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Home My WebLink About15757-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15709 Date April 30, 1987 THIS CERTIFIES that the building Addition to accessory building Location of Pr err !235,Factor Avenue Ma. ttituck, New York op Y ~usb'~'o: ....... Y .............. 'S't/e~i ...................... ~l'e~ County Tax Map No. 1000 Section 12 2 .Block 0 2 ,Lot 18 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 11, 1987 pursuant to which Building Permit No. 15757 z dated. ...........................Ma r e h I 5, I 987 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 ......... ADDITION TO ACCESSORY BUILDING AS APPLIED FOR Th~ certificate is issued to L 0 U I S $ T 0 KE S ..................... ?oY.'o;, x x ................... of the aforesaid building. Suffolk County Department of Health Approval Iq/A UNDERWRITERS ~CERTIFICATE NO .................. N / A PLUMBERS CERTIFICATION DATED: Rev, 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST gE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15757 Z hereby Permission is granted to; ...~.....~....I ....................................................... ...... ~~.. ~.:.....!.) at promises located at .../....~...~.'~ ......... .~... . ........ County Tax Map No. 1000 Section ..... /..~....'~. ...... Block ........C?.....~:.,,, ..... Lot No....t.,.~.. .............. Building Inspector. Fee $..~....~./.. ?...~. and approved by the Building Inspector ~v. 6~80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,¥. 11971 765 - 1802 Instructions '~r.c~ . A, This application must be filled in typewriter OR ink, and submitted ma,--,.--- 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 Res{dences 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 pzoperty showing all property lines, streets, buildings and unusua~ natural or topograph ic 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 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$ ]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50. ~) 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20,00 5.Updated C.O. $ 50.00 Date .......................... NewConst'z'uction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... Jo.$~ NO, ~_2 ~ f Street Yamlet Owner or Owners of Propert .................................. County Tax Map No. 1000 Section .../.c~ .~ ........ Block . .0.~. ........... Lot,..].~ .......... ,Subdivision .............................. , . ,Filed Map No ........... Lot No .............. Perm it No. . . Date of Permit . ,Applicant .~'~. ,4~'~/j~{'. .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...]./~4 ~ .................... Construction on above described building a~rmit meets all/~).pJic_~ab~;codes and regulations. Rev. 10-10-78 Co i,SToq OUNDATION ( ls t) OUNDATION (2nd) OUGH FRAME & FLUMBING ~NSULATION ?ER N. Y. STATE ENERGY CODE FI ,AL ADDITIONAL COMMENTS: BOARD OF HEALTH .'-~'.':.. 3 SETS OF PLANS .-~;.~;.. 'FORM r~o. ~ SORVEY .......... , TOWN OF SOUTHOLD CHECK .... ~ - - - BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~'.~.qc~..~..].~.., 19~. ?. Approved . .~....o~ ./..~..'~.., 1972 Permit No./.6.~..7..~5.?.~ Disapproved a/c ..................................... (Building Inspector) CALL ................ MAIL TO: APPLICATION FOR BUILDING PERMIT Date .................. , 19... 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. ~7,/--- f,, (Signature of applicant, or name, if a corporation) ./. .6... ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premis .~.~... :~......~..ff~. · · ................................................... (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....~.z+Z..~... ~ ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... / .~..3.3.~ ....................................../Tt~ ~ ~'q~, House Number Street Hamlet 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 occupancy of proposed construction: a. Existing use and occupancy ......... .0...,ya.~...~ ............................................ b. Intended use and occupancy ........ ~. ,4q~...... ~..~.. ~...~~ 3. Nature of work (check which applicable): New Building .. ' ... Addition . ~. · .~f~. · · Alteration .......... Repair .............. Removal .............. Demolition ............. Other Work ............... 4. Estimated Cost ~ c/ '7 ~ fJ ~,,~ ~ ~ (Description) ...................................... Fee ........... . .................. ; ....... " (to be paid on filing this application) 5. If dwelling, number of dwelling units ./ ............ Number of dwelling unitg on each floor ................ If garage, number of cars ......... a~....~tg~. ......................... ! ........... T ............... 6. If business, commercial or mixed occupancy, specify nature and extent of each typb of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ........ : ...... Depth ............... Hight N be fSi i e ............... gin r o or es ............................. , ........................... Dimensions'of same structure with alterations or additions: Front ............. i .... Rear .................. Depth ...................... Height ...................... Number of Stories 8. Dimensions of entire new construction: Front .......... . ..... Rear ......... ! ...... Depth ............... Height ............... Number of Stories ............................. I ........................... 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner . .i ........................... 11. Zone or use district in which premises are situated .................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... I ........................... 13..W_ill lot be regraded ....... ~ ....... :~>...~ ...... Will excess fig be removedifrom 15remises: _.-._.Yes _ NQ i4. Name of Owner of premise~Z ~..~.. Address .~..d../O*.O....~. ,,(.~.~.~.. Phone No.~'..t?..,~.c..o~. ~...q~? Name of Architect ........................... Address ................ I... Phone No ................ Nan~e of Co ctor Add ' P1 e No ntra .......................... tess .... : ........... ]... ion ................ 15. Is this property located within 300 feet of a tidal wetland? *Yesl ..... No ..... · If yes, South01d Town Trustees Permit maybe required. PLOW DIAGRAM : Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from 9roperty lines. Give street and block number or description according to deed, and showistreet names and indicate whether .nterior or corner lot. T, ATE OF NEW YORK, I .OUNTY OF ................. S.S being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) hove named. [e is the ........................................ (Contractor, agent~ ~;;~;~'a~e o'f~i~;;,'e't~.') ........... ~?~'~ '~' '" ....... f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this ............. {./ ........ day of .... ..~~ ........ 19~7. I~)T/~RY PUBI. IC, State of New York (Signature of applicant) No. 4707878, Suffo k County ~,...~ Term Exoires U~,rch 30, 19__-~.~ ,/'