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Home My WebLink About16102-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... Z. 1..5,9.4.1. .... Date ... July 13, 1987 THIS CERTIFIES that the building ........ .p.a.t.i.o,. ,e.n.c. 3:..o.s.u.r.e. ...................... Location of Property ...... .42.5. ........... P.a..c.i.f.i.c,..S.t.r.e, ,e,t ..... Mattituck House No. Street Hamlet County Tax Map No. 1000 Section .... 1. 4. .1 ..... Block ..... 4. ......... 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 .... Jline. J- .,..1, 98.7 ..... pursuant to which Building Permit No.. 16.102 g dated ........ June..~g,..1.9.87 ...... 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 ......... A patio enclosure. The certificate is issued to ................ IGC....~..M.R.S.,...E.D.W.A.R.D...W.I.L.C..E.N.S.t.~ .I ........... (owner, of the aforesaid building. Suffolk County Department of Health Approval ................... .N./.A. ................... UNDERWRITERS CERTIFICATE NO ........................... .N./.A. ................... PLUMBERS CERTIFICATION DATED: N/A Rm. 1/81 FOB~ NO. B TO~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ............ ~ ........................., Permission is hereby granted to: ................. m ............................................................................................................ .~1.~...-~ .............. at premises located at ..................................... Counly Tox Map No. 1000 Section ...... l..,~,J, .......... Block ..... .,(~,,.,~, ......... Lot No ...... ~..~ ............. pursuant to application dated ...... ...~..~...!.: ........................19...~...,'L-- end approved by the Building Inspector, Fee $...~.?....:....~ 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 OCCUPA Instructions This application must be filled in typewriter OR ink, and submitted -, ~ to the Building Inspec- tor with the foltowing; for new bui)dings 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. 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: 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 $]0.00 .vacantLando.o. 2o.oo 5.Updated C.O. $ 50.00 Date ............. New C ohs t r uc ~ io~..~... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~ ............................... House No. . S¢reet . / I Hamlet Owner or Owners of Property 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 . V ee bu m~t ~ .......... ~ ............... ~ Constfpction on above described building and ~eets aJl~ml,~l ~'~ ~ ~-,~-, .......................... .................... Rev, 10-10-78 UNDATION ~ (1st) UNDATION (2nd) 'UGH FRAME & FLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL . ADDITIONAL COMMENTS: ~ ~t.~-~/''~' 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.: 765-1803 CALL ................ MAIL TO: q~4~!~...L..~..~.., 19~ Permit No. !.g'../.9..~--..~ Approved Disapproved a/¢ ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..... ~'. .......19 . INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter orin ink ant Iff&,, ~d to~Nte 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 premis~l~ hjpl~ or public streets or areas, and giving a detailed description of layout of property,,~el~d'ia~vq ~3~] ~ dj~i~ is part of this appli- cation, t%['~'~ '~.~ c. The work covered by this app, lication may not be com~n'~e~d(b~e~)/ss' ~c~ ~%;ermit. d. Upon approval of this application, the Building Inspe%tor~q~ue~'~ ~l~in~ ~the applicant. Such permit shall be kept on the premises available for inspection throug~out~~ e No building shall be occupied or used in whole or in part fpt[~'~l~pc ~[~ e~ntil a Certificate of occupancy shall ~ave been granted by the Building Inspector· ' '~{~h ~ ~ APPLICATION IS HEREBY MADE to the Building Department'~.,?~i' )lev2SJuance'~.l¢ of a Building Pernfit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,/~w~,,~o k, and other applicable Laws~ Ordinances or Regulations, for the construction of buildings, additions or alterations, .o~r.zf~ffemoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buitQ~l~ j;ode, ho~de,ml~l reactions, and to admit authorized inspectors on premises and in building for necessaryssary'~r~t~'~c/~tsfl~ ,, f,/' .>~4 ~.....'7-~..~..-Y...~'.' .¢~... 7. ~,--- .......... :..i ....... (Signature of applicant, or name, if a corporation) (Marling address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general ~ontractor, electrician, plumber or builder. [as on the tax roi1 or latest ct~L~-) If applicant is a corporation, signature of duly authorized officer. ~ ~TE: (Name and title of co~orate officer) ~tO~]~' ~llkDt~G DEPARTM~T A~ ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED 76~-~)2 9 A~ TO .~ ~ ~fi ~'~ Builder's License No ...... ~ ~.. ~ ..... FO~LOWtN~i ~O~ Electrician's License No ....................... 4, ~;i~A. Other Trade's License No ...................... ALi. 1. Location orhnd on which proposed work will be done: ................ ~.~, Gtl~Ji?~.&.~E~Y ..... .,. Z X ....................... .............. House Num bet StrUt Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ....... /~../ ..... ' Filed Map No ..... ~.. ....... Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /~ ~.......~..~..~..~...l~..-~.. .................................. b. Intended use and occupancy ........ . .~....,~'~?..z.~ ................................................ 3.~ Nature ofwork (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Remq~at .............. Demolition .............. Other Work ............... i (DescriPlion) 4. Estimated Cost ........... .~/.~.a.?.o.:...~f~.. .............. Fee ...................................... , ' (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 ......................................................................... 6. If business, commercial or mixed occupancy, specify naturetand extent of each type of us~ · 7. Dimensions of existing structur(s, if any: Front.. ~..~r~..~ .~:..~'.~. Rear ....... 'l~)~it~ ........... ... ~_~.~.~. ~. ~"''..~. Height ............... Number of Stories .............. J .......... ' ....... · ........................ Dimensions' of same structure wlth alterations or additions: Front ...-~.. A7 ........... Rear .................. S~zeoflot Front ./5. . .. ..... Rear..~ ...... /~...~ ........ De th ..../...~...~.~.0..~-... , P Date of Purchase ........ ~..~. ................ Name of Former Owner ...... ~.(~. · ................. Zone or use district in which pr~mises are situated ....... ~..t ........................................... Does proposed construction rio!ate 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 ...! ................. Address ................... Phone No ................ Name of Architect .......... i~ ................. Address ............ /~j ..... Phone No ................ Name of Contractor ~, c~4f~ ....... Address .Ct..~. flff~:~..~... Phone No...~.7. oc .~/.5~. ~.~.. 15. Is this property ,loca~ed~i~hin 300 feet of a tidal wetland? *Yes ..... No ..... If yes, 8outho}d;T~w~ TrusDee~Permzt maybe required ' ' '~-~ ~' / '~ i ~. PLOW[DIAGRAM Locate clearly and~ distinctly all '.bufilaings; Whether .existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number oi~ description according to deed, and show street names and indicate whether interior or cornerlot ' ~ ~ · [ ."' - 9. 10. 11. 12. STA'f'E OF NEW YORK, COUNTY OF ............ (Name above named. IS.S .................... being duly sworn, deposes and says that he is the applicant contract) He is the ..................... :~ ................................................................... : (Contractor, 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 con[ained 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 of ...................... 19... Notat~ Public ................. i ................. County (Signature of applicant)