The URL can be used to link to this page

Home My WebLink About15815-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy Date April 13, 1987 THIS CERTIFIES that the building DECK ADDITION 2500 Grand Avenue Mattituck, New York Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section t 07 .Block 02 . .Lot. I 6 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 20, 1987 15815Z ......................... pursuant to which Building Permit No ...................... March 28, 1987 dated ............................. 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 ROBERT & JOAN CHRISTIANSON The certificate is issued to ..................... ioWn.oi.,.t~l~f~2g~xt~.~x .................... of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO ..... N/A N/A PLUMBERS CERTIFICATION DATED: / Bui~Ing Inspector Rev. 1/81 ~OF~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 158i. 5 Z Permission is hereby grante~_d_.to: ~ .~....;.~...~.....~ .... .~.-~.....~..~....~ ...................... ~.~~........~.:.~..,...L!...~.~;..~ ..... ,o .~~..~....~.,~.....~...~.....~....~.%...~ et premises located at ....L~...>~...,...~....~.~.....~ ........ ~.~.~ ...................... County Tax Map No. 1000 Section ...... 1...~...-2 ...... Block ...... ..C~.....:~...... Lot No ..... ~...(4~. ............ pursuant to application dated .... ...~.~.~......~.....~.. ............... , 19.?....~., and approv~ by the Building Insp~tor. Fee Building I~tor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 BLDG. DEPT. TOWN OF SOUYHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 featu res. 2.Final approval of Health Dept. of water supply and sewerage disposal-iS-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters, 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- lions, 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 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 $ 50.00 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~.. , ~1 New Cons truc lion ...... Old or Pre-existing Building ............ Vacant Land ............. Owner or Owners of Property ..... ,.,.r. ..................... County Tax Map No. 1000 Section ...~0.? ........ Block .. , ~ ~ ....... Lot.. ~/~. .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets ali applicable codes and regulations. Ap p lican t ./~Z::~:~ ~-~. Rev. 10-10-78 '?T£L~ 7(55-1 TOWN OF SOU'I OLD : OFFICE OF BUILDING INSPECTOR P.O. BOX 728 , ,,I ' ' TOWN HALL SOUTttOLD, N.Y. 11971 To Whom This May Concern, . ': We are unable to complete your Certificate. l- of Occupancy because ,of the following reasons.'. : /--/~An application for Certificate of Occupancy. The check is ~a~a~a~xx not on file $ 25.00'. /_--/ No final inspection has been made. ' Please contact our office on this matter. ~':; Thank you for your cooperation. ~,.~ ~;,~ , Building Dept. ; ,, OUNDAT!ON ( 1 s t) OUNDATION (2nd) OUGH FRAME & PLUMBING [NSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: I! Approved .~...~.~. ·., 19.~.'']. Permit No. 1.~.~.~. ! .~'~..'~.. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEI:'TIC t~ORM ............. TOWN HALL SOUTHOLD, N.Y. 11971 ~0~[~ TEL: 765-1802 CA~ ~-~-~-'-'-' ....... Disapproved a/c ..................................... BLDG, DEPT. ........................................... .,~ TOWN OF SOU~HOLD (Building Inspector). APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This applicafion must be completely filled in b~/typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acco~lS~k~to schedule. b. Plot plan showing location of lot a.n~ b~i~%~[emme~ relationship to adjoining premises or public streets or areas, and giving a detailed descripti~out_ ~ ~,~0~e drawn on the diagram which is part of this appli- c. The work covered by_fl~or~ ~,~d before issuance of Building Permit. d. Upon approval of th~l~li~a~i(~h~l~aifa~t?~&~or will issued a Building Permit to the applicant. Such permit shall be kept on the premises~a~a_'fl~a4~ fo~i~lsp~oi~t the work. e. No building shall be oO~o? ~¥h~K~t for any purpose whatever until a Certificate of Occupancy shall have been granted by the B'~I. d~l~fff~r.,~%\~'~ e~ 1APPLICATION IS HEREBY~-Z°n~Ordinance~the T~f~--~ t~~g Dep~ment for the issuance of a B~Iding Pe~it pu~uant to the ~uiSuffolk County, New York, ~d other applicable Laws, Ord~ces or ~egmations, mr the construction o~d~gs, additions or alterations, or for removal or demolition, as here~ desc~bed. The applicant agrees to comply with~il app~cable laws, ordinances, bu~d~g code, hous~g code, and ~egulations, and to admit authorized inspectors on premises and ~ bulldog for necessa~ inspections. .. ~0.b.