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Home My WebLink About13559-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z13091 Date .D.~Q~...2.~. 19 .8.4. THIS CERTIFIES that the building ....... R.e.p.a.~.r..s ................................. Location of Property 9700 Main Rd. & 40 Sigsbee Rd. Mattituck House IVo. Street Hamlet County Tax Map No. 1000 Section . . .1.4.3. ...... Block . . .0.1 ........... Lot ...0.0.2. ........... Subdivision X ...Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore fried in this office dated Oct. 15 , 198..4 pursuant to which Building Permit No. 13559Z dated ............. .~.o.v.:...2.0. ..... 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 ......... R.el~.airs to Fire Damaged Building The certificate is issued to .................. .P,.T.U.I~. ~..S.~ g.3tC, g.U.~.I.I~..E' p.. R..I.C.H.A.R..D (owner, ~e~ee-o~ of the aforesaid building. Suffolk County Department of Health Approval ......... ~./.A. ............................. UNDERWRITERS CERTIFICATE NO ................. ~/.~. ............................. Rev. 1/81 Building Inspector i~*P..M' NO. 0 TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 13559 Z Date Building Inspector. Building Impector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall · ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLDG, DEFT. TOWN OF, SOUTHOLD A. This application must be filled in typewriter OR ink, and submitted~'~,[':c=t= 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" 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. C. Fees: · . ,$5.00.) I. Certificate of occupancy 2. Certificate of occupancy on p~b:mx.istidg dwelling[ land use --?ve-~;xis bing C. 0. $15.00 3. Copy of certificate of occupancy $1.00 Vacant, land C.0. $ 5.00 Date .... New Building ............. Old or Pre-existing Building ~~Vacant Land ............. Location of Property ........ ~,~./.,~..5./.G :s. ~. ,~'.. ~,../~..~././~.., ./~. q .~..~. ....................... House No. Street Ham/et Owner or Owners of Property .... ,).~.~' ~ V~:..Z./.~'. *~-X.~./.c. ~ ~ .~../~...,.~.z~..~.~ ./~../.~.'. ............ County Tax Map No. 1000 Section ...... ./'i?i-~. .... Block .0, .O./. :..-~.. .... Lot...0..~. .......... Subdivision ................... .' ............. Filed Map No...~.o,,/ ..... Lot No.. 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 $ ........ ,D- '? a ~.rc)o d regulations. Construction~ on~_above described building and pedr~/~me.ets all applic des a~ App,ioan ..... .................... Rev. 10-10.78 FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY %ODE COMMENTS FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~...~....., 19.~. Approved Z.~ 1 Permit No Disapproved a/c . . .~ ......................... ~ / , (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date" -/'0'/i5 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 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 ali applicable laws, ordinances, building_.qcode, housing cod..e,~nd regulations, and to admit authorized inspectors on premises and in building for necessary i,nspec~/~.,~ ' ,- f-~// . ' ' ..... ..... (Signature of applicant, or name, if a cqrporation) (Mailing address of applicant) State whether applicant is ~wn~see, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ......... . ................................. , .................. ': ........ Name of owner of premises ~. . ,,'l .'.'~. ~. '/: ....~ .... 'z : ................................................... (as on the tax roll or latest deed) If applicanJAs3a corporation, si.g,t~re of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... Plumber's License No. Electrician's License No ....................... Other Trade's License No t I. Location of land p,~ Eh~ich proposed work will be done ...... ~ · · ¢ ................................... . .... House Number Street Hamlet County Tax Map No. 1000 Section . .~5.../.,4f..3. :Z/..'7..2... Block .,~. ..... Q./.-. O..o.... Lot .'~...~..O.'~.,t .O..O.?... ~ Filed Map No Lot Subdivision ................................................................... (Name) m 2. State existing use and occupancy of.p. rgmi~es and intended use a~ oc~.llpanc, K,gi provoae~[co.ns~r_p_uctioaz- a. Existing use and occupancy .~ Y....~7-~..~. ;: ~b. Intended use and occupancy ~..~..~. .... ~.,,'~,. ;~..G~.. · ' ,~dditi 3. Nature ofwo.rk (check which applicable): New Building .......... on. i ........ Alteration .......... Repair .~.~..&q¢'-..4.'U/'~.~'¢Removai;. ............ Demolition .......... !... Other Work ............... ~ ' (Descriptlon) 4 Estimated Cost ~. .~...c? .o Fee '" (to b~ 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 t~ipe of use .................. 7 Dimensions of existing struct6res, if any: Front Rear ' Depth Height ............... Number of Stories ........................... i .......................... Dimensions of same structure with alterations or additions: Front ........... ~ ...... Rear ............... Depth ...................... Height ...................... Number oF Stories ................... 8 Dimensions of entire new construction: Front Rear ' Depth Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... I Depth ..................... 10 Date of Purchase Name of Former Owner 11 Zone or use district in which premises are situated ?~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ... i ............................. 13. Will lot be regraded ..... c~' .~ ·. '~t~ .............. Will excess fill be removed from premises: Yes , No 14. Name of Owner of premises I3:~c3~f~.~bg,~vg/3. ~.. .... Address .............. ; .... Phone No. ~q ~.'.~0..t'4..~.. Nmne of Architect Address , I Phone No Name of Contractor Address i Phone No PLOT DIAGRAM Locate. clearly and distinctly all buildings, whether existing or proposed, and, ifidicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shdw street names and indicate whether interior or corner lot. '~r'Z ST,XTE OF NEW ¥ORIC cou,vr¥ OF.. 5:.v. ..... S.S .... .... ............................. (Name of individual signing contract) above named. being, duly sworn, deploses and says that he is the applicant (Contractor, agent, corporate officer, etc4) of said owner or ownem, ~d is duly authorized to perfom or have perfo~ed the ~aid work and to m~e and file ~is application;'that all statements contained ~ this application are true to the besLof his ~owledge and belief; and that the work w~l be ~erfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ~ Nots Public ~ .. ~( Commission Expires March 30~ 1~ 1 C)