The URL can be used to link to this page

Home My WebLink About13260-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13373 Date April 18 985 THIS CERTIFIES that the building ...... .A.d.d. $ .t.i.o.n. ................................ Location of Property .9. .7.0 ........ Village Lane Mattituck House No, Street Hamlet County Tax Map No. ]000 Section . .1..~.4 ....... Block . . ..0.6 .......... Lot 03.5 Subdivision ......... X. ..................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J..u..n,~ ..... 2.6. ...., 19.8.4. pursuant to wt~ich Building Permit No....1.3.2..69.Z ............ dated ....... J...u.iX ..... 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 ......... ..... ~.~..c.K .%a..~.~.e.~. o..n..t.o...~.x.~, s..e.~.n.~. 9.n.e.. ~..a.m.~.~.7. p?..~.~.n.q: .................... Tile certificate is issued to .................. K.U .H.N.,' .H..E.N.R.Y...~..G.O.P..N.N.E. ................. (owner, le*see-er-tene~t) of the aforesaid building. Suffolk County Department of Health Approval .......... .N].~. ............................ UNDERWRITERS CERTIFICATE NO .................. .N/.~. ............................ Building Inspector Re'*'. 1/81 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PE~RIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13260 County Tax Mop No. 1000 Section ..... .~.)..,~ .......... Block ......... ,,~,, ......... Lot No. o.L,~,,--~,. ............. ~-~uon~ ~o o~,co.on ~ot~ ...... ~.~...~..¢. ...................... . I~...L~. ond o~p~o~O by Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrica~ 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: 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. C. 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 New Building . ,. ~ ....... Old or Pre-existing Building $15.00 Date .... ~. [~ ././.~. ,~. ~ ..... ............ Vacant Land House No. Hamlet Owner or Owl~ers of Property /-/~ .~..~.~/ ~ · .~..~- .0~. -~. ~~--~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. [~.(~..~. D te of P rmit Applicant Permit No. a e ............................................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~.. ......................... Construction on above described building and permit meets all applicable codes and regulations. ~5 ~ t~r~ Applicant .................................................... Rev, 10-10-78 FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & INSULATION (1st) (2nd) PLUMBING PER N. Y. STATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL - ,, SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~..~j .~:. .... , 19~. Y. Approved...~ .~ ..... 19.~.t} Permit No. ] .~..'~..~..0..~. 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 di/tgmm 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 thd 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, buildin~ code, housing code, ami. regulations, and to admit authorized inspectors on premises and in building for necessary insp~.~ ~.~j ~/~, ~ ' ' ' i~i~~~ :ii ~(~2~a~)'~''' .... .q. . .La ......... · (Mailing addresls of applicant)/~/~ OCTP{ ' pctc~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ......................... . ............. .................... ............. Name of owner of premises. ~.l .~...~ .~.~ .... ~_~.... ~.~'~.~.... ~.....~...t~...~..~..~r.' ..~. :....~...~..2-/; ! (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 ...................... 1. Location of land on which proposed work will be done .................................................. V,'/lo fi ........... ........... house' ~q~ g~r ........................ ~r;ii ............... Hamlet " County Tax Map No. 1000 Section . .t/./.~..-. ..~.: ..... Block ..... .& .......... Lot ..... /.~.. ......... 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 ...... J .....~'-.~. CO. i J .~]... ~. ~...~. (.(. }. i~..~ ....... · ..................... b. Intended use and occupancy .......... [.~.(~ .~.... -..L~. ?~..(~..~. 10. 11. 12. 13. 14. property lines. Give street and block humber or interior or corner lot. Nature of work (check which applicable) New Building ..... ' ..... Addition ..~)..~..~..F~. Alteration .......... Repair .............. Removal .............. Demolition-.]. ............ Other Work ......... · . ,~ ~ ~ (Description) ,: Estimated Cost.. , .................... Fee .. ......... .... .... q. (to be paid on filing this application) If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ If g~age number of cars ' If business commercial or mixed occupancy specify nature and extent of each type of use D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth ~ HeiSt Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...........[ ........... Rear ...................... Depth ...................... Date of Purchase ........... : .................. Name of Fomer Owner ............................. Zone or use district in whlc premises are s~tuated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded.........~...............~ .... Will excess fill be removed from premises: Yes No Nme of Owner of premises ...~ ................. Address ................... Phone No ................ Nme of Architect .......... ~ ................. Address ................... Phone No ................ Nme of Contractor .~ Address Phone No PLOT DIAG~M Locate clearly ~d distinctly ~1~ buildhgs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from description accord~g to deed, ~d show street names and indicate whether STATE OF NEW YORK, S.S COUNTY OF ................. ' being duly deposes and says that he is the applicant .................................................. sworn, (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 tb make and file this apphcat~on; .that all statements contained m this apphcat~on 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 .......... rid...~.. ..... '.day of ...... ~ ...... ., 19~.~r Notary Public, ........ ~---t~.. !. ~..D ~ Coun~ .... JTenw £aplres March 30, 19P-° , LOT lc~ $. 17' I1' 40" E.~ 179.~6 N. TT'I 1'40"W.- 87.36 LOT IT L.Lt '7