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HomeMy WebLinkAbout16339-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16183 Date September 17, 1987 THIS CERTIFIES that tbe building SCREENED DECK ADDITION Location of Property 780 Deep Hole Drive Mattituck, New York House No. Street Hamlet County Tax Map No. 1000 Section 1 I 5 ..... Block 12 .Lot 1 I Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated August 10, 1987 pursuant to which Building Permit No. 16339 Z dated .......................August .17, 1987 ..... 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 ......... SCREENED ~N DECK UNDER AN EXISTING 2ND STORY DECK AS APPLI~ED FOR The certificate is issued to CLIFFORD & MARY EGINTON ..................... ?o¥.b/, lr f 3x x .................... of the aforesaid building. Suffolk County Department of Health Approval ...... N../.A ................................. N/A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATIOI~ DATED: Rev. 1/81 FOUM NO. lB TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL, SOUTHOLD, H. Y. BUILDSHG PERMIT (THIS PEPu~ET MUST BI= KEPT ON THE PREMISES UNTIL FULL CC~MPLETION OF THE WORK AUTHORIZ£D) NO- ] ~33c/ Z Permission is hereby granted to: - , . ~~.....~.:~..,....~.:...~.~.~ ......... ~.~....~~~.....~.......~~....~ ................................. , ...................... County Tax Mop No. lO00 Sec/tl~. ........ /../..~.. ..... Block ...... ~....-~... ....... Lot No...~./. pursuant to application dated~.~....~......(....~.. ............. , 19"~".'7', and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971' 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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'buiidings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual 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 buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.(10, Accessory ~lO.00 B,usiness $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $~0.00 4.Vacant Land C.O. $ 20.00 5 .Updated C.O. $'50.00 Date .......... ~.. - ~- .~..~ .. New C on s t r u c t i on ...... Old or P re-existing Building .... ~ ..... Vacant Land ............. Location of Property ~..~.~ ~..~..~F~..~. /Tz?,Z. ~ .Z?.,~.....~ ................. House No. Street Ham/et Owner or Owners of Property ~'ZZ.~'/¢'~2~ ~ /~ ... ././~'~. ...................... County Tax Map No. 1000 Section .... d,/. ,-~.. .....Block ..... /. ~ ....... Lot ..... /./ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~..~-~-.~... Date of Permit ~./F~oc...2'. .Applicant .~...~/?../--~..,~.~,.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~.~.,.~. ~ .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant....i~....~..~ ............................... Rev, 10-10-78 co UNDATION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG, FOUNDATION 2ND £ ] INSULATION FRAMING [ F~'~INAL REMARKS: INSPECTOR.~/~ FORM NO. 1 .... TOWN OF SOUTHOL. D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~L_~. TEL.: 765-1802 .pprove,~..~r~....I..~., 19~..~. Permit No..]..~..~.~. ?..~. ~isapproved a/c ..................................... (Bnilding Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ~19... Date .................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 'ts 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 · areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. c. The work covered by this application may not be commenced before issuance of Building Perinit. d. Upoa approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit alt 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 all 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 ailding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or agulations, for the construction of buildings, additions or alterations, or for.removal or demolition, as herein described. xe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to init authorized inspectom on premises and in building for necessary inspections. (Signature of app!jcant~,or name, if a corporation) (mailing address of applicant) rate xvhetber applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ................................................................................. am e of owner of premises ~ ~J ~ ~0. ~.~ . . .t. ~ ~.~.~. . .~ 7 ~1.~0 ~. ........ ~~ (as on the tax roll or latest'dee~~r / ~ ~'~O'~D .... 