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Home My WebLink About15933-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi{icafe Of Occupancy No. Z15787 Date May 29, 1987 THIS CERTIF'IES that tile braiding deck addition to ex3_stlng dwelling. 1805 Grand Avenue Matkltuck Location of Proper~y ................................................ . House No Street Ham/er County Tax Map No. 1000 Section . ...1.0.7 .... Block ..... .8 ..... Lot ....41 ......... Subdivision ,.. X ...Filed Map No X .Lot No X conforms substantially to the Application for Building Permit heretofore filed in tins office dated ·..ARr. i..1 .1.7. t. ,.i.9.8 7... , pursuant to which Building Permit No 15 9 3 3 Z I rll 25, 1987 dated ..... P ............. was issued, and conforms to aU of the requirements of the applicable prbvlslons of tile law. The occupancy for winch tins certificate is issued is ...... · p.e. ck. a.dd.$.~,.o.n., tq ,an ex.%st.i, ncj. o.neufa.m.~.l-y' .d.w.e..1l.~.n.g.: ............. The certificate ts issued to ............ .M.R: . ,&..M..R,S., R. ,U.S,S.E. If, L...C,.. ,W.E,L,L.S, .............. I of the aforesaid building. Suffolk County Department of Health Approval ............. .M/..~ ........... UNDERWRITERS CERTIFICATE NO .... N./.A ................ PLUMBERS CERTIFICATION DATED: N/A Rev 1/81 FOH~d[ NO. 0 TOWN OF So~'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLET!ON OF THE WORK AUTHORIZED) i5933 Z D~te ...... ~.....~...' ..................... ~' , 19.~...7. Permissio~ is hereby ,r=~,.~,.~ ' _~f..,....; ........................ ..~..,~ ............................ ..L.~..~.....~.~....~..~ ................. ,o _~.t..~..~....~~~.....~....~ ..... ..,...~...~~. ~...... ........................................ ~, ,~.,,, ,=,.,., .~L~..,~_~.._~....~..~ ............................. ~.~ ~.~ ~., ,~. ~ s..,,~Z.%7 ...... ,~ ....... ~..~ ....... ~,,~....~ ......... Building Inspector. ,. ,..~.:...~. ........ 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, Thru applicaUon mu~t be filled in Wpewriter OR ink, and submitted ~ to the Building Inspec- tor with the follow~qg; for new buddings or new use: 1. Final survey of p~opertv with accurate location of all buddings, property lines, streets, and ,,nusual natural or topographic featu res. 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 F~re Underwmters. 4. Commercml buddings, Industmal buddings, Multiple Remdences and similar buddings 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 apphcable. B. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses 1. Accurate survey of prOperty showing all property lines, streets, buddings and unusual natural or topographic featu[es. 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 buddmgs or premises, or other pertinent informa- tlon required to prepare a certificate. C Fees' Additions $25.00 1. Cert~ficateofoccu~ancy New Dwellzng $25·00, Accessory ,$I0.00 Business $50.00 2 Certificate of occupancy on pre-exist~ng dwelhng $ 50.00 3. Copy of certlflcatff of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land ',C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ........................ NewCons true t zon. + :~ .................... · . Old or Pre-existing Budding Vacant Land , . S'~reet: Hamlet Owner or Owners of Prop~erty .. County Tax Map No 1000 Sect,on .[0..7. .. Block ..... .~.. ....... Lot... </ / . · Subdw,smn ......... , ................ Fded Map No .......... Lot No ............ Perm~tNo ..... ate of Permit... . .... mant ........................ ........ .. Health Dept. Approval ...................... Labor Dept. Approval U nderwr,ters Approval..' ..................... Planmng Board Approval ..................... Request for Temporary Certificate ..................... Fma[ Certd[cate ....................... Construction on above de OUNDATION ( ls t) OUNDATIO:4 ( 2nd ) OUGH FRAME & PLUMBING NSULATION FERN. Y. STATE ENERGY CODE FI:~AL ADDITIONAL COMMENTS: H 0 U S E 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING DATE INSPECTO~ l Examined ~ Approved~ .~.~' Dmapproved a/c . FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY $OUTHOLD, N Y. 11971 TEL.. 765-1802 CALL MAIL ,19 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ......... CHECK .......... FORM ............. TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ?