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HomeMy WebLinkAbout13225-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy No. Z 15866 Date . June 19, 1987 THIS CERTIFIES that the building ...A.c.c..e .s.s.o.r..y ................................... Location of Property 50 Breakwater Rd. & 105 Mill Road Mat:tituck h3ds~ 'N'ol ................................. Street Hamlet County Tax Map No. 1000 Section I 13 ..... Block 03 .Lot 007. 2 Ar 1 e.ne Marvin--Minor . 149 I Subdivision .............................. F,led Map No ......... Lot No .............. conforms substantially to the Application for Building Pernfit heretofore filed in this office dated June I I , 1984 pursuant to whicb Building Permit No. 13225. z dated.......................June 14, 1984 ..... 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 storage building as applied for. The certificate is issued to MICHAEl, AND JOYCE MATTES ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. Iq /A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWH OF SO~33'IOLD SUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. N? BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 13225 Z Dote ........ ~..,'~'...~ ......... /. ....................... , Permission is hereby granted to: ...... ~..©. ....... .,..~.....~..~./.. ..................... ...... Z/~.~.z~.~...=.~.~......zz.~...~z.. ,o .....~. ~..~zz~..~....q~....,~. ~.~.~. z~..fL .~....~..~....~.~......~.4~ .~...~ at ................... premises ,ocated:'""i ....... a,': ......................................................... ~..~...... ,~-~..~ ~' '"'~ii 'i "i"i ~"°i ~i~.'.~ii i~~ .~.~. ........ Count~ Tax Map No. 1000 Section ..././..~... ........... Block .....<~.. ............. Lot No. pursuant to appiicotion doted ........ ~..~...~....~.. ........ ~.~ ................... , 1~....~., and approved by the Building Inspector. Fee $..i~, .............. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~,~ 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: I. 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. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.'00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... New Cons tz-uc t i on ...... OJd or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property ...~..(..Cr.("~ .~i?...(-7-../~f.A(.D....?~F.(~..C~...~. ?r..' .7~..~.~..~ .-?. .......... County Tax Map No. 1000 Section ............... Block ., ~ Lot.. Subdivision ..... ~]~' -~..~'~. ~ ............. Filed Map No. ?. ?.? ..... Lot No .............. z V Permit ........ Date of Permit .......... Applicant .................................. Health Dept Approval . L b O pt App I · · ...................... a or e . rova ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. C°nstructi°n °n ab°ye described building an~~a.. I1_ aTic~gulations.. Applicant .... .. ~ .~. ~..~¢~r~.. ~ · - ~'. ~k~.~..r~....c.~<,~%....., . ................... e..,o.,o.,a FIELD INSPECTION COMMENTS FOUNDATION ( 1st } FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: -'1 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN IIALL SOUTHOLD, N.Y. t 1971 TEL. 765-18o2 This is Lo advise you that the job under building permit no. 13225Z issued to Michael Mattes on 6/14/84 for Accessory ia completed ;, final Inspection has ( ) has not ~Y'-been done. and in order to complete this file, it is necessary that ;~ Cc'rtificatc of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a cheek lotS10.00 payable to tile Town of Sonthold. Please indicate to %{hem the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or uae in unlawfnl witbout n Certificate of Occupancy. Please h(,lp un to clear lip this matter so that legal action does not have to be taken. Thank you for your prompt attention. Very truly Victor Lessard Executive Administrator VI,:gnr eric! . 0 '~' ~' "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 ~, TEL.: 765-1803 Examined..//~,4~...fBi...., 19~. ~ Received ~//~'~ 9..~. Disapprom a/c ........ .:: ...... .... /.. ,... uilding Inspector) APPLICATION FOR BUILDii'qG PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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. 4. 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, buil~h,~g code, housingx.~X~e, and regulations, and to admit authorized inspectors on premises and in building for necessary in~~. (Signathre ofapplicant, or name, if a corporation) .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. .................................................................................. Name of owner of premises .,~./.C~g*~..&~..~:../~.../~./fl... v.~.~.g-~J.~-../~..~..~..~. 5 ........................... (as~on the tax roll or latest deed) If applicant is a corporation, signature of duty 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 ...................... Location of land on which proposed y/9~k will be done. A/~.//ff.'~.e'~.~. '.f~..~.~..~,4/.e7~.. ~..~. · .~'~...~../-?..~. · .Y~. · · ..... House Number Street Hamlet County Tax Map No. 1000 Section . ./~.. ~ ......... Block ~ Lot..~..~. 7~ 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 .. ~..~..~.. ~ ........................................................ and ~ · b. Intended use occupancy.../~:4.r-~..'~. ~ ...... ;~,/...~..~.~.~..~.ll[[ll~..~,....;~ .... / 3. ature of work (check which apphcable): New Building . .2e~.~".. ~.. 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 'g' i '~ff O DOfq ~ TOl~,~6-~' /~(J/ff~)/fff ~,- ,t~,~Jq4 (Description) 4. Lstnnated Cost ....... i ....................... Fee ................. (to be paid on filing this application) 5' If dwelling ..... Number of dwelling units on each floor . , number of dwelling iumts .......................... If garage, number of cars . .~. ..... i .................................... ....... .. . .... . . ..... .. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...~'.... ~ ........... 7. r)imensions of existing structurds, if any: Front. · ~* ~. ..... Rear . .f~. ~. ........ Depth ..~. f.~..... Height .. ~..~. ....... Number of Stories .... ~ ................................................ r)im f 'ith It ' dditions ,.,?.477 ~ R ensions o same structure w a eratmns or a : Front ........... ear ................. I ?pth ...................... Height ...................... Number of Stones ..................... 8. Dunensions of e,~ntire new construction: Front... i ./..Q.a ..... .~ Rear .../. (.,9 ........ Depth . ~..z~'. ......... Height .... 25. ......... Number of Stories .... .ff...f. -3"/-(.odJ ........................................ 1 i. ~one or use alSmCt in WnlCn pr~mlses are Slruateu .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: . .,~..o.. ' ...................... 13. Will lot be regraded ...... ;,~..Q ....... , ........... Will excess I~11 be remDved from premises: Yes No 14. Name of Owner of premisesZ~./~g~..t-..Z~..,~. T .7j.~-.5. Address ./>.~. ~'o~- ,R..3 / Phone No.~.- amc of Architect ........................... Address ................... Phone No ................ Name of Contractor... . . .~.'~ ~*- .......... ......... Address ................... Phone No ................ · i PLOT DIAGRAM Locate .clearly and distinctly all! buildings, whether existing or proposed, and~indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ,S.S COUNTY OF ................ ................ ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... ................................................................... (Contractor, 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 belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... /..~.....? ..... day o.f ............ 19 .~. Notary Public, ........ ~ounty ' ~,' SYLVIA EL8AUM i NOTARY PUBLIC, State of Naw York ...... , No. 4146809~0-Sult01k County (Signature of. applicant) ! Commission EXpires Ma~ch 30,19