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Home My WebLink About13294-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13093 Date Dec. 31 .8.4 .................................................. 19 . THIS CERTIFIES that the building Addition Location of Property ..3.2.5. .... Center St. Mattituck Ho~ No. ' ..... 'S'tle~i ..................... hid, tot County Tax Map No. 1000 Section 123 .Block 02 .Lot 007.2 Subdivision X ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore f'ded in this office dated ..... J..u .ly....9 ........ , 19.8..4 pursuant to which Building Permit No...1.3.2. 9. .4 .Z ............. dated ......... .J.u. 1. y ....... .2.5. ....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 ......... Addition To Existing One Family Dwelling The certificate is issued to HAROLD & ADA KEYES ..................... ?oYn'o;,:~.~:&~) ...................... of the aforesaid building. Suffolk County Department of Health Approval ......... .N/.A. ............................. UNDERWRITERS CERTIFICATE NO .......... N669101 Rev. 1/81 Building Inspector · OB~ NO. ~ TOWN OF $OUTHOLD 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? i329~ Z Permission is hereby granted to: ...[[~.~ ~..~ ~ ~ ~ ...~.~.~.~.~.....(~..¥:~;~....~j~..~.~ ................... .... :.m ;...i...~.;.,:.....~ ......... .t .................... .;..~ .......... at premises located at ;~ ~ {~ -t, ~ .,~.. ~ -. ....... County Tax Map No. 1000 Section .... !...'.'.~...~ ........ Block ....... ~ ..........Lot No ......'.~..:..:.%Z... ....... pursuant to application dated ..................................... , 19.~.[:[., and approved by the Building Inspector. Fee $. ~2.,~.; ............. · C/: ~-~ ~-~-~ ~c ~ ........... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fitied in typewriter OR ink, and submitted-~;~c~,[[c=tc 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 suppiv 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: 1. Accurate survey of property showing all propertv lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: I. Certificate of occupancy on pre-existing dwelling Certificate of occupancy $5.00 2. 3. Copy of certificate of occupancy $1.00 land use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building // Old or Pre-existing Building Vacant Land Location of Property ,~.~ .~ ....................................... House IVo. Street Hamlet Owner or Owners of Property ~..'~ ~ .~..~ .~ ~2 /~] County Tax Map No. 1000 Section ...~ ~ ....... Block ............. Lot ~ ~ =' ~ Subdivision ................................. Filed Map No ........... Lot No .............. ~:~Dat, ofPermit ?~>~Applicant ~p(Q~.c~ ~5~,~ Permit No ................ Health Dept. Approval . .~ J' ~ . Labor Dept Appro al ........ Unde~riters Approval .................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ............... Fee Submitted Construction on above described building and p~r~rf~t meets ali applicable cpde~and regulations. ~-C~ ~"~q ~'~ D Applican~~ ~~. :~~ ................. R~. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~000~'~4 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 Jpplicatlon No. onyile 288415/84 N 6 8 9101 THIS C6RTIFIES THAT only the electrical equip.~ent as described below and introduced by the applicant named on the able application number in the prem~es of 123.00 0200 007002 in the following Iocatio,~; ~ Base,tent ~ 1st ~. ~ 2nd FI. Sectim, Block Lot was exa,~ined on and found to be in cotnpllance with the requiretnents of this Board. OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT VAPO~ 4 8 5 4 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLE DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-~e deteGtor R V I C 2/0 1 2/0 325 Willow Li¢#2816 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectorls may be ! FOR BI · THI,~ [RTIFI, RED credentials. NER. 765-1802 BUILDING DEPT, INSPECTION~ [ ] FOUNDATION 1ST [ ] ROUGH' PLBG. [ ] FOUNDATION 1ND [ ] INSU ~LATION [ ] FRAMING REMARKS: 'DATE FINAL INSPECTOR, FIELD ~NS?h~CTION COMMENTS FOUNDATION FOUNDATION 2. (2nd) STATE ENERGY QODE FZNAL . o~ Ct6~, ~ ADDITI~ONAL CONMENTS: 'FORM NO. 1~ TOWN OF SOUTHOLD BUILDING DEPAR'I'MENT TOWN HALL · ~OUTHOLD, N.Y. 11971 TEL.: 765-1805~ Examined ..... TM[ ~¢'' .......... , 19'.~!. Approved ....... ?.1.~.~ ...., 1~5'7.. Permit No...~'..~.~.~.% Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING'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. 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~ns. '2 ~.. ~) ·. , ~.eO~h.. [/: ,., ,, .~ ...... /~'~ ~x,~ai~r~ ~..T~l~cant, or name,,i~co~poration) State whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder. Name o; owner of premises.../~.~./r~.0 .~..~...~.....'~...~. &...4 .~ .... . .~...~.~..g...'~. .................. (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 ...... ~ .7 .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..Ct~ . . · .?~..~..~ ............................ .......... ..C. . ........................................... ............... House Number Street Hamlet County Tax Map No. 1000 Section ] ...... .~. ...... Block ~ Lot....~...~7 · 3 .................. ..... 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 . ~). 7.~"~......~.~ , ..... · ...... b. Intended use and occupancy.. ,gT--~-~'~..'i .~/.. ~ ...... iiiiiiiiiiiiiiiiiiiiiiiiiiiii property lines. Give.street and blocs interior or corner lot. k ( PPil ) ' Alt " ' 3. Nature of wor check which a cable: New Building .......... Addition .......... eration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... _a~ (Description) 4. Estimated Cost ............................... Fee . ' ................................. *" (to be paid on filing this application) 5. If/dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage num her of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .. ................ 7. Dnnensmns of ex~stmg structures, if any: Front .... ~7...O. ...... Rear ...~.?. ....... Depth .............. ,/~'. * Number of Stories ! Height .................................................................... Dimensions of same structure With alterations or additions: Front .... ~. ~. ......... Rear .. ~. ~. ............ Depth ...... .~. ~ ......... ;... Height .... /O.'~. ( ............. Number of Stories .... ( ................. 8. Dimensions of entire new cons[ruction: Front ..... /..~.. ...... Rear ... [.~ ......... Depth . .~. ?.'. ......... , Height .... /~.-~-. ....... NUr0ber of Stories: ..... ! ....' .............................................. 9. Sizeoflot: Front ..... 1.7. E,t~ ......... Rear.. tt~ ~. . Depth lO Date of Purchase ~.0 .~. ~ I-- ~. ~ ~'aMe ;f~o'r~e'r'6~v ........................ ............ : .......... ner ...................... ! I. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction vidlate any zoning law ordinance or regulation: ............. 13. Will lot be regraded .7~.~. ~. i .......... . Will excess fill be removed fnom premises: Yes 14. Name of Owner of premises P~[t~4~....., ~'~?v~... Address . ~ ~.-~st :g?., .~P]~,.. Phone No ................ Name of Architect . z.~ ........ Name of Contractor .o..65.~.~. r~. · a ........... Address .................. Phone No .... :.: .......... .~.'.. ~)~. N ~...~w-... Address r~ a~.~..~ .~.~.. Phone No.?.g.~. ~ .4~.. PLOT DIAGRAM Locate clearly and distinctly all 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 170 ' 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 duty authorized to !3erform or have performed the said work and to make and file this application: that all statements contpined 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 b~fore me this Notary Public, .... ~ .~.c../~..~..~..P~.... County NOTARY PUDLE, State oi New Yor~' , · · No. 4707878, St*lf0lk ~0unt~rt' (Signature of applicant)