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Home My WebLink About12995-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No. ZI5377 Date ...M~a.r.c.h..18, 1987 THIS CERTIFIES that the building ........ A..c.c.e.s..s p.r.y. ............................. Location of Property . .R...O.: .~....i~..A.~.~. ROAD MATT ITUCK House No. ' .............. 'S't/e$i ....................... ['l~ie~ County Tax Map No. 1000 Section ...1.2.6. ...... Block ...6 ............ Lot .... 2.4. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .' April 4, 1984 .. pursuant to which Building Permit No. 12995z dated................april 9, 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 ......... ..... .A.q q e..s.s.q r. y..b.q i..1 .d.i.n.g, .i.n..r. ?.a.r..y..a.r.d... .................................... The certificate is issued to HAil131 E MILE S of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.A. ............................... UNDERWRITERS CERTIFICATE NO .................................................. FLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 IPOR~ NO. 9 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERk41T k4UST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12995 Z Building Inspector, Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- lB02 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted m I~m=a===a to the Building Inmec* 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 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 property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use. occupancy end 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: . ' i. Certificate of occupano¥ Neu D~ellzng,$25.00, Accessory :$10.00 Busu~ess $50.00 2. Certificate of occupancy on prmexisting dwelling ~ 50.00 3. Copy of certiflcate of occupancy $ 5.00, ove~ 5 yea~ $10.00 4.Vacant Land C.O. $ 20.00 5.Updated ~.0. $ 50.00 Oa~e .......................... 6. ~lteratlon $25.00 New C on = t ~ u c b t on ...... Old or Pre-existing 8uilding . .~ ......... Vacant Land ,. ............ House ~o. &treet am Owner or Owners of Property ./~~a~' ."' ............... ...... ........ ..... Subdivision ................................. Ftl~d Map No ........... Lot No .............. Health Dept, Approval ........................ Labor Dept. Approval ........................ Plonning Board Approval Underwriters Approval .............................................. Request for TemperaW Certificate ..................... Final Certtflcate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets ell applicable codes and regulations. Applicant .................................................... Ilev. lO.lO,7a FIELD INS?ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTIqOLD, N,Y, 11971 TEL. 765-t 802 This is to advise you chat the job under buildlng permit no. !,2~95Z_ issued to Maddie Miles on -.4~84 for Accessory is completed and n final inspection has ( ) has not ( x ) been done. In order to complete this file, it is necessary cha~ a Certificate of Occupancy be issued. Please fill out the cnc%osed form, return same to the above office with a check for'~$10.00 payable to the Town of Sou~hold. Please indicate to Whom th~ Certificate of Occupancy ia to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Ptense. help u~ to clear ~p chi~ mst~er aa thnt legal action does r~ot have to be taken. Thank you for your prompt attencion. Very truly Victor Le~sard Execut ~ve Admln~strator Vi:gar encl . 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL qeOUTHOLD, N.Y. 11971 TEL.: 765-1802 E×amined I. Approved .~...~.., 19~..~. Permit No. !..~..q. 9. ~ ~ Disapproveci 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 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 applicmlt. 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,~ins~pection~,~, r 2/97 f~//~ · ~..~....~...-:~t..../...~ ............ '(Slgtnature of applicant, or name, if a corporation) .... .~..~...~.~./.~. .... ~..~.~.. .......... (Mailing address of applicant) State whether applicant i 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. (Name and title of corporate officer) Builder's License No ........... ~//~. .......... Plumber's License No ......... ]~/.//~. .......... Electrician's License No ....... ]~/~. ........... Other~rade's License No ....... j~lf~ .......... - 1. Location of land on which proposed work will be done ..... '~foff~... ~.~ ...... ~7..~.~.~. ...... ....r.s. .............. ................. ' .. House Number Street Hamlet County T~ ~ap No. 1000 Section ...... ~..~ .a. ....... Blo~...~ .............. Lot..d. 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 ..................................................................... b Intended use and occupancy 3. Nature of work (check which a ~plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem ~vai .............. Demolition .............. Other Work ~.*!~. ~.r.7..~FJ)... 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, number of cars .... . ....... . ............................................................. 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height Nurpber 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 ........................................................ 9. Size of lot: Front ........... ~ ............ Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which p(emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will 10t be regraded ' Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ! Address Phone No Name of Architect ......... .................. Address ................... Phone No ................ Name of Contractor i .......... Address ......... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block, number or description according to deed, and show street names and indicate whether interior lot. or corner STATE OF NEW YORK, i S.S COUNTY OF ................. ................................................ being duly sworn, deposes and says that he is the applicant ~ (Name of individual sighing contract) above named. He is the ..................... ~ ................................................................. i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y 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 knqwledge and belief; and that the work will be performed in the mann6r set forth in the application filed therewith. Sworn to before me this i · Notary Public,. NOTARY PtJ[I/IO, Sta~e ol New Yor,~ NO. 4701878, ,ql~ff01k Comity ,~,i (Signature of applicant) Telm Expires ~vbrch 30, 19~,5