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HomeMy WebLinkAbout13466-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13851 Date September 12 85 THIS CERTIFIES that the building inground pool. 1010 Donna Dr. Mattituck Location of Property House No. Street ..... ~ ....... Hamlet 115 15 17 County Tax Map No. 1000 Section ............ Block ............... Lot ................. × × Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated September 26 1984. pursuant to which Building Permit No.__ 13466Z dated....0ct°..............ber 5 .... ..19...,wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Inground pool & fence. ROBERT & SHELIA KLOS The certificate is issued to ..................... ?o'~,b~~ ...................... of the aforesaid building. Suffolk County Department of Health Approval N/ UNDERWRITERS CERTIFICATE NO N 6671 Building. Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13166 Z Permission is hereby granted to: ......~.~.~....~.~ ............................................. .... ..~.,..~,~ .................. ~...~, ........................ ~.~, ot premises located at .l...~.J......[.....~..~%....~.,~,.~ ........ .~.~ ................ County Tax Map No. 1000 Section ....... l..J....b..~.. ...... Block......................] ~' Lot No ...... ~...~. ............. pursuant tO application dated .... ..~..~...~.........~...(..e .......... , 19.~..~..., and approved by the Building Inspector. ~'~'~uilding In.~ector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted i ~ 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 [ines, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual 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. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. '$5.00 $15.00 .... ...... New Building .....~.. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./.~./.~....~3./~/Q ./~' .'.'~. I~..~. ".L>.~_~..., ........ .~ House No. Street Ham/et Owner or Owners of Property . .~..~. O~'.r~...~. ?'....~..b .~.'.\.. ?[~........./ ~-~\ .~ ............... l/. "-' County Tax Map No. 1000 Section ... ~% ....... Block .. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~..4TI&..~.. Date of Permit]/c//~.~'.'~' .... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary ~ertificate ..................... Final Certificate ....................... Construction on above described building and permit meets all applicable codes and regulations. ._~,~, ~.,.,_7L40d Applicant .................. Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia II1~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.Oo $5.00 $15.00 Date ..... ' ........ New Building ~ Old or Pre-existing Building Vacant Land Location of Property .~.~./~ . .~.~./~)../.~/?~. D~" (~:; ~../.~. '.~./). '~.(~.c¢. ~ Owner or Owners of Property I~...~. ..... ~. I ........................ / County Tax Map No. 1000 Section .... ~'.O ....... Block .... /...O.~.. ..... Lot...(,~t'..~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. 1~.~.~'~. · Date of Permit //~/~ .~.Applican, Permit No .................................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ............. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .L~ ............... .... .~. ...... Construction on above described building and permit meets all applicable codes and reg¥1ations. ~.(~Applicant ............ ;~e,¢~, '~'y~-O, '~-~ ................... Rev, 10-10-78 E1ELD IN ~I~ECm~I~ON COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C DE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~..~.~. · -, 19~'~'' Permit Nol..~.%~ ;~ Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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. e. 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 4the 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,,r-~ova, l, xor dem~Li~tion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building[cod~, t~ou~inggffode,~ and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~~~ ......... d ; .... (Signature of applicant, o~r[]~ n~a~ ifa corporati ) · (Mailing address o~fJapplicant) State whether applicant is owner, lessee, a~, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................................................... (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 ....................... ...... ................ /. .......... ........ ltouse Number Street Hamlet County Tax Map No. 1000 Section ....... J ].~'~. ...... Block ....... ./.~.'~. ...... Lot .... ~ .7. ............ Subdivision~9. ~..~~ Filed Map No ............... Lot..~. ~.:.. ' · (Name) 2. State existiog use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................................................. b. Intended use and occupancy . ~.&AffG-Af~./'.C/f-d,4A~f4... ,~ff:(~. ........ · ............................ 3. Nature of work (check which apt~licable): New Building .......... Addition ....... Alteratio/a ....... ~.. Repair .............. Remgval .............. Demolition .............. Other Work ............... ' (Description) 4. Estimated Cost ........................... Fee ...................................... ' '~' (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixe~ occupancy, specify.~nats:re and extent of each ty3?.~ of use ....... ..~.~ ·, ......... 7. Dimensions of existing structures, if any: Front .-ff.~...% ~..' j ...... Rea~: .4~ :~. ....... Depth .'~.'~.. ..... Hei ht . . Number of Stories . . r)imensions of same structure with alterations o.~o. ns:'Front ................. Rear ................ Depth .................... i' ' Height ... t..agi~,~ ............. Number of Stories ......... 2..~ ........ 8. Dimensions of entire new construction: Front ...... /..Z/6~' .... Rear .... c~.(.~, ....... Deptho?.. O~ ........ Height ................ Number 9f Stones .................... 2 ............... i/' ~..~' ~"5. ' i .... 9. Size of lot: Front ...././.D.. t.t~9 ......... Rear ....~e~.~,e.tS~) ......... Depth .- ........... I0 [)ate of Purchase Name of Former Owner I 1. Zone or use district in which pr~mises are situated 7; ................................................. 12. Does propbsed construction vioiate any zoning law, ordinance or regulation: ...~ ..................... 13. Will lot be regraded ........ i .... * .............. Will excess fill.be removed from premises: _,.t,~e~ _ No I4.Name of Owner of preanises~ ~.D.~ .... Address (0."?',~). ~Phone No.. ,~/ff.~.. Name of Architect '/~~'.3 ~ L" Address~"F~' '- ~'~'~ ' Phone No. ~.' .~.f ..... ~./..J/... Name of Contractor. ~.~~..,~ff/~-.4~.... Address. ~ ~i. Phone No ................ PLOT DIAGRAM Locate~ .clearly and distinctly ali buildings, whether existing or proposed, and. indicate ail 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. STATEOF' N li.V~/.YDg K (Name of individual sigfling contract) above named. ....... being duly sworn, deposes and says that he is the applicant He is the ............................................................ ' ! (Cc~t~actor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements con~;ained 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 befor~ me this N0ta~T Public, .. nty NOTARY PUBEIC State of New York Qualified in Suffolk County ' : (Signature of applicant) LOT N:'M[Sb.R ~J N I SUFFOLK.,COUNTy DEPARTML. NT OF HEALTH SERVICES FOUtVDATION Z O~ATIOH 1~'~3 '1~ TNE WATER :~UPPL, Y & NAME SEWAGE DIUPOSAL FOR TNIS RE. SIDENCE WILL ADDRESS CONFORM TO THE STANDARDS OF SLJFFO LK COUNTY FOR APPROVAL OF CONSTRt~CTIQ. i'~ uNt. Y .: 5O 0 09,3) ('I8 _J O , , ,. DATE ............. HS R'EE NO._ ......... HEALTH SERVICES APPROVED ................ TELEPHO~ E ,, ' I GUARANTEED ONLY TO, C/f/¢,4G0 T/7Z[ I~ I V~'/PH~'A D ,SAVINGS StTUAIF:D AT MAT'rlTUCK ' TOWN OF SOUTHOLD- SUFCFO/ K SCALE: 1": 40' DATE FILED MAP. NO: 4256 DATE' 5UCCESSQR TO THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY YORK 10038 ~ ~J~ (~ ~SS JOHN STREET, NEW YORK, NEW~/ ~.,~ ~.~..o.,~o.o,,~.~ N 667~49 THIS CERTIFIES THAT in the following location; ~ Basement ~ 1st FI. ~ 2nd ~. (~side Section Block Lot DRYERS SYSTEMS NO. OF FEET E E R V I C NO OFpERCC.,i~COND, OS ACC,W'CONDG' NO, OS HI-lEG oFA Hi. LEGW' O,NO OF NEUTRAt$ A W, ~w_~mi~ P_ool~ %his certificate ~rs ~1~ at the ~e of ~ection only. A~~vtz~n'ts it is advi~le ~ ~ f~uen~ te~ ~/o~ r~aJ~s ~ by q~lified No~th ~yview l~ad This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. Inspectors may be identified ~ COPY;~FOR Bp~LDING DEPARTMENT~ T.I~ cOPY OE CERT!RCATE I , I~N ANy MANNER.