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Home My WebLink About13523-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate O[ Occupancy Z13292 APRIL 1 85 No .................. Date ................................. 19 ... ADDITION THIS CERTIFIES that the building ................................................ Location of Property ....6.5.5..ppp.w. qpp..L.~..~F ..............E.~..S.T..~. ~..~.r.?. ............... Mouse No. Street Hamlet County Tax Map No. 1000 Section ...0.3.7 ....... Block 01 ...... Lot 1 0 Subdivision..q.~.R.D.~.N..E..R.,.g. BAY ESTATES .2.Ffled Map No' 275 LotNo. 97 conforms substantially to the Application for Building Permit heretofore flied in this office dated OCTOBER 10 198.4. pursuant to which Building Permit No. 135.23Z dated ....N.O.V..E .IyI.B.E.R...8 .............195.4. ., 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 ......... .... F.Q.~..~.N .6P.~.~.T.zo.~. .T9. AN EXISTING DWELLING The certificate is issued to LAWRENCE J. MATZEN & WIFE ..................... io~n'o;', 'l;s~e'dr't~t~a'n't} ...................... of the aforesaid building. Suffolk County Department of Health Approval ....N./.3,. ................................... UNDERWRITERS CERTIFICATE NO .... r...E.N.D.I.~ 9.. ~.fl~ ¢ 5.6.9 ........................... Rev. 1/81 Building Inspector FOR~ ~0. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CDHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 13523 Z Permission is hereby gronted to: ..... ~ ..... ~ ., ......... ~..~. ........................................................... County Tax Map No. ]000 Sect,on ............. ..~. ....... Block .......... .[ .......... Lot No ......................... ,ursuan, tO opplication dated .,O,,,~....L..~. ................. , 19,~...¢~.., ond approYed by the Building Inspector. Fee 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 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: I. Accurate survey of p~operty 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.00 3. Copy of certificate of occupancy $1.00 4.vac.nt ,,and o.o. Date .................~..~,"' [.~.~..~' New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ~..~.~... ~.o.~ .~.o?./..~.~: ....... , ............ ~..~.: ............ House No. Street Hamlet Owner or Owners of Property ...... County Tax Map No. 1000 Section .... ~ ~ ....... Block / Lot ,/,dp ........ Subdivision ............ ~7. ................... Filed Map No... ~ ..... Lot No .............. Permit No../. ~,~...~ Date of Permit ////°P//~EApplicant 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 perr~it,Fleet, S,,all applica~e)codes and regulations. Applica ................ Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW Y~ORK 100~ only the electrlcal equipment as described belo~ and introduced by the applicant named on the above application number in the pretnlses of ~ry ~tz~n~ E/S ~d ~e~ 300' ~f Old ~d, ~0 ~iew ~d, F~st ~rion, N.Y. ~n tke follow[ag location; ~ Baseme.t ~ lsr FI. ~ 2nd FL Section Block Lot was examined on ~ ~ ~ ~ and found to be in compliance with the requlretnents of this Board. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES OUTLETS FLUORESCENT 5 DRYERS SYSTEMS NO. OF FEET S E NO. O~C~C~,COND OTHER APPARATUS: /Aectric F~oln iI~tars~ 2-1.25l~ 1-1,Okw~ 1 C NO OF HI-LEG OF NEUTRAL This cert[fkale must ~oi b~ elfered ~n ~ny manner; return to the otfice of the Boerd if incorrect. Inspectors m~y be identified by their credenfiels. COPY~OR B~ILOING DEPARTMENT THIS COPY ~F~ER~ IN ANY MANNER. DINSPECTION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. PLUMBING - INSULATION PER N. Y. .' STATEENERGY !?/>~ o~ ~<~ ...... ~DE m . FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~)...~..*~.~ ~ , 19~ tI Approved .~. ~..~. - - -~.. ~, 19~. ~. Pe~it No. ].~.~ Disapproved a/c ..................................... TOWN OF SOUTHOLD Received ........... ,19... (Building Inspec~r) APPLICATION FOR BUILDING PERMIT Date../.