLLOWING INSPECTIONS: l, FOUNDATION - TWO REQUIRED .............................................. FOR POURED CONCP. ETE (Name and title of corporate officer) 2, ROUGH - FRAMING & PLUMBING Builder's License No...~. ~ .~D..~..~-.~ ...... 2 .... 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O. Plumber's License No ......................... ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N. Y, Electrician's License No ....................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR Other Trade's License No ...................... DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done ................................................. ../..7.. 2-.. 7. 5 .--L'-. ......... . .-:-m.. ~:-.....Cw4.... .......... ~~..~,-..., .o., .% ......... House Number Street Hamlet County Tax Map No. 1000 Section ...[.../.'~. · ....... Block . .~.. ........... Lot .~.47..~. Filed Map No ........... Lot ............... Subdivision ..................................... ' ' ' ' (Name) · · ' · u anc of ro osedconstructlon: 2. State ex~st~ng use and occupancy of premises and intended use and occ p y~c p ,,p a. Existing use and occupancy .... ~'~",r ~/ ~ ~ ..~"~t'~~ ~~ b. Intended use and occupancy .... ~ .... ~?.....~ .(.~-~.-.<..u-~-A~..~.y. ( ................... 3. Nature ofwork (check which applicable): New Building ..... ' .....'Addition .......... Alteration ..'~..'i ..... Repair .............. Removal .............. Demolition ........... .... Other Work ............... 4. Estimated Cost .~.~..Q .O. ~ (to b~ paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling un{ts 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 structures, if any: Front ............... Rear ...... ! ........ Depth ............... Height Number of Stories .' Dimensions of same structure with ' ' ' Front i , Rear ' ' ' alteratxons or addxtmns: ............. ..................... Depth Height Number o" Stories 8. Dimensions of entire new construction: Front ............... Rear .............. De?th : .... ,,; .......... Height Number of Stories . ' ~ ' : 9 Size of lot: Front Rear '~ ,~ ~' :~ i Depth 10 Date of Purchase Name of Former Owner ' 1 1 Zone or use district in which premises are situated ': 12. Does proposed construction vi~late any zoning law, ordinance or regulat~on: ... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes': No' 14 Name of Owner of premises Address ~ Phone No Name of Architect ' ' Address i Phone No Name of Contractor Address · ' ~ ' ' PhoneNo PLOT DIAGRAM ,.':. Locate clearly and distinctly all buildings, whether existing or proposed, ~ind, ifidiefite all set-back dimensions from property lines. Give street and block number or description according to deed, and sho~,v street names and indicate whether interior or cornerlot. ~ ': i,' x', " STATE OF NEW YORK, COUNTY OF ................. S.S ................................................. being duly sworn, deposes and says that (Name of indivklual sig~ing contract) above named· He is the ............................................................ (Contractor, agent, corporate officer, etc. of said owner or owners, 'and is duly authorized to perfo~n or have performed the: application; that all statements contained in this application are true to the best of hi work will be performed in the manner set forth in the application filed therewith. Sworn to before me this he is the applicant aid work and to make and file this knowledge and belief; and that the ................. .,..day of ......... ~ .......... , 19... . Notary Public, ........ County ~ L.~.~ ~OTg~Y PUBliC, Slale of Now York N, la/,