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Home My WebLink About13371-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15750 Date May {3, 1987 THIS CERTIFIES that the building .... .A.C.C.E..8 .S.0.R.Y...8.H.E.D. ........................... Location of Property 18485 Main Road Mattituck, New York House No. Street Ham/et County Tax Map No. 1000 Section l 08 ...... Block 4 .Lot .. 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated August 20, I984 ., pursuant to which Building Permit No. 13371Z dated . . .A.u.g..uy.t...2 .7.,.. ! 9. .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 ......... ACCESSORY SHED AS APPLIED FOR CHARLES B GARDNER & MILDRED /~i~.~GARDNER The certificate is issued to ..................... [o'~n~), 7~eYo~'[,~ev~X ..................... of the aforesaid building. Suffolk County Department of Health Approval N / A N/A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: 'Building Inspector Rev. 1/81 I~OR.H NO. ~ TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, H. Y. N? BUILDING PERMIT (THIS PERMITMUST BE KEPTON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13371 Z Date .... ~ ............ 3 .............. . ~ Permission is hereby granted tg: ,, ~-~ ..L~..~.......~.~.....~ .......................... ..... .~.:.~.:....L/...~.~..~ , ~ .... at premises located at ............................................................................................................................ County Tax Map No. 1000 Sec,t, io~n ...J. ...... ..~.. ......... Block .....~ ............. Lot No .....~ ............... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. $ TOWN OF SOUTI4OLD Building Department Town Hell Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must bo filled in typewriter OR ink, end submitted ~a~ to the Building Inspec- tor with tho following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unu~al natural or topographic features. 2. Final approval of Health Dept, of water supply and sewerage dlsposal-(S-D 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 tho 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: 3. Accurate survey of p~opert¥ showing all property lines, streets, buildings and unusua~ 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 cortH~cate. C. Fees: 1. Certificate of occupancy New DwellJ. nLt.$25.00. Acce.,sory ;$10.00 BusJ.~leS..i $50.00 2. Certificate ~f occupancy on pre-existing dwelling ~ 50.00 3. Copy of ccrtlficate of occupancy $ 5.'00~ over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Uodated C.O. $ 50.00 Date .......................... 6. Alteration $25.00 NewCons t~uc ~ion .... Oldo~P~e.ex~stln uildlng ............ Vacant Land ............. Location of Property . .~.~ · ~'~. ~ ............................................... Owner or Owners of Property . County Tax M~ o, 1000S~c on .......... ~ .... Bloc ............ et .......... · ' ' Filed Map No Lot No SubdlVlSlOrl ..... , .................................................... Permit No ........... Date of Permit ......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for . · ' FinaICertiflcate Temporary Certihcate ............................................ Fee Submitted $ ............................. Applicant .'g...ww.~-.~?.-.' ~'..'.~w'.~: .'~.~ ............................ I1.. 10,10 70 t 0 F1ELD INSI~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR I'.0. BOX 728 TOWN ttALL SOUTHOLD, N.Y. 11971 TEL 7654 802 This is to advise you that the job under building permit no. 13371Z issued to Charles Bardner, Jr on ___~J~7_~___ for Accessory' is completed il final inspection bas ( ) has not ( X--j--bee. done. and in order to complete this file, it is necessary that a Certificate of Occupaacy be issued. Please fill out the enclosed form, return same to the above office with a cheek for $10.O0Payable to the Town of Southold. Please indicate to Whom tbs Certificate of Occupancy is to be mailed, a,d arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Otc.panty. l'lest~e, help .s to clear .p this matter so thst legal action does not have to be taken. Thank yeu for year prompt attention. Very truly y~, Victor Lessard Executive Administrator Vt:gar encl . BI.D(], ., '~ ,JWN OF SOUTHOLD ~FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 d~.~.~.. TEL.: 765-1802 Examine ..... a~.~...~.~/..., 19~..~. Approved~.~-~.~. .~'.~., 19 ~.~. Permit No. l ?'~.~'..~.}..~.'. Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 st'~:eets 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, ordinanc~er% building c~ot[el, housing co~e, and regulations, and to admit authorized inspectors on premises and in building for necess~r~nspo~tion~ ~ [ ~ · .................. (Signature of ,applicant, or na/oe, if a c~rporation) · ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. U/.~ .~¢.tZ ~.t¢,'~...O.(~.l.~j!¥ .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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location o~fland on which proposed work will be done...~...~..... ~ ............................. ............................... ................... ii House Number Street Hamlet County Tax Map No. I000 Section ..... I.~..~.. ....... Block ..... .~. ........... Lot..3 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 .... ~:.t),,-z~5...,~. ,~.,,-~.~.. ~ ....... b. Intended use and occupancy ~..~ ~. '.~. ~.'.~ 3. Nature of work (check which applicable): New Building . .~...' ..... Addition .......... Alteration .......... Repair .............. RemCval .............. Demolition .............. Other Work ~ .............. ~ iO ~ (Description) 4. Estimated Cost..'~.~t.,...gr.0 ......................... 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 type of use ..................... 7 ..... if any: Front Rear Depth I)nnens~ons of ex~st~ng structures · tleight Number of Stories ............................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... Number of S.tories ....... ~ ......... 8. Dimensions of entire new constrUction: Front ........ ~.! .... Rear ...... ~ .t ...... 'ISdp'tit .... {~ .......... tteight .... '~. ! ........ Number of Stories ......... [ .............................................. 9. 8izeoflot: Front ........ ' ........... .R~[ ...................... ,~ep~tL4 ...................... 10. Date of Purchase ....~.~ }~i~.. i .............. Name of Former Owner .~..: ................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vio!a~ning law, ordinance or regulation: ..... ~ .................. 13. Will lot be regraded ........ I ................... Will excess fill be removed from premises: Yes. ' ~ 14. Name 0f Owner of premises .q~t~'~... Address ................... Phone No..[kgK .~.~6.tff.../'~-~~. Name of Architect ........... '.~ ............... Address ................... Phone No ................ Name of Contractor ......................... 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 block!number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .......... ....... .S'S ............................. : ............. ~.. ':. and says that he is the applicant (Name of individual sighting contract) }~5~: above named. He is the ..................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized to perform or have performed the said work and to make and file this application; that all statements tout'fined 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 ............ o~.0 .(~. ..... day o~ .... ~ .... , 19 .g)L ~