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Home My WebLink About13205-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12577 Date June 27 ........ , THIS CERTIFIES that thc building .. D..e .c.k.. a..d.d.i.t.i. 9.n ............................... Location of Property 355 Woodcliff Drive Mattituck House No. Street Hamlet County Tax Map No. 1000 Section .. 3.0.7. ...... Block .7 ............. Lot ...2~ ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated .... ~ .ay..3. Q ........... 198. 5. pursuant to which Building Permit No..~ .3.2.0. 5. .Z .............. dated . .J.u.n.e...1.0. .................. 198.4. ., 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.e.q ¢. ~.4q $ .t,t.qn .......................................................... The certificate is issued to ...I5.~.qh..a.e.1..? ... 5..C..a.~.h.e.~..~.n.e..L.:..D.~.c..k.sg.n' (owner, of the aforesaid building. Suffolk County Department of Health Approval ........ .N/.A, .............................. UNDERWRITERS CERTIFICATE NO ................ ~1/j~, .............................. Rev. 1/81 Building Inspector Folr~ No. ~ TO~N OF Sou'rHOLD BUILDIHG DEPAI~TMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13205 Z Permission is hereby gr~nted t?: ~L, ' ~...i..b..~ .......... /'~ A_ ~ ............. ~-'":"'"l ............................ L' .... ~o../~,,~,~,~......~..........,_~..~....A......M.~.~,...~ ...... ~.. ............................. at premises located at ...~...~.,.~........'~..~r~..~.~.-~°..$.....~.~(~ ........... County Tax Mop No. 1000 Section ..... }....(~..] ........ Block ....... ] ..........Lot No....;;:~..~,... ......... Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,%uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted--ia=dup)~c=t~ 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. Commercia{ 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. 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 unusuat naturat or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 ! 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date...~.: .~.~...~.~i.~. · .... New Building ~ Old or Pre-existing Building Vacant Land Locat,on of Prop,tv .-~...-~....~e.....~. ~..cJ..r..~...~r.. ......... ~ .~.'.,.~ .~ ........ HouseNo, Strut , ~. Hamlet Owner or Owners of Property..~,;.~¢.t,.,'/:...,~_~,L%~r~.~....q.._~_ . .~4~ County Tax Map No. 1000 Section .../~..~ ....... Block ..... ,O..~ ...... Lot .... ~..,~.-~. ...... Subdivision ................................. Filed Map No ........... Lot No .............. ~' of P er m it ~.//. ~./~.A pp 'ica nt Permit No. G2.O..~....~ate .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building ane"~rmit meets ~11 applicablR cod~ro~nd regulations. Applicant , ~..%~. .... ~, ~-~ ....... ,~. ................. Rev. 10-1o-7e FIELD i~SPECTION FOUNDATION (1st) FOUNDATION 2. ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE COMMENTS FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-180;] Examined.. ~ !.~. .... , 19~ .~. - Approved...x~'~}0 , 19~ Permit No } aD.~o,~ 9c; Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter 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 remg~w or ~eny~lition, as kerein described. The applicant agrees to comply with all applicable laws, ordinances, building/ce, d/0/,2 )upiffg~dlg?'and regulations, and to admit authorized inspectors on premises and in building for necessary i~pe~ ~0 _,~ · .................. (Signature o~f al)pi ~aqt, or name, if a corporation) (Mailing address of applicant) (Name and title of corporate officer) Builder's License No ....... ~ ~ .[.~. ........... % Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .................................................... , ...................... Name of owner of premises ~ d ~/~: "7~ ~.oz/ .~.,~..'..~J?.~./?~....~.~... b! .c~...~.:q .&). ................. (as on the tax roll or late~,lt~l~ED AS NOTED If applicant is a corporation, signature of duly authorized officer. DATE: 6//o/~,~ B.P. '~ ] ~, & o S~ ~ FEE: ~. ~. '-- BY: ~..), 6. ,/'-- · NOTIFY BUILDi'NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INS;ULAT!ON 4. FINAL - C,")N'STqUC-FIgN MUST BE C"'?m-[ ['TF FOR C, O, ALL CONSTRUCTION SHALL MEET ...... THE REOU RF^4r-blT$ DE THE N Y ..... I Location of land on which proposeo work will De sene ....................... :. :. · :.: ........... · / I~ ; ~ .-~ STAT£ CD, NSTRUCTI~ON~,8~E~,ECGy ...3X7 ................ ...... House Number Street DESIGNI~r~mCI~NSTRUCTION ERRORS. County Tax Map No. I000 Section ...... /..riff. ........ Block ...~. ~. ............ Lot....~ ~ .~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~..t4)..~ J..~{~ t4ff. .............................................. b. Intended use and occupancy ......... ~.~,;.t~ ,~-~'~iliii~.. ,0_/~.~-7~ .................... 10. 11. 12. 13. 14. Locate clearly and distinctly all property lines. Give street and block interior or corner lot. Nature of work (check which a~plicable): New Building ..... ' ..... Addition ......... Alteration .......... Repair .............. Removal ......... Demolition ............ Other Work ............... ~:~Oai'° ~ .Q:..~-..00. (Description) Estimated Cost Fee , q' (to be paid on filing this application) If dwelling, number of dwelling [units ............... 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 structures,, if any: Front ............... Rear .............. Depth ............. Height ............... Num her of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ' Height Nu ber of Stori Dimensions of entire new construction: Front ... Lo ' Rear ...7~ ........... Depth ........ Height ............... NUmber of Stories ........................................................ Size of lot: Front . ' R pth ......... ~ ........... ear ...................... De ...................... Date of Purchase .......... ~ .................. Name of Former Owner .............................. Zone or use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law,, ordinance or regulation: ................................ Will lot be regraded ........ : ................... Will excess fill be removed from premises: ~.Y~es No Name of Owner of premises .. i ................. Address ................... Phone No. t~c~.~... Name of Architect ~ Address Phone No Name of C t act i Address Phone No PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from or description according to deed, and show street names and indicate whether STATE OF NE~R~,~ ~ ~S S cou~Y~... · (Name o~ inoivioua~ gignjng contract) above named. says that he is the applicant e 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 cont fined in this application are true to the best O~v~wledge and belief; and that the work will be performed in the manta r set forth in the application filed therewith. Sworn to before me this ............ ..... .......... No taQ Public, ....... z~, ....... ~... ~~. County// , ~ ~,~ ~ ~ ~%~,~ (Signature of applic~t) .% FOR APPROVAL TO CONSTRUCT SURVEY FOR 'ROBERT HILTZ AT M,~TTITUCI( TOWN OF $OUTHO~ SUFFOLK COUNTY, NEW YORK ' RO4P JULY 30,/982 oAr¢: FEB. ~5, 1~;82 SCALE: I"-' 30' ~o. 8,E - 2'9