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Home My WebLink About13486-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13957 Date Oc.~ober 24 ................................................. 19 85 THIS CERTIFIES that the building ........ .N.e.w..D..w.e.l. 1..i.n~. ......................... Location of Property 1100 Miller Rd. & 100 Raccoon Rd. Mattituck House No. Street Hamlet County Tax Map No. 1000 Section ...1.0.6. ...... Block . 10. . .Lot . 006 Subdivision....Hfi. c}9..A..~...ay..E.~..~.. .......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 4 19 .8.4. pursuant to which Building Permit No. 13486Z dated ..... .O.c.t.o.b..e.r..2. 3. ........... 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 ......... ......... New Private One Family .D.welling ........... The certificate isissued to BOECKMAN, MARK & CAROLYN (owner, ~8~=~F~ of the aforesaid building. Suffolk County Department of Health Approval 14- $O-188 UNDERWRITERS CERTIFICATE NO ............. P..e.n.d.i.n. ~ ............................. Building Inspector Rev. 1/81 TOWN OF SO~THOLD B~ILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 13~86 Z Permission is hereby granted to~ j~ \ ~j ....... ................... · "r .............................................. ;'"'";"'_' ............................. c'~ ......................... ~'"'"'~"~""~";~ · ~o t I .~.. cc.o. ~ at premises located at ..].J ........... ~//~..~.....~..~. ....... .~.....~ ............. (-t~O ............... ..l~.. (:3 .~. ........ County Tox Mop No. 1000 Section ..... ]...?...~. ........ Block ...... J .............. Lot No ............ ,,ur~uont to op,,,=,on dat~ ..... .~..~.....~ ................. , '~.~.'t., ond op,,ro¥.d by th, Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall .~;touthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ocr 2 4198 !, BLDG. DEPT ~ TOWN OF SO ~I~ in duplicate ~ A. This application must be filled in typewriter OR ink, and submitted/. ~V, ,:~o~zhe Building Inspec- tor with the following; for new buildings or new use: ' ' ' 1. Final survey of property with accurate location of all buildings, property dnes, streets, and unusual natural or topogra ph ic 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. Su bruit Plann lng Board approval of comp leted site p lan 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 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 requ ired to p reDare a certificate. C. Fees: ~1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date .~..~..~. ~.. · .~...l.~. ~.~.... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property House No. Stree t~J Hamlet Owner or Owners of Property ~.~.~,..~lO. (~. ~)~.~..~...~..0'..~~ .................. County Tax Map No. 1000 Section . .~..~.~. ........ Blo~k ..." ' !.~. ......... Lot...~. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~?.4¢-~ .~. ·. Date of Permit /. ¢'2.~.l~J~.~/Applicant ~~ ....... Health Dept. Approval ........ - ........... Labor Dept. Approval ........................ Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $,..~'.~ ..................... / Constructi~n above described building and per~it~ts~ apple codes~ regulations. q .......... ........ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner ~ A~< ~-~ ~ ~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this Notary Public ~~_~County SUSAN KOWALSKI NOTARY PUBLIC, Stale of Ne~ No. 4734102 Qualified in Suffolk County ~emmission Expires March 30, FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY 20DE 4 o FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1003~ THIS CERTIFIES THAT only the electrical equipment as described below and $ntroduc~ by the applicant ~med on the abo~ application number in the premises of ~.s exami,~ed on 0(~ ~ob~F ~;~ ~ ~i~ a~d found ~o be in compliance wi~h ~he r~quirements of this Board. FIXTURE FIXTURES RANGES EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 4,4 42 DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET $ E E OF "~C COND' 2/0 HO. OF HI-LEG O~ HI-LEG NO, OF NEUTRALS OF NEUTRAL L~do21e Eelctrlcal Cont~ 783 ,~G~ENEI~AL MANAGER This certificate must not be altered in any manner~ return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ~_ ~ .... = _CO.O~PY FOR I~!,LD!NGpEPAF~TMENT. THI~ COP~y O~F CE F[?~ ~! ~ATF[M ~S!:,Np~,I~ ~ETEB ED}IN ANy MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined C~ .o~...'~..., 19~. ~! Approved .......... ~.~..., 19~.. Permit No ............ 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 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 admit authorized inspectors on premises and in building for necessary inspectio,ns~//~ ~ (Signatug~ of applicant, or name, if a corporation) ..... ( .... .......... ' . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0..,,9 " ............... -i. - .~.,...c..~ .~.~ .................................. Name or owner of premises ....... .~..~,..~.~:,_....~...~:.%.~..~. ~.A). ........................................... (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 ...................... i. Location of land on which proposed work will be done .................................................. ... ...... .... ....... ttouse Number Street Hamlet . County Tax Map No. 1000 Section . [ .cO..(.~ Block l ~. Lot ' t ' J~ ........ Filed Map No ............... Lot ............... Subdivision..' ~O~-~. ~'[Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ~.(,¢~c~ ~,3 ~ f-~O ~ :. b. Intended use and occupancy ........ (~.6I.E_. ..... .~.,~..,(~..,~.~( ..... ~'-~..~,.:'¢'.6~&, .&J.f~ ............ ~ii~'~.~ .?i}.,.,~ 3. Nature of work (check which applicable): New Building .......... Addition . ~ ........ Alteration ......... Repair ' Removal Demolition ' Other Work ~.~ (Description) 4. Estimated Cost ........................ Fee .......................... '~' (to bel paid on filing this application) 5. If dwelling, number of dwelling units . .~...~...v · ' · Number of dwalling units on each floor ............... If garage, number of cars ........... '"' ~'" -' ~"~ ...................... i .......................... 6. If business, commercial or mixed occupancy, specifylllj,t~e~an, dgxtentofeachtyPeofu~e .............. .~, .. 7. Dimensions of existing structures, if any: Front .... i~... Rear .... Height ............... Number of Stories ........ .~; fiL .............. ~ .......................... Dimensions of same structure with alterations or additions: Front ~ Rear Depth ...................... Height ...................... Number of Stories .............. ~ .... ~¢.. 8. Dimensions of entire new construction: Front .... :7.7~...(~.. Rear ......... Depth . .. Height ............... Number of Stories ....... J .~. 9 Size of lot: Front ~-,.~ 1 Rear 2~.~..~. :' Depth Z .~7. 10 Date of Purchase Name of Former Owner 11 Zone or use district in which premises are situated 7~ 12 Does proposed construction violate any zoning law, ordinance or regulation: Will lot be regraded ........................... a.,~l/ill excess fill be removed from premises: ~ Yes ^ Name of Owner of premises ~r~.~~6/....~_~}ess..' ............ i .... Phone No.'~..~.~. · .~.Q")..~...N.o. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. igdicate 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 NE~'~RK.,,/4 ~ ~ ......... ({ F.g'o"??n' ivii l' Uiiti _.. ? ..... above named. being duly sworn, deposes and says that he is the 'applicant lie is the ~¢~4-':..-~ i ' (Contrac~r, 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 contained in this application are true to the best of his knowledge and behef; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Not, afl( P,u,blic, ....,, .,,~ ......~./'~.g~d'Aff'../.~ County ,~ / ~ .... BETH ANN NEV " ~ 4,-- ~, 52-B125850, Suffolk C~ ~--~/ ~J ..D o ;,fi?:' Sq / // / / ///