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Home My WebLink About13099-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No.z. ? .25.~.0. .......... Date .g.u.n..e..~.l. ........................ 19 .~.~ THIS CERTIFIES that the building., p.e.a.k...a.d.d.~..L .~p.n. .............................. Location of Property ..... J ,1.5.0...L,u,p,L, 9.~' .~,L.:..~.o.a.d. ......... Mattituck House glo. Street Hamlet County Tax Map No. 1000 Section .~ .q.D. ........ Block . .~ .1 ............ Lot . 3.3. ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ t? .v.i.1.. 1 J ...... 19 .~.~. pursuant to which Building Permit No... ~. .3 .0 .9. 9. Z. ............ dated . ?..a. y ....?. .................. 19 .~.~., 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 ......... ....~P..~ 9i3D.L.v. ~.a.t..a...d.e.q~...a,d.d. J;. ~.i.o.~...t.o..a.n...e.x.J:. ~..L.ip.~...o.n.e.. ~ .a.m.i.];y....d.w.e..1 .]_~.n.g.: The cer~ificate is issued to . .E.a.b..eft & Lois Barker ............... ...................... of the aforesaid building. Suffolk County Department of Health Approval ......... I~/. ~ .............................. UNDERWRITERS CERTIFICATE NO ................. ~/..b. .............................. Building Inspector Rev. 1/81 lrou~r NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEI~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13099 Z Permission is hereby granted ~ , ~ .... [...~~ ....... ..K.~,~,~ ........................... ~,~ ~(~2 ~k.~ ............. .... ~;:;,"- ...... *'--" .... ;~'"'"i",'~'"?~E~ ......... .~.~.-~. ........ :~ .......... ~..::....:. ...c~,.~:,. ............... ~......& ...... , ....... ¢.~,,;A.~, .......................... ~A..,.. ......... ~ ..... ~. %~-~.,: ¢,,,'-~ ~.~.,,,,;,~. ,.. a~. ~z~'.,~....,j.~.~. ............................ "¢ ....... '"7 ....... :'"";'; ..... "". ...... .:~---:;;- ;,-- .r: -. , .............. at premises ,ocoted ot ...../~...~.:.~-........ ~;.¢?.'~. ~.... ~J..... · ........ }.~I...oL~.'A .................. ...... ~.~ ....... ~:~ ................ ~,~fJ[~: ............................................................................... ..................... County Tax Map No. 1000 Section .~,...,(/..~.,~. ...... Block ....... .).~ ........... Lot No ...... ~....~ .......... pursuant to application dated ...../ '~.(.:.~'/.~....~......f..~2 ................ , 19:~..(./and approved by the Building Inspector. Rev. 6/30/80 FORM NO, 0 TOWN OF SOUTHOLD Duildinl] Dopartmont Town Hall ,")outhold, N.Y. 11071 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter. OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or now use: 1, Final survey of property with accurate Iocatlon of all buildings, property lines, streets, and u~usual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposaI-(S-9 form or equal). 3. Approval of electrical installation from Board of Fira 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 a~l property lines, streets, buildings and unusua~ 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 building'; or premises, or other pertinent informa- tion required to prepare a certificata. Fees: 1. Certificate of occupancy $5.00 2. Certificateof occupancy on pre-existing dwelling/ land uso 3. Copy of certificate'" of occupancy $1.00 --Pre.-E×ist£ng C.O. $15.00 Vacant land C.O. $ 5.00 ............. New Building ...... Old or Pre*existing Building ............ Vacant Lsnd ............. Location of Property · Hou,~e No. Owner or Owners of Property . //.? /.(. County TaxM~pNo. 1000 Section... ........, .. . Block ............ Lot. .......... ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ~) '-~ Date of Permit//F. ~'....Apphcant Health Dept. Approval ........................ LaSer Dapt. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above de~ribed building and ~,r ~it rn0ets all applicable codes and regulations. FOUND) ROUGtl FRAME & ?LUMBING 7NSUI,ATION PER N. STATE ENERGY C,ODE F£N^L ADDITIOnaL COMMENTS: TOWN O. SOUT.OL .U,'"'N" TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... Received ........... ,19... (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 hereha described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ha building for necessary inspection~ .......... .... (Signature of applicant, or name, if a corporation) ............ ................ (Mailing address'' of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .../~...~.e.,.~.~ :[.` .~... ~.o.t.~ ...... /.~...z4.~../~. C. ~ .................... (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 ..... ?..7'.~ ................ 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 .... .~. t .'~. ..... Block ..... i[[t/ .'~. W. ........ Lot .... 1"~ ~.~ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f.pr~p~sed c~nstructi~n: b. Intended use and occupancy .......................................................... 3. Nature of work (check which applicable): 10. 11. 12. 13. 14. New Building ..... ' ..... Addition...--~..'. .... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............... i .... J~ (Description) Estimated Cost.. o..o p. ~ . Fee ~ · "' ' *'. (to be paid on filing this application) If dwel)ing, number of dwelling ~nits ............... Number of dwelling units on each floor ............... If garage, number of cars ..... i ................................................................... If' business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height '. .............. Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... [.. Height ...................... Number of Stories ...................... Dimensions of entire new constrgction: 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 violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No Name of Owner of premises ... i ................. Address ................... Phone No..~.~'.~..~.. Name of Architect . ~ ....... t..~ ............ Address .~ ............... Name of Contractor . ~ ~ . .<~................~..~. ~, (~' ....... Addres .~..~"-'"'- ~ "Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all lbulidings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. . STATE OF NEW YORK, S.S COUNTY OF ................. ............................ i .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigqing contract) above named. He is 'the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this applicationi tt~at all statements contained in this application are true .to, th,e best of his knowledge and belief; and that the work will be performed in the mann? sci forth in the application filed '~l~ereWith. Swam to before me this ~q01AR'i I'[JBLIC, State 0~ New Y01k ......................... }')a 4~/a78, ~tlfie~ C0un~..~- (Signature of applicant) lerm F_x[ar~.s ~/la~cl~ 30, t / / .h / 8~ ~o r 3::