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Home My WebLink About12885-zFORM NO. 4 TOWN OF SOUTHOLD ' BUILDING DEPARTMENT Office of the Building Inspector Town Hall, Southold, N.Y. Certificate Of Occupancy Date ............ J$1M ~ 9 .... 19 84 · THIS CERTIFIES that the building ........ p~.e.= ~'o;n.J~ly..d.w.~ ~..1,i.qg ................. 785 Village Lane Mattituck Location of Property ............................................................... House No. Street Ham/et 114 6 10 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision .... V. 5, ]- %.a.g ~. M.a.q q ~' ............ Filed Map No..3.6.6.9....Lot No ..... .5 ........ conforras substantially to the Application for Building Permit heretofore fried in this office dated ....... E o b r.u,a r y..1.z~., 19 ~b. pursuant to which Building Permit No... ! 2 8.8 5 ~. dated .......... ¥ ~ .b.~. U ~ r.y.. ~ 3 .' .... 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 ......... ........ 1~ r £.v.a t,e..~n~ .-f.~ro $ ly..cl¥9%.t.5, r~g ......................................... JOHN WALLRAFF The certificate is issued to ........................................................... (owner, le~--...%-'~et-te, r*m~) of the aforesaid building. Suffolk County Department of Health Approval ] .4:-S.Q-~.8 UNDERWRITERS CERTIFICATE NO ................. .N.6 505.9.~ ........................ Building Inspector Rev, 1181 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) 12885 Z Permission is hereby granted to: ........ d~.~. ./,...~',.~:,~.~ .................... ............ .................................. County Tax Map No. 1000 Section .../.../....4~.. .......... Block .~T"~ ............Lot No.....O...d..~.. ......... tO application dated .~~.~..~...~....../...~-......, 19. nd approved by the pursuant Building Inspector. ....... ~7.; ...... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 1197]~ APPLICATION FOR CERTIFICATE OF OCCUPANCY pplical;ion must be filled ill wi)ewriter OR ink, and sul)n)itted'in duplicate to ti'la Building Jnspec- the following; for new buildings or new use: hal survey of property with accurate location of all buildings, property lines, streets, a~d unusual topographic features. approval of t lealth Dept. of water supply and sewerage disposal-(S:9 form o~' equal). of electrical installation from Board of Fire Unch?rwriters. :Ommercial buildings, Industrial buildings, Multiple Residences and similar buildings and instalJa- a certificate of Code compliance from the Architect or Engineer responsible for the building, ,it Planning Board approval of completed site plan requirements where applicable. buildings (prior to April 1957), Nomconfomling uses, or buildings and "pre-existing" e of occupancy $5.00 [ficate of occupancy on pre existing dwelling of'certificate of occupancv land use I~ /~/$'5.00 Date . . January 13,1984 ............. Old of' Pre-existing ]u Idi ~(](,'~) ...... ,% ~ /Vaeant Land . . ~ House N~ PatricLa & Street Property WJ 11 Jam Ba~er,. Robe(~ & Jane Goet ler.,. ~nd. Bea.trl~ ~ter Map ~o. 1000 Section .... ~ ~4 ........ Block .... fi .......... lot.. JD .... .... ' D alp mit Appli 'Approval Labor Dept Approv31 ' sApproval ' .Planning BoardAppr val ;.; .............. Temporary Certificate ..................... Final Ce.rtificate . on above dm;cribcd I)uildm~ and ~errn~e~,ts~l ~p~c,~hlr~) ~ s d regt atiomL Mattituc L N.'/. I 952 survey of peoperty showing ali property lines, streets, buildings and unusual natural or ahic features. rn statement of owner or previous owner as to use, occupancy and condition of bu!ldings. of any housing code or safety inspection of buildings or premises, or other pertinent informa'- kfired to prepare a certificate. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-J~=~'pl!cct~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. B. For existing buildings (prior to April 1957), Non-conformir~g uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic 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/ land use -- ?r e-Ex ls tlng C. 0. $15 · 0 0 3. Copy of certificate of occupancy $1.00 Vacant land C.O. $ 5 · 00 Date...?/. f.~..'?, ff ............ New Building ...~/. ........ Old or Pre-existing Building ..... ~... Vacant Land ...... ~ .... Location of Property . Ownor or Owners of Propertg .... ' ............... ~ ................................... County Tax Map No. 1000 Section Permit No./~ ~.~.. Date of Permit ¢~¢~ ~ Applicant ~ pt Appr Health Dept, Approval .................... Labor De . oval ........................ Unde~riters Approval ..... ~oqu,st ~or Tamporarg ~ertificato ..................... Final Gortificat~ .................. · ' Fee Submitted $ ..... '. Construction on above de~ribed building ~rmi~al~plicable codes and regulat,ons. . .......................... THE NEW YORK BOARD OF FIRE uNDERWRITERS 85 JOHN STREET. NEW YORK, NEW YORK 1OO;~,B TNIS CERTIFIE~ THAT only the electrical equlpmertt as ~scribed bel~ and introduced by the appllccnt ~med o~ tl~ able appilvatlo~ number in t~ premises of i. the yottowln~ Iocatlon; ~ Basement ~ 1st FI. ~ 2nd FL Section Block' Lot ~us examined on and found to be in compliance with thd requirements of this Board. d~te ~ 1984 FIXTURE FIXTURES RANGES OVENS ~DISH WASHERS EXHAUST FANS OUTLEIS SV4~TCHES NCANDE$CENT FLUORESCENT 17 17 DRYERS SYSTEMS NO. OF FEET E OTHER APPARATUS: Ato'~ors; 1-F 1-G. F ,C · £ 1-~J~e E R V I C I 4 1 4 0 ~ 8 ~l~ ~15 GENERAl. MANAGER COPY FOR B~ILOING DEPARTMENT. THIS cOPY, OF CERTiFiCAT~U~T NOT BE I~TERED IN ANY MAN~- 7GS-X802 ~. BUILDING DEPT. INSPECTION FOUNDATION ',ST [ ~. ROUGH ~pLBG; FOUNDATION 2ND ~,~ INSULATION · FRAMING NAL '~ ]FI ~ , FIELD INSPE~CTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. Y. STATE ENERGY ~DE FINAL ADD TIONAL COMMENTS: ,OO08 .sr- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..*".~T.4-.-~: .~.>...Off.~..-., 19 Approved . .~.~.'.~... Disapproved a/c ..................................... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submittbd 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 Buildhag 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, bqitf~g,cod ,~ohsing code, and regulations, and to admit authorized inspectors on premises and in building for necessary in~pec_,~s. [ ?'ff ,,,, .... ..we... ./. :. ............ .(~ign2ffture of applican.~ or nan/~ if a corporation) (Mailing address of applicant) State whether_applicant is o(~wne~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o£premises ......................................................................... (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 Trade's License No ...................... 1. Location o~land on which proposed work will be done ............... ~ .............. ; .................. House Nub ber Street Hamlet County Tax Map No. 1000 Section .... ( .{.~. ......... Block ...... ~ .......... Lot ..... (~ ........... Subdivision ~/~C ~ ~4~.{~. .. Filed Map No. ~ ~7 Lot ............... ........... t' '(ffahe) .............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: , a. Existing use and occupancy .......... ~q~.([-~ ................................................. b. Intended use and occupancy 3. Nature of work (check which applicable Buildi ...... Addition .......... Alteration .......... Repair .............. Removal ...... :~.; .... /Semolition .............. Other Work ............ i ~ (D ripti .~../..(~..¢~..~.~_. esc on 4. Estimated Cost ...... ( ........................ Fee .... ' ........................... : ! (to be paid on filing this application) 5. If dwelhng, number of dwelhngjumts .......... Number of dwelling umts on each floor ............... If garage, number of cars [~ 6. If business, commercial or mixed occupancy, specify natcre and extent of ea~ type of use .................... 7. D~ensions of existing structures, if any: Front...~ ..... Rear . .~ ....... Depth.. Height ............... Number of Stories ........................................................ D~ensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ;.. Height ...................... Number of Sto~es ...................... 8. Dimensions of entire new c.onstmction: Front ..... (~.~ ...... Rear .... ~ ....... Depth .~ ......... Height ............... Number of Sto~es ........................................................ 9. Size oflot: Front ...l.0q.}.[ ........... Rear...~.~ ............ Depth g ........ I0. ~)ate of Purchase .......... ~ .................. 11. Zone or use district in which pr~mises are situated ..................... . ~.... ~ .~ ~ff~ ........ 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ~ ............... ~. ......... 13. Will lot be regraded ........ } .................. Will ~xcess fill be removed from premises: f Y~ No 14. Nme of Owner of premises .. & ................. Address ................... Phone No ................ Nme of Architect ......... ~ ................. Address ................... Phone No ............ k... Nme of Contractor .~*~. ~.q~ ~(ff ........ Address ~ ~ ~Q 2 ~.., v '~'3' Phone No. ~.~. PLOT DIAGRAM Locate clearly ~d dist~ctly fl! bufldhgs, whether existing or proposed, ~d. indicate fll sebback d~ensions from property ~nes. Give street ~d blocknumber or description according to deed, ~d show street nines and indicate whether interior or corner lot. STATE OF ' '"' S S COUNTY O .... 1.. i ' · .~~;'~i',~~ ......... being duly sworn, deposes and says that he is the applicant above named. He is the .................. · .... ........................................... ~ ........... : : ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~, 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 mannelr set forth in the application filed therewith. Sworn to before me this Of. .......... ...... day .~.~ .... 19~f. N u~b!ic, .......... ~. .' . County ll/~a. ....... ..... C/ ~Ut_t!~ ~ W ~£1~t~ e ~" ~/~ ...... }/t(Sig~ature o applic~ti u ~Kr.l BLIP, IMe of New YOl~ . ~// No, 52 ~ ~8860, Soffolk COOety Tern~ Ex es March $0~ ~9,~