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HomeMy WebLinkAbout13539-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfi[icate O[ Occupancy No...Z. 1.3..29.4 ......... Date APRIL 1 19 85 THIS CERTIFIES that the building NEW DWELLING Location of Property 1~5 MARRATOOKA ROAD MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section . .. 1 .1 ~ ...... Block ...0.4. .......... Lot .... .0.0.9. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .. 9.C.T.O..B.~.R....2 .4 ..... ,19 .8.4. pursuant to which Building Permit No .... .~.3.5. 3. .9.Z ........... dated .~ O..V.E.N.B.E..~..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 ......... FOR A NEW DWELLING The certificate is issued to ,~.~TQN~..~..J.E.A~J. ¢i.I. 45 ~.K.A. (owner, Ys~ge' ~r't~a'n't) ...................... of the aforesaid building. Suffolk County Department of Health Approval 14 - S O- 90 UNDERWRITERS CERTIFICATE NO.. N. .fi ~ 0.4.9.5 ...................................... Rev. 1/81 Building Inspector ]FORM NO. 2 TOV,'N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, bi, Yo BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13539 Z Permission is hereby granted to: ......... 5~...×.:.........~ ........................... ........ ....~..~.,.~.~..~...~..?~z ........... .C~.~.~.~..~.~......~.....~ ....... ~.....~......~.......~... ........ 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 featu res. 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 "pre-e_xist!ng" 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. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling er land use $ Is-/$5.00 3. Copy of certificate of occupancy $1.00 Date ....... New Building ............. Old or Pre-existing Building(Z) ......... ~ ZVacant Land Location of Property ./.~. )7.,~. ........... ~. ~..~../¢...~..~.~. ~...~... ~¢2~.. ~ .... Hou~ No. Street Haml~ Owner or Owners of Property .. .'.. ........... . .................................. Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. Approval. ,/,Z./. ~.~ .'. .... Labor Dept. Approval . /, % ....................... Unde~riters Approval ~/~ ........ P ann ng Board Approva ........... Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $ ............................. Construction on above described building and permit mee~s all app~ab~Je~co~e¢ and regulations. Rev, 10-10-78 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY , 85 JOHN S~REET, NEW YORK, NEW ~ORK 10038 Oate Febraary 27, 1985 /lpplication No. o. file308852/84 · .,s ~.~,~,~ ~.~ ~ N 680493 was examined on ~D~ ~ Lot FIXTURE OUTLETS 3O RECEPTACLES} ; SWITCHES DRYERS FURNACE [] 2nd FI. Section Block andfound to b~in compliance with the rb~uirementsofthis Board. INCANDESCENT FLUORESCENT FIXTURES RANGES OVENS EXHAUST 30 ~ FUTURE APPLIANCE TIME CLOCKS LJNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Motors; l=lhp 1-G.F.C.I 1-Smoke Detector. S E R V I C E I COND' OF ~C COND OF HI-LEG OF NEUTRAL 2/0 P. O. Box 143 , ~ttieuck, N.Y. 11952 Lie, 242 Ibis certificate mus~ ~o~ be ~le~ed ;~ ~¥ m~e~; re~u~ ~o lhe office o{ ~he Eo~d i{ ~¢o~:~¢1. ~spe¢lo~ m~ be identified by ~he;~ COpY FOR BI IILDING DEpA dr I ANY MANNER, TOWN OF. SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD~ N.Y. 11971 TEL. 765-1802 CERTIFICATION Date March 25, 1985 Building Permit NO. /-~3 ? Owner , ¢~ ~" ~ ~ · '(pTease p~int) (please ~print ) .~ I certify that the solder used in the water contains less than 2/10 of 1% lead. supply system Sworn to before me this 25th day .of ~[arch, 1985 , , 19 85 Notary Public, Suffolk County (plumber ' S Notary Public FIE~D I~SFECTION DATE COMMENT'S ~ % -- FOUNDA~TION ,(.1 ~ t~) /?~: ~ U~ FOUNDATION ( 2nd) I~ !. ROUGH FRAME & /~/~ ~ ~ ~ ~ FLUMBING ~ ~ODE ~ ADDITIONAL COMMENTS: 76S-~802 BUILDING DEPT. INSPECTION [X] FOUNDATION XST [ ] ROUGH PLBG' [ ] FOUNDATION 2ND [ ] INSULATION [] FRAMING [ ] FINAL REMARKS: '~-~ DATE ~1 INS . L. 76S'1802 BUILDING DEPT. INSPECTION [] FOUNDATION IST [~/~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ZaP/FRAMING [ ] FINAL REMARKS: DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~°OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .l~....c:7~'.... ,/..5~. .... 1~-.'.. Permit No ....... Disapproved a/c .............. _~. .............. ./~..7c. // APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19.. · Date ~.,. 19 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 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, building code, housing code, and regulations, and to in building for necessary inspections. admit authorized inspectors on premises and ... ~,.:. ~.~./..--.~..,X.. .-~. ). 0..,~..J'.... (Signature of applidant, or name, if a corporation) ,. . ..~. ~....F.:..~".. ..... f.~.~>..~...~.....z//. