HomeMy WebLinkAbout16695-zFOR~ NO. 4.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hail
Southold, N.Y.
Certificate Of Occupancy
No. ZI6666 Date February 25, 1988
THIS CERTIFIES that the building .... A. 1..r .e.r.a. ~..i 9.n. ................................
Location of Property 9820 RT. 25 & 55 SIGSBEE ROAD MATTITUCK
- - h~d~ ~'oi ....................... 's't/e~i .......................
County Tax Map No. 1000 Section 143 .Block 02 .Lot 01
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.D..e .e.... ! .7 :.. 1. 9. .8 .7 .....pursuant to which Building Permit No, . 1. ~ 62.5.~ .............
dated . .~ .e.c.e.m.b..e .r..2.4. .,..1.9. 8..7 ....... 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 .........
Alteration, construct: partition (room divider) & change windows
zn a professzona[ 'd£~_'i'c'di .................................................
The certificate is issued to MORCBEL SItEETMETAL
..................... ?o¥,'o;,'Fo,~d~'~X ....................
of the aforesaid building.
Suffolk County Department of Health Approval ....... ~./.A. ...............................
UNDERWRITERS CERTIFICATE NO ............... ?.0.0.4..6.2.4....2./.1.0. ./.8.8 ................
PLUMBERS CERTIFICATION DATED: N/A
L
" '~i,~g Inspector
Rev. 1/81
lvOK~ NO. ~
TO~FN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Na16675 z
Permission is hereby granted to:
...6...~.~ ....... ~_..~...~ ...............
,o ..............
~,t premises located at .................. ~......~....~.....~. ............. ~..-..~..-..~ ......... ~..~ .......
County Tax Map No. 1000 Section ...... ~/..q...~... ........ Block ...... .~ ............. Lot No.
pursuant to application doted ~.~.~dl,~,...../..7. ........... 19.?...7.., and approved by the
Building Inspector.
Fee $./.....~....:..~..
Building Inspector
Rev. 6/30/,~0
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 ~ 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 p~operty 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 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 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory ,$]0.00 Business $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 $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..........................
NewCons truct'ion ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .......................... /?),~.(J~J...~,.... //~/~.'~ ?~.V..~-.~-.. ....
House No. Street (' ' ' Hamlet
Owner or Owners of Property ................. : ..........................................
County Tax Map NO. 1000 Section ... Y.~'.~. ...... Block ...... ~..'.-~. ..... Lot ..... .d,/ .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.l ~,~.f~, · ,~, Date of Permit/'?~, ?/~l...App licant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Req stf T mp yC tiff Fi aIC tiff
ue or e orar er cate ..................... n er cate ..................
FeeSubmitted$...~..~..,.O..~, ................
~ licable ~:odes and regulations.
Construction on above described building an ermit meets all at~'
App,,ean, ...............
TOgrN OF SOUTLIOLD
OFPlCF OF BUILDING INSPECTOR
ILO. BOX '
TOWN IIALL
$OUTIIOLD, N.Y. I 19'71
February 16, 1988
TEL. 765-1802
Robins & Speed, Inc.
625 Second Street
Greenport, New York
11944
Re: Morchel Sheet Metal
(North Fork Counseling)
To Whom This M~¥ Concern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/3 An application for Certificate of Occupancy
is not on file. (ENCLOSED)
/_--/ No Underwriters Certificate on file.
/.~_~ 'Phc check i.,;~)lgt~ig[~/not on file.) $25.00
/]/ No tlealth Dept. Approval on file.
/--/ No final inspection has been made.
Please contact ()ur office on this matter.
Thank you for your cooperation.
lluildi~;g Permit # I 6 6 9 5 Z
Building Dept.
***/]/ ~Io Plumber solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
UNDATION (1st)
UNDATION ( 2nd )
UGH FRAME &
PLUMBING
SULATION FER N. Y.
