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.