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, e~n~neer, general' contractor, electrician, plumber or builder. Nan~e of owner of premises ~]./~...~.O../y: .~... ~r...~.~,.~t)...~ ./.Z:.~.~.-~.~.... ' ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporat~officer) Builder's License No ..... .~.~. · ? .............. Plumber's License No..~-~.../~..~.-'...~.~. · .-~..~ ~ · Electrician's License No Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~../.'~. ' · ............................. .../.¥..f..f. .............. ~:.~ ~ ./.~'. o.<~. X:,~. ,..~D..~..//7./~...7:~...2. ~ .c~;...,~,/ ...... House Nulnber Street Hamlet County Tax Map No. 1000 Section .... //.~: ........ Block ..... ~/. ........... Lot .... .~.'. ' ........... Subdivision ..................................... Filed Map No ............... Lot . · ·/?. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: V:4 c,4,~'~ 7.' ....................... a. Existing use and occupancy ............................................ b. Intended use and occupancy .... f..~..~...,rtl0../ /,f .~<'.~. ~.~r~..~[~:,q~tlm ~'~.0~. 3. Natur6 of work (check whlcl~ a plicable): New Building ..... Addition .......... Alteration .......... R~epair ..ilai~.a.~.~a,. R6rh~sval .............. Demolition .............. ~-, OtherWork ............... (to be paid on filing this apPlicatiOn) 5. If dwelling, number of dwellingiunits .............. Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mix4d 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 ..... Rear of same structure with alterations or additions: Front .................................. Depth ' Height Number of Stories 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth .............. ~ Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........ ..; .......... .. Rear ..................... · Depth ............. ... . ..... 10 Date Of Purchase ' Name of Former Owner 1 1. Zone or use district in which prlemises are situated ..................................................... 12. Does proposed construction vi61ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... /rio....-~...~ ........... Will excess fill be removed from premises: Yes No 14. Name:of Owner of premises .~., .... Address ................... Phone o ................ Name of Architect ......... , .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloclq number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OE NEBYY~RK, /7~; o o . COUNTY OF~. i o.o '..' ..;~P. (Nameofindividualsigningcon~ac;~p ~J ........ being duly sworn, deposes ~d says that he is the applicant a~ove named. ~ He is the ..................... , ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ngr set forth in the application filed therewith. Sworn to bgfore me this ; ....... ....... .... No~~P~btis ........ ~, .... ~. ~CountyK ~//~5.-.5 .: ~.....~'.~' ~;~ ~ ..... . 2 ~te~l in lan agr~ult~ bi~/ ~xists that mm/ lcontmn trace ~ qml/or mtmte~ SUFFOLK CO. HEALTF H.S. I STATEMENT O THE WATER SUPPLY AND SYSTEMS FOR THIS CONFORM TO THE SUFFOLK CO. DEPT. O~ (S)~ ~, APPLICANT / SUFFOLK COUNTY SERVICES - FOR CONSTRUCTION ONLY DATE: H.S. REF NO. i1~%2 APPROVED. SINGLE FAMILY DWEE; SUFFOLK CO TAX DIST. SECT OWNERS ADDRESS: z ,_x S_.: 9 _?~ DEED: L.,DS_.J P. I /~ TEST HOLE propedy~-iS located in erea, th~' possibil~ water ~ply ma.y afllOU~ts Special ~i~alysis- o ~ince that c~ntain SUFFOLK CO. HEALTH DEPT. APPROVAL ~ ¥. H.s. NO. ~ STATEMENT O~ INTENT THE WATER SUPPLY AND SEWAGE DI~OSAI ..... SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT OF HEALTH SERVICES. ~ iPPLiCANT .~ SUFFOLK ~OUNTY DEPT~ Of HEALTH ~l~ SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY ~ 2~ ~'1 / H. S. R~ APPR~V~: .......... ~ ~ ~v~ ~j SINGLE FAMI~ DWE~NG 0~ ''- SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BL~K PCL. OWNERS ADD~ESS: DEED. L,6~) P. ~71 ~ TE~T HOLE' STAMP ~VEYORS NEW Y~K , LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H. S, NO. ~'l~ ' i90 ' [ I STATEMENT OF INTENT I THE WATER SUPPLY AND SEWAGE DtS~:)SAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (S) .... APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCT ION ONLY DATE: APPROVED: DIST. SECT. BL~K OWNERS ADDRE~: TEST HOLE ..... ' Im , STAMP ~ ~Q~ I r~ PLUMBEf~ cE~TFF£CATION' ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDEt~ uSED IN WATEI~ PLY sYSTEM CA~NOT SUE;cEED ~/10 of 1% LEAD, i I~ copper tubing is useC~ for water distributing - system; P~P~ of types NOTIFY t~u~ *~A TO 4 pM FO~. ~ 1. FOUNDA~Ju'~ ' &ED coNCRET~ ' FOR pOU .~,,~ , pLUM~{NG ~. RouGH ' FR~,, ..... 8 3, INSU~TION MUST 4. FINAL ' coNSTpUCTION ~AT~ cON~UcTION & ~N~RGY ~D~S. NOT ~Es~oNS~BL~ ~ D~IG~ O~ CoN~U~ION E~ Phone 4; 74)400 M,dn Road , I 27 '6" x.F LOOP-. .... o: -p.L_A Phone 4774)400 Msim Road GREENPORI, N.Y~ 11944 h ~F - ~ .(~] FOUND& I" I Oi"'q V '/0'" _L_.. II ~1 IP 7~0 ,!