~./.Q .......... , 19 .fffzf 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 this 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 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 Y6rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. te, and regulations, and to The applicant agrees to comply with ............. all applicable laws, ordinances, building code, housing c9t ad nut authorized insp¢ctom on premises and m ~u:ldmg for neces~~ (Mailing address of applicant) 11'7~91 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .... ./,.¢... -' Name of owner of premises . .~...~..7'.2-.~-'7.~...)..g:..~..~..~.~..~.¢.~'....~....~..~..~'. .................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duiy authorized officer. (Name and title of corporate officer) _C, ,~ .~ ,Jj . . .~f~. .~. .~'*. .... Builder's License No. ',o~- ·: :~. · Plumber's License No.../~J.q. ~/~)~ .............. Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~..~z..~../9, tlg.&7.~, t.3. · · .~ff./5~. ~....~'.~. ~.~. ?.~...~ ............. ltouse Number Street Hamlet (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..~lO.~.~..~l~..~..~....~.~...'.Y[~.. .... /. '~'J~A~.... b. Intended use and occ~upancy ..~...~. · .~...~...~_7~1. ~d.~.. e'~_~.... ~, ~.~_~4. ]. ~..~../..q~...-~/~.. ~'. 3. Nature of work (check whi¢t~ a~plicable): New Building .......... Addition ....... Alteration ....... Repair .............. Rbmoval ............. Demolition ......... Other Work ........... "~'"~ ~ ! ~ I ~ _ _~ ~ (Description) ' 4. Estimated Cost... 9 ~ ........................ Fee ............................... q' (to be paid on filing this application) 5. Ifdwe!ling, numbe{ofdw611inffunits ....... ~ ..... . Number of dwelling units on each floor ~ .............. If garage, number of cars .... ; ....~ .............................................................. 6. If business, commercial or mixe~ occupancy, specify nature ~d extent of each tvge ~f uso ........... ,...., ...... 7. Dmensions of e~istinastmcturgs, if any: Front..~. ~ ...... Rear . ~.~ ~ ...... Depth.~.~ ....... Hmght .... ~..~ .... Number of Stories .... 1 ..................... ~ ............................. D~ensions of same sImcture ~ith alterations or additions: Front . .~7~ ........ Rear .~ ......... Dep~ .... ~ ........... ;.. HeiSt ...................... Number of Stories ...................... 8. Dimensions of eBtire new const~ction: Front ........... Rear ............... D~ ............... tle~ght .... r ..... Number of Sto~es ...................... ,. ' ...... ........... q:. 9. S~zeoflot: Front ............... Rear .... ~' . .......... ' e ......... '. .. 10. Date 0fPurchase . ~:..~/..Z~. ......... Name of Fomer Owner ~O~g~.'.%..~.~. 1 I.Zone or use district in which pr~mises are situated 7 2 ...................... C~ .......................... 1 2.Does proposed construction viohta any zoning law, ordinance or regulation: ...~ ................... 13. Will lot be regraded ....... ..; ~ ............... Will excess fill be removed fr~,~[emises: _ Yes No Nme of Owner of re ises X~e- ~, Address q~ ~//~ ~ ~e~ne N~f~'~ 14. Name of Architect ~ ~.~l~~ddress ~qO.~O.~.~Phone No. Nme of Contractor .......................... Address ................... Phone ~ PLOT DIAG~ Locate cle~ly ~d dis~ctly ~i bufld~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from property ~nes. Give street ~d blockl number or description accord~g to deed, ~d show street nines and ~dicate whether interior or comer lot. cou~Y OF..~.. &0.4~.. S.S ..... ~./4. A$'.Z.~ .Z~. .... k ~.Q.~¢~.~ ..... being duly sworn, deposes md says that he is the applic~t (Name of individual sig(ing contract) above named. He is the ...... ~. ~ ~d~C ~Tp. .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly autho~zed to perfom or have perfo~ed the said work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ........... ~.~ ....... day of~ .......... ,19~ Notary Public, ~..~~ ..... Count ~mJseio Expir~ ~rch 30, I~