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Home My WebLink About12957-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12501 Date May 30 1984. THIS CERTIFIES that the building....................deck additio.n.. ...................... .. ., Location of Property .... 2Z.0.5 ................. M..i.l.1..R..o.a.d. ...........M.a.t..t.i.t.u.c..k ..... House No. Street Ham/et County Tax Map No. 1000 Section . . .10O ...... Block ....... .3 .......Lot ' 13 Subdivision ................. x ............. Filed Map No ..... .x...Lot No ...... x. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. March. 22 ........ ,19 B.4 pursuant to which Building Permit No. 12957Z · dated ..... March..30 ............. 19 B.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 ......... ....... ~eo~ · ad~i~ ion .%o. axis~ing. ~ 11 lng ................................ MICHAEL GAYDOS IK The certificate is issued to ........................................................... (owner, ~,~6 of the aforesaid building. Suffolk County Department of Health Approval ........ N/A UNDERWRITERS CERTIFICATE NO.. N/A Building Inspector Rev. 1/81 lrO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ z ~o,, ....... h.~.~.....~ .................. ,,,.~.~. Permission is hereby grante.d to: . ~. ~ -- , [ ....... .......... ~..~..~.~:...~...~....£~..~....¢..¢..~.~....~..¢.. .... i ......... : ...... ~.:...~......, ........ k/. ..................... ., ..~.~..~' ~ ~~ ~...~' . . .~...~ ~ ...1..~..~.¢...,.....0~.......~...~...~....~ .................... ~ .................... ~ .............. .. ............... at premises located at .....~,,.)..?...~......,.~....,~,...~,,~.....~..,...~...-b,',...J..~,-,%c~,,-,L%°, ....,~.......-,.~.~~..J.,~*.. County Tax Map No. 1000 Section ..J..~ .......... Block ....... [..~.. .......... Lot No ..... !..'..~. ............. pursuant ,o opplication dated ..... i..~..~.......'~....~:.. ................. , 1,..?..L.[, and opproved by the Building Inspecto¢. Building Insl>ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted in duplicate to the Building ~nspec- tor w~th the follow~ g; 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-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 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 3. Copy of certificate of occupancy $1.00 use--?re-Existir]g C.O. $15.00 Vacant land C,O. $ 5,00 Date .('!(.~ ~ ................ 'b Land New Building.... ....... .. Old or Pre-existing Building ............ Vacant Location of Property~] J O~' I ~,~L .~. ~t~. .... Hou~ No. Street f/am/et O ..r orP op.rty . C~nty Tax Map No. 1000 Section ' ' .... ............... Block ............... Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~g~ Date of Permit ~ [~/.~.Appiicant..",~'~}%*.~.~ .~.7.~ J-(~: ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval..,,,,,,,.,,,,.,,.,.....Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... ,,, S bmit,ed $ ................... Construction on above described building and permit meets all 9pplicable co~es and regulations, Applicant 7~~~ Rev, 10-10-78 FIEPD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpDE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Received ........... ,19... )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 Its 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ltion. 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 ~ail be kept on the premises available for inspection throughout tile work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy mit 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or _egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections.~ .1 ,;' ,/] (Signature of applic,~, or name, if a corporation) (Mailing address of applicant) ~tate whethe~ applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... {?. ......... . ........................................... qame of owner of premises .~)~.(e.~.0 .Q~ .~..~.~.]').0.~. I, .~.~.../~../4./L. ?/..~. ~.1)...~../J.~. ............................. (as on the tax roll or latest deed) f 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 ...................... Location of land on which proposed work will be done ............... ' .................................... 1 .0[ ..... ....................... ............. House Number Street Hamlet lP.o ,'-:- CountyTax Map No. 1000 Section ............... Block .................. Lot ................... Subdivision ..................................... Filed Map NO ............... Lot ............... (Nmne) State existing use dud occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.? ...................... : .......................... b. Intended use and occu anc . ~.~..¢.C(Q.. w J D~.~.~ ~f. · ~ P Y ............... '~'d: %;~-' '~ ~ ' '7' ......................... 3. Nature of work (check which applicable): New Building O, 1. 2. 3. 4. ' Addition .~..e~. ~. Alteration Repair .............. Remova:l ............ Demolition .............. Other Work ~ _~ (Description) 0 Fee ................................... Estimated Cost ·. · .......... I .................... °°' (to be paid on filing this application) un'its N mb fd 11' ' fl If dwelling, number ofdwelling ~ ............. u crc we mgumtsoneach ocr ................ If garage, number of cars ....... ' ...................... ;'. ......................................... If business, commercial or mixed Occupancy, sp¢cify~n~aturc and extent of each type of use ........ ,'~:.'~'? '/7 ...... Dimensions of ,e~xi,st!rng structures, ,if any: Front.. Y3.~ ......... Rear .............. Depth..7. y..c? ........ tteight ... 0,3..(v. ...... Number of Stories ....................... .3 .............................. Din~ensions of same structure with alterations or additions: Front ...~ ........ Rear .................. ~ Height Number of Stories Depth ..................... ; ............................................ of entire new construction' Front Rear Depth Dimensions .............................................. Height ............... Number of Stories ........................................................ Size of lot: Front Rear Depth Date of Purchase ' Name of Former Owner which premises are situated Zone or use district in ..................................................... Does proposed construction violaie any zoning law, ordinance or regulation: ................................ Will lot be regraded .......... , ................ Will excess fill be removed from premises: Yes No Name of Owner of premises .... J ......... Name of Architect ' ' Name of Contractor " ..... Address ................... Phone No ................ ..... Address ................... Phone No ................ ..... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ~uildings, whether existing or proposed, and. indicate all set-back dimensions from ,roperty lines. Give street and block nmnber or description according to deed, and show street hanes and indicate whether ~terior or corner lot. :OUN*¥ OF. iv. ~. ~//~. .... !~'~ .......... (Name of individual sigmhg contract) .hove named. ....... being duly sworn, deposes and says that he is the applicant · leis the .............. .~..C~.~..e~...~..~. ................................................. ' (Contractor,~rl/ent, corporate officer, etc.) ff said owner or owners, and is du'ly authorized to perform or have/~erformed the said work and to make and file this pplication; that all statements contained h~ this application are true to the best of his knowledge and belief; and that the york will be performed in tile manner set forth in the application filed therewith. ;worn to before me this .~ . .../.; .... qotary Public,..~, .'~ . ~ ~.8.[i_g._~.~..~..t~t~.Ogi ,,,r'/. (Signature of applicant) ~ no. ~.14~.n.~