'app cant s ~orporation, signature of duly autt~orized officer. , ............................................. ~>/. NOTIFY ~iLDING OEPA~TM~T AT (Name and title of corporate officer) '~ Plumber's License No.. N.Q ~ ~ .... :: .... :'> , '~ ~,~ . ~ ~ ~U~P* F~IAM~IG ~,~ euUMatNO Electrician's License No..~. ~ ........ ': ':. . ,/ f'.'~. ~%?,~ ~,~ ~ "'7 4. F~aa~ Cr)mST~U(;'¢~O~ MUST Location of land on whicn proposea wor~ Wlll,..b¢;,L,l~Ohe'''' .' ' ' ............ ' ' ' ~. ,~;~ ..... t~u~;"~'~' L,..,~:¥.~;.~X ~L e ~: .... ...Z~ ....... D~.I(.. ~P.4 ~. · .~.~ .............. ~ .~, ~- ;. -~,w~.'= .............. ' .......... House Number Street Hamlet County Tax Map No. 1000 Section ..... Z.4 ~ ....... Block .... Z.~ .......... Lot ..... /.J ........... 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 ..... /,~.14/..~.&.L/..~.~ .................................................... b. Intended use and occupancy ~..~..~--~Z~?/VF~.. ~,~,'77h'..../9./).~.~.~/. 0..,N./~L_... ~.q~?~...~7~' ..... .~.~-..¢.~.; ...... 3. Nature of work (check which applicable): New Building .......... Addition . i ~ ..... Alteration Repair .............. Removal ............ Demolition .......... I... Other Work ~ ~-/~-o i (Description): 4 Esti~n~ted Cost : ~ Fee :' ' (to beI paid on filing this application) 5. If dwblling, number of dwelling units.. / Number of dwelling units on each floor.. If garage, nnmber of cars ........................................... ~, ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each tylpe of use ..................... 7. Dimensions of existing structures, if any: Front ..... .~ .~.' ......Rear .... 5 & q ...... Depth ... ~ f ........ , Height Number of Stories .../. D~ensions of same structure with alterations or additions: Front .. ~ ....... . ..... Rear }~ ~ .......... Depth . . . .¢~ ~ ................ He~t' O~ff; 2/ ............ Number o~ Stories .... ~)'. >f.~ ......... 8. Dimensions of entire new constmcfion: Fr ...... Rear ...... ~ ...... Heighf . .............. ~umber of St~ .... ~l, ............ ~ .............. , ............. .. 9. Size of lot: Front .... ~ ........... ~e~....~.~ ....... ] Depth .. ~. .... 0. Date of Purchase ...(~1 .......... ~-~O.~fF~Owner ~.~/+~.S.+~.~. ........... 1. Zone or use district in which premises ~~~V~ "'l .................. '.. 2. Does proposed construction violate a~l~{~~~it~: . .~:? ................ ~::~: 3. Will lot be regraded .. ~q ........ ~ ~, ~~I~emov~d from premises: Yes .... 4. Name of Owner of premises 9,?~,..q.t~[l~~ ~ ~ PhoneNo~gg-~'Tg Nmne of Contractor .......................... ~'-- --~t- "Adfl~ ~ ......... %.: ..... Phone mo ................ 5. is thks property located w~tbinlO0 feet of a ttd~'~ wetland? *lYes .~.. ~o ..... ~ If yes, Southold Tom Trustees Permit maybe requSred. PLOT DIAG~M ,' Locate clearly ~d distinctly ~1 bufld~gs, whether existing or proposed, and. md~cate ~1 set-back dimensions from roperty lines. Give street and block number or description according to deed, and shqw street names and indicgte whether nterior or corner lot. I'AT~ OF NEW YORK, OUNTY OF .............. S.S . .... (-~ U/. l=7.~. 0 Iff. 13 .... ~. ~ ! .N. .~.O .~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) e is the .:O..t~.. ~ ~ ~. ' (Contractor, agent, corporate officer, etc.) :' saki owner or ownem, ~d is duly autho~zed to perform or bare performed the ~aid work and to make and file this ~plication; that all statements contained ~ this application are true to tim best of hi's knowledge and belief; and that the ork will be perfomed'in the-m~ner set forth h the application filed therewith. .vorn to before me this .......... [..~ ........ day of.. ~.~... . flUALI~I~D I~ $UFFO~ ~0,, ~0. ' TOWN ~ :: $OUTHOLD ~;~LDING ~;PARTN~ENT SOUTHOLD~ N. Y. .... APPLICATION FOR BUILDING PE~IT Application No. ~ .~..~ ~ Date ..................... , 19 ............ INSTRUCTIONS o. This application must be completely, filled in by typewriter or~ in ink and s~ed in triplicate to the Buildin~ Ins~e~to~wJth 3 set~ of pl~n~, .a~mt~ p~t plan to ~olq~ng to~chedule:~ b~'Plot~lon showing Ioc~ti%~ of~l~t~'~f buildings on p;emises, r~]otion~ip to~O~joining premises or public streets areas, and giving o detailed description of layout ofproperty must be drown on**~ro~m which is pa~ of this application. c. The work covered by this application may not be commenced before iss~e~b~ Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permil snail be kept on the premises available for inspection throughout the work. e. No building shall ~e occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuancb of o Building Permit pursuant to th~ Building Zone Ordinance of the Town of 5outhold, Suffolk County, New York, and other applicable L6~s, Ordinances o~ Regulations, fox,the construction of buildings, additions or alterations, or for removal or demolition, as herein described ~J~t~gre~S t6'c~m~ with all applicable laws, ordinances building code, housing c~, and regulations, and tc admit authorized inspectors on premises and in buildings for n~es~aw inapt.ions. (Sig~ur~p~t, ~ nome, if a corporation) ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pI.Dmber or builder. ...... ~..