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Home My WebLink About15909-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z- 15646 Date April 15, 1987 THIS CERTIFIES that the build~g D E C K AD D I T I 0 N Location of Property 265 Walnut Avenue Mattituck, New York 121~ HO: ........................................................ Street Hamlet County Tax Map No. 1000 Section 142 .Block 01 ..... Lot 16.2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore f'fled in this office dated April 3, 1987 pursuant to which Building Pem~it No. 15909 Z dated...........April .... 15,......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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING THEODORE & MARTA ANDRUSKI The certificate is issued to ..................... /o'a;n~),'~l~J~'l~l~l~k ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... i ....N../.A. .......................... UNDERWRITERS CERTIFICATE NO .................... ~ ./.A. ....... i .................. PLUMBERS CERTIFICATION DATED: N/A .......... * '~iiciing Insplit;; ............. 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 ^UTHORITED) N9 15909 Z Date ...... ~......./...~.. ............... ,19.~.~ Permission is hereby gronted to: ~ /'~ . ~ , ...%~...I..2~....: ............................................ ~'~.....~....,x..,. ..... /./..~.~.~ ............... ,o.~.~. ~ ...~.....~ .~ .~..~.~' ' et premises located at ....~...,.~...'~. ....... ~.~~....~.. !......~...I/.]L~ ........... County Tax Mop No '1000 Sect,on ...... /..~.....~. ...... Block ...... ..(~.....1 ........ Lot No .... 1..~'...~. ..... , pursuant to application dated .......... .~ .................. , 19..~..~., and approved by the Building Inspector. Fee $...'~.... ............... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Buildmg Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions A. This application must be filled in typewmter OR ink, and submitted i Ilmm~ to the Building Inspec- tor with the following; for new buddmgs or new use: 1. Final survey of ptoper~y 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 buddmgs, Industrial buddmgs, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the buildm9. 5.Submit Plannmg Board approval of completed site plan requirements where applicable. B. For existing buddirigs (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. Accurate survey 0f property showmg all property lines, streets, bullrings and unusual natural or topographic featu~'es. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildlngs. 3. Date of any housing code or safety inspection of buddmgs or premises, or other pertment informa- tion required to prepare a cert~fmate. C. Fees: Additions $25.00 1. Cert~flcate of occupancy New Dwellzng.$25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-exist~ng dwelling $ 50.00 3. Copy of cert~ficatb of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 ,,,~// 5.Updated C.O. $ 50.00 Date ..... ,~/4 ...... ~. ........... NewC ons truc t z on Old or Pre-existmg Building Vacant Land ti ty Loca onofProper .... ~..) ................ ¢~, .. r. ............ ¢ ................ House No. Street tCamlet Owner or Owners of Property ..... ,'.,--. ~ .... ~f ,~'..,.~ ... 2~. . . ~ev'.% ................... County Tax Map No. 1000 Section /~, Z Block . ./ Lot.../~'. Subdivimon ............................. Fded Map No ........... Lot No ............. Permit No .......... Date of Permit .......... Applicant .. ~ ~ ... ~,~. ,~4 ...... Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ....................... Ptannmg Board Approval .............. Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ ............................. Construction on above descmbed building and permit meets all apphcable codes ~nd regulations. Apphcant .... ~. l/, .... ~.-... ~ ...................... Rev. 10-10 78 OUNDATION ( ls t) OUNDATION ( 2nd ) OUGH FRAME & PLUMBING :~SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all s~t-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether Examined .~.../.~.. Approved .~A~.. l ~. Disapproved a/c .. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORMNO. 1 SURVEY ......... , TOWN OF SOUTHOLD .CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.:765-1B02 CALL ................ MAIL TO: ,1947 ,'19~ 7[ Permit No ./~'~. O ~ .~. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled m by typewriter or in znk and submitted to the Bmldmg Inspector, wd sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showmg locatton of lotan. libyan of buddings on premises, relationship to adjoining premises or pubhc str. or areas, and g~vmg a detailed descnptlont~Y~-,~kyou t_,of property must be drawn on the dmgmm whxch is part of th~s al: cation, y tk~,~j~~1~-. c. The work covered b lo ced before issuance of Buddmg Permit d. Upon approval of thl~"~I~'io~.ql,tl~lhll~ffll'c ~,~l~for will issued a Bmldmg Permit to the applicant Such pe~ shall be kept on the pr¢l~Tm}lil~. ~}~ ~r~Ughout the work e. No budding ~'~ci.~[e~l~ ~ }o'1~ or in part for any purpose whatever until a Certificate of Occupa shall have been grant~ilb~,l~ B~l~r}gt~sp~:' APPLICATION IS ~_~,~~.~lmng Department for the xssuance of a Bmldmg Permit pursuant to Building Zone Ord:nance p~O~n_~i-q~t~dld, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for theconsl~%h ~f~'t~qll~s, addmons or alterations, or for removal or demohbon, as hereto descnl ipphcable laws, ordmances, bufldmg code, housing code, and regulations, an, The apphcant agrees to con~i~l~wi~lttl: admit authorized inspectors oh~ l~r~emlses and m braiding for necessary inspsctions (Signature of apphcant, or name, if a corporation) (Malh'ng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bud, · C<~..~ .'-... la'r~OVEO ~$ NOTED (as on the tax roll ~.~test d;eX)~] ~V' ~' ~ ~. ' If applicant is a corporation, signature of duly authorized officer (Name and tttle of cgrporate officer) ALL CONTRACTOR'S MUST BE ~U~FFOLK COUNTY LICENSED Builder's License No , '7~,. " ,". . Plumber's License No Electrician's License No Ott er Trade s L~cense No Location of land on which proposed work will be done House Nmnber Street County Tax Map No 1000 Section e,,~ Block 'xtC'TIIm¢ 9&JIt. DtNG DEPARYMF:~IT AT '651~)2 fi A~a TO & P~ ~R THE =OU~dI~A~(I~~ ~O ~O~RED tlamlet .... Lot. Subd]vmton Filed Map No Lot .. t (Name) State existing use and occupancy of premmes and intended use and occupancy of proposed construction a Existing use and occupancy ................ b Intended use and occupancy ./) ,-¢~-~. - 3. Nature of work (check which applicable) New Budding ...... Addition ~,,.: .... Alteranon Repmr .......... Removal ,. Demolmon ........ Other Work ....... (Description) 4. Estimated Cost .?.c.' . .c.: c ......... Fee ............................ ' (to be prod on filing thru apphcat~on) 5. If dwelling, number of dwelhng umts .. Number of dwelhng umtS 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. Dtmenslonsofex~stingstructures,~fany Front..~.( 4'~.... Rear ...,~f ~(f . Depth. Hmght .. f~.j~. . Number of Stones .... /. ~ ........ ~ ...................... D~rnenmons of sa~ructure with alterations or addit~ons Front .... ~ /~ .. Rear /.fife.. ..... Depth . . /d. ,-& ~ ..... Height ............ Number of Stones... 7 .Z ~ ........... - B. Dlmenmons of entlre new construction Front ..... Rear .......... Depth Height ....... Number of Stones ................... 9 S~zeoflot Front ...~ ~ ........ Rear .............. Depth v'., -- ' 10. Date of Purchase .}'/.tff' ..- ~ e? . Name of Former Owner . . /54~/( iz7./13'' 11. Zone or use d~stnct ~n which premises are mtuated .. 12 Does proposed construct~on,violate any zoning law, ordinance or regulatmn ....... ~ {5 ............ 13 Will lot be regraded .... . ., ~. ~ ......... Will excess fi, ll be:removed from premises Yes __151 14. Name of Owner of premises .~?~.~'~,'~ ~4.. ~,~.f,~ 4' Address ~ cz ~/~. (~'.~. .... Phone No.. ~'J~ Name of Architect .............. Address ............... Phone No .......... Name of Contractor ............. Address .......... Phone No ............. 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permmt maybe required. PLOT DIAGRAM Locate clearly and distinctly all bufldmgs, whether exlshng or prolSpsed, and indicate all set-back d~menmons rrm property hnes Gwe street and block number or descnphon aocord~n~p deed, alld show street names and ~ndlcate wheth, mtenor or corner lot ~ ~' ~,~ ~ ,' ' STATE OF NEW Y~RI~I ~/. COUNTY OF. '~ff' ~ l S S ~ ........~-~' '. ~.~ '.. . being duly sworn, deposes and says that he is the apphcm (Name of individual ~gmng contract) above named , He ~s the ................................ (Contractor, agent, corporate officer, etc.) of smd owner or owners, and m duly authorized to perform or have performed the smd work and to make and file th apphcat~on, that all statements contained m thru apphcat~on are true to the best of his knowledge and belief; and that tt work w~II be performed in the manner set forth m the apphcat~on filed therewith Sworn to before me th~s .... .~. ...... da~ of. N~ Pu~hc S~a~ ~f ~ew No. 52-9703725 Su~oik (S~gnature of apphcan F?,C-/'ORY