The URL can be used to link to this page

Home My WebLink About13337-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Il3001 Date November 21 19 ..8.4 THIS CERTIFIES that the building ...A.d..d.i.t.i.o..n .................................... Location of Property 2300 Grand Ave Mattituck House No. Street Hamlet County Tax Map No. 1000 Section ....1.0.7 ...... Block .... .0.2 ......... Lot 009 Subdivision .......... .X .................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Aug B , 19 8.4. pursuant to which Building Permit No. 13 3 3 7. Z dated ....... ~..ug.. .......8. ......... 19.8.4., 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 ......... ... Ac!d. $.t.~.qn...~9..~: .x:L.s. tj .rig..D.W.e.Z.i.~.n. g ....... (.D.e. 9.k) ............................. The certificate is issued to ....... JEMMOTT, DOROTHY a OLIVER (owner,-le~ee er.-ter~t) of the aforesaid building. Suffolk County Department of Health Approval ........... .N/.A. ........................... UNDERWRITERS CERTIFICATE NO ................... ~1./~ ........................... Building Inspector Rev. 1/81 TOWN OP 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) N? 13337 Z ....... Lot No ................ pursuant to application dated ..... ~......~... ...................... , 19..~...~., and approved by the - / Building Inspector. Fee ,.~...~....~.~.... 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 typewriter OR inl<, and su ' .~; tor with the following; for new buildings or new use: bm tted-~., ...... to the Building I nspec- 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 topograph ic 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-existingdwe ng/ land use --?re-~;xlsLln~ C. 0. $1~5.00 3. Copy of certificate of occupancy $1.00 Vac~nf, land C.0. $ 5.00 Date .... ]~ ~..~.l ~..~ .......... New Building . .~...~ ..... Old or Pre-existing Building ............ Vacant Land ............. Locat,on ofPrope .............. ~ , ~otreet Ham/et County Tax Map No. 1000 Section . ./..~...~,..~.. Block ............... Lot ................ Subdivision '/ ................................ Filed Map No ........... Lot No .............. Permit No. 7(~l~j~....~.. Date of Parrot AoDlicant~.~.~..~.~_ .~5:-.~4~.~"'-~..,~..~.~ Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted ~) O Rev. 10-10-78 ~.~ FIELD I~S?ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 ToWN OF souTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 xamined · ~' '~''' '" ipproved~...~. ..... 1 rmit No../.~..~. '~' (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ..... ' Date .... ' ...... 19. INSTRUCTIONS · must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 a. This applicahon~ ...... ,_ Fee according to schedule. . ....... n:^;.,ina nremises or public streets sets ~f Ppl~o~ ~lu~toewPint~t lPjcaa~itfn~t~ot and of bUllod~g~o;~rtP~emm~setS~)~e~rt~lS~np ~ea~;~l~ ~vhich is part of this appli or areas, and giving a detailed description of layout P ' '- mmenced before issuance of Building Permit. cation. 's a lication may not be co .... ~ ~ ~,~a~,, Permit to the applicant. Such permit c. The work covered by.. tM ,..P~.,^~ the Building Inspector wm ~ssueu a ~, ...... d. Upon approval of tins appuua~, .... the work. ' shall be kept on the premises available for inspection throughout 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· MADE to the Building Department for the i~suance of a Building Per,nit pursuant to the w York, and o ' hie Laws, Ordinances or APPLICATION IS HEREBY~ ~ o~..+hal Suffolk County, Ne ~ ,~ as-herein described. Regulations, for the construc~-- '[th all a-plicable laws, ordinances, ouaa~m~ yves, .... ~ ~L w /, - (Mailing address of appii State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.~.t?. ~..~.. (as ont~~ax roll or latest (leeS) If applicant is a corporation, signature of duly authorized officer· ....... (Name and title of corporate officer) Builder's License No..~t .O. ~..c~ ~ .... , ........ Plumber's License No ......................... Electrician License No ............... Other Trade's License No ...................... tion of land on which proposed work will be done ............. '. ...."' ' ' '~'~"i~¢ .................... Loca ~-,__ ^/ ~.~/~ .~../~..~.c..~...E~..... · .................. 'q'~/~/h (.~t~/-h,~-/ . fj.-.c.._ .............. : ' ' Hamlet/ I ' House Number ~treet a No 1000 Section t~).~ ~ '~' ' Block .................. Lot ............. County Tax M p · ' ........... Lot · ....... Subdivision ................ (iq'a'r~) ......... Filed Map No State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...~..S...~.~ ~.Q .c~.... ~ (.M. ~--f...".'~.~,~...A~..~: ?"...~,).,. ...................... b. Intended use and occupancy ·..~.%-~' '~'~c~e~' ' '~'" '~? "(~' '~'' ' '~' '~' ' .~.c~. ~. ~4~.~).~.t~./, -8. lq. 1i. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ......... Alteration .......... Repair .............. Rembval .............. Demolition ....... -- i .... Other Work .~.4~. ~.~.. 4. Estimated Cost..g ...... ' ............................. Fee ...... [c~-..'77. ......................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling!units ............... Number of dwelling units on each floor ............... If garage, number of cars .... ; ................................................................ 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use .................. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............ Height ............... Number of Stories ..................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth ................... i · · Height ...................... Number of Stories .................... Dimensions of entire new consti'uction: Front ............... Rear ............... Depth ............. , Height ............... Number of Stories ........ .............................................. Size of lot: Front ...................... Rear ...................... Depth .................... Date Of Purchase .': ........ i .................. Name of Former Owner ............................ Zone or use district in, which premises are situated ..................................................... Does proposed construction vic [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 ................ 12. 13. 14. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ...................... , ................... (Contractor, agent, 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 manner set forth in the application filed therewith. Sworn to before me this i ........... NOTE~ ~ MONUMENT SHOW~i EE~E~I A~E FROM FIELD .~vzs~o.s YOUNG & YOUNG DEC. 20~1975 400 OSTRANDEE AVENUE, ~IVERH/AD SURVEY FOE: . ATLANTIC HOMES OF SUFFOLK, INC. ~WN O~' ~ SECURITY TITLE ~ GUArANTY CO, SOUTHOLD .'__L