~~ .................................................................................................. ~,~..L ........................................................... N~ o~ ow~ o~ p~.mi~ ...(~.~.~...~..~m~..~E~.e~ ....... ~ ........................................................... If applicant is a corporate, signature of duly authorized officer. ......... .~.........................~................~``~.`.~.~`~...`.~.`~``(Name and title of corporate officer) X Builder's License No ....... ~.~..~ .......................... Plumber's License No .... ~ ........................... .~.....~~ ................... ~'~<~,_-'~'~ ,~ ~ ~ Electrician's License No. Other Trade's License No....~ ......................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ..~.~.~.....~..~.~....~...~.~.~ ......................................................... Municipali~ 2. State existing use and occupancy of pre~ses and intended use and occupancy of proposed construction: ......... .......... ................ . .......................................................... b. Intended uso ond occupancy ....................................... .-~......~ ...................... ~............~- ................ ~ ............... 3. Nature of work (check which applicable): New Building. ................. Addition i....../~. ......... Alteration .............. Repair .................. Removal .................. Demolitior, .................... Other Work[ .................................................... ~ (Description) 4. Estimated Cost .... ~..~..,~.~ ......... ~ .................................. tee ..; ............................... r ....................................................... (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 mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....... .'~..-~. .............. Rear ............., ................... Depth .,..~...,~',..~ ...... Dimensions of some structure with alterations or additions: Front ...... ,.~'4~......~..~. Rear ....~..~...~'~ 8. Dimensions of entire new construction: Front ...,,~.¢~. ......................... Rear ..... ~,, ................... Depth ..../.?.;.'. .............. Height ..... ,.~......,!..f., Number of Stories ............. ~ ........................................... I ........................................................ 10. Date of Purchase .... ~...~...~.../. ...................................... Name of Former O, ............................................................ 1 1. Zone or use district in which premises are situated ....................................... ~ ........................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: i ........................................................ 13. W~ll lot be regraded ...... /~..~ ............. Wdl excess fill be removed from premises. ( ) Yes ( ) No Name of Architect ~..°/~1.(..~.~.. Address I Phone No. Nome of Contractor ........ 4~..~..A~...,~,. .................................... Address ................. I ............... Phone No ....................... 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, COUNTY 0 .~?. ......... ~ ~ ....... ~. ~ ......................................... be ng (Nome of indivlduol signing contracf) above named. duly sworn, deposes and says that he is the applicam Fie is the ..... ~ '" (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed th~ said work and to make and file this application; that ali statements contained in this application ore true to the b~st of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith, Sworn to before/me this ~-~ ....... 4~.'~....~..~f~ztay of ......~,,..~.~..~.~.~. 4-19.Z..~- ~-~. ' i / '--~ . JUDITH T. BC)KEN Notary l'uJ~hc, $lale of Ixlew York No, 52-0344963 Suffoik Ceunt~(/ Commission Explro~ Match 3(1 "