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Home My WebLink About13019-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... ZJ,3.Q09 ........ Date ...~9Y.e.m.b.e..v ..... .2.1 .............. 19 84 · o o THIS CERTIFIES that the building .... .A.d.d..t .~.qn. .................................. Location of Property ..... ~..~.~.~.Z.e.y. ' s Beach Road Mattituak House No. Street Ham/et County Tax Map No. 1000 Section . 99 ......... Block ..... 3. ......... Lot ...6 .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms snbstantially to the Application for Building Permit heretofore filed in this office dated .... .~p?.i.~...4 ......... , 19~..4. pursuant to which Building Permit No..3.3. Q ? 9.Z .............. dated ...~ P..v .~.~.. 1 ] ................ 19 ~..~., 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 ......... .... .B.a.t.h.v. 9p.m' .a..d.d.i.t.i. 9.n' .t..o..e.x.i..s.t.i.n.g.. one family dwelling. The certificate is issued to .. A.t.b.~..v~..9..u.ng.a.n., .a.n. fl., ¥.if.e.: ............................. (owner, ~,t~X ~.]~gl~ X of the aforesaid building, Suffolk County Department of Health Approval ..... iq../.,5 .................................. UNDERWRITERS CERTIFICATE NO. # N 6 6 3 1 4 6 Rev. 1/81 Building Inspector FOUM' NO, S TOWN OF SOUT~OLD 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? 13019 Z Permission granted to: ,,hereby ......... ~.~.~....~.~ .............................................. ...~..~&;..~..:~,. ...... J..l..~.x..~ .... .~~.~.. ~.~~ .QA,~,~' ~~' ~ at premises located ot ...~...~..~.......~....c. ~........~...~...,....~...(...., ...... ~.~.C~ ............ ............ County Tax Mop No. lO00 Section ..... ,..~,,,c~.,,,.~. .... Block. ...... ~ ........... Lot No ...... b ............... pursuant to application dated .................................. , 19.~..., Building Inspector, Fee ~...~..~: ............ and approved by the Building Inspector Rev. 6130/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,:~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~l;'Jc;t: to the Building Inspec- tor with the following; for new buildings or new use' 1, Fina~ suwey of property with accurate ~ocation of a~ buildings, property ~ines, streets, and unusua~ 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1, Certificate of occupancy $5.00 / 2, Certificate of occupancy on pre-existing dwelling / 3, Copy of certificate of occupancy $1,00 land use --Pre-Existing C.O. $15.00 Vacant land C..O. $ 5.00 Date . .~/~.~q ............ New Building ............. Old or P.re-existing Building . .~.~ ....... Vacant Land . .z .......... Location of Property ~.~.~. ~J~ .... ~'~4~..~.~..~,~ ,~. ....... ............................. / Cou.t . ,.o.,OOOSeot'on ..... ....... ...... ....... .... .......... 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~it meets all apple codes and regulations. Applicant.. ~, ,~.~d.~-,"~, .,,~~ ~ ........... Rev. 10-10-78 F I'~-~D I~S?ECTION 1. FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL Y) ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS, BUREAU OF ELECTRICITY ~-[P~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,e 0~o~- ~.z, ~ ~.on~o.o.~.~ ~/~ N 663146 THIS CERTIFIES THAT only the electrical equipment as ~scribed below and introduced by the applicant named on the able application number in the premises of in the following location; [] Basement ~ 1st Fl. wasexaminedon O~tob(~)? 4~ l~.~ FIXTURE FIXTURES OU~TS t2 9 12 12 [] 2nd Fl. Section Block and found to be in compliance with the requirements of this Board. Lot RANGES OVENS EXHAUST FANS DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: i~aaelboax~ls; l~-].~cl~'. 125a~gt~. S E NO, OF CC. COND [ A W.G. NO` OF HI-LEG PER ,~ OF CC. COND R V I C E A. WG OF HI-LEG NO. OF NEUTRAL! AW, G OF NEUTRAL H. Dllltn~]am ~ox 574 [aur ~1 ~ N. ¥o 1194~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto~ may be identified COPY FOR BI · THI,' IN ANY MANNER. oJs. 'FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . ~. )) .... , 1971. Approved.. ~..\.~ .... , 19~.q . Permit No..I..~..b).~. j.-~. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs 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 ~ctions. (Signature;' z of applicant, or name, if a corporation) ./d ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. & ' ............................... Name of owner of premises .... ./:~.~/~.....~.'..~.~ ~ ~o:~,... ~..~ p/.F~.~. ~/ ................................ (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 ...................... h llbedone ~.~dcc ~¢'.¢~Z,~-Z ~d 1. Location of land on w ich proposed work wi ........ )~ .... ,, .'! . ~..'~ .... ' ........................ / t/.t .. .................. I ' ' ' Street ' Hamlet House Number County Tax Map No. 1000 Section .... ~.~ ........... Block .... ~ ............ Lot../-F ................ 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 . ./..../,~/.~?:¢ ...... .~.~..~.5: (7' ........................................... b. Intended use and occupancy .... ~,4-f.d ,.~/( .c 0~ ................................... '; ................ 3. Nature of work (check which applicable): New Building ' Addition .. ~. ...... Alteration .......... Repair .............. Rempval .............. Demolition .............. ethel_Work ............... 4. Estimated Cost. :~. · · ~ ......................... Fee ............................. i **' (to be paid on filing this application) 5. If dwelling, number of dwelhnglun,ts ...... ./ ........ Number of dwelling units on each floor .............. If garage number of cars 6. If business, commercial or mlxeld occupancy, specify nature and extent of each type of use ..................... 7. Dmaens~ons of exl~st,ng structuros, ,f any: Front... ~/~ ...... Rear .............. e th.. ,~ Height ..../ ........... Nu , bet of S ./. .... :-- '~. ......... tories .2~ n~ ....................................... Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth . ...... i Height .... , ............ Number of Stories .......... 8. D,menslons of/entire new construct, on: Front . . .~.../~ ....... Rear . .3. ~ Depth ./. ~.. 9. ~ze of lot: Front ...... ./~r~ ........... Rear ...... ~..~ ............. Depth .... ~ ~.~ .............. 10. Date of Purchase . . /. ~r~./~ Name of Former Owner ............ 11. Zone or use dmnct ~n which pr~m~ses are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: .... ./.~'..¢ ........................ 13. Will lot be regraded .... ,Z/~. ( ................... Will exce~ss fill be removed from premises: Yes 14. Name of Owner of premises /...g f~.d.'5: .7-./~..~..~. ~;?. ?Address~.~ -~. ~..~: ~ 7,5.' ~ .....Phone No. 2~./. ~- ........ Nm ........... i~ct ........ i .......... Address . ./~/.~. ~//-< r./q' .. Phone No..:+~.~. z ??.4 ~.... Name'of Contractor Cr~/ . . . Address ///7~. r:, q/ .. Phone No. ~ 7.~-..~.2~.. ~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ...... !S'S ............................ , .................... being duly sworn, deposes and says that he is the applicant ~ (Name of individual sighing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of smd owner or owners and ~s 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 mannor set forth in the application filed therewith. Sworn to before me this ............. ..... Nota, P b ic,, .... County NOL '~ t t. · I~, S~!~,! of New Yor,~ i ..... N0. 4707878, S~lf0]l( (;0unt~ / / /(Signature of applicant) b