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Home My WebLink About13536-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.3. ! .5.8 .......... Date ..... d..a.n.u.a.~, y..2.2. ................ 19~5. THIS CERTIFIES th th ildi Deck addition at e bu ng ................................................ Location of Property .... .2.1.0..5..C.~.m.p. Mineola Rd. Mattituck House No. Street Ham/et County Tax Map No. 1000 Section 123 ..... Block 06 .Lot 05,2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...0.q t.,..1.8. ......... ,19.8. q pursuant to which Building Permit No...~ ~5.3.~ ¢ ............. dated .... .N.o.v. :. .1.5. ............... 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 ......... ... ?.q .k..a.d.d..~.~Aq~...~.q .~..~.~.~.~..~.n~..~. ¥?).~.~..~.. ................................... The certificate is issued to THOMAS & BARBARA MAC LEOD (°wner,XIq~'~ ftr~r~t~ X of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N / A Building Inspector Rev. 1/81 FOB~ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 13536 Z Permission is hereby granted to: ..... ,o ....... ~.'~.~:.~..~.........,~.~.~..... ~.~..~..~.~.~t~....~......~.~.~... ..... .... .~.~//..,~ ....................................... / at premises located at ...... ~..~.r~............~.......~........~.~.~--~...~ ............................ ..................................................... pursuant to application dated .OC .~......../..~.... ........................ , 19 ~.~**.~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Depertment Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~to the Building Inspec- tor with the fol[owincj; for new b~dldings 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and flpre-existing" land uses: ~ 1. Accurate survey of peoperty showing ail property lines, streets, buildings and unus~al, 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificato of occupancy on pre-existing dwelling / land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C,O. $15.00 Vacant land C.O. $ 5.00 Date ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..c~../ ......... .~1~../~/./~.o¢~ ¢.~/ /.~/[,7L~./,..-~ ~,?.~ ...................... House No. '/ Street Ham/et Owner or Owners of Property....~..~ (f .5.. ~-...~?../~.~?..Y~.~ .... ~ ~ .q<..~. ~.~ .~ ................. County Tax Map ,o. 1000 Section .... ./.~..-~ ...... Block .... .~.. ......... Lot..~..' Subdivision ................................. Filed Map No ........... Lot No .............. 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 perrnit meets all applicable codes and regulations. Rev. 10-10-78 FIELD INSFE~'~~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ?LUMBING INSULATION PER N. STATE ENERGY q~DE FINAL ADDITIONAL COMMENTS: TEL.: 765-1803 l TOWN OF'SOUT~IOLD . , ........... Disapproved a/c ............................. /,Z .....~ ~ .... .~ ................... ............. , ....... (Building Inspector) ~PPklCATIO~ FOB B~I~DI~G PERMIT ~ {~:tr:¢ ........ ~... ;i,'-~ b~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 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 Bnilding 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 York, and other applicable Laws, Ordinances or Regulations, for the construcQon 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 to admit authorized inspectors on premises and in building for necessary inspections. . .~...~..~ ~5~& ....................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~¢L~. · .~ . . .P..~.~..~..r, ff?.~.. ~-r.~ ...................................... (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..~.~.--t_...~. ............ : .... Plumber's License No. ~~'~..~.¢~- Electrician's License No ....................... Other Trade's License No. ./L)~ ~ cr~ ' ' /~+,~ 1. Location of land on which proposed work will be done .... ~./.g)..~...0..F.../~..5.(..~.3).0t.~ (q.~ ..... ~..q. ?.a.{., ...... I ~.t.o.~ ........ .~.~. ~.~,.~..,.x.~ .... ~.. ......... ~..~.¢.,~.~ .................................... House Nmn ber Street Hamlet County Tax Map No. 1000 Section ...1.~. ~. ........... Block 6 Lot ~-..~. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 ..... O.q./~:~..r~.....~. ........................................... 3. Nature of work (cheek which apphcable): New Building .......... d ition.., ........ Alteratioa .......... Repair .............. Removal .............. Demolition ......... h . Other Work ....... I (Description) 4. Estimated Cost ..... , ....................... Fee .~ ......... ~ ............................ ~ (to be 'paid on filing this application) 5. If dwelling, number of dwelling units .............. 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 tyl~e of use ..................... 7 Dimensions of existing structures, if any: Front Rear i Depth Height ............... Number of Stories ............................ I ................... ~ ........ Dimensions of same struc~ture with alterations or additions: Front : Rear Depth ...................... Height ...................... Number ofi Stories ...................... 8. Dimensions of entire new construction: Front . . .a.'~.'~.~.". ..... Rear ....~./. i~.". ..... Depth .. ~.~ .~'.'. . Height ...q~" ' i ' ..... .......... Number of Stones....':-7:. ..................... : .......................... 9. Size of lot: Front ...................... Rear ...................... !Depth ...................... 10. Date of Purchase . I.o.~j.-85 ..................... Name of Former Owner .i .y..ge. b. ~.~ ?.k.q ................ 11. Zone or use district in which premises are situated ................ 12. Doesproposedconstruction'violateanyzoninglaw, ordinance or regulation: ...r'v~ .......................... 13. Will lot be regraded ..... ~ ..................... Will excess fill be remove~ from premises: Y~s 14. Nan~e of Owner of prem~ses~'~t.0.~s../q.~.~ .~ .~.d ........Address .-~??..~?.f..~! ~.*t~. ~ ... Phone No. ~..~.g.-.~.~.~. ~. ...... 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 she' v street names and indicate whether interior or corner lot. STATE OF NEW .~K,.. '/~' SS COUNTY OF. ~.~. (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the .................. (Contrac ' ~r~~:~ idr' ....................... r ........................... agent, corporate officer, etc.)I of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best of his! knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith.. Sworn to befOre me this · /.~..'~'.~. .....dayof..~...~'.:.,19./7"f, f ~':"'~ Notary Public, . ............... ~~. County ~'!; ~ ............ ; ~,(JRCHGESS:VE?~ C, vr