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Home My WebLink About12894-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-I5318 Date March 3, I987 THIS CERTIFIES that the building Deck add i t i on 2.8..5..I.n. 1..e.~ V.i..e.w E.a..s.t Mattifuck, N.Y. Location of Property ~ouse ~Vo. ' ........................................... Street Hamlet County Tax Map No, 1000 Section . l 00 .Block 3 ..... Lot 10.7 Subdivision M/o Inlet View Ests. .Filed Map No..6.24..9 .... Lot No. 7 conforms substantially to the Application for Building Permit heretofore filed in this office dated February 17, 198/4 1289/4Z ........................ pursuant to which Building Permit No ...................... dated .... ~.e.b.r..u.a.r.y...2.8.,.. J .9.8.4. .... 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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING POLIUIOS POLI & CHEANTHY POLl The certificate is issued to ..................... [o~'n'o'r~[~,fli~v;~'i~ ..................... of the aforesaid building. Suffolk County Department of Health Approval N /A N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FOEM NO. ~ TOWH 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) 12594 Z Permission is hereby granted to: /~ //~' .... .............................. ../~.~.~~/~..;,...~....~.....1~7 ,o ......... .C~n:/.~.:~.......~/Z..~..>..~.~.~::~.......'~.....~'...,D~...G ....... ..~..~.~:...~...,/.~ ....... .~:~: .............. .4.~..~...~:.....:=.. ................................................ at premises Iocated4t ..... .~.~..~..~../.~- ~ .......... . ..~.~.~..~...~'~.....~4~...~~" ............................... v County Tax Map No. 1000 Section ..~,,O.~. .......... Block ...,~,.~ .......... Lot No. ,(~,,41',~...~..~,... ,,,ua,t to opp,co,on dated ..... ~.~.,~..~../~....Z.Z., ]9 ~...~ a,d approv~ by the Building Inspector. ~ ' ~uilding Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~a ~am===~ to the Building Inspec- tot with the following; for new buildings or new use: 1. Finat survey of property with acCUrate |ocatlon of all buildings, property lines, streets, and unu~l 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 ~r~ey of property, 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 flew Dwei. lJ, o~.$25.00. Acce,~,~ocy ,,$10,00 ~lu~[ne¢.~ $'}0.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.'00. over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5 Updated ~ O $ 50 00 Oate ......... 6. Alteration $2~00 NewCons t~uc~ton ;~.. Old or Pre existing Building Vacant Land Location of Property Owner or Owners of Property ...... ~,>~.. ~XX ~% .. ~X~.X t X~ .... · oubdlwslon ................ ~.Fll0d Map No .......... Lot No ............. Permit No ..... Date of Permit ....... cant ................................. 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 permit me?s all applicable co_desAnd regulations. ^,,,,c:., ................... 10.10.71] FIELD INSP~CTIgN DATE COMMENTS FOUNDATION (1st) FOUNDATION {2nd) ROUGH FRAME & ?LU~BING INSULATION FERN. Y. STATE ENERGY ~ODE ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y, 11971 TEL. 765-1802 This is to advise you that the job under building permit no. 12894Z issued to Paul Poli on ___2~128_~.8~ __ for Addition is completed and a final inspection has ( ) has not ( X ) been done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable to the Tows of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or nsc is nnlawful without a Certificate of Occupancy. Please hclp us to clear up this matter so that lega! action does not have to be taken. Thank y(m for your prompt attention. Very truly yo~, Victor Lessard Executive Administrator VL:gar earl. P 1. of 5 $1~.§6 ' Lol Z L~! ~ G 76§-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: L1. FOUNDATION - TWO REQUIRED FOR PouRED CONCRETE ~,.ROUGH - FRAMING & PLUMBING ~.INSULATION 4. FINAL - CON'STRUCTION MUST BE COMPLETE FOR C. O, ALL CONSTRUCTION SHALL- MEL~-r THE REQUIREMENTS OF THE N,Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR cONSTRUCTION ERRORS. ~...