HomeMy WebLinkAbout13171-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18420
Date SEPTEMBER 26~ 1989
THIS CERTIFIES that the building
Location of Property 16105 MAIN ROAD
House No.
County Tax Map No. 1000 Section 115
Subdivision
ACCESSORY
Street
Block
Filed Map No.
MATTITUCK, N.Y.
Hamlet~
Lot 8
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 25~ 1984 pursuant to which
Building Permit No. 13171-Z dated MAY 31~ 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 ACCESSORY 3 CAR GARAGE AS APPLIED FOR.
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. l/B1
JOHN M. & JANET J. STEWART
N/A
H-005627 - OCTOBER 6t 1988
[ Building Inspector
FOB]M[ NO. S
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13171 Z
Permission is hereby gronteRI to;. ~ -~ . -
....~....~.~.~..~...~~...
.... ~..~...~ ................................................
.... ~.~..~.:~.:..../../...~..~....~......
,o ...~.~.....~........~.~....~....~.~...~..~.~ ............
~'"'"~""~'--'"'~. ....... w~ ......... :'""~'"7 ....... ~':~'""~:T ....................
I ~olo~ ~ . .gl, ...... ~'~.
at prem,ses located at .............................. '["~Jr .... ~' ........... 'r"/'"~ ~ .....................
County TOX Map No. 1000 Section ....... ~..~...~.: ...... Block I Lot No. '~
I~uildlng Inspector.
F~,.a.~..:~.S ....
and approved by the
Rev. 6/30/B0
FORM NO.
TONN OF SOUTHOLD
BUILDING DEPARTMENT
TONN UALL
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that solder used in system contains less
than 2/I0 of IZ lead.
5. Commercial buildings, industrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (Prior to April 9, 1957~ non-conforming uses, or buildings
and "pre-existing" land uses:
I. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire Iot prior to April 9, 1957.
. If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
i. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of the entire 10t prior to April 9, 1957 shall also accompany
the application., If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
FEES:
~. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2, Certificate of Occupancy on pre-existing dwelling - $]00.00.
3. Copy of Certificate of Occupancy - $5.00 - over $ years - $I0.00
4, Vacant Land Certificate of Occupancy - $20.00
5, Updated Certificate of Occupancy - $50.00
6, Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
rev' 70/14/88
TOWN OF SOUTHOLD
BUILDING DEPARTHENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ..... fOLD OR PRE-EXISTING BUILDING ..VACANT LAND
~ocation of ProperW .... Z$JA~..; ..... ~.~.~.
..... /Y~.~7.~z~._.~ ~/...
HOUSE NO. HAMLET /
Owner or Owners of
County Tax Hap No.
Subdivision .............
I~1 7/ ~. D t
Permit No ......... a
Health Dept. Approval
''' ............... Underwriters
Planning Board Approval
Request for Temporary Certificate ....... Final Certificate
Fee Submitted:
I STREET
Property.. ']~''~' .... V~. .
,ooo Se=tion l/~E~oe~ ...i. ~ot' ..2' .....
......... Filed Map ........ Loc ..........
of Permit .......... Applicant
Approval ..............
co%:l~qan
rev. ]0/]4/88
TOgrN OF $OUTLIOLD
OFFICE OF BUILDING INSPECTOR
ILO. BOX 1179
TOWN IIALL
$oU'rlIOLD, N.Y. 11971
September 21, 1989
TEL. 765-1802
JORN H. & JANET J. STEWART
16105 MAIN ROAD
MATTIlllCK, R.¥. 11952
To Whom %hzs May Concern,
We are unable r.o complete your Certificate
of Occupancy because .of the following reasons.
/_--//An application for Certificate of Occupancy
--A/-A is not on file. (.ENCLOSED)
/~/// No Underwriters Certzficate On file.
/~// The cheek i'.; (o~u~JJfl~Kot on f/lc. ) $25.00
/.~/ No Heal. th Dept. Approval on file.
/--/ No final insDection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
lhlkldkr',g Permit }} I 3 I ? I Z
Dui ld (hq Dept.
*'**/~/ ~Io Plumber solder Certificate on file.
( all permits involvitig plumbing being
issued after April 1,1984 )
TOWN OF $OUTHOLD
OFFICI'~ OF BUILDING INSPECTOR
P.O. BOX 728
TOWN ItALL
SOUTIIOLD. N.Y. 11971
TEL. 765d8o2
'rh i ,~:, is
permit no;
,,,, /,a, L8.4
a f i n a 1
to advise y:ou that the job under building
t3171Z issued to John Stewart ii :
.... for A~cessory ' ts completed
iO,;pectioa ha:; (-----7--l~-~a-s' n~been done.
and
rn older to cqmplcte this f:ilc, it is necessary that
;t Certlfigate of 0c. ct panty be issued. Plean~ fllt Out !thai
enclosed for.m, return same to tile above office with a dheek
for $10.00 p'aynble to the Town of Sou(hold..~ Please indicate
to Whom the Certificate of Occup'ancy is tO be mailed, 4nd
arrange w~tb this office for an iiDspection (late
0ccnl)ancy or uae in unlawful w{thout :a Certif{cat6 of
Occupancy
legal act
Plea~e.',help ils to
~.on does not have to
yon for yuur prompt
Than
el'ear up this matter so that
be taken.
attention.
