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Home My WebLink About13259-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15382 Date March 18, 1987 THIS CERTIFIES that the building ... Ad. .d .i.t.i.o.n. ................................... Location of Property 12605 MAIN ROAD MATTITUCK /t~/~s; '~0: ....................... Street Ham/et County Tax Map No. 1000 Section 14 I ..... Block 4 .Lot 32, 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 25, 198/4 13259Z ....................... . pursuant to which Building Permit No ...................... dated . .J..u.ly..3.,..I.9.8.~. ............ 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 ......... .qOl~s.t.r.~t¢.C..Rh.~.d. type roof over rear steps. The certificate is issued to Presbyterian Church Mattituck ..................... ' ..................... of the aforesaid building. Suffolk County Department of Health Approval ......... N../.-5 .............................. UNDERWRITERS CERTIFICATE NO ..... N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13259 Z Permission is hereby gronted t~:~4 ~..:.~ ........ .~.:.~.: ............................. ,o .:.~~....~:~..~......~...,~....~ .......... ...~2~~.....~.....: ....................................... , .......................................... of premises located at .]...'~...~..~...~'.. ......... .~..q~...J~;~ ............. ~~ ............................ County Tax Mop No. 1000 Section.~.i.i..~l. ......... e,ock ........ ~. .......... Lot No....~:L~..I ........... pursuant to application dated ...... ~.~.....:~.....~... ................ , 19.~...~., and approved by the Building Inspector. ~ Fee $.........~.... ........... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Fluilding Department Town Hall Southold, N.Y. 11971 765- t802 APPLiCATiON FOR CERTiFiCATE OF OCCUPANCY Instructions A. ~his application must bo filled in Wpewritar OR ink, and submitted ~a maa=~a=a to the Building In~pec- '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 unu~al natural or topographic features. 2. Final approval of Health Dept, of water supply and sewerage d|sposal-{S-9 form or equal}. 3. Approval of electrical installation from Board of Fire Underwriters. 4..C. ommercial .b. ulldings, Industrial .buildings, Multiple R. esldences a.nd similar buildings and in;talla- tigris0 a cart{finale of Code comphancc from the Archttect or Engineer responstble for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957)0 Non.conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pcoperty 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 {nspectior~ of buildings or premises, or other pertinent informa- lion required to prepare a certificate, C, Foes: 1, Certificate of occupancy New D~elllng,$25.00, '^cces.~ory :$10,00 Buo[,e~, 550.00 2, Certificate of occupancy on pro-exi~ting dwo.llino $ 5 0. O0 3. Copvefccrti([cate~foccupanc~ $ 5.00, ove~ 5 yea~s ~10.00 c.o. o.o0 5.Uoda[ed C.O. $ 50.00 Oate .......... 6. ~lteration $25.00 No. Construction...... O~dof~-ex~s~noSuHd~n~ ............ Vacam~[amd ............. House No, Street tta/nl~ t County T~x M~p No. 1000 Section ........... o ............................. ~ ' ' ' Flied Map No Lot No oubdw~smn .......................................................... Permit No. ~.~.~..5'?.~,., Date of Perm,t. Z;'~,~; ,,,...Applicant., u',; ..... ~ ...... Health Dept Approval Labor Dept Approval . Ur~derwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~... ................. Foe Submitted FIELD INS?ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD OF[qCI'.' OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTIIOLD, N.Y. 11971 TEL. 765.1802 This £s to advise you that the job under bu[ld£ng on __.1./_3~.~4__._ for 'Addition is completed a fi. hal ~nspection has ( ) has not ( x ) been done. and In order to complete this file, it is necessary that a Certificate of Occupancy be i~sued. Please fill out the enclosed form, return same to the above office with a cheek for $25.00payable to tile Town of Southold. Please indlca:e to 14bom the Cerclficate of Occupancy is to be mailed, and arranse with tills office for an inspection (late Occnpancy or use in unlawful wlthout a Certificate of Occ.pnncy. l'lense, help lis tO clear t,p ch{n mat:er so that legal action doe~ tloC have to be Cakes. Thank you for your prompt attention. Very truly y~, Victor Lessard Executive Adm{nistrator VI,: ga r Examined .~..~. · · Approved .... ~¢- Disapproved a/c ........ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 76,5-1802 ., ., I~.L~. Permit No. t h~53 ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 properW 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 auth°rized inspect°rs °n premises and in building f°r necessary insT,' .w..~:.. ~ (Signature of applicant,/_o4 na~ae, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ................................................. (as on the tax roll or latest deed) If applicant is a yorporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ Plumber's License No ...... t~,/O. 6ff~'. .......... Electrician's License No .... ~..c~.g~ .......... Other Trade's License No ...................... 1. Location of land qr~ which prol~osed work will be done .................................................. ...... ¢ ..... x../.?..sz.a ................ House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................... b. Intended use and occupancy ..--.~.~.--.O.d.. ~. O,O..~..'..~' .~7.0. ~C... ~ .~:..$:t~ ...................... 3. Nature of work (check which apphcable): New Building .......... Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition .............. Other Work ............... 4. Estimated Cost .................... Fee o~ .... '~' (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 ' mlxe:d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .............. Rear Depth Height ............... Number of Stories ........................................................ Dnnenslons of same structure with alterations or additions: Front ................. Rear .................. D pth ................... !.. He:ght ...e J ' · ................ Number of Stories ......... 8. Dimensions ~f ~re new construction: Front...~?~..', .... Rear .............. Depth.. Height .../. ........... Number of Stories ...................................................... Size of lot: Front .......... ~ ........... Rear ...................... Depth ...................... Date of Purchase .......... i .................. Name of Former Owner ............................. Zone Or use district in which prbmises are situated ................................................. Does proposed construction vic ~t,e any zoning law, ordinance or regulation: .. i: ........................ ~.~ Will Io~ be regraded ...... ~,, · .~... ........... , ...... Will excess fill be r~mo~ted from premises: Yes Name of Owner of premises .t'C, ~.~7..-Pq.~.~ .~..C~. y: ?.U) Address ~.~.th. ~., ~ .q-t~../7~o~-k Phone No .... Name of Architect ............ ~ ............ Address ................... Phone No ................ Name of Contractor . .i~F'OX~ .,e ~... ,/R.o~ ~..t~ ...... Address . ./.~...~'~.o./3~, ~'f~C~.:. Phone No.. 7~. 2~.. t~..~.~. PLOT DIAGRAM 10. 11. 12. 13. 14. Locate clearly and distinctly ale 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. lO.Pt STATE OF NEW YORK, COUNTY OF .............. S'S ............................. ; .................... 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 manne~ set forth in the application filed therewith. Sworn to before me this .... ..... County. ' ;e a lic/ t)" NOt/~Y ?UBLIG, State a~ New yorl~