~ .j'~ z S.84°46 '55 W. &Of 8 AN 2 9 1980' e.D. ~. ~~~ ~wage d~sposal ~nd wate~ ~upply SURVEY FOR POLlY/OS POLl 8 CLEANTHY POLl LOT NO. 7, "INLET EAST ESTATES" AT MATT/TUCK TOWN OF SOUTNOLD SUFFOLK COUNTY, NEW YORK ~ted by this tLL NO ALDEN W YOUNG, t~'O~[$51ONAL ENGINEER AN[~ LANO SUR~[.YOR N Y$ LJ¢[NE, E NO 12845 HOWARD W YOUNG, LANO SuRyEYOR YOUNG YOUNG 400 OSTR/ RIVERHEA FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined .~;~'-~ .... , 19 Approved .../J-~..~..~... ~..~. .... 1 c~..~. Permit No../.'4~ 7~z'. . . ~ Disapproved a/c ..... T.-.-.-; .--7-.... ~...~... ,~ ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .... ~19 ~ - 19 .~..5~ Date ......... , 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, buil~ing code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necg4sa~y ins, p'~c~ons. (Signature of applicant, or name, if a corporation) · .al.~ .~..~,~ ...... /Iq.~/. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~..~..e.< .&%... ~,~..or..~,4,<_~.. ............ .............................................. Name of owner of premises .'.'-./...~..O..c.:...' ~,' //".~.O~.lC~iO~ .~OL./ 4-0_~Lr, eA'-~.~.~.p ~)oC/ ......... ('at~ 'o'n' t'he' ia'x' ;o'li ;; ilt~'}t' rile'al') ................ ~' ....... If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No..3.°?~?.4... ~.~.. (~. .......... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .............. .............. House Number ~/-- Street Hamlet County Tax Map No. 1000 Section ..... l ~c~ ........ Block ..... ~. ........... L,~ · ~ ..... , ........... Subdivision. [.~.Z.e.~. -.~< .,/g..c¢.... ~.~.47'~.,5 .......... 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 ... I...~.~.':¢... ~. $.,A~,-.~. ~:/a~.: ................................. b Intended use and ,<~',f2~,q¢,-~, ,~,v ~.4,' . ,~ · occupancy ..... > ....."~ ~- .............. ;~: · .: ;, · · , ................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .... RemOval .............. Demolition .... Other Work..-~.. ,~-~l~_~ 4. EstimateaCost...~.f,/.~.O.l~i,..o?... ..................... Fee ....-~. ........................ (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... ! ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ...... · ~ ......... Rear .... ~'C-.O ....... Depth...~c). 7. D~mens~ons ofemstmgstmctures,~fany: Front .. z~ '--o" ' o" Height ............... Number of Stories ...... ~_9...-~..~. ........................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ~- ', /. ~,o '--- o" .. . Size of lot: Front ..... [.5~.0. ~ .(P ......... Rear ................ Depth ~tZ.. ~..--.~.~ .......... [)ate of Purchase Name of Former Owner Zone or use district in which premises are situated...'-'~at.~.~,'.'77. ,.4.~. ................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ ~ ............... Will excess fill be removed .f~om premises: Yes No Name of Owner of premises .-~u.~..~.,.~k i ........ Address t~0 ~>.*.'~?..~ .~,~.,~, .'~.~ '.. Phone No ............. Name of Architect Address Phone No Name of Contractor t~.~'i~...l~,u'ze'.~.. ~."q.. ~ Address S~ .z.~ .,~q,.~.. ~'..q[; Phone No. 2,,~.';. 3.~.~..1. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from or description according to deed, and show street names and indicate whether 10. 11. 12. 13. 14. property lines. Give street and blocklnumber interior or corner lot. STATE OF.NE~O,I{K, z S S COUNTY OF '...~ ~~ being duly sworn, deposes and says that he is the applicant (Name oi inctiviauat signing contract) above named. He is the ..................... ~........~ ............... ~ ..... ..., ............................ :( ~(Contr~, agent, corporate o~ficer, of said owner or owners, and is dutyXauthorized to perform or have performed the said work and to make and file this application; that all statements cont:ained 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 / biic, !elm (Signature of applicant)