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Home My WebLink About15729-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date April 27, 1987 THIS CERTIFIES that the budding . A d d x t z o n ..................... Locatlon of Property 910 Sxgsbee Road Mattituck h~e ~o ................................ steer County Tax Map No. 1000 Section . ) 4.3. Block . . .l ..... Lot I 1 Subdivision ............... Fried Map No ..... Lot No ........... conforms substantially to the Application for Building Permit heretofore fried tn this office dated March 4, 1987 1572.9Z .......... ! ..... pursuant to wluch Braiding Permit No ................ dated .. M.a.r c.h. 5, . J .9.8.7 .... was issued, and conforms to all of the reqmrements of the applicable provisions of the law The occupancy for winch ttus certificate is ~ssued ~s .. Dormer on.exzstzng dwelling--summer use only--unfinished. The certificate is issued to . of the aforesaid buridzng Suffolk County Dep~rtment of Health Approval UNDERWRITERS C~RTIFICATE NO .... PLUMBERS CERTIFICATION DATED: RICHARD VAHEY .......... F &,.ok, x~( ieaigzei ir k ............. N/a Building Inspector Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. nUILDING PEIU~rr (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15729 Z pursuant to application dated ....~..~ ........................ , 19 and approved by the Budding Inspector. Rev. 6130/80 FORM NO 6 TOWN OF SOUTHOLD Budding Department Town Hall Southold, N.Y. 11971 iAPPLICATION FOR CERTIFICATE OF OCCUPANCY A Instructions Th~s apphcat~on must be filled m typewriter OR ink, and submitted in duplicate to the Budding Inspec- tor w~th the following; for new buddings or new use' 1. Final survey of property w~th accurate location of all buddings, property hnes, streets, and unusual natural or topographic features 2. Final approval of Health Dept of water supply and sewerage d~sposal-(S-9 form or equal). 3. Approvat of electrmal Installation from Board of F~re Underwriters 4. Commercial buddings, Industrial buddings, Multiple Residences and simdar buildings and installa- tions, a certificate of Code comphance from the Architect or Engineer responsible for the braiding. 5. Submit Planning Board approval of completed s~te plan reqmrements where applicable. B. For ex~st~ng buddings (prior to April 1957), Non-conforming uses, or buddings and "pre-exist~ng" land uses 1. Accurate survey of peoperty showing all property hnes, streets, buddings and unusual natural or topographic features. 2. Sworn statement of owner or prevtous owner as to use, occupancy and conditton of buildings. 3. Date of any housing code or safety inspection of buddings or premises, or other pertinent informa- t~on reqmred to prepare a cert~fmate. C Fees' ' 1. Certificate of occul~ancy $5.00 2. Certffmate of occupancy on pre-ex~stmg dwelling or land use $5.00 3. Copy of certificate ,of occupancy $1 00 Date .. New Building .... Old or Pre-existing Building ....~. Vacant Land .......... Locat,on of Property ...?~/~..~..~ ....... ..~. ~....~..~.... Hou~ No. ~ ~/, / · ~ Street ~' Hamlet Owner or Owners of Property . /~( ,~.. 4~' ~ ~' ~ Subdiwslon ........ Filed Map No. . .Lot No. Perm,t No./.~.?~-¢. Date of Perm,t. ~/~F(~Appl,cant . ~. ~.. ~ .~.' .~'-.,...~--~-'~. Health Dept. Approval ........... Labor Dept Approval ...................... Underwriters Approval ............... PIannmg Board Approval ................... Request for Temporary C~rt,ficate ... Fee Submitted $.. ~'~,¢~.. .......... ..... F~nal Certificate .................... Construction on above described budding and permit meets~ll applicable codes and regulations. Apphcant .... 3 f 5- ELD I~;SI'ECTiON UNDATION ( 1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATIO~ FER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined f~ .~....,19~.Z ^pproved l TPermit No /. Disapproved a/c ................................ Apphcation No ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..., 19(/. INSTRUCTIONS a This apphcat~on must be completely filled in by typewriter or m ink and submxtted in triplicate to the Bud&r 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 pre~mses, relationship to adjoining premises or public stree or areas, and gwing a detailed descriphon of layout of property must be drawn on the diagram which is part of th~s appl cation c The work covered by th~s apphcatton may not be commenced before issuance of Braiding Penmt d Upon approval of this application, the Building Inspector will issue a Bmldmg Permit to the apphcant. Such perm 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 Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance or a Building Permit pursuant to tb Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulatmns, for the construction of buildings, additions or alterations, or for removal or demohtmn, as herein describe, The apphcant agrees to comply with all applicable laws, or&nances, build~ng code, housing code, and regulations, and t admit authorized inspectors on premises and in bmld~ngs for necessary mspechons (S~gnature of applicant, or name, if a corporation) address of apphch~{t) State whether applicant is owner, l¢ssee, agent, architect, engineer, general contractor, electncmn, plumber or bmlde Name of owner of premises . .. ~'~/~'n'~....~"~~...~,___:~' .,~.~/'~.~.~.a. ~/ ..... 'x (as on tl~x roll or~lates~e,~, If applicant is a co.rporation, signature of duly authorized officer (Name and title of corporate officer) Bu,lder's L,cense No. I ~,~,t:~..~ ~/tTt."~ .... Plumber's License No ................... Electrician's License No .............. Other Trade's License No .................... .~2£~O~ ~Vr ,~ ,'~' ', ,,~A~. ,~ ~, ,, g'- . ..... ltouse Nu~t/ber Street ' ' ~ ........... County Tax Map No. lO00Se~tion ...t '~'7- .. Block../ . Lot. [.[ .. 2 Subdivmon ................................ Filed Map No ...... Lot ......... (Name) State existing use and occupancy of premises and ~ntende~d use and occupancy of proposed constructmn a, Existing use ~nd occupancy ........................... 0 ~ ~ ~-~ Nature of work (check which Applicable) New Building A'd t .... u ~ ton ix AlteratJon Repair ......... Removal ........... Demohtlon ........... Other Work ............. .~ (Description) Estimated Cost . ..r~.~.~t..'~/r~X) ............. Fee ............................... (to be paid on filing this application) If dwellmg, number of dwelling units ..... [... Number of dwelling units on each floor ... If garage, number of cars . · 4 ........ / ........................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ Dm~ensmnsofe. xlstingstructui'es, ifany. Front... ,d[.// ( . Rear ~./ Deoth ~t/{.) [' tte~ght ] .~o ........ Number of Stones ..... [ ...... Dimensions of same structure with alterations or additions' Front . . ~,~,.'-~f-'Z/' ./. ..... Rear. 'J~J'/' 't' ': 'i' :: Depth . ~/~ .(. ..... 4-.. Height .. /.O..( ... Number of Stones .... /',;3-----: ....... Dnnenslons of ehtire new construction' Front~ }~ }.,~.(~.1,,,<. R.ea.r t. r r '! '/' r' · · · Depth ............ Height ........ Number of Stories .......... ]..~..ti( /~o.. [ ............ Size of lot. Front .................. Rear ..... Depth ......... Date of Purchase ......................... Name of Former Owner ............ Zone or use district m which premises are situated ............................. Does proposed construct~lotn~/olate any zoning law, ordinance or regulation /.~k4/ O ...... ~ Wdl lot be regraded ../.g ~ .................... Will excess fill be remove~l from premises: Yes ~ Name of Owner of premises .~.l&~l-I~d-- .[/t~/Address .pld~ 7t~? FO ~ .//7:x~.. Phone Noo~_ ~,~Z~ -O¢'~rJ ~ Name of Architect ......................... /.Address ....... Phone No ................ NameofContractor ~..~'..e.bt.~ttl/lf~i~ddress . .~>~U'{'Ot~,,~ PhoneNo.~.~'.~.,-?~.d~. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and. indicate all set-back dimensions from operty hnes. Give street and block number or descnphon according to deed, and show street names and indicate whether tenor or corner lot. FATE OF NEW YORK, S S /)UNTY OF ................ , ............................. being duly sworn, deposes and says that he is the applicant (Nan~e of individual signing contract) ,ove named e is the .......... .' .......................................... (Contractor, agent, corporate officer, etc ) · said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tlus ~phcation, that all statements contained in this application are true to the best of his knowledge and belief, and that the ork wdl be performed in the manner set forth in the application filed therewith. ~orn to before me th~s ........... ,~7. ...... day of ..... 2~.~..-~ ..., 19 >tary Public ...... ~ . .---~. ,~. ........... County Ht~'N K. ~ VOE (Signature of applicant) 4 ~