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Home My WebLink About16046-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z-]5836 Date June 10, 1987 THIS CERTIFIES that the building UTILITY BUILDING Location of Property 925 Theresa Drive Mattituck, New York House No. Street Hamlet County Tax Map No. 1000 Section .. ! .1.5 ....... Block 15 .Lot . 9 · .. M/o Deep Hole Creek Ests. 38 Subdivision ............................... Filed Map No. 4256 .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 5, 1987 16046Z ....................... pursuant to which Building Permit No ...................... dated June 9, 1'987 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 ......... UTIL IT~( BUILDING The certificate is issued to NANCY J. BERTORELLO ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ........ N / A UNDERWRITERS CERTIFICATE NO. N / A N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15837 Date June 10, 1987 THIS CERTIFIES that the building DECK ADDITION Location of Property . 925 Theresa Drive Mattituck, New York House No. Street Hamlet County Tax Map No. 1000 Section 1 l 5 ..... Block 15 .Lot 9 Subdivision. M/o Deep Hole Creek Ests. ...Filed Map No. 4256 .Lot No. 38 conforms substantially to the Application for Building Permit heretofore filed in this office dated J un e 5, 1 9 8 7 pursuant to which Building Permit No. 1 6 0 4 5 Z dated Juno 9, 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 ......... BECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to NANCY J. BERTORELLO ..................... .................... of the aforesaid building. Suffolk County Department of Health Approval N /A N/A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 ~OuM 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) Permission is hereby granted to: .~.......'.......~.~ ....... l...~ ........ .f.. ............. ...~.~.....,..... _~.......¢-'2. I/~-,'-:-~ County Tax Mop No. I000 Section .././.~...~.. ...... Block ..../.~ ..... Lot No......~... .............. pursuont '0 application doted ............. ~.....J...~......, 19~...~and opproved by the Building Inspector. Fee $..~.. ....... Rev. 6/30/80 FO~ NO. si TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 16045 z Permission is hereby granted to: ...~.~ ....... ~..;..~.~ ~.~.~~.~....: .................................. County Tax Map No. ,000 Section .... /../...~... ..... Block .....l....~..... .... Lot No ....... ..~... ........... pursuant to application dated .... ~ ............. ~ ........., 19.~....~ and approved by the Building Inspector. uuilding InSl:~:tor 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 i ,,.....,i to the Building Inspec- tor with the following; for new buildings or new use: I. 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-'~xisting" 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: l. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACC;ISSORY $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 4.Vacant Land C.O. $ 20.00 ~ I. /n 5.Updated C.O. $ 50.00 Date ................... New C OhS t]cuc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property · House No. Street Ham/et Owner orOwnersofProDertv ~2~.~/ ~.-.~ County Tax Map No. 1000 Sect on"/'t6~-, Block . ./~x--~ Lot ~ ....... Permit No./.~.~../Z/~. Z Date of Permit~../~./~/~ppIicant~ ..~. ~_j~ ....~~ Health Dept. Approval Labor Dept Approval Underwriters Approval r Planning Board Approval .... Request for Temporary Certificate . .Final Certificate ...................... Fee SubmittedS. /b.¢ Construction on above described building and permit meets all applicable codes and regulations. ................... Rev. 10-10-78 FORM NO, 6 TOWN OF SOUTHOLD Bu Jlding 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.m,mm 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 property showing all property tines, 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. Fees; 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $I0.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.wo~nt ~.a.d c.o. $ 2o.oo I~]~..7. 5.updated C.O. $ 50.00 Date ....(< .............. New C OhS t r u c t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~2~.. ..... .. ~ ...... ,..../~' . ...... ~Z~.-.4-.~-' ' ~' ........ House No. Street Nam/et o , .&. . ......................... County Tax Map No. 1000 Section ... L/~ ....... Block .... A~ ...... Lot .... ~ ......... su~,,.,,,o. ~. ¢~. ~.~ .,,,e~ ~, ~o.. ¢~..,o, ~o..*.~. ....... Health ~e~t Ao~rova~ ~ kabor ~e~t A~roual ~ Underwriters Approval ........................ Planning Board Approval ...................... ,~..~ Request for Temporary Certificate ..................... Final Certificate , . ,/..,., ...... Fee Submitted S. c~.-~)~, ....~f3. ............. Construction on above described building and permit meets all applicable codes and regulations. ..................... Rev. 10-10-78 O~ THERESA N. 2 ° 40'40" E'. DRIVE I10. 00' POOL 40' 40" W. 860. O0 ' BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILOINGDEPARTMENT SEPTIC FORM ............. TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... NOTIFY CALL ................ MAIL TO: JUN 5 l Jli{ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS c. TO?&q OF $OUTHOLD Date.. ,~,/$~/ ......... 19.~ / / h. 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. e. 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 Department 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 necessa~y~inspections.t~t~ / 'k..~/.'/~ ~ '~' (Signatur~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 ~Q,.~3-- . 4:...~..~.. ...................................... V (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co.orate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No...,~.<-.~ .~ ............... Plumber's License No ......................... Electrician's License No ....................... Otlier Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... ..................... ........... .............. House Number Street Hamlet County Tax Map No. 1000 Section . //~ Block /'~ Lot f .............. Subdivision .~-_~..~.-~{.~ .~JL&t~. ~ .... Filed Map No.. ~J.~...~'~... ...... Lot...~.? .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. ]. 4 ~./~l~. ~A~qC~ ................................ b. Intended use and occupancy ~..,~..