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Home My WebLink About13251-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12636 Date July 23 984. addition THIS CERTIFIES that the building ................................................ Location of Property 275 Alois Lane Mattituck House No. Street Ham/et County Tax Map No. 1000 Section .... .1.2.3. ....Block . 6 ......... Lot 4 7 S ..... Applonia Kirchgessner -..- uomwsmn ............................... rhea Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated J u n e 25 ,19 .8.4. pursuant to which Building Permit No. 1 3251 Z dated ...................,........June 26 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 ......... Deck addition to existing one-family dwelling. The certificate is issued to ...... EDWARD SIEGMANN ...... (owner, ,levee or tena~ of the aforesaid building. ' N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector I~0~'~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13251 Z Permission is hereby granted to: ..... ~.~.~.....~.~ .................... .:.~.~....~..:~:....?..L?.~.~ ...... , .... ~.~.....~.......~: ........... ~.....~.......~..1 ..................... - '- '. . - --- ' - .-' - - - -___ .............. ; ......... : ............................. at premises located at ......~.....~..~ ...... ~...~....~ ....... .~.~ ......................... County Tax Map No. 1000 Section ...... ~,.,,,;~,.,,,~. ...... Block ........ '!,~, .......... Lot No..,,~,:.:] .............. pursuant to application dated ...... ~ ................................. , 19 ., and approved by the Building Inspector. Fee $....~..'../. ............. Rev. 6/30/80 FORM NO. 8 TOWN OF SOUTHOLD Bu ildi~g Depart~ent Town Hall ,~,;outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted~i~dupl~teto 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. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peoperty 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 anv housing code or' safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: ' C. I. Certificate of occupancy 2, Certificate of occupancy on pre-ex~s~g dwelling / land use 3, Copy of certificate of occupancy $1.00 --Pre-Existing C.O. ~15.00 Vacant land C.O.~-~ 5.00~ Date , .~ P.~.. ~ ...... New Building .... '~. ........ Old or Pre-existing Building .......... Vacant Land ............. Location of Property ~, ~2 ~ f) .~7~..~ s ........................ Hou.~ No. Street Hamlet County Tax Map No. 1000 Section ..../. ~ .~. ...... Block ...... ~ ........ Lot .... ~'. ~ ....... Subdivision o~o~ r~ci~(~Ess~Z=-~ . .Filed Map No. - .Lot No. Health Dept, Approval ........................ Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above demribed building and~/,rmi~ me;ts~l_a_pp_l~able cod~ Rev. 10-10.78 FIELD INSPECTION me FOUNDATION FOUNDATION 2. (lst) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE (2nd) FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ ,,. ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~....,~.. ~.~. .... 19~. .~. Approved ~t~-..'~. ~. ·., 19~ .~. Permit No.}..~.~. .~../..~. Disapproved a/c ..................................... Received ........... ,19... (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. 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 ihall 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 tmtil 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 inspec~ns. (Signature of applicant,~or name, if a corporation) .. .75. h.m. ...... (Mailing address of applicant) State whether applicant, is owner, lessee, agent, 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. AP?~O*J~D AS NOTED FEE:...~_~_,.._~-___.By: __~. C=. L-. Builder's License No .......................... NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE Plumber's License No ......................... FOLLOWING ~NSPECTIONS: 1. FOUNr3,ATtON - TWO REQUIRED Electrician's License No ....................... FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Other Trade's License No ...................... 3, INSULATION Location f ' . 4. FINAL - CONSTRUCTION MUST 1. o land on winch proposed work will be done ............. BE Ce)MPLETE FOR C.O. L "'" ~'~ '"" "},'L[ db~s'~di'~5~' '~'OXt'_C' ~T .... .27.5 ......................... .......... House Number Street STATI}I~4~I~STRUCT ON & ~I~IE G .... ~CoDES. NOT RESPONSIBLE FOR Subdivision ./~. 'P.~.~ ~.O../~./~../.~.I/~C-~.~. ~,'5..~..~.. ,~w. 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 ...~. ~. ~.~.. ~.~. P.//./.~.' K..~.~(J. 5~ ~-~.. · · · ~..D..}~....g~..i(< ./~..~1.... .............. b. Intendeduseandoccupancy AP'Pi'T~o~! .0/~.....~..~..c:.&.. 10. 11. 12. 13. 14. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ... ~ .... Alteration a ' ~ .. 't ...... epalr .............. Removal .............. Demolition .............. Other Work .... · , , (DesCription) 4. Estimated Cost...[.~..0.0.' .O.0.I .......................... 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. nnenslons of exlstmg structures, if any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimensions of same structure With,, alterations or additions: Front ................. Rear ...... ...... ~. Depth ................... .. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories . :" - .......... Size of lot: Front ........ ........,.....~ Re/~r, ........ .. ............ Depth ...................... Date of P rchase ! Name of Forme Owner Zone or use district in which prbmises are situated ............. Does proposed construction rio,late any zoning law, ordinance or regulation: ................................ Will lot be regraded ...... f~,~., ..... >,. .......... Will excess till be removed from premises: Yes No Name of Owner of premises .~.?,tqha?.~. ~.l?oo.~.a..a.v]. Address ;.75 h~"~l'~. ~,'v~.. Phone No .~q~..~'{J.id ...... Name of Architect ......... : ................. Address ................... Phone No ................ Name of Contractor Address Phone No I PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether Locate clearly and distinctly all property lines. Give street and block interior or comer lot. STATE OF NEW YORK, COUNTY OF .................. S.S iI II ......... ; ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual sign!ng contract) above named. He is the ...................... i ................................................................... i (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 p¢rformed in the manne~ set forth in the application filed therewith. Sworn to before me this ............ dayof Notary Public, ] [[ii. [ [~:i... ,]~...~.¢-: ~/~County H[t[a NOTARY PUBLIC, State of New Yeik k: ........................... No, 4,707878, Sutf0tk C0unt;;..i ~ (Signature of. applicant) Term [xi]lres Maroi 30