HomeMy WebLinkAbout16034-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No .. .~.15.87.8 Date ..... 3.u..n?..24.: .19.8..7 ..
THIS CERTIFIES that the bmldmg . .deck...a,d.d~..fi.~.o.n.. ,~o..e.?_s.t xng..d.w.e.~.~in.?. ,
Location of Property , .. 76.5. ..... .C.e,d.a.r..Dr.i¥? ........ .~,a..~.~.~.tu.ck .
House No Street Hamlet
County Tax Map No. 1000 Section 10.6. .Block I 1 Lot
Subd~vision. Matt%t.uqk., .D.ev. el..opi, n.q..Cq.Fted Map No 776.. . Lot No. .. ...32 .....& 33
conforms substantially to the Application for Building Pemut heretofore fried m this office dated
·...M~y..1.2, .1.9.~7 .. pursuant to wtuch Braiding Permit No. .1.6.0.3 4 .Z .........
dated . .. Ju, r~q~ .8,..1~.8.7
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 .......
Deck addition to an exzsting one-family dwelling.
The certificate is issued to
of the aforesaid building
Suffolk County Department of Health Approval
UNDERWRITERS CERTIFICATE NO ..
ROBERT & MARION SLATER
N39801
PLUMBERS CERTIFICATION DATED:
N/A
,r' l~[dddmg Inspector
Rev 1/81
· OEM NO. ,a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO- 16034 Z
Permtss~on is hereby granted to:
.~.~..~T~..5...~[.~
...~...v. ...... ~.~~ .............
· ..~ ........... ~..~ .......... ~.%.,.....~.~.~.1...
ot p~m,se~ ,oeo,ed o, ...a.~ ....... .~.~.~.......~~.~,,. .........................
County Tax Map No 1000 Section ..... t .~..~.- · · Block .... ,,~,,..~,,~ ........ Lot No ..... .C~..~, ......
~u~o., ,o o~,,~,,o~ do,~ ... ~......~..~..~ ............. , ,~.~.. o,~ o~o~ ~ ~,
Building Inspector,
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
Thru application must be filled ~n typewriter OR ink, and submitted m ~ to the Building Inspec-
tot w~th the following, for new buildings or new use'
1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual
natural or topographic features.
2. Fma[ 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 Underwriters.
4 Commercml buildings, Industrial buildings, Multiple Residences and similar buddings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responmble for the building.
5. Submit Planmng Board approval of completed site plan requirements where apphcable.
Bo
For existing buddings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing"
land uses.
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographm 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 buddings or premmes, or other pertinent reforma-
tion reqmred to prepare a certificate.
C. Fees'
1. Certlflcate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00
2. Certificate of occupancy on pre-exmting dwelling $ 50,00
3. Copy of cert[flcate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O- $ 20.00
5.updated c.o. ~ 50.00 Date ..W.:J..~J ...............
NewCons truc t,~on ...... Old or Pre-exmtmg Building ............ Vacant Land .............
Location of Property ..
Hou~ No. Street ~amlet
O~per o~ O~se~s of Property .................................................
co~ty ~ s~ ~o. ~ o0o s~o~,o~ Z~,.~. ..... ~o~ . ~ ~.~,.~ ..... uo~. ~ P. ~ ~ ~ ....
Subd,v,sion ......................... F,led Map No .......... Lot No. ~ g.t ~ ....
Health Dept Approval ................... Labor Dept Approval .......................
Underwriters Approval....~..~. ~ .~0. / ......... Planning Board Approval .....................
Request for Temporary Certificate ................ Final Certificate ...~.. .................
Fee Submitted $ ........................
Construction on above ~escnbad budding ancLperm~t meets ali, apphcab[e codes and regulations.
~,"~ '~%5 App Ica /~ . .. ~.~.~ .......................
Rev 10 10 78
OUNDATiO.U
(1st)
OUNDAT!ON (2nd)
OUGH FRAME &
PLUMBING
NSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECTOR
P O, BOX 728
TOWN HALL
SOUTIIOLD, N.Y. 11971
TEL 765-1802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
/5/ An application for Certificate of Occupancy
is not on file.
No Underwriters Certificate on file.
/5/ Tile check ~s(outdated/not on file.)
/~/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit t~ ~_ _~ ~)_t ~ Z
Building Dept.
*~*/~/ No Plumber solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
Memorandum from ....
BUILDING INSPECTOR'S OFFICE
TOWN OF SOUTHOLD
TOWN HALL, SOUTHOL~ N Y 11971
765-1802
May 12, 1987
Dear Mr. Slater:
I am returning your application.
Please sign ~t and have the sig-
nature notarized and return it to
us. When you return the applicatxon
please mention that the rest of the
paper work zs zn slot 25. Thank you.
Secretary
FORM NO 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, NY 11971
TEL.: 765-1802
Examined x~.4~ 9..
,19 ~"/
, 19g''/ Penmt No. } {~o&q..'~
(Building Inspector)
A~PLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .o
3 SETS OF PLUS
SURVEY . ..-~'~---'--,
NOTIFY
CALL
MAIL TO: ...........
~ BLDG.
" [ TOWN OF SOU~HOLD
Date.~.k~. /e2.'/q~ -2 19
INSTRUCTIONS
a. Ttus application must be completely filled in by typewnter or in ink and submitted to the Building Inspector, wztb
sets of plans, accurate plot plan to scale Fee according to schedule
b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc sire,
br areas, and givmg a detailed descnptmn of layout of property must be drawn on the diagram which is part of this apl~
caatlon.
c The work covered by tlns application may not be commenced before issuance of Budding Permit
d Upon approval of this application, the Bulldmg Inspector will issued a Building Permit to the apphcant. Such per~
shall be kept on the premises avadable for inspection throusmut the work
e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan
shall have been granted by the Building Inspector·
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldlng Pennlt pursuant to t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances
Regulations, for the construction of buddings, additions or alterations, or for removal or demohtlon, as herein descnb,
The applicant agrees to comply with ali applicable laws, ordinances, buddmg code, housing code, and regulatlons, and
admit authorized inspectors on premlses and in bulldmg for necessary mspec.~..~/.~~...