Victor Lessard
gxecutive Administrator
VL: ga r
('11£ ] .
~-' i E I,D '[;ISPECTiOI~
FCU Ut) A'? foil ( 2nd )
[:}lAME &
PLUHBING
3.
STATE
C,ODE
q.
A D D I '[";. OH A L COHHF
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ]INSULATION
FRAMING [ ~FINAL /~
765-S802
BUILDING DEPT.
INSPECTION
FOUNDATION SST
FOUNDATION 2ND
FRAMING
ROUGH PLBG.
INSULATION
[ ~l~L
DATE
//
'FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
8OUTHOLD, N,Y. 11971
TEL.: 765-1803
...~..~.1.. 19 .~.5'
Examined ..,
Approved . . .~...~..~./.., 19~..ti. Permit No./..~.! .7.]. ..~..
Disapproved a/c .....................................
....... i~~;it;;~' ' '
................................. ...... ..
APPLICATION FOR BUILDING PERMIT
Date ............. i .
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 properW 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 regulations, and to
admit authorized inspectors on premises and in building for ne~nspect~_~ ~--.,-.~ -~.~~x-.~~%. ~C~........'-'-'"~""-"~'[ ,~t~u/ .
(Signature of-l~t, or name, if a co}poration)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
....................................... ~ 21 .................... : ........................
Nameofownerofpremises ..~.XYklO ..~....~....~.~...~.....~..~."~'"..~...~.. ................. (as on the tax roll or latest deed)
If a~ant is a corporation, signature of duly authorized officer.
.....
(Name and title of c'm!cmdate offi )
Builder's License No .... ~.'.~ ..............
Plumber's LicenSe No ..... .~..O..~___~. ..........
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done....~. ~w¥~-., .......
.../. ~./. ?..¥ ......... ~ .....................................
House Number Street Hamlet
"-" ...... ]. ....... Lot .... ~
I r.x
County Tax Map No. 1000 Section ...... ,. ,.~-~. ....... Block ...................
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....................................
b. Intended use and occupancy ............ .~..0~,..e~....~. (~.Ox...C~, ........ (?...u,)~ ..................
3. Nature of work (check which abplicable): New Building ....~.' ..... Addition .......... Alteration ..........
Repair .............. Rembval .............. Demolition .............. Other Work ...............
(Description)
4. Estimated Cost ........... ................... .... .. Fee ......................................
'" (to be paid on filing this application)
5. Ifdweiling, number of dwelling units~ ............... Number of dwelling units on each floor ............... .
If garage, number of cars ............ ~ .~.~..~ ...~5:~..C~.. .......................................
6. If business, commerciai or mixeld occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structurgs, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure With alterations or additions: Front Rear ................
Depth ' Height Number of Stories
8, Dimensions of entire new consti~ction: Front .. .~,, ........ Rear ,.. :'Ok ........ Depth , ,;g,Q' ..........
Height Number of Stories \ .%~r~x~
9. Size of lot: Front ..................... Rear ...................... Depth ......................
10. Date of Purchase ............................ Name of Former Owner .............................
11. Zone or use district in which premises are situated ......... .~~ .................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~;2~ .......................
13. Will lot be regraded ...... k)~ ................... Will ex~ess fill be removed from premises: Yes (~
14. Name of Owner of premises 5~-~O...~...~e~..... Address .~_'~ .O.~.~-!~.~... Phone No ................
Name of Architect . .~~ .~;9~,4C~... Address . [ .~qg,.~'..1~..~.\~.~.. Phone No.. ~ .~.~\\ ....
Name of Contractor ~ Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
C OUNT._Y~OF .................
..... .%.4-.LJ~..-w. L:f,.X.~5'q&g~.~DlO.~.~eing duly sworn, deposes and says that he is the applicant
(Name of individua-T~gn~ng contract)
above named.
He is the ..................... i .........................................................
~ (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dul~ 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 manne~ set forth in the application filed therewith.
Sworn to before me this
No. 4707878, ~uff0 k C0un}y ( TSi~aature of applicant)
d,
~PP[~Ot'CD ~S NOTED
7~-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNnATION - TWO REQLJtRED
FOR POURED CONCRETE
2. ROUGH ~ FRAMING & PLUMBING
3. INSULATION
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N, Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.