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Home My WebLink About15906-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..z.!.5.67.1 ....... Pate .. ^p. rx.1 .ltl,. 1.9.87 .. THIS CERTIFIES that the building .. A..e.c.e s s o r .. . Locatton of Property .6.0 5., $.AL W. 6 .I .R.~' .~.AY ...... MATTITUCK County Tax Map No. 1000 Section . 19.0 ...... Block .1 ......... Lot 19 Sub&vision ........................... Filed Map No ...... Lot No ........ conforms substantially to the Application for Building Permit heretofore filed In tins office dated ..../~l?r.i.1. 8.~. 1.9.8.7 ~ pursuanttowtuchBulldingPermltNo . 1.5906.Z ...... dated . .-5~.r z..1..Itl ~..1.9.8.7. ........ was issued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which tlus certificate is issued is .. .A c.c.e s..s 9.r.y, . .bu £ 1 d..in~ ..zn..re. ay. yard.. .............. The certificate is issued to . .$%p..I'II~E~. /~BID RITA WOWAK ....... ?odne~,Y~a&a~X x k'x ........ of the aforesaid building Suffolk County Department of Health Approval ..... Iq / ^ UNDERWRITERS CERTIFICATE NO ....... lq/A PLUHBERS CERTIFICATIOlq DATED: Rev. 1/81 TOWN 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) 15906 Z Permission is hereby granted to: ¢"-~, ~, .._.-...~_¥.,,..,.,,..: ....... ~ ............ .~....L..':z~. ....... 0~ p~,i~ I~at~d ot .i..¢...o...~':....~~..~..~....~...~.~ ............... County Tax Mop No. lO00 Sect,on . /.~ ........ Block ........~....l ........ Lot No .... .(...~ ......... pursuant to application Building Inspector. Fee $...~....~..: ............ and approved by the Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD , t,L]] Building Department LI~L . __.....-.~,-.,' i Town Hall BLDG, DEF L Southold, N.Y. 11971 TOWN OF SOUTHOLD~.~, 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be fdled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following, for new buddings or new use: 1. Final survey of properW with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. F~nal approval of Health Dept. of water supply and sewerage dlsposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial bufld~ngs, Industrial buildings, Multiple Remdences and similar buildings and installa- tions, a cemf~cate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed site plan requirements where apphcable. B. For existing buildings (prior to April 1957}, Non-conforming uses, or buddings and "pre-existing" land uses' 1. Accurate survey df property showing all property hnes, streets, buildings and unusual natural or topograph ~c featu res. 2.Sworn statement Of owner or prewous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buddings or prermses, or other pertinent mforma- tlon reqmred to prepare a certificate. C. Fees' Additions $25,00 1. Certlflcate of occupancy New Dwelling $25.00, ~ccesso~$j.Q_~_~ Business $50.00 2. Cemflcate of occupancy on pre-existing dwelling $ 5 0.0 0 3 Copy of certlflcate of occupancy $ 5.00, over 5 years $10.00 5.Updated C.O. $ 50.00 Date ................ NewConstructlon. ~ .... Old or Pre-exlstlng Building ........... Vacant Land ............ House No ~ Street /-/am/et County Tax Map No 1000 Sect,on .... /.~'~ Block / Lot ./.P Subdivision ................... · . .Filed Map No ........... Lot No ............ Permit No .......... ,Date of Permit .......... Apphcant .................................. Health Dept. Approval ................... Labor Dept. Approval ....................... Underwriters Approval .................... Planning Board Approval ..................... Request for Temporary Cert~hcate ............... Final Certificate ....................... Fee Submitted $ ........................ Construction on above de,scribed bm drag and permit meets all apphcable codes and regulations OUNDATIO.