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
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