HomeMy WebLinkAbout13131-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y,
Certificate O[ Occupancy
THIS CERTIFIES that the building . .N..eK .D..w.e.l.l.i..n9 ................................
Location of Property ...2.45 ......... Theresa Dr. MaLtituck
House No. Street Hamlet
County Tax Map No. 1000 Section ...1.1.5. ...... Block ..... 1. 5. ........Lot ...0.0.2. ...........
Subdivision .D..eg&q..H.o.l.e..~T?.e.k...E.s.'q: ...... Filed Map No...4.2.5.~..Lot No...4..4 .........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
·..l~.a. y .... 1.~ ......... , 19~.4. pursuant to which Building Permit No ....... .1.3.1..3.1.Z ........
dated ............ ~,ay. ...... 3:..6 .... 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 .........
...P..r.i.v.a.t..e..O.n.e...F.a.m.i..ly..D.w..e.l.l.i.n. g .............................................
The certificate is issued to ............... .J. QH..N..J.....M.I.E.S..N.E.R. .........................
(owner, Je~ee.o~
of the aforesaid building.
Suffolk County Department of Health Approval ... }.4.r$9.-.B. 8. .............................
N661219
UNDERWRITERS CERTIFICATE NO ..................................................
Rev. 1/81
Building Inspector
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING FERMIT
CI'HIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13131 Z
Permission is hereby granted to.~___ , ~ ~
..... ~..,.~ ,~..~...~.,~...,~
...... ~.~ .......?..~.~., ....................................... ,
,~ ...... ~..v~.,~..~=.~..:..~.....~.~.~.~Z,
~o ......... ~.O~...~-.(.ZC...~.T......~ ......,w~.....E~ .~,~.~..~.~...... x~.~..(. ~-~~/ ......................
/
~t ~i~es located '~'i'.i~.Z!ii..!!~.~.~."~i.....~."~"'ii.~......i ....... i ....... ii...iiiii, ii ....... iiiii
....................................................................................................... .~..~.;./..¢,,,.~..=~..-..~.
County Tax Map No. I000 Section .../../.~...] ......... Block ....~..~ ....... Lot No..(~..~....~...'~., .......
pursuant to application dated .... ~/~.~...........~... ..................... ' . . ,192.~., and approved by the
Building Inspector.
Fee $../~..~...,...~. 0
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
¢,~uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in Wpewriter OR ink, and submitted-icr~c~J~cc%" 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 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 featu res.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings.
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
3. Copy of certificate of occupancy $1.00
landuse--Pre-Existing C.O. $15.00
Vacant land C.O. $ 5.00
New Building ............. Old or Pre-existing Building ............. Vacant Land ..............
Location of Property ............... ~ .............. ~ .... ~ ...... · .--~-~. , .
. ...........
Owner or Owners of Property
County Tax Map No. 100~Sec~ron~L/ .... /...,~..~... Block ............... Lot ......... 7. '; ....
Subd,v,s,o £ ~t..~.?~. F,ledMap'No ~. -~' LotNo~
"' ....... '
Permit N o. '..'~J .~.~.[...~-~. DatLo, f Permit ..........App licant~,~/. ~./.~/~'~. ....
Health Dept. Approval ,JJ d., ~ .-.~ ....... Labor De~rt~. Approv~l/ ......................
Underwriters Approval .............. Plannin oar royal ....................
Request for Temporary Certificate ..................... Final Certificate ...
Fee Submitted $ ~7~.. ............
Construction on above described bu ilding/
R~. 10-10-~B ~
THE
102501.8
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
N 661219
only the electrical equipment as described below and introduced by the applicant named on the above application t~umber in the premises of
John Miesner, E/S 'iheresa Lmle, 150' S/O New Suffolk Avenu% ~Mattituck~ N.Y.
in the following location; ~ Basement ~ 1st Fl. [~ 2nd FI. Section Block Lot
was exa,nined on ~O~)t~l' ~0~ ~[~ and found to be in compliance with the requirements of this Board.
FIXTURE
OUTLETS
DRYERS
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
Motors: 1-
E R V I C
NO, OF CC, COND A W, O. NO OF HI-/~O A W, O NO, OF N~UTRALS A- W. O
]. 21o ~. 21o
Peter Chnrbonne~u ~~
L~5 Sheppa.~d ~e
S~t~o~, N.Y. Lie, ~97
GENERAL MANA~
This certificate must not be o{tered in ony monner; return to the office of the Board if incorrect. InspectoYs may be identified by their credentials.
~OPY FOR BUILDING DEPARTMENT. THI~ ~OPY OF GERTIFIGATE MU~T NOT BE ~LTERED IN ANY MANNER.
~iELD~ iNSf~EC7 iON
~OUNDATION (1st)
FOUNDATION (2nd
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
FINAL
ADDITIONAL COMMENTS:
765-1~0Z
BUILDING DEPT.
INSPECTION
FOUNDATION ZST [ ] ROUGH :PLBG.
FOUNDATION 2ND [~ INSULATION
[ ] FRAMING
[ ] FINAL
DATE '-~///~ ~ INSPECTOR L,) .~o/.--
INSPECTION
FOUNDATION 1ST ~ ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
~ FRAMING [ ]FINAL
REMARKS: ~ )*~'~'~ ~J~,
~
DATE
BUILDING DEPT.
