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Home My WebLink About13018-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z13021 Date Novem, ber 26 .,1084J.- No. THIS CERTIFIES that the building ........... ~. g.p.~.c.u..1 .~.u.~. a. $..b.u. ~..~ .d3.n.~' ............ Location of Property .R...O.:?.'..9.f.f..E, 1..~.J.a.h.'s Lane Mattituck House NO. ' .................................... Street County Tax Map No. 1000 Section ... ] .0.8 ...... Block 3 .Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...Ap.p.~ .i..6 .......... ,19 ~,4. pursuant to which Building Permit No. ,. ! .3.0.1.8..Z ............ dated ..... B.P. ~..5.~.. 1. ~. ............. 19 ~.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 ......... ~gr. $ 9.u ]~ t. U ~.a% buildin~ ..... The certificate is issued to Ju,liana ?erse (owner, I~ ~q~z~ X X X of the aforesaid building· Suffolk County Department of Health Approval ............ .N/.A. .......................... #N665669 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOB, M NO. O 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? 13018 Z Permission is hereby gronte~to: , ~ · ~.~.~g....7~.~-:.,~-.:~~ ............... .?~ ........ .,...~ ............ .~...~. ................. ...~.~. .~A~.... .g~.~.......~.:~:.....t./.2..~..~ ............ ' '~'"""" ....................... i .................................. ~'"" : ....... '~'i""'~ ............ ~: ................ : .......... ': ............ atpremlses ocotedo, .~....?.: ..~Q.;.....~O~. .....~~...~',.~ ...... .....~..~~ .......... County Tox Mop No. 1000 Section ....... LO...~. ....... Block ...... .~. ............ Lot No.....~..:..cJ..I ........ pursuant to application dated .................................... , 19~. .... ond approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Ha~l ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY iinstructions A. This application must be filled in typewriter OR ink, and submitte~tCieet~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 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-existing" land uses'. 1, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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/ landuse--t~re-E×±st,±r~; C.0. $15.00 3. Copy of certificate of occupancy $1.00 ~ac~n'c :L~nd C.0. $ 5.00 .... ..... New Building ... ~ ...... Old or Pre-existing BuiMing ............ Vacant Land ............. Location of Property . ~ .~. f?-~/~'~.~. .... ~..'~ ftC...~-... ~.4~ .'~.5.?.-.~2~. ~/.~qq~ ...... Hou~ No, ~ ~ ~ ~ ~ ~ ~ --Street NataNt Owner or Owners of Property . ~~ ..... ~ ~ ................................. County Tax Map No~000 Secti, on...~ ....... Block .... ~ ....... Lot..~.~.. Subdivision .~.~. ~:...F ,led Map No. ~...Lot No~.~T .~ Permit No. ~/- .......... .,,,,...,. ..... Health Dept. Approval ... ~ ................... Labor Dept. Approval ~ Unde~riters Approval ~ , .Planning Board Approvs{ ~ Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $. ~ ..................... Construction on above described bu ilding andj)ermit meet~le codes and regulations. Applic~ .... /,~ ............... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY OC"~O~.~ ~0~, [~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.~ ~,~,~.,on ~o.--~,~ ~0~/~ N 665669 THIS CERTIFIES THAT only the e~c trical equipment as described below and introduced by t~ applicant ~med on the ab~ application number in the premises of in rhe followlng location; ~ Basement ~ 1st Fl. ~ 2nd Fl. G~'~O Section Block rot was examined on and found to be in cotnpliance with the requirements of this Board. EIXTURE OUTLETS DRYERS RECEPTACLES SWITCHES FIXTURES RANGES OVENS EXHAUST FANS FLUORESCENT SYSTEMS E OT R APP ATUS: E NO R V I C OF CC, COND, NO OF HI-LEG A, W. G OF HI LEG NO. OF NEUTRAl AW, G, OF NEUTRAl. This certificate must not be altered Jn any manner; return to the office of the Board if incorrect Inspectors O0P~ FOIl B. ~LDI~G DEPAHT~ENT. THIS OOP~ OF 0~ 0FIOATE ~U T NOT BE FIELD FOUNDATION FOUNDATION ROUGH e INSULATION SFECTION DATE II COMMENTS ON {1st) :Oi~ ( 2nd ) PLUMBING iON FERN. Y. ~E ENERGY :,ODE gDBITIONAL COMMENTS: STATE C now or £OrmerJ? Richard Woodhull d. 491 ~Cces --- ~ p68.18 ' ~ ~25°4.G'20 "w. :24~18 ' G$~ 95 ' N. P5 ,5 20 W. 100.02 ................. -- ...... N. 25°11 90 W. IJPlN Q 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ,pproved ......... I.I ..... 19 · Permit No J ~/) I ? ::~ )isapproved a/c ..................................... ?eceJved ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date . ~P~ 'L.. fo a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatior~ship to adjoining premises or public streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 roll 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 mil 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or _egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to flmit authorized inspectors on premises and in building for necess~~ (Mailing address of applicant) grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises .................................................................. (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ .~...~] .C..~.,,.~. ....... Plmnber's License No ............. :" ........... Electrician's License No ....................... Other Trade's License No ...................... ~.. Location of land on which proposed work will be done .............. ' .................................... House Number Street / ~ --~ ~ Hamlet--. County Tax Map No. 1000 Section .~ ........ Block '~ . ~ ................. Lot .... n .-.v..? ........ Subdivision .~../~.~?../~../~./3..I.~-.~..~¢~.~ ............. Filed So.. .qg ....... rot (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 ...................... ~ '/~ ........... ~J~q4~(~7, f: .......~ .... 3. Nature of work (check which applicable): New Building ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ................................ Fee ......................... · ' ' ' °°. (to be paid on filing this application) 5. If dwelling, number of dwelling uoits ............... Number of dwelling units on each floor ............... If garage, number of cars ...... ~ ........................ ' .......................................... 6 If business commercial or mixed ¢ccupancy, specify nature and extent of each type of use ~} ............ ~..~.t'.O. ~.t-.W.q &~ 7. Dimensions of existing structuresI if any: Front ............... Rear .............. Depth .............. tteight ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. D .h .. : Height ....... Number of Stories ..................... 8. Dimensions o~nt~ire new constm, ctmn: eront . .~o.~.~. ......... lqear . .~ ............ ~,vvm ~.- ........... Height /.¢..O . Nnml~er of Stories.../. ................................... .~-. · ..- ........... DateofPurchase /~.~r./.~..~. ............ Name of Former Owner ¢.~.~.~..t.L.~/~/.~."3..~/.~'!?':~.,,.'.~.~.~' I. Zone or use district in which premises are situated ..................................................... 2. Does proposed construction violate any zoning law, ordinance o,r, regulation: ................................ / 3. Will lot be regraded ....... /~Q .................. Will excess fill b,e rempved from premises: Yes Name of Architect .......... i ................ Address ................... Phone No ................ Name of Contractor ......... i ................ Address ................. .. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ,roperty 5ne~. G{vq strp~ ' block umber or description according to deed, and show street names and indicate whether lterior or comer lot. '~OUNTY O~u'.' (Name of individual sig~ing con!tact) .hove named. · being duly sworn, deposes and says thane is the applicant is the ................ ~ ........................................................ (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have l~erformed the said work and to make and file this pplication; that .all statements contained in this application are trne to the best of 2~wledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. ;worn to before me this qotary Public, . ....... :" -- ~ [tl/.~l~q~t ~ ~ \ /1 b' (Signature of applicant) ! NOTARY PtIIILIC~ 8tlte ~ NM YMI \