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Home My WebLink About15973-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...Z.1.5.7.8.1 ....... Date May 28, 1987 THIS CERTIFIES that tile building . a.cc.e.s.s.o.r.y, shed. Location of Property 13 .4 .5. ........ S. 1. g .s.b.e.e...~p.~. ~ MatLituck . b![~so 'Nd ' Street .................. hJmlo't County Tax Map No 1000 Section . .1. 44 ...Block ...... 2. ....... Lot .. . 8. ....... SubdlVlSmn . .M.a.t.t;~.tuqk...Par. k..P.rqp....Filed Map No .89.1 . Lot No .... .76.&.77.. .. conforms substantially to the Apphcahon for Building Permzt heretofore filed in this office dated .... APTg,], ~7 · 191~.7. pnrsuant to which Bmldlng Permit No .... .1.59.7.3..Z ...... dated ....... M~y ~ ~..1.9 ~ 7 was issued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for wluch tlus certificate is issued is ....... ·. Acceasory..~he~ .... The certificate is issued to .... of the aforesmd building. Suffolk County Department of Health Approval .......... [q/~. .............. UNDERWRITERS CERTIFICATE NO ................. 31/A ............... PLUMBERS CERTIFICATION DATED: N/A ~[~ulldlng Inspector 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) 15973 Z pursuant to appl,cation doted ...~.....:~:...~ ............ , 19.~..'~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. co TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCI Instructions This application must be fd~ed in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor with the following; for new buddings or new use: 1. F~nal survey of property with accurate location of all buildings, property hnes, streets, and unusual natural or topographic features 2. F~nal 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 buddings, Industrial buddings, Multiple Residences and mmilar buildings and ~nstaila- tions, a certd~cate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buddings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buddings and unusual natural or topographic features. 2 Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any houmng code or safety inspection of buildings or premises, or other pertinent mforma- t~on required to prepare a certificate C Fees: 1. Cert~fmate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $]0.00 2. Cert~fmate of occupancy on pre-existing dwelhng $ 50.00 3. Copy of cert~ficate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ,,,~-/~CQ.. )~ 5.upclatecl C.O- $ 50.00 Date .. ~ ............ NewCons tructlon..~.. Old or Pre-exmtmg Budding ............ Vacant Land ............. Location of Proper~ ~ c Hou~ No. Stree ~ , Ham/e ~ Owner or Owners of Prope~y . .~J~.. ~... ~ .~r~:~r~...~.. ~ ~.<~< ...... County Tax Map No. 1000 Section ............. Block ............... Lot ............ Subd,v,sion.~+.'. ?¢f~..~¢'. ....... F,1odMapNo 70) LotNo W~77 = ~.,. , ~ ~/F/; ~,~,~ ............. ,...:.. /~ .......... ~ Date of Permit .................................... Permit No. Health Dept Approval Labor Dept Approval .. . Underwriters Approval .................. Planning Board Approvai ...................... Request for Temporary Certificate ................. Final Cert~fmate ·. ~ ................. ubm, te S..I ......... Construct,on on above descnbed bu,ldmg and.p.~er.?t me~./_~cab~ cod. es and regulat,ons ........... ~.~.5~5 ~,,~.t ........ Rev 10 10-78 OUNDATION I 1st) OUNDATION (2n~) OUGH FRAME & ?LUMBING NSULATION PER N. STATE ENERGY CODE FIliAL ADDITIONAL COMMENTS: PROPERTY AT Examined Approved Disapproved a/c FORNI NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N Y 11971 TEL 765-1803 ~}q .~ ~.... ,19~'') eermitNo ),..-?'~.~.~= (Building Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY SEPTIC FORM ............. : MAIL APPLICATION FOR BUILDING PERMIT Date .. , 19. INSTRUCTIONS a. Tins appl,cation must be completely filled m by typewriter or in ink and submitted to the Bmldmg Inspector, wit sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of bmldmgs on premises, relatmnshlp to adjoining premises or pubhc str. or areas, and g~vmg a detailed descnptmn of layout of property must be drawn on the diagram which is part of this ap cation. c. The work covered by this apphcahon may not be commenced before issuance of Bmldmg Permit d. Upon approval of this application, the Bmld~ng Inspector will ~ssued a Buddmg Permit to the apphcant Such per shall be kept on the premises avadable for mspechon throughout the work e. No bmldmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa: shall have been granted by the Building Inspector· APPLICATION I$ HEREBY MADE to the Bmldmg Department for the issuance of a Bmldmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance- Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herem descnb The applicant agrees to comply with all anphc,a,b, le laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectors on premises an~ m bmldmg for necessa~.~)t~ ~ '~t/ ~ 5/_(Slgnatnre of appbca~t,%r name, if a corporation) (Madmg address of apphcant) //t~j 7~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bullr O co ,'J - Name of owner of prem:ses ~ ~ ~j ist,~,,.~.~ ~7, St /'9') ,4- ,'?..~ ,&/~.,, ~ ~/~ ,~ ~ (as on the tax roll or latest deed) If apphcant ~s a corporatmn, mgnature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK Builder's License No. COUNTY LICENSED Plumber's License No Electrlclan's License No Other Trade's License No .. Locahon of land on which proposed work will be done .... /,7%s'-c. , ttouse Number Street Hamlet ~-~ County Tax Map No 1000Section ~ /~.(// Block ..o./'~ . Lot .~1~.... Subdl~ls:on Filed Map No Lot 7 (Nar~e) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Exmt:ng use and occupancy . ~. b Intended use and occupancy ...... 3. Nature of work (check which applicable) New Budding ..... Addition .... Alteration Repn,r .... Removal .... Demolition ........ Other Work . (Description) 4 Estimated Cost . ~ O Fee * (to be paid on filing this application) 5. If dwelling, rlumber of 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, if any Front Rear ....... Depth ...... Height ..... Number of Stones ........................ Dimensions of same structure with alteraQons or additions Front .......... Rear ............ 10 11. 12 13 14. ~, .~ ,.A~,[ . Height Depth . · Dm~enslons of entire new construct&on' Front Height ....... Number of Stones Size of lot Front Date of Purchase .... ...... Number of Stones ................ .... Rear .......... Depth ...... Rear ............. Depth ........ · Name of Former Owner .................... 15. Is this property located wzthin 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permzt may be required. PLOW DIAGRAM Zone or use district In which premises are situated Does proposed construction violate any zoning law, ordinance or regulation W~I1 lot be regraded ............... Will excess fill be removed from premises' Yes N, Name of Owner of premises .. Address ............ Phone No .............. Name of Architect ............. Address ............. Phone No. Name of Contractor ............. Address ............ Phone No ........... interior or corner lot. Locate clearly and distinctly all bufldmgs, whether existing or proposed, and indicate all set-back dzmenslons fron property hnes Give street and block number or description accordmg to deed, and show street names and ~ndlcate whethe \ 13 $, STATE OF NEW YORK, COUNTY OF SS (Name of md~wdual signing contract) above named .... being duly sworn, deposes and says that he is the apphcan He is the .......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ss duly author]zed to perform or have performed the said work and to make and file tiff apphcat~on, that all statements contained m this application are true to the best of his knowledge and belief, and that th work will be performed in the manner set forth m the application filed therewith Sworn to before me this ..... ~'~, .. dayof .CL]~ .~.x~ ..... 19~2 N°taryPubhc' '"~%~?~'"~'"~[ J//~"' ' C°unty~'~K~,[ "' ''" ' ~~~ ~ ~1[ ~ ~ ~ ' ' ............ ~ 4707878, S~k ~u~ f apphcanl T~m ~r~ Mamh 3~