~~~~. ............ 3. Nature of work (check which apphcable): New Building .......... Addition .......... Alteration .......... Repair .............. Remo ~al .............. Demolition .............. Other Work ............... 4. Estimated Cost. ., ......................... Fee ................................. " (to be paid on filing this application) 5. If dwelling, number of dwelling nits ............... . 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 stmcture~ if any: Front ................ Rear .............. Depth ............... Height Num bet of Stories Dimensions'of same,structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories Dimensions of entire new constrBction: Front .......... ' ..... Rear ............... Depth ............... Height ............... Number of Stories ........ , ............................................... 9 Size of lot: Front j Rear ~ Depth 10 Date of Purchase' ' ..... Name of Former Owner ' which prgmises are situated 1 1..Zone oi',use district in ....................................... . .............. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~/4V..t~...'/-~'3~do... .... Address,.~/.~.~ .... Name of Architect .......... ,'. ................ Address ................... Phone No ................ Name of Contractor ~ , . .............. ......... , ................. Address .... : .............. Phone No. 15. Is this property located Within 300 feat of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trulstees Permit may be required. PLO~f DIAGRAM Locate clearly and distinctly a/Ii buildings, whether existing or proposed, an& indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 'Y~5, IBO~ 9 AM TO 4 PM FOR Tbt~ FOLLOWING INSPECTIONS: t, ~OUNDATION . TWO REQ01R~D FOR POURED CONCRETE :~, ROUGH - FRA~ING & PLUMBING 3, INSULATION 4. FINAL .. CON'STRUC'I'ION ~UST BE COMPLETE FOR C.O. ' ALt. CONSTRUCTION SHALL ~E~T THE REQUIREMENTS OF TH~ N.Y. STATE CONSTRUCTION & ENERGy CODES. NOT R~SPONSIB~E ~OR D,~s~ oR CO~STR~CT~oN ERROr, STATE OF NEW YORK, COUNTY OF .... S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named· j He is the ' ,, (Contractqr, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 mann¢r set forth in the application filed therewith. Sworn to before me this ............ · ~..~ ......... day of ..... ~ ......... 1 9 ~.~. $ota~-~ Public,..~'~?.....~.. D .Z~ .~..~.~.: i ..... County, ~.4707~?8.8~ffdk ~O~ntl~_.~ , , ~ , / (Signature o~ appLicanD ~m Exph'Qs hl~rch 30, BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 appticatidn, 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 Department 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 inspections./] ~ . .................. · ~o,~,~ o~/l~ame, if a corporation) . (Mailing address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises ~. ~../A~t~....~ .-.. -~..~ ./~. · ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate 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 ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet r~ County Tax Map No. 1000 Section .... II..b. ......... Block .... /.S.. .......... Lot...vi ............... (Name) 2. State existiug use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . '/l' ~.~' tI. LL~..~...'~// ~.~u ................ ' .... "' ..... b. Intended use and occupancy , :F:. v~,~-.. ................ 3. Nature of work (check which abplicable): New Building ..... ' ..... Addition .......... Alteratiom ........... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Descdp~tion) 4. Estimated Cost ......... ' ........................ Fee . . ~: .O..O. ........................... ' ~ (to be paid on filing this application) 5. If dwelling, number of dwellingi units ............. Number of dwelling units on each floor ................ Zf garage, number of cars .... ,i .................................................................... 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 Stories ...... : ....... ' ........................................... Dimensions'of san~e structure With alterations or additions: Front ................. Rear .................. pth ~; ' 'ght De ......... : .. ..... ?.. Hel .......... Number of Stories ...................... -'.8. Dimensions of entire new construction: Front .......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .......... i ............ Rear ..... ~ ...... ~ ........... Depth ...................... 10. Date of Purchase .......... ~ .......... - ........ Name of Former Owner 11. Zone or use district in which p['emises are situated ..................................................... 12. Does proposed Construction violate any zoning law, ordinance or regulation: Will lot be regraded, . ....... : .................... Will excess fill be removed from premises: Yes No 14. Name of Owner.ofpremisesA( .t~A~'.~.7~/~To~'.~.C.z.Q Address ?/~?./5¢5.~..~.~..~..a'.~.,.. Phone No~.¢.~.'.~..~'.~.~ ..... Name of Architect ' Address Phone No Name of Contractor . ....... I .................. Address .... : .............. Phone No ................ located~within 300 feet of a tidal wetland? *Yes ..... No ..... 15. Is this property *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether Locate clearly and distinctly al property lines. Give street and block interior or corner lot. OTIFy BUILDING D~ 765-18021 9 AM TO 4 PM FOR THE FOLLowING INSPECTIONs: ,'l. FOUNDATION _ TWO REQUIRED FOR POURED CONCRETE 2. ROUGHi. FRAMING & PLUMBING '3. INSULATION 4. FINAl_ i- CON'STRUCTION MUST BE CO/~PI.ETE FOR C.O. ALL CON~TR/JCTION SHALL M THE REQUIREMENTS ,*, .... EET :RGY CODES. NOT RESPONSIBLE FOR DESf~iN OR JCONSTRUCTION ERROP$. STATE OF NEW YORK, COUNTY OF ................. S.S ............................ ~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sigfling contract) above named. He is the ..................... i .................................................................... ! (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed the said work and to make and file this applic, ation; 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 Notm~ Public, . ..... ' ............... County I ~ ItELDI ~ DE rOE j ' NOTARY PUBLIC, ~ate of flew Y0~, _ (Signature of applicant) - No. 4707878, Saftolk _ _~mty m'm Expi~ M~rch 30,1~ ! , O0 098 0 , ,£ 'sz ,00 'Oil 'R,,O~,O'~ o :~ 'N 3AI ~tO