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Home My WebLink About13021-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.~.3.9.8.3 ......... Date Dec. 27 ., 198.4 THIS CERTIFIES that the building Addition Location of Property/:/3~s~)v'd ......P.Y.~... 33.d....~.1.0..(.l~-ko.q~;. ~.~n~) Mattituck - Street ............. ~13~l'e~ County Tax Map No. 1000 Section ....~.~.2 ...... Block 01 .Lot 004 Subdivision ....X. .......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated April 3 19 .8.4. pursuant to which Building Permit No. 13021Z dated ............. .........April .... 12 .. 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 & Partition (Interior) of. Existing One Family Dwelling The certificate is issued to GAIL DESSIMOZ & MICHAEL RACZ ~ow, er, ~g~¥';~ ...................... of the aforesaid building. Suffolk County Department of Health Approval . N./A UNDERWRITERS CERTIFICATE NO. N 671165 Rev. 1/81 Building Inspector FORM NO. ~ TOWN OF $O~T~OL~ BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13021 Z Permission is hereby granted to: ,o -- ........ .......... ~ .... ;;~..~. .-~. ........................ ~ ..... o, premises Iocoted ot~...~.:..J..O. .......... .~.~)_,~...~...c~.'.'~....~,~.~~ ............ County Tax Map No. 1000 Section .... ,~./.....~.. ......... Block I Lot No. ~ ~u~uont to opp,cot~on dot~ ...... ~&.....~ ........................ . ~'~'~t.. ond opp~o~ by the Building Inspector. Fee $. .: ....... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Build{n~ Department Town HaH t;outhold, N,Y, 11971 APPLICATION FOR CERT~FICA'rE OF OCCUPANCY Instructions A. This application must be tilted in typewriter OR ink. and submitte~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. 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 safeW 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 New Building ............. Old or Pre existing Building ............ Vacant Land ............. ocation of Property .~.~..-~..c~.'.~.. ! ~ ~ ~.~.c../-z~...~.~...c~.~..~y~.~. Hou~ No. Stmet Ham/et Owner or Owners of ProperW ~ou~ty Tax Map No. 1000 S~C~io~ ~.~ l~,. Bfoc~ i ...... Lo~. landuse--?~e-~×isti~ C.o. $~5.00 Vacant land C.O. $ 5.00 ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 1.".':~2~.~ ! ~... Dat~of Permit .~ iz//8't~ ~T/~,-r~'- CP~(x)~¢C/~ ~ ...... Applicant ............ ~ ..................... Unde~dters Approval ....................... . Planning Board ApprovaT ...................... Request for Temporary Certificate Final Certificate Fee Submitted $ .- .~.'~. · ....................... Construction on above described building and_~pem~s all appl[c,ab__l~..dg~_~a_n~ reg_ulations. R~v. 10-10-78 t qq FIELD I~Sf E'E TION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY ~ODE 2nd) rG ADBS?IOS^L ~OMMENTS: FINAL THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY SE, JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of in the following location; [] Basement was examined on D~J¢~b~r ~ 1 I~F~ FIXTURE OUTLETS DRYERS [] 1st FI. [] 2nd FI. Section Block Lot ar~cl fou~d to be i~ compila~ce ~vith the reclulren~ents of tltis Board. FIXTURES RANGES COOKING DECKS OVENS FLUORESCENT SYSTEMS NO. OF FEET EXHAUST FANS E OTHER APPARATUS: *~l~i. Outlet Systems ~ 50'~"50' 5-G.F.C.I. 1-~ke R V I C AWG, OF CC, COND. OF HI-LEG NO OF NEUTRALS OF NEUTRAL John Glella 3 L~lg~bn Strut Isl:L~, N.Y. 1175]. Ltc, 780 GENERAl. This certificate must not be altered in any manner; return to the office of the Board if inco~rrect. Inspectors may be identified by COPY FOR B~JILD[NG DEPARTMENT. THIS COPY OF CERTIFICATE [~U~T NO'I~ SE &LTEREO IN ANY MANNER, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ,.~ / 2_ ., 197.~. Approved .'.~ iiI ~., 19~.~ .PennitNo.)...~..~.!..~w. Disapproved a/c .. .