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Home My WebLink About12857-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No S-26728 Date OCTOBER 6, 1999 THIS CERTIFIES that the building Location of Property 10450 SOUND AVE. House No. County Tax Map No. 1000 Section 122 Subdivision Filed Map No. ALTERATION MATTITUCK, N.Y. Street Hamlet Block 2 Lot 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRU~/~Y 1, 1984 pursuant to which Building Permit No. 12857-Z dated FEBRUARY 2, 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 ALTERATION TO EXISTING PORCH AS APPLIED FOR. * ~g&T.DIN~ B. WORTHINGTON The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *THIS UPDATES CO Z-13108 DATED JAN. 3, 1984. ~7/BuZg~I~ Spect0r Rev. 1/81 FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALl, SOUTHOLD, N. Y. BUILDING PERMIT (TI{IS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12857 Z Permission is hereby granted to: .......... ...... ....... ,...,..~.~/z.~.~,~.~.....~..~.~ ............... ,o ...~~...~~~4 ....... ~.....~.~~.....~~ ............ / ......................................... ~'O'~'~ ........... ~ ........................ ~ ............... 7"~"'~'" ~ ....... at premises I~ated at ...~,,~.~..~ ....... ~aO~..-.~......~ County Tax Map No. 1000 Section../.~.C~. .......... Block ....~...~.. ....... Lot No..~../.~ pursuant to application dated ....~.~.~...~..,~../~.'.~.........~.. .......... , 19Z~.., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~>PLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar building and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-confo[~ing uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling ~25.00, Swimming pool ~25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinz - $100.00 3. Copy of Certificate of Occupancy - .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 October 5, 1999 Date - New Construction ........... Old Or Pre-existing Building.~T~ ......... ~0450 Sound Avenue Mattituck, N.Y. Location of Property.. ............................................ .. ..... ..... ....... ------ House No. Street Hamlet GERALDINE B. WORTHINGTON Onwer or Owners of Property...... ................................................. . ........ 122 2 14 County Tax Map No 1000, Section .............. Block ................ Lot .................... Subdivision .................................... Filed Map ............ Lot .................... ~ ._ 2/1/]984 Permit No............I2857-Z .... D~Ce Off ~erm~c .............. .. Applicant ........................ Health Dept. Approval .......................... Underwriters Approval ....................... Planning Board Approval ........................ Request for: Temporary Certificate ........... ~F~rra-kCerticate...U.PD.A.T.~.. Fee Submitted: $ ...... .5.0...0.0 ................ !~ff...~.~ ....... .......... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z13108 Date . Janu. ary 3 ................................................. 19 .~). THIS CERTIFIES that the building ....~.l.~.? .~.a.~.5. o..n..~.q..a.n..e.x..i.s.~.~.n. 6' .p.o..r.c.h.. ....... Location of Property .... ~ 9.4.5q. ~ .o.u.r~ d...~.v.e., ....................... ~I.a.~.~. ~ .~.u.c.g ...... House No. Street Ham/et County Tax Map No. 1000 Section ...l.~ ...... Block ...0.2. .......... Lot ..... Q ] .2 ......... Subdivision ............................... Filed Map No. : ....... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated .. F..eb. ~ ............ 19 8. .6 . pursuant to which Building Pem~it No .... 1..2.8.5.7. Z. ........... dated ...? e..t2...2. ................. 19 ~. z)., 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 ......... Alteration tp an existing porch. The certificate is issued to Ge rald ine Davis (owner, ~,,~o~ ~a~,~.lX X X of the aforesaid building. SuffolkC nt~D pa tme tofHealthAppro I $/A ou e r n va .......................................... UNDERWRITER~ CERTIFICATE NO ................... N ./.~ ............................ Rev. 1/81 Building Inspector FORM NO. 6 TOWN OF 80UTHOLD Building Department Town Hal! ~=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled 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,~roperty 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. B. 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 OT uccupa~ ,~y or, Ftc sxb:t~g dw~l~a_. ~a1~d_u sX_-- ~ ~ e ~ Ex i s t i n g C. 0. $1 5.0 0 3. Copy of certificate of occupancy $1.00 ! Vacant lan'a-%-Tc7-'-~ g .05 -- Date ...... ) 2..-;-./.~..'7. ~. ..... New Building ........... ,!~Q.!d or Pre-existing Building ............. vacant Land ............. Location of Property ...... ~/~! f~. .... ~]..~ ........ ¢~..~..~'/.'~./-~- ............ Hou~ No. Steer , ~ Hamlet Owner or Owners of Property .~.'~.~ .... ~ ~ ........................... .... ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval........................Planning Board:ApprovaJ , ...................... -' ' . ' Final Certificate Re(fue~ fer Tgmporai y ~ert~rlcat~ ............................................ Fee Submitted $ ........................... Construction on above described building and permit meets alt, applicable codes and regulations. Applicant .............. P- / ~bio ,f FIEL~ INtECTION DATE COMMENTS 1. FOUNDATION (1st) FOUNDATION (2nd) __-- 2. PLUMBING -- 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 Approved J Permit No / Disapproved a/c ....... '. :':~7'~ ........ ~ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT DateaY.../i...cf.. .......... ,19... 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 bullding,,~ode, hou~)ag code, ar)0rregulations, and to admit authorized inspectors on pr~mises and in building for necessary inspect.~J~ / (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ............................................................... Name of owner of premises ..... ~.,,~..~.z.: ~ ..... ~.~.~;v,..~. ?. ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Bulider'~ License No. Plumber s License No../;~... ..... Electrician's Licens(~qo ............... . .-~<..~--5 ,~' Other Trade's License No ....... .,~..~.~...'~. .... 1. Location of/and on which proposed work will be done .................................................. 7.0. .... : .............. .............. ............... House Number Street Hamlet County Tax Map No. 1000 Section . .t/.2". · .~.. · ......... Block .. (D2"~ Lot (D/"z'"~ "" 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 ....... ~...'.x~q2i-'E · · ~ ............................ use and occupancy ........ ./..~/~).~)..ciE.. ~. ............................................. b. Intended 10. I1. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... , (Description) Estimated Cost .... ,-,A .C~. ~. ........ Fee. .. : (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... If garage, number of cars ..... ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures,.if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w!th alterations or additions: Front ................. Rear .................. Depth ..... ' ............... .. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ........... i ....... Rear ...................... Depth ...................... Date of Purchase ........... .................. Name of Former Owner ............................. Zone or use district in which promises are situated ..................................................... Does proposed construction vie!ate any zoning law, ordinance or regulation: ........................... . ..... Will lot be regraded ........ , ................... Will excess fill be removed from premises: Yes No Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ......... : ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ Locate clearly and distinctly all' property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STAT~3 OF NEW/YOP~I~ ,~ ~ S .~'t3~Q'~..(~/..~z~,,~. j ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abov(; named. . ' ,~)He is the ~i ag;nt ') (,Oontractor, , corporate officer, etc. of said owner or owners, and is 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 mander set forth in the application filed therewith. ............. ........ Notary Public,..fi(~.~. ,f~ .' ./~ ........... County ~.~u~, I~,-, ~,r,~ ~p, ~/ ' (Signature of applicant)