//¢ ... ,19c INSTRUCTIONS a. Ttus apphcatmn must be completely filled m by typewnter or ~n ink and submitted to the Budding Inspector, sets of plans, accurate plot plan to scale Fee accordmg to schedule b. Plot plan showing location of lot and of bmldmgs on premmes, relatmnslnp to adjoining premises or public str or areas, and gtvtng a detaled descnptton of layout of property must be drawn on the dmgram whmh is part of this al cation. c The work covered by this application may not be commenced before issuance of Budding Penmt d Upon approval of thru application, the Bmld~ng Inspector will issued a Budding Permit to the apphcan, t Such pex shall be kept on the premmes available for mspechon throughout the work. e No budding shall be occupmd or used m whole or m part for any purpose whatever untd a Certificate of Occup~ shall have been granted by the Bmldlng Inspector APPLICATION IS HEREBY MADE to the Budding Department for the msuance of a Bmlding Permit pursuant to Building Zone Ordinance of th~ Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinance Regulations, for the construction of braidings, addmons or alterations, or for removal or demolition, as hereto descnk The applicant agrees to comply with all applicable laws, ordinances, bu,ldmg code, housing code, and regulations, and admit authorized inspectors on premises and m bmldmg for necessary lnspechonS..~ _ , / ....../c ..... (Si=nature of applicant, or name, if a corporation) r). (Maflzng address of apphcant) State whether apphcant m owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises ~1- ~i~'/( O, ........ (as on the tax roll or latest deed) If apphcant ts a corporation, s~ghature of duly authorized officer (Name and title of cqrporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . ~ 0 h.-'/~. ~,A . . Plumber's L~cense No Electrlctan's License No Other Trade's License No ............ Location of land on which p,roposed work will be done. //"~... [louse Number County Tax Map No 1000 Sectton /0~ Block Hamlet Sltbdtviaon .... Fried Map No Lot ' (Name) State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction a Exmttng use and occupanc'y ~ g, ~ .~J/.t4'~ ~.~ ¢ {f-_. .. b Intended use and occupancy ....................... 3. Nature of work (check which apphcable)~ New Building . .. Additzon /~ ..... Alteration .. Repmr ...... Removal ....... Demolition ......... Other Work ....... 4 Estzmated Cost ~tJ 0 Fee · (to be paid on fihng this apphcation) 5. If dwelling, number o f dwelling units .............. Number of dwelling units 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. Dimensions of existing structures, tf any Front .......... Rear ........... Depth ............ Height ...... Number of Stones .................................. Dimensions of same structure w~th alterations or additions Front ......... Rear ....... Depth ................ Height ................. Number of Stones .................. D~mensmns 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 11. Zoneorusedlstrlctmwhlchpremlsesaresltuated ............ ''..ii i'.ii. '.i'.'..'' 12 Does proposed construction violate any zomng law, ordinance or regulatlon ........................... 13 Will lot be regraded ............. Will excess fiil be removed from premises. Yes N 14 Name of Owner of premmes ........ Address ............. Phone No ............ Name of Architect .................... Address ............ Phone No. Name of Contractor .................... Address ............ Phone No ............ 15. Is this property located withxn 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and~ mdmate all set-back d~mens~ons rrm property hnes. Give street and block number or description according to deed, and show street names and mdlcate whethc mtenor or corner lot. STATE OF NEW YORK, S S COUNTY OF. .. ~ (Name of individual signing contract) above named ...... being duly sworn, deposes and says that he is the appllcan~ (Signature of applicant He is the .............. (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ttu, apphcatmn, that ali statements cor~tamed m thru application are true to the best of his knowledge and belief; and that thc work wall be performed in the m~ner set forth in the application filed therewith. Sworn to before me this Notary mubhc, .~. ~)¢/.~/...~/~:~.... County HELF.~ K. B£ ~ ' NOTARY PUBLIC, State of Term .E, xp~res Mamh ;~u, i~,~