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Home My WebLink About16739-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18019 Date F~kY 10, 1989 THIS CERTIFIES that the building. ADDITION Location of Property 4055 NEW SUFFOLK AVENUE House No. Street County Tax Map No. 1000 Section 115 Block 4 Subdivision Filed Map No. MATTITUCK~ N.Y. Hamlet Lot 10 L~t No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 1,1988 pursuant to which Building Permit No. 16739-Z dated FEBRUARY 11~ 1988 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 GARAGE ADDITION WITH COVERED DECK ATTACHED TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD S. ADAMS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-023190 - JULY 25~ 1988 PLUMBERS CERTIFICATION DATED N/A y ~uilding I~spector Rev. 1/81 FORM NO. ~ TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~167~'? z Permission is hereby granted to: ~..~...~.,....~. ................................................... ..... ,o ~:.~......~~:..,,~.~...~.~ ~.~....~ o, premises located at ....~...~.~..~..:...)-~/~..~...~..........---.'~'/~. ......................................... ............................................. .~....~...~.,.~ ................................................................. Counh/ Tax Map No, 1000 Section ...... ./.,/., .~... ..... Block ........ ~ ....... Lot No ......... ../'.,.~,. ......... pursuant to application dated .... ~...../.'./. ........................................ , 19.~....~.., and approved by the Building Inspector. Fee 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 I~ 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 unusua 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 Eng nee~r responsible for the bud ng §.Subm t P arming Board approval of completed site plan requirements w6ere applicable. 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 requ ired to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1.~Certi~ficateofoccupa,cy New Dwelling $25.00, Accessory '$~0.00 Business $50.00 2.:[~ert~f~cate of occupancy on pre-existing dwelling $ 50 0 0 '~' 3. Copy of certificate of occupancy $ 5 00, ove~' ~ years $10.00 ,, 4.Vacant Land C.O. $ 20.00 Z~ 5.Updated C.O. $ 50.00 Date ..... ~ .... : .......... NewC ohs truct, ion ...... Old or Pre-existing Building ............ Vacant Land ' . Location of Property Z,~,~A" ~.4~v~ ~'("~'~'~'~ ~/~' ~..f/.~ House No. Street Ham/et Owner or Owners of Property ...,~. ~.-... . ...................... County Tax Map No 1000 Section //.~ Block . .~. ' . ...... '.~..~. ................ . Lot Subdivision ................................. Filed Map No ............ Lot NO ........ ...... Permit No.~... ~I~Z....... Date of Permit .~..~.~.'.~..~..Applicant..~11..~..~,. ,/~..~. ...... .~.,~..~....~.. ..... Health Dept Approval Labor Dept Approval Underwriters Approval ........................ Planning Bpard Approval ..................... . Request for Temporary Certificate ........ '. · .' ..........Final Certificate ............. .......... Fee Submitted $ ............................. Construction on above described 5uilding and permit meets all applicable codes and regulations. FOUNDATION (1st) FOUNDATION (2nd) PLUMB~,NG INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1~0Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION [ ~FRAMING [ ] ROUGH PLBG. AND [ ] INSULATION [//~INAL /Y~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 "'UW~AU OF --,,CTmCn'V [-- eS JOHN STREET° NEW YORK. NEW YORK 1OO3e THIS CERTIFIES THAT EDWARD AD~S~ N/S N~V SUFFOI.~ ~V~. ~A't'TITUCK~ ~ exami~ ~ ..df~nd to ~ ~n ~m~ianc. with the ~ui~men~ of th~ ~. OVENS 4 2 4 ~llVl(:l ~ s E It v I C ~.w.o. ~,,~. o(...*~G A.W. O* RULAND ~LEC/W.B. ROI,AND BOX 143 MATTITUCK, ICY,, 11952 This certificate must not Ix altered in manner; return to the off~ of th~ Bom'd if incorrect. their . CGJ~' F?~ ~L,It~JI~ .D~)~._~T. THIS COPY OF CERTIFICATE MU~T NOT BE ALT~ iN M4Y . _ Examined . 'fl" > ....... Approved · .~.//! ....... Disapproved a/c ..................................... ~idin' '~ns~ector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEP?IC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAlL TO: INSTRUCTIONS a. TI'tis 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. e. 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 insp,~tions. / ~ ,~// ..... g ............ (Signature of applicant, or name, if a corporation) ¢::... ¥.'/.¥¢:z. ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~'~.~.47d/.47. :d. .... ./??..'~. (.~?.: ~X dZ~ ~ ~;~//~ ~dr (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. .4..~.~?. ....... g/~ ~;.,fe.<~.e,:L... d.~ ~ ...................... .~..~./7~.,.~,4.c.'/.4 .... ~.. !/ House Number Street Hamlet County Tax Map No. 1000 Section ....... //'~--- Block ~// Lot. / Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occtmaa¢.y..of proposed construction: a. Existing use and occupancy ~..~¢..-.. ~ 7 ..... ~.~.~..., ~... ~:~ ¢.*~. ·. ~? ~ a o~p~ ~. ~/.~ ..... ~ ....................................... . ..... z ........ 3. Nature 0fwork (check which applicable): New Building . .~..~.'~../~.~.?Addition .......... Alteration ......... Repair .............. Removal .............. Demolition ......... Other Work , 4. Estimated Cost ............................... Fee ................... ' (to be paid on filing this application) 5. If dwelling, numbei of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, nmnber of cars . ~ ~ (~ ........................... 6. If business, commercial or mixedjoccupancy, specify nature and extent of each ~ype of use ................. 7. D mensions of existing stmcturesl, if any: Front ..... ~ ~ ..... Rear .. ~ .......... Depth ............... Height Number of Stories Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... J. Height ...................... Number of Stories ...................... 8. Dimensions of entire new const~ction: Front ....... 2.~ ~ .... Rear ............... Depth ... ~ ........ Height ....... ~.* ...... Number of Stories ' . ............................... 9. Size of lot: Front ............ ~ .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ , ................. Name of Fomer Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction v~l~te any zoning law, ordinance or regulation: ................................ 13. ~11 lot be regraded ....... ~ff .................. Will excess fill be removed from premises: Yes No 14. NameofOwnerofpremises .~ 5 ~Address ~ ~d~<~neNo ~ . N~e of Architect ........... ~ ................ Address ................... Phone No ................ N~e of Contractor .......... , ................ Address .... : .............. Phone No ................ 15. Is this property located Within 300 feet of a tidal wetland? *Yes ..... No ..~. *If yes, Southold To~ Trustees Permit maybe required. PLO~ DIAG~M Locate clearly ~d distinctly fll bufld~gs, whether existing or proposed, an&indicate fll set-back d~ensions from prope~y lines. Give street ~d block umber or description accord~g to deed, ~d show street nines and indicate whether interior or corner lot. I.-I STAT~ OF N[W YOR~, ' gd ly .............................. ~ ................... bein u sworn, deposes and says that he is the applicant (Name of individual signifig contract) above named. He is the ....................... ~ .................................................................. i (Contractor, agent corporgte officer, etc.) of said owner or owners, ~d is dulyi autho~zed to perform or have perf6nned the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner:set forth in the application filed therewith. Sworn to before me this ............ / ........... day ..................... ou t, ' ..... ........... ~m K. D~ ~E N~A~ ~BLI~ ~te of New. Y~ (Signature of applica~t) . No, 4707878 Surfak mrm Exp res M~rch'30,1~ ~-/ I~' >:7' OCCUPANCY OR WITHOUT CERTIFICATE OF OCCUPANCY 1,6' x7'