~; { 1 st) OUNDATION ( 2nd ) OUGH FRAME & ?LUMBING NSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Approved Disapproved a/c FORM NO. I TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL MAlL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... FORM ............. : TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ a. Tlus apphcatlon must be completely filled m by typewnter or in ink and submitted to the Bufldmg Inspector, with 3 sets of plans, accurate plot plan to scale Fee according to schedule· b. Plot plan showing location of lot and of buildmgs on premises, relationship to adjommg premises or pubhc streets or areas, and glvmg a detmled descnptmn of layout of property must be drawn on the diagram which is part of this apph- cahon. c. The work covered by tins apphcahon may not be commenced before issuance of Building Permit. d Upon approval of this application, the Bml&ng Inspector will issued a Budding Permit to the apphcant. Such permit shall be kept on the premises available for mspectlon throughout the work e, No buildmg shall be occupied or used in whole or m part for any purpose whatever unttl a Certificate of Occupancy shall have been granted by the Bmlchng Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Bml&ng 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 bufldmgs, addlttons or alterations, or for removal or demohtion, as hereto described. The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m budding for necessary ins~//~ /, 6, .. ,~ x/~ (Signature of app)ffcant, or name, if a corporation) (Maillng, ffddress of apphcafft) State whether apphcant is owner, lessee, agent, arctutect, engineer, general contracto[~electnclan, plumber or builder. Name of owner of premmes '/ (as on [: apphcant m a co~oraUon, agnatqre of duly authorized officer (Name and t~tle of co~qrate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's L~cense 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 .. House Num her Street County Tax Map No 1000 Section //~(D. . . . Block Hamlet .... 2 Sub&vision ,. . . Filed Map No ....... Lot ............ (Name) State ex~shng use and occupancy of premises and intended use and occupancy of proposed construchon a Existing use and occupancy . o~. ~ -'~ /~ ~ ,~k--~-2PL ~-~'~/--> -- 7~ ,3'~-~-- b. Intended use and occupancy .... ~.~. . .' .' .'~.Z>(~t~- 3 Nature of work (check which applicable) New Bmldlng .. Addition ...... ' Alteration Repair .... Removal ......... Demolition ......... Other Work ~,~. i .. 4. Estimated Cost . ~. /0 Q . 5. If dwelhng, number of dwelling units ~..,I~ ~(Descnptmn) (to be paid on fihng thts apphcatmn) ....... Number of dwelling umts on each floor .......... If garage, number of cars ~ .................................................. 6 If bumness, commercial or mixed occupancy, specrfy nature and extent of each type of use ............ 7. D~nenmons of ex~stmg structures, if any Front .. Rear ...... Depth . .. Height ....... Number of Stories ..................................... D~nenmons of same structure w~th alterations or ad&hons Front ....... Rear ......... Depth .............. Height ........... Number of Stones ................ 8. Dunenmons of entire new construction Front. .. Rear ............. Depth ............ Height ......... Number of Stones ......................................... 9. Size of lot Front .. ~ ....... Rear ............. Depth ................ 10. Date of Purchase ............ Name of Former Owner ................ I 1 Zone or use district ~n which premises are situated ............................. 12 Does proposed constructmn violate any zoning law, ordinance or regulahon' . .......................... 13 W~/I lot be regraded ................. W~I1 excess filI be removed from premises' Yes No 14 Name of Owner of premmes ....... Address ........ Phone No.A ~.f.. = Yg72. g/~?W-~ Name of Architect .... 2 ........... Address ......... Phone No ~f~.~- ~'~¢.~...~'..'~-~.. Name of Contractor I Address Phone No No 15. Is this property located within 300 feet of a tzdal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and dist~nctly all braidings, whether existing or proposed, and indicate all set-back d~rnenslons from )roperty hnes Give street and block number or descnpbon according to deed, and show street names and indicate whether ntenor or corner lot ,- ..,CUPANC OR Ol= OCCUPANOY ~TATE OF NEW YORK, S S 2OUNTY OF ...... (Name of Individual signing contract) ~bove named. .... being duly sworn, deposes and says that he is the applicant is the ..................................................................... (Contractor, agent, corporate officer, etc.) smd owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file ttus ,pphcatlon; that all statements contained m thru apphcatmn are true to the best of hm knowledge and behef, and that the york wall be performed m the manner set forth m the apphcation filed therewith. lworn to before me th~s d . 9~. HELEN[DEVOE .. NOTi~RY PUBLIC, 5t~ o~ I~ Ym'k No 4707878, Sm~ Tem~ Exli~ l~Ja~ch 30,19 (S~gnature of apphcant)