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Home My WebLink About15842-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z-15577- Date April 2, 1987 DECK ADDITION THIS CERTIFIES that the building ................................................ 210 Pat Lane Mattituck, New York Location of Property/~s~ 3/0 .......................................................... · Street Hamlet 114 I0 10 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 2, 1987 15842Z ......................... pursuant to which Building Permit No ...................... April 2, 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 AROUND SWIMHING POOL. JODY & CHRIS PUMILLO The certificate is issued to ..................... [o~,n'o;',~Y,~,r~ ..................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................. .N./.A. ............................. N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 1~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 15842 Z Permission is hereby granted to: ~...x....~~......~~ ..->~..~~.....,...~.,....~.../../~,~ ~ . .. ._/__ /__ /. / .:/_ ~':,;. at premises located ot ......~,.X~./~.~.-.....~ ........ ...,...j ....... .,. .......... : .......... ....................... .,~~. ~...~/,..~. .... zz..~ ....... ~.. cau,~ Tax Mop No. ~O00 S.~t,on ....l..L..~ ...... ~l=k ...... /.~.. ........ Lot No ..... /...~ ........... pursuant to application doted ...~ ........ ~ .............. , Ig~"...'Z, and approved by the Building Inspector. Rev. 6130/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 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 approvat 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 Residences 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: I. Accurate survey of pZ'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~,.$10.00 Business $50.00 2. Certificate of-occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00 over 5 years $10 00 4.VacantLand C.O. $ 20.00 ' 5.Updated C.~ $ 50.00 Date ............. ~ ........... New C on s t z~ u c ~; i O~Pre.ex isting Building ............ Vacant Land ............. Location of Property... ~/, .~. .................... ,~, .~, ,~,. ,~,' .~:~. ,~,.',,,` ,/~,,, ,~,, ./~.~..~.~_. Owner or Owners of Prooertv . L/f //'L~,~?/ CountyTax Map No. 1000Section .. /./. ........ Block ...... /'..~). ...... Lot.../..~.. . Subdivision ................................. Filed Map No ........... Lot Ne ........... ,: ' ....... Permit No ........... Date of Permit .......... Applicant .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ,..,_,~>~....... ,.. RequestforTemporaryCertificatex./ ..................... FinalCertificate..",~.,,,.,'"'"' , Fee Submitted ¢.~, ,~,~.~...~, .............. Construction on above described building and permit meets a~l app~des an~Fr, edblations. Rev. 10-10-78 .OF ,.'% , ow. oho °w, Approved ., 19~. Permit No./~.,-~..~..~.~, ~ Disapproved a/c ..................................... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 throushout the work. e. No building shail 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 Southol.d, Suffolk County, New York, and, other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demoli.fion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, ho, g~g code, arid regulations, and tQ admit authorized inspectors on premises and in building for necessary inspe~ction~.,._lr ~.~ / ~j ' / / ........ o....¢':..:. :,/p., ............. (Signatct'e of applicfint, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...................... ]J ................................................ (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 I~IUSTr~B~YS~FFOLK COUNTY LICENSED Builder's License No .......................... ds ~"-c- Plumber's License No ............... · .......... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done 6pf' ..... . .o. . .............. . . . . . . C. ........... . :. / .:: .... , . //. ::. House Number Street Hamlet County Tax Map No. , 000 Section ...... [(..~. ....... Block ..... L? ......... Lot. /O Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and/~tended use and occupancy of proposed construction: a. Existing use and occupancy ....... '. .....!...~~~..~A~.. ~/'f~ :.Dc~ d-~ ... b. Intended use and occupancy .............................. ~ ....... ,... ..... ...................... 3. Nature of work (check which a~plicable): New Building ' Addition. ~ ..... Alteration .......... Repair Rem:oval Demolition ~ · Other Work ~.~dpO,-~. i ~o ~ (Description) 4..Estimated Cost ............ . .......................... Fee ... ~t.~. ta,?~ ~. ~'.. ,<. .................... i " iO:i~-h~paid ~n filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling udilgbhT¢~ich ilo. or. ............... If garage, number of cars .... ~ .................................................................... 6. If business, commercial or.mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of exi§tin'~ stfucturps, if any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimensions'of same structure With alterations or additions: Front Rear Depth ................... j... Height ...................... Number of Stories ...................... --.8. D~mensmns of entire new cons~ructmn: Front ......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... : ................... Name of Forme~Ow~er . ............ .................. 11. Zone or use district in which p~emises are situated 12. Does proposed construction vin/~Z~ny zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... -:--~.~-..h~',o-L' ·/5D .... ,, Will excess fill be removed from premises: Yes 14. NameofOwnerofpremises ..,,uk:Ja~..~d'}I../.~_.~..-~. (f~ress ................... PhoneNo '.Name of Architect ....... ¢~,a~ ...... Address ................... Phone No. ~.~ .., :Name of Contractor ..... .-,-,~...}.~i--'(.,/~. ..... Address .... : .............. Phone No. ~.'~. 15.."~. ?..=5.' 15. Is this property located'within 3G0 feet of a tidal wetland? *Yes ..... No ~.. · If yes, $outhold Town Trustees Permit may be required. ; PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed~, and. indicate all set-back dimensions from property lines. Give street and blocl: number or description according to deed, and show street names and indicate whether interior or corner lot. STATE O F NEW YORK, S.S 7 ~"~g/~-~' / ! o~ ,~ COUNTY OF ................. ' ~r/da~, ,.~.),-- ................................................ being duly sworn, deposes and says that he is the applicant (Name of individual sigoing contract) above named. He is the ..................... , .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · ..' ......... .~. ·., ....... day olf ..... ~ ....... 19~]. Notary Public,..~.. ~. ~J.~.~..~.. ..... County _.~[._~ ~t 0t ~ ! ' ' ~/ (Signature of applicant)