~.~.~o.e ..... Ckr.,.~.~.,:¢~.o.~. (Signature of applicant, or name, if a corporation) . ~ .~ &.~e¢.. ~z 0.., ~ o. tg~ ~ ........ (Mailing address of applicant) ~own~ lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. State whether applicant N~e of owner of premises . ~0~ ~ .~. .~0~. ..... ~ F. I.'~. ~.l:a.~ ~ (as on the tax roll or latest d[~)I' ~.. :~'~a~QTED ...... If applicant is a corporation, signature of duly authorized officer. (Name and title of co¢orate officer) . NOTIFY ALL CONTRACTOR'S RUST BE SUFFOLK COUNTY LICENSED FOIl. OWiNG Builder's License No .......................... FOONDgwlO~ FOR ~U~EO Plumber's License No ......................... ~OOGH Electrician's License No ....................... 4, [qhg[, Other Trade's License No.. ~.~ ............. ~.~ ~ AL~ COF~Wf~,J(;~ 1. Location of land on which proposed work will be done: ................. ~O~B~[{['(;~¢~?~."I' ~ ~ ~../~ ~ ,/~ ~'~S'T~UC'I'~O~~ 5~RORS, ~.~. , , ~,i~, , .~1.¢~ ................................ ¢ Z~7,r, ~ ¢ . .~.; .... ; ............. House Number Street Hamlet co~.t~ ~, ~ ~o. t000 s~t~o. .... Za ~ ......... ,~o~ ...... 0.~ ........ ~ot.../. ~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State ¢xistin~ use and occupancy o[ premises and intended use and occupancy of proposed construction: a. ExJstin~ use and occupancy .. ~0.~ .~ ........................................................... .. ......................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . · · ~ ...... Alteration, .......... Repair .............. Removal .............. Demolition ............ ~. Other Work.. ~. ¢..e,,/q~ ...... (Description) 4 EstimatedCost "~]~0~.O. : ' (to. be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units 0n each floor ................ If garage number of cars 6. If business, commerciaI 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 Stories ............................. ! .......................... Dimensions of same structure with alterations or additions: Front ............. i · · · Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions o~nti!~e new construction: Front . ./~..t .... . ..... Rear .../.&.../.. ~ ..... Depth ... ]z~../ ....... Height . ~ fi/~-J~,~L~...... Number of Stories .... ~.~[.IO.¢lt.~..--.x ............. : ................ ~ ......... 9. Size of lot: Front ....... /~ 3,/Q_,-~../ ..... Rear ..... ./3.~../ ........... Dcpt, h .. ,.~ .].t~: .~..I ........... I 0. Date of Purchase . .,,~.. eIP.+., t.q.~] ............. ,~ Name. o~ Form, er OFner ,~. 0~t~.~/~-..~,,J.~ l~.q-... I 1. Zone or use district in which premises are situated.. 1~ .q-.~ ;.~.{ .~. '/Z./. ~/.I.. ........ a. ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ../~.0J .......................... 13. Will lot be regraded ....... ,~ ...................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Id. oh ...Oo. Otq.Cbr.tM-/4ttai 4~-00 ~/I-~/,.~.~#gPhone No ~.°t[.~..~.. Name of Architect ...... ~. I~. ............... Address .. ,P/.a..-/f.l?-?.{ ./~ .... :.. Phone No Name of Contractor .......................... Address .... : ........... i ·, Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ~... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from lines. Give street and block number or description according t.o deed, and show itreet names and indicate whether r corner lot. ' ~il~le of individual signing contract) bore named. being duly sworn, deposes and says that he is the applicant te is the ............................................................... , .......................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said w~{a~Ne 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 befor~ me this ........... ........ day of..; mCJC .......... ~ ~ .~?..- ..~/..'~'~-.. County .~.~.~.~... ,rotary Public, , I~tt£S ~. ~ ~0i (Signature of applicant) WARY PUBLIC, State of New Yo~k . No. 4707878, Suffolk Count~ lerm Expires March 30, 19 .... ,