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Home My WebLink About12895-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-1835B Date SEPTEMBER 8~ 1989 THIS CERTIFIES that the building Location of Property 1600 PARK AVE. House No. County Tax Map No. 1000 Section 123 Subdivision MARRATOOKA PARK ALTERATION MATTIT~CKr N.Y. Street Block 08 Lot Filed Map No. 19 Lot No. Hamlet 004 15 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 10, 1984 pursuant to which Building Permit No. 12895-Z dated FEBRUARY 29, 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 ENCLOSE EXISTING PORCH OF ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to CORRINE GERHOLD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DA~ED N-802380 - APRIL 7~ 1987 Building Inspector Rev. 1/81 FO]tM 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) 12895 Z Permission is hereby granted to: ~ .......... ....~..~/_~.....~. ~. ~.~. .......... .......... .......... _ · .......... ~.~..~.-~,~.~:=.~..~..,.....~.,.. ............. ,o ..... ~..~.~.~::.....~_~.~-.../.~.....~.~....: ........................................... ............. ~:.....-. ......... ~~Z~.. ....... .~..~-~.4~..... ......................................... at premises located at ..~.i.'~...~....0...........~.~.~~ ........ ~.~~_~.~..~...: ~. ~ ...~.~..... Lot Coun~ Tax Map No. 1000 Section .../.~. ............. Block ....... No. ~:~..~../.~ ........ pursuant to application dated Z.. ....... ~ ................. . approved by the Building Inspector. Rev. 6/30/80 J FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~a ~ 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 unu~al natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-iS-9 form or equal). ,4. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar b~ldlngs and instatla- tions, a certificate of Coda 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 p~operty showing all property lines, streets, buildings and unusua~ natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancv 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 Neu Dwelling. S25.00, Acces.~ory ..$10.00 Bua~ne.~, $50.00 2. Certificate of .occupancy on pre-existing dwelling $ 5 O. 00 3. Copyofcertihcateofoccupancy $ 5.'00, over 5 yeare $I0.00 4.Vacant Land C.O. $ 20.00 5.uodated C..O. $ 50.00 Date .......................... 6. Alteratzon $25.00 NewCons tt"uc t, ion...... Old or Pre-existing Building ............ Vacant Lend ............. Location of Property ........ ~ ....................... Owner or Owners of Property .. ~O. gl.M..¢~.~,,....,~. :....~-----~.~-,,~ ~...0..~. ..................... B ock Lot County Tax Map No. 1000 Section ......... , ............................ · ' ' ~ Filed Map No Lot No Subdwm~on ............................................... Permit No ........... Date of Perm t,. ....... ¢,.Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... ~-'--~equest for Temporar~ Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. on on above II.v. 10.10 70 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PI,~BG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~INAL INSPECTO ~ FIELD,~INSP~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~?DE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 7654802 Thls is to advise you that the job~un.de~building permit no. 12~95Z issued to Corrine ~erno±~ on _--~_i~9/8~___ for Addition is completed and a final {nspection has ( ) has not ( x ) been done. An Underwriters Certificate is needed fn order to complete this file, it is necessary that ~ Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable ~o the Towu 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 unlawful without a Certificate of Occup,qncy. Please help ns to clear up this matter so that legal action does eot have to be taken. Thank you for your prompt attention. Very truly you~, Victor Lessard Executive Administrator VL:gar encl FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, '11971 TEL.: Examined ~,~... ~.,?.., Disapproved a/c ........ M" ....... ] ............ ~'"~ / ~ ~ (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 reg~atio~, and to (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is 9wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~me of owner o~premises ..... C:,.~. x,~: ~¢.~ .... ~¢..k.~../-.. 4 .................................. (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 ......................... Electri0ian's License No. ?. ~. ?.5 .t. ~.~:'! 5.! .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... /.6~.0. 'Pe,~ lff g~ ~ ~TT,Y~,~ rf . .N.,.V.., .......... House Number Street Hamlet co~ut~ Tax ~ap ~o. 1000 sec.on .../.'Z-5 ......... Block... O..27. .......... ~ot. ~. · .%. ........... Subdivision ~/~.~-~t:~;?....~.,~ ...... Filed Map No ............... Lot../(, ~ ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex,sting use and occupancy .......... ~ .................... -(~-- .... ~. (~..~. ............ b. Intended use and occupancy~.~...[..~ .~ ?.' 3. Nature of wdrk (check which applicable): New Building .......... Additi~)n //~ Alteration Repair .............. Removal .; ............. Demolition .............. Other Work ............... 4. Estimated Cost ~ 6'0~ ................ : ..................... Fee ......................... i (to be paid on filing this application) 5. If dwelling, number of dwelling unitsj ............... Number of dwelling units on each floor ................ If garage, number of ears ......... ! ............................................................... 6. If busaness, commercial or mixed occupancy, specify nature ~d extent of each type~f use ........ .~. (D ~ ........ 7. Dimensions of exis~tin~ s/tructures, if any: Front ~4, {~. , Rear ....f~.d5 ...... Depth. ~.~. ....... Height ....... ~.~. '~... Number 9f Stones ... ~ ..................... l ................... ; .......... Dimensions of .~.~same sttmcmre with a!terations__ or .~, ,~].~/.additi°ns" Front i i i ~u~oj~S,~i~s, .~] O . .. Rear..~,.. ,~.~ii ~- . iiiii.." Depth .... .. ............ ..... .... , ~- 8. Dimensions ofen;lr~njew constructmn. Front.. ,~., .~. 7,. ~/~.. Rear,..~.~'..~.! .... Depth .. ~ ........... Height ....... [ .~<;]X(... Number bf Stories ...~. ......................... ......................... 9. Size of lot: Front ........... ;..,i ........ Rear ...................... Depth ...................... 10. Date of Purchase ...... ] .~. ~. ~..j ............... Name of Former Owner ...... ~.'%.~-:V'..~'..q ............ 11, Zone or use district in which premises are situated .... .~.J>l.~ ................................ 12. Does proposed construction 71elate any zoning law, ordinance or regulatmn: 13. Will lot be regraded ..... ~ .... ................. Will excess fill be remov~ ~d from premises: _Yes 14. Name of Owner of premises ~.o.~.~.t,~.-5...~-.~.~..[q~.~... Address ~ F,,~.l.~.~.%~ ...... Phone No..~cj,~. ? .... Name of Architect ............ ( .,,~.. ~ ......... Address ................... Phone No ............... Name of Contractor .'~.~. ?.¥~.~.-~ .~?.KLi ~ .~.. Address .g,~x.T...~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines, Give street and block nu 'abet or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW.~R~,/. /2/~ ' S S COUNTYO ............ J ' ~ , .......,~ ,,z~,//__~~..~l .~. ~.d .......... being duly sworn, deposes and says that he is the applicant (,lqlame of indMdual signing contract) above named. He is the (Contractor, agent, corporate officer, otc.) of said owner or owners, and is d01¥ authorized to perform or have performed the said work and to make and file this application; that all statements co~tained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fdrth in the application filed therewith. Sworn to before me this, /t~2~ day ii f. . ~ ,19 , NoIBtY PubliC, State of New Yulk~ ...._.. ./ .................. ;7. ~.~., ,-. ~ ~.~4~.- NO. $2-0~ ~Uffolk CountltJ~ .' ~ ~fl~JtM M&fllh 30, 19~'..T ' (Signature of applicant)~