STATE ENERGY
CODE
FINAL
. ADDITIONAL COMMENTS:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
N 004624
NO~TH FORK CO~CELINO, ~IN ~OAD, MA~I~CK, N.Y.
~ e~ ~ ~f~nd to ~ in ~fl~ with the ~ui~ ~ t~ ~.
I I
PAUL R. BURNS
275 TOHN HARBOR LANE
$OUTHOLD, NY~ 11971
of~h~ ~
BLDG, DEPT,
TOWN OF SOUTHOLD
Examined~.. ~..&.q., 19'.].
Approv;d~..~ · .~. ~., ] 9~. .~. Permit No. ).¢.~ ~.g.~
BOARD OF HEALTH ......
3 SETS OF PLANS .......
'FORM NO. 1 SURVEY ..........
TOWN OF SOUTHOLD CHECK ..........
BUILDING DEPARTMENT SEPTIC FORM ............. :
TOWN HALL
NOTIFY
$OUTHOLD, N.Y. 11971
TEL.: 765-1803 CALL
MAIL
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date..~-¢,-.~...~. '~' "/.'~..] 19.~.7.
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 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 necessary inspections. ~
... ..............
(Signature of applicant, or name, if a corporation)
· ·
(Mailing address of applicant)
If applicant is .a corporati~, signature of duly authorized officer.
~/ (Name and title of corporate of~i'cer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Sta.~_whether applichnt is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Namet~."'o~~.ses..~. 0...~....{~...~. ~.~.~ ..................... : ..... /":' 5~ ........
(as on the tax roi1 or latest de ~, ~,~.~ . :; 4~; ~iO
Other Trade's License No ...................... rtk $O~:4~?~ [Zrk ~<~¢, C O
1. Location of land on which proposed work will be done~ ........... .,~. ~mz~.,--~.~,'*~:,.~t .......
House Number Street
County Tax Map No. 1000 Section ..... [ ~ ........ Block ......~.~ ....... Lot... ~..~ ............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupan~ of proposed construction:
a. Existing use and occupancy . ~~ ~e~...~ .( ~.~.~/~ ~.~(~~ .....
b. Intended use and occupancy ..............................................................
3. Nature of work (check which alpplicable): New Building ..... ' ..... Addition ......... Alteration ~ .
Repaar .............. Removal .............. Demolition . Other Work ..............
4. Estimated Cost .... ~. ~). ~ ................... Fee .....................................
~' (to be paid on filing this application)
5. If dwelling, number o f 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 i if any: Front ..... Rear Depth
structures, .......................................
Height Number of Stories ....
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ................... i... Height ...................... Number of Stories ......................
Dimensions of entire new cons(ruction: Front ~ Rear Depth
Height ............... Number of Stories ........................................................
9 Siz of lot: Fr ' Rear Depth
10 Date of Purchase Name of Former Owner
1 1. Zone or use district in which piemises are situated ................................................. ... .
12. Does proposed construction wolate any zoning law, ordinance or regulation: . ./~r. .O ...........................
Will lot be'regradedx ........ l .................... Will exce~s fill be removed from premises: Yes No
amc of Architect ......... ................... Address ................... Phone No ................
Name of Contractor
15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes .....
*.If yes, Southold Town Trustees Permit maybe required.
! PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, ~ensions from
property lines. Give street and blocki number or description according to whether
interior or corner lot.
]3.
14.
{ 'F-o o
J
STATE OF NEW YORK,
COUNTY OF ................. S.S
..............................i .................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ...................... i .................................. -~ ................. : ..............
~ (Contractor, agent, corporate officer;etc.)
!
of said owner or owners, and is dul~ authorized to perform or havb 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 mannei set forth in the application filed therewith.
Sworn to before me this
........... .......... dayof! .....
........ ,19 ..$.71
Notary Public,.· .~-~¢4... ~. ~.q:-...~..d~. .... County~
...............
T~nn Expires ~,ch a0,1~/q O' (Signature of applicant)