(Signature of applicant, or name, if a corporation)
.~HP~'~ ~. O~. c>P-~--My.. /,, 2. ~ /. ......... (Malhng address of applicant)
State whether apphcant l~WO_wne~r lessee, agent, architect, engineer, general contractor, electrician, plumber or build,
Name of owner of premises ,'~(~-- .~- ,~/),~-~VA.) {.,c) O'"~../~7",',~.~
(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 ...............
Plumber's License No .....
Electrlclan's License No ..........
Other Trade's License No
Location of land on which proposed work will be done
House Number Street
County Tax Map No 1000 Section /g)~ · ~
Subdivision . .
(Name)
Fd .............
Handet
Block . q ./[.~ .~? .. Lot .0. O~. ,.~,h~:EO. .....
FfledMapNo . .. Lot '-~ff-~.~.~ · ..
State exlstnlg use and occupancy of premises and intended use and occupancy of proposed construction
a Exlstmg use and °ccupancy /~7/~"'q '~4'(~'/~ ~'~/~9~>, ..... '~~'._
b Intended use and occupancy ~-~ ~-,~ 2P~J/~ L
· Nature of work (check which apphcable) New Bmldlng
Repmr ...... Removal ......... Demoht~on
Estimated Cost ~'/,30 C)
If dwelhng, number of dwelhng umts .
Ad&t~on Alteration
........ tX,,,Other Work.. 7-7~.~,~....
(Descnptmn)
-. .. Fee ..... . .... .. ... .... ..
' (to be prod on fihng ttus apphcat~on)
....... Number of dwelhng umts on each floor .....
If garage, number of cars ........................................
,. If business, commercml or m~xed occupancy, specify nature and extent of each type of use ...........
Dm~ensmnsofexistlngstructures, ffany Front ~to Z Rear .,J ..... Depth ~.
Hmght ..... ~1 .....Number of Stones / ...........
Dmlens~ons of same structure with alterations or additions Front .. Rear .....
Depth ............ Hmght . Number of Stones ..............
,. Dimensmns of entire new constr,uctmn' Front / 7 ! ~ ' Rear . ./. 7.' a. :'.... Depth ./. Z: ~. ~'. ....
Height ........... Number of Stones ..................................
S~ze of lot Front . d.~.o.~ ....... Rear .. ,Z. o.o. ? ..... '. Depth /0.?,.).: .............
Date of Purchase ~g~O5 r-../,~. O ........ Name of Former Owner~. 7',/FqMK.~.~. ...........
Zone or use dmtnct m which premmes are s~tuated _~ltP~r,~4.t-. ...................
Does proposed constructmn violate any zomng law, ordinance or regulation' M.O ......................
Will lot be regraded .. ~ <3 . . ........ Will excess fill be removed froi~l.prem~ses .Yes
Name of Owner of prem~ses/~.~'~F.*/~OA!o'O:-,Fz,~f~'~. Address2.J~z~.~.d.~..P.z-~.-.alO-~...i~.9-T."'P~one No.o//.(o. ~.5.9.
Name of Architect ................ Address ............ Phone No ..............
Name of Contractor ... ,.5.~ ~-.~. ........... Address ................ Phone No ..............
,. Is this property located w~thin 300 feet of a tidal wetland? *Yes ..... No ~...
*If yes, Southold Town Trustees Permit ma~ be required.
PLOT DIAGRAM
Locate clearly and d~stmctly all bmldmgs, whether existing or proposed, and intimate all set-back dlmens~ons from
aperty hnes Give street and block number or description according to deed, and show street names and ~nd~cate whether
enor or corner lot /~/9~Z~ t~O/0
?
'C
i,o /--~.,z.t o,O.. ,l-o7-'
ATE OF NEW YORK, ~--~t-~
· ' (Name of md~ual s~gmng.c~nt;:ct}~.~J ..... being duly sworn, deposes and says that he ~s the apphcant
ove named
~s the .... ~.~
(Contractor, agent, co,orate officer, etc )
smd owner or ownem, ~d m duly authorized to perform or have performed the smd work and to m~e and file tlus
ahcat~on, that all statements contmned m thru apphcat~on are true to the best of h~s knowledge and behef, and that the
~rk will be perfo~ed ~n the m~ner set forth m the apphcatton filed therewtth.
om to before me th~s
..... /~r~ .... dayor .... ~ .... ,19~
taw Pubhc, . .~~
...... ~~~ ~'' (S,~a}u~e'~ f :Opl;c~nt,
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N 52'0Z'00 '
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LOT
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LOT
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LOTS
MAP Ot
'MA T TI TUCK DEVELOPING
FIL£D MAY I, 19R$ ] ~IL~
MATTI~
TOWN OF ~U~O~
$UPFOLK ~, N.Y.
CO.,
EMPIRE OF AMERICA
COMMONWEALTH LAND TITLE
INSURANCE CO
N~RT ~ ~ MARION W/N/FRED
SL A
donack associates
~13 west main street
riverhead, new york 11901
(516) 369-1717 (212) 746-3020
July 26, 1983 Job N2 85-313
I000- 106-11-08 Scale :1" =30'