'INSPECTION
[ 'I FOUNDATION XST [ ] ROUGH PLBG,
FOUNDATION ZND [ ] INsULATiON
[ ] FRAMING [ ~FINAL
REMARKS:
DATE
INSPEcTOR..////~ .
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y, 11971
TEL.: 765-1803
Examined . .~..~. ~.~. 19~
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. Tkis 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 l~remises 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 escribed.
The a licant agrees to comply with all applicable laws, ordinances bulldog, code, housing code, and regulatio~ ts, and ~to
PP .......
admit authorized inspectors on premises and m building for necessa~z~,2~. -~_~ f~
(Mailing address of applicant)
State w~ether appl~.~ant is pwner, 1,egsee, hgent, architect, engineer, general contractor, electrician, plumber or builder.
Naln~ of owner of premises ~~./. V..c'~- · · .~....7. 7~ 7.'..- ......... ].~d~). --..~ ....................
// // (as onthe tax roll or latCt dee )
~a~ pli c~is/a~ ~ h(4~ign .a. t 7e
z/ '( ,~]ne and title of corpora[e office )
mlumber'sLicenseNo...~-./~.~. ~.~
Electrician's License No. /Z /t 4,.~ ....
Other Trade's License No ......................
... ~ .................. . ..%~.. ~....~.. ~ .......... ~ .z~./~.. .........
House Number Street Hamlet
County Tax Map No. I000 Segtio~l ...~../.[~, .... ~../ Block . /. Lot ... ..............
2. State existing use and occupancy of premises a~n~ intended use and occupancy of proposed construction:
a. Existing use and occupancy
.. ..... : .................. ,,. ...... ....................
b. Intended use and occupancy ~...(~..~..~...~;~ ......................
3. Nature of work (check which applicable): New Building .... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...... ..........
4. Estima~edCost ........................... Fee... ..... · · · ... .......' .............. .
'-' (to be paid on filing this application)
If dwelling number bf dweliln~ Units ...... ~ ...... Number of dwelling units on each floor.
If garage, number of cars . . ~. ............................
If business, commercial or mixed occupancy, specify nature and extent of each type of use*. ....................
' ' pth
rd if any ...- ........ Rear .............. De ...............
Dimensions of e sting structures, : FrOnt ~ '
' Number of Stories
~ Dimensions of same atructure with alterations or additions: Front ................. Rear ..................
8. Dimensions of entire new construction: Front .., .C~. ~. ........ Rear . Z;Ld'...cq. ...... Depth . .~. ..........
Height ..: .......... ,'-~' Number of Stories ........... / ~ .,~ ..................... .,. r~^ ................
.Date of PurChase . .~/.,~6..~d..]~...c']. ............... Name of Former Owner . J~-~./~-Jff~ .~.~..~f. ........
11. Zone'or u~se distric~~--~'in'which pre~nises are situated ........................ ~ ..............................
12 Does proposed constr?Jinn violate any zoning law, ordinance or regulation: /'~. ~. .........................
'13 Will lol be'regraded '.'9/~.~... i ............. .Will exc_.~ess fill be~removed from premises: _ Y,~, ( No~
PLOT DIAGRAM
Locate clearly and distinctly all!buildings, whether existing or proposed, and~ indicate all set-back dimensions from
properly 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 YOR[,
COUNTRY OF >5~.L.¥ .t~.~9 glO.... S.S
...~.'~.F~..~...Y~.. ~'.~. y~. ,/~. S ./~..~:/~ ................. ' being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above namea~j~..,~_/yL, ,_e,~.
He is the . .,~.,~r..,rt. r .......... I ...............................................................
: (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 t~he best of his knowledge and belief; and that the
work will be perforfiled in the manndr set forth in the application filed therewith.
Swum to before me this I .
· ....: ...... 2.../.(d ....... dayo~ ...... (.\l .]...
LINDA F. KOW, ALSKI . ~;..; ....'.
'' NOTARY?UIBLI¢', N~. 52-~24771Stat" of New ¥~rk [//// ' 'k//// (Signature Of applicant)
Qualifi(ld In Suffolk County . ' - ,
,: -: . ~mmmm~n Expires March 30, 198,'
· 'SLI~FOLN COUN'Pr FIFP.~I~I'MENT OF H~LTH SFRVIC£S
NF-W
SUFFOLK 4 VE.
FOR A~'?~:O:,',~i_ OF CONSTRUCTION OF
$ing~ ;':.:m~y Residence Only
/ -
LOT 20
LOT44
/82.0
I'zZ'4 N. $7° Ig'20* W
LOT 21
SU~¥EY FOR
JOHN MIESNER
AT M4 TT/TUCK
TO,lIN O~ $OUTHOLD
SUFFOLK COUNTY, N. Y,
SCALE: I "~ 40'
~PRIL 21,1984
REF£R~NCE '
'DEEP HOLE CFIEEK EST,,~TE5
FILE NO.42~i FILED
I MIARANTE'ED TO '
NEW
SUFFOLK
LOT 20
$' 87°19'20" E.
N. B?~ I..o'20" ~
LOT 21
18~. 0 '
LOT 4~I
~4
I$~.0 '
LOT 45
~ LOT2~
SURVEY FOR
JOHN M/E:SNER
AT MB TTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY,
$CAL£ ~ I% 40'
F;R$T AMERIC&,N TITLE INSURANCE OOMPANY OF
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