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Home My WebLink About12850-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z12620 Date July 19 198~ THIS CERTIFIES that the build~g .......... -.;. ad.dj t ia~ ......................... 700 Wavecrest Lane Mattituck Loc~ion of Property hSds~ ~¢] ....................... ~/e~i ....................... h~/~i 100 03 007 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Estabes 4682 . ,. 39 Subdivision.Saltaire .Filed Map No ........ ~o[ ~o. conforms substantially to the Application for Building Permit heretofore fried in this office dated January 27 1984 12850Z ......................... pursuant to which Building Permit No ...................... dated......................January 31~ .. 19 .8?. , 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 dwelling. The certificate is issued to GEORGE & ALICE GLOGG (owner, lessee or tenant] of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ? e n d i n g Building Inspector Rev. 1/81 FORM NO. 2 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) Permission is hereby granted to: .... ~.~...~ ........................ .~..~ ..... .,zf~.~.~,.z~.~.~...~..~.;__ _ ........... ././.?~. .... · - .... ~ .~.'./..~< .~./..e.....~×, .... ~ ....... ,o ..... ~o~..~.~......~ .~.~ ...... ./.. ....... ~:..~ at premises located at ...lC2,~o .......~,,.~., .,~,,~~...~...,~.,,,,'~,.~ ........... ,,-,~,-,~2M,~,~,. ,/~..~.~ ? ................................... : ............ ,~ ....................................................................... ~..~ ...................... Tax Map No. 1000 Section ..../..~..~.. ......... Block .....~....~.... .......... Lot No...0'.~...~.. County / pursuont ,o opp,,,ot,on do,,~ ........ ~h~. ....... Z.Z... ................ . "!t.../.. ,nd opprov,~ b~ ,~e Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 Ao FORM NO. 6 TOWN OF SOUTHOLD 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~,Hc;*,c 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 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/ land 3. Copy of certificate of occupancy $1.00 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 ..7~.~....~..'~.~...~..-'~.'~./.-'] .~.'~: .............. ~'/'?'~c~"~' '~'-~'~- Ham/et House No, .~ St._~eet Owner or Owners of Property .~/~'~.': ~. ~'4'~-~...~../~..~.(;~ ...... County Tax MaENo. 1000 Section .~.. ........ Block, .~,.~. ......... Lot .... .<~../~.. ........ S u bd ivisio n ,~ .~.7'..~../,~E~.. ~7~. ~.~.~ ~ ......... Filed Map' No ~.( .~..~/. Lot No. ~.~. ....... Permit No../. ,~.~".~.~..-~Date of Permit ./ ...... Applicant. .~. ............... t ..../3 .:: ................. Labor Dept. Approval ...... ~ ............. Health Dept, Approval ~ Underwriters Approval /~10~'~ , .Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate'~. ...................... Fee Submitted $.. ~,, ....................... d p pplic~l OhS. Construction on above described building an ermit meets all a e codes and regulati ~. Apphcant ........................ Rev. 10-10-78 FIELD.~INSP~CTION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd).___ 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~xamined .~ .~'~27.. .......... , 19...' ~ e c e 5 v e d ? Approved ..~.. ..... &~ermit No../.'.~..~. ~..X D '~ed a/c . . ~ . . . .,~... isapprove 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 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 regulation_s, and to admit authorized inspectors on premises and in buildingfor necessary... ~~'insp'e~'[i°ns', '~."~'~' I ................. ~ i~a~ure ofapp i a t, o na e, ifa corporation) .... · . -, It (Mailing address of appucanr) State whether applicant i ow~"~ner~}lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises & ~' ~. ~..,~ ,e.~. ~--~/~J ~(as ~.~n t b e/. t~a.x/, r~i'~i o¢~. late st 5d./)o~ ~ 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. ~1~/...~.~..~}¢y ........ Other Trade's License No ...................... 1. Location of land on wbich proposed work will be done .................................................. ................ e '.r. ............. ./. Z-. ). . .......... ttouse Number Street Hamlet County Tax Map No. 1000 Section/. r~.o ............... Block .... ~ ............ Lot.. ~. ............... Subdivision..~..~.P¢tz4z'~.. ~..-~.~/~.~-..~ ................. 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/¢~(,~-I/-d~'~ ................................................. b. Intended use and occupancy ~'& 2t, t ~o~,~1 ................... '. ........................... 3. Nature of work (check which applicable): New Building .......... Addition ~ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost /~/aa~* ~i ...... . ........~ ......................... Fee ............................ [ (to be paid on filing this application) 5. If dwelling, ngm, her of dwellingl units ..... .] ......... Number of dwelling units on each floor... If garage number~of cars I ' . . ~' ~ 6. If business, commercial 9r mixed occupancy, specify naturq and extent of each type of use ..................... ...... pth ":~. ............ 7. D~menslons of existing structures, if any: Front ..... , ......... Rear .............. De . Height .. ~Z.t. .. Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... Height ...................... Number of Stories ........... t ........... ' t ~...5' qO Y..'..( pth 8 Dimensions of entire new construction: Fron . t' ............. Rear ........ De ........... Height Number of Stories /.~ 9. Size of lot: Front ...,(0(~.,... ........... Rear. l~.g.,.7.. ............... Depth .Z..~.~. ~. ~ .............. 10. Date of Purchase ] q. 7/ Name of Former Owner A~.,~./~.~4*' .// I 1. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation' 13. Will lot be regraded .... ~. · ! ................... Will excess fill be removed from premises: Yes . 1 4. Name of Owner of prem~ses~,~,}~.~e ~ A~/~¢ e..(:~/~ ~,e. Address '7.,,e.~.~'t~.¢,~e..vZ//,4.,*'t'¢. Phone No. ~'~>.': ¢/(~.. 2, .... Name of Architect ......... i .............. t.:. Address ....... !?.~.~?.' .~:: .~.. Phone No.., .............. Name of Contractor ~P~ ?(~/~. tr. ..... Address ~t~[.~.. ~.~.~..v/.~..~'.~. Phone No.. ~..(,~'.'.~ 7. ~..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property line~A~¥e~street and l~lock!number or description according to deed, and show street names and indicate whether interior or(~o~rner lot~ ] STATE OF NE~YORK .... S S · .. /'.~.0~.~ .... ~]~,~..-D~.~ .... i...~..~ ......... ' being duly sworn, deposes and says that he is the applicant (Name of indiv~ual sig~ing contract) above named. He is the ...................... ( ontractor, 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 knowledge and belief; and that the work will be performed in the mann6r set forth in the application filed therewith. Sworn to before me this ........ ...... ..... ~/0TARy . ~o. s~.~24~ ,' '- deSighature of applicant) Qualified in SuCre k County/ ' &O ~o~ ,,) '7: Z