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Home My WebLink About15881-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... ~.1.~77 ..... Dat ....... .......... THIS CERTIFIES that the building accessory lOO5 .......... R&~:¥6~' kV6fi/~ ....................... Oak Street Mattituck Location of Property ..... 1.Q 0. ............................... House No. Street ................... County Tax Map No. 1000 Section 141 .Block 1 .Lot 1 Subdivision X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .¢p.r.i.~.. ~..1.9. ~ y pursuant to which Building Permit No. 15881Z dated ........ ~p.r.~ .1. .6. ,. . .1.9 .8. 7 ..... 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 ......... Accessory building., The certificate is issued to .............. JOHN & DOROTHY VICTORIA ....... ...................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 I~OEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. No BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15881 Z Dote .......... ~. .................... Permission is hereby granted to: .... ~ II . Count~, Ta~ ~ap ~o. lO00 Sea,on ...... i.~l ......... ~o~ ............ ~ ......... 'at .a ........................ pursuant to application dated ..... ~..~ .................................. , 19..~..~., and Building Inspector. Fee $ ......... : .............. approved by the 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. This application must be filled in typewriter OR ink, and submitted ~ am=tomato 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 features. 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 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: 1. Accurate survey of p~operty showing alt 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: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10~.00 5.Updatecl C.O. $ 50.00 Date .../.j. ....... f. ............ NewC°nstruc~;i°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property (~J ~/ .x .' /.T'. (~' . .~-;..~., ............. Ho,, No. ..... Owner or Owners of Property ......... ~ County Tax Map No. 1000 Section . ./..~/'. ....... Block ..... / ......... Lot ..... ~L ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit · . .Applicant ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... FeeSubm,tted ........ Construction on above described building and pe~it/~/~eets all ap~ica, bt~ c~des and r, egulations. //. p . ' ..... ....... OU~;DA TIO.~l OUNDATION (2nd) OUGH FRAME & PLUMBING 'NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: z ~ 6~ Examined ~..~o..., 19~..7. Approved ...Lc.., 19~...~. Permit No. /..~.?fl. !'.% Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... /OWN OF SOU/HOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : /OWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL ........ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD Date ' . .~/..-.~ ..... 19 .~/ 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 throughout the work, e. No building shall 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 Depart~nent for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary, in~cti~s. ~,9 .~/. ', ~ignature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................. Name of owner of premises .~..~.~. ~ .... ~.%'..-~..~? .~. './~ .~. .......................................... (as on the tax roi1 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 ......................... Electrician's License No ....................... Other Trade's License No ...................... 10o,-,c I. Location of land on which proposed work will be done. ~..~. ~. ~..,.. V.. *~ .~.~21. ~...~.~.-.~ .......... ................................................. House Number Street Hamlet ' /¢/ l // County Tax Map No. 1000 Section .... ~,.. .......... Block ................ Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. ~J~e3:/.O/.~.O.~-~ .l .................................................. b. Intended use and occupancy~ff.~e.~/.O(.~,0 ~' '~'l-- ' '' '(' ' '~' ' "" ................... ~., ,(,,:; ....... ~?. ~. ~ .............. 3. Nature of work (check whichI ' ' "~ ~ ' · .. Add~tmn .~, ....... Alteration apphcable): New Building ' ~ Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost '~' ..... i .......................... Fee...~...~.:.'..~L~.. ........................ : ~' (to be paid on filing this application) , . 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... If garage, number of cars .... i ................................................................... 6. If business, commercial or mixed occupancy, specit~y~ nature and extent of each tyl~e of use .................... 7. Dimens~ona of existi,n~g structures, if any Front ~.j>.~..-... Rear .~. ~:~-~-~. Depth ~.O./~e~. Height ~//~-~...~. Number of Stones· J. ................................................. 'Dimensions of same stm~c~ure vfith alterations or additions: Front ................. Rear .................. Depth .............. ..... I. · · Height ...................... Number o~f Stories ............. ~, ........ Dim~t~~ ojalallire new consiruction: Front./~. ~ .... Rear./~.. ~ ..... Depth . .~..~... Heigl~;~..~l~.~.... ?.. Nulnber of Stories .... ¥ ................... ~' ................... ~. .......... 9. Size of lo~:~t~;~l~t-i .i~17.~. ....... Rear./¥~/~ .......... Depth J./..~o_.~.. 10. ate of Purchase . !?.~,-~ .... ................. z.' Name. of Former Owner ~t~.//./././~.~.. ~_2a)O.¥'.'.~ .......... 11. · Zone or use district in which p~emises are situated. ~/~.g 77;//'! ........................................... 12. Does proposed construction vidlate any zoning law, ordinance or regulation: ~.0. ............................. 13. Wall lot be regraded . ./~? ...-t,. ~ .................. Will excess fill be removed from premises: Yes 14. Name o~Owner 0fpremises .d.~ ~ .~./.'O.'T7o. p.t.'.~.. Address F~.~..35.~.P~.70~.7~./Fb'.~-~. Phone No~97.~.'; {(.~'..~ff. .... Name of Architect ......... 1 .......... Address .. Phone No. Name of Contractor ........ ! .................. Address .... : .............. Phone No ................ 15. Is this property located!within 300 feet of a tidal wetland~ *Yes No ;~... · If yes, Southold Town TrCstees Permit may be required. ... i PLO'r DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give stree2t and block number or description according to deed, and show street names and indicate whether ~ntenor or cornerlot. ~ STATE OF NEW YORK, COUNTY OF ................. (Name of individual sigt~ing contract) being duly sworn, deposes and says that he is the applicant above named. : He is the ..................... i ................................................................... ! (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 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 flied/h.erewith. Sworn to before me this ............... ...... ..... Notary Public,. ~-~....~... i..././~.~.. &..... ' County ~ ~.... L.~-~~~~-~ ~.~'~ ....... '. flttl~ltDEl~Ol~ : ~. r.-.,.-¢ .-~.~_.. (Signature of applicant) PU~tlg ~ Nm YM~