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. Tkis 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 w/il 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 inspections. ...... .& (Signature of applicant, or name, if a corporation) .?~...D.-~¥ 5q~, C_3~4 ~---~Z.V//x/, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ~..~v~c....C~>.~.~w7o.~.' ................................................. Name of owner of premises .... ~ ~..~.~0.~.~.~.~...~...~ (~.~..~[A~. ............. (as on the tax roll or latest deed) If ap~'}~oratign,~re o[ duly authorized officer. (Name and title of co¢orate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other ~rade s License No ...................... 1. Location of land on which proposed work will be done .................. \',L'~ '~.~ .................. .................... HA-cno.q~.~....C.~.u ~.~¢...!~ ..... -~...~..N.., .o~., EVO. TX~.~-~. .... : ..... House Number Street Hamlet County Tax Map No. I000 Section .... /../...~. ....... Block ....~.. ............ Lot....~. ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) , State existing use and occupancy of premises and intended use and occupancy of proposed construction: , 3. ,Nat,ur '6fw0tk check Whidh a cable: New Building .......... Addition ........ Alteration .......... l~p'alr .............. , l~'emoval .............. Demolition .............. Other Work ............... :: i, ling'"' e.~ i,-,i' i ~C) ' '-'' (Description) .... Fee ..................................... ' --[,--~ ,il '*' (to be paid on filing this application) If dwelling number ' ' ' Number of dwelling units on each floor 5. , of dwelling iumts .............................. If garage number of cars , 6.If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7.Dimensions of existing structures if any: Front ............... Rear .............. Depth .............. Height ............... Number of St ..... ones .................................................. Dimensions of same structure w~th alterations or additions: Front ...~.. Z..~ ......... Rear...~.Z. ( .......... 3i5' ' ' Depth ............... ~.. Height ... I.~. ...... ~ ......... Number of Stories .................. 8. Dimensions of entire new construction Front / ~..' . Rear ,1 ;~ '.. De,,th ~./.. · /. ~>.! lfib ' ' ..... /. '": ............. .~...(~..(~, ~--: ........ Height ........ ,. Nu er of Stones ....... ~./f~-~ .......................................... 9. Size of lot: Front . ?..O.:. i'. ..... Rear .... .'~.C).: .......... Depth .............. 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~q'ZP ........................ 13. Will lot be regraded ...... .~'.i'~O.. ................. Will excess fill be removed from premises: _Yes ~ 14. Name of Owner of premises,..(-ff ./'ifil.c:.. ~.q-~.~l ~T)OX. Address &O~.~: $.'~..A.'4.~../iq.Y.~. Phone No. (2...~ ~.) .......... Name of Architect ..~! .g..?.. ~_~..~.~.?.~..v~. ........ Address ,~.o.&.-:?~...~.V.¢..~.~.%. Phone No~.C~iB$.'7 .q.~..~.I~.. Name of Contractor .5-../. 3.'Cc~--. ~.gy~,~...c:q..~? .... Address .~ 7~SA¥.'~q..~. .~."C .... Phone Nto~.'?~q.~.~'~..~.B..~... PLOT DIAGRAM Locate clearly and distinctly al~ buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF !S.S ..... ' ............ ....... . .~... C9.....~P.c4'T~./ ...... being duly sworn, deposes and says that he is the applicant ~(Name of individual signing contract) above named. ,e is the ........ .... ............................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty 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 manner set forth in the application filed therewith. Sworn to before me this ~ ......... · .. ~ ~ ...... day o~..~'~ ............. 19~. Notary Public, . ....... , .......... County NO't^RY PL~BLIC, State 0~ ~'4ew Y0rf¢ ....' .......... J ~r~,OY~k2B7,9, Sltliotl< OcmnI~ ..... (Signature of applicant)