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Home My WebLink About16133-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z16797 Date April 13, 1988 THIS CERTIFIES that the building ...A..1 .t.e.r.a. F .i.o.n...a p.d.. r..e.n.o.v.a..t .i.o.n. ............... Location of Property 13400 Main Road Matt i tuck House No. Street Hamlet County Tax Map No. 1000 Section 114 ...Block I I .Lot 7. 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 6, 1987 pursuant to which Building Permit No...1.6. 1. 3. .3 .g .......... -... dated ..... q .u.n.e.. 2. .5 .,.. 1. 9. .8.7 ........ was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Alter & renovate an ex.isting building as applied for. The certificate is issued to ALLBOBRIK REALTY CORP. ..................... ?o¥.'o;, ...................... of the aforesaid building. %--~ Suffolk County Department of Health Approval .... N / A UNDERWRITERS CERTIFICATE NO... Pending 4/11/88 PLUMBERS CERTIFICATION DATED: Robert Bugdin Building Inspector Rev. 1/81 FO~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERAtlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16153 Z Permission is hereby granted to: ~ ..!..~...~:tg... ...... .'. ~_\~.....Ir:~...~...' ....................... , at premises located at ....L.~.~.~.......V~...).~....~: ........ m~ ............................ County Tax Map No. 1000 Section ....... J.!...~. ........ Block ........ I.I ........... Lot No...~...~.:./ pursuont to application dated ..... ~.....~'.. ........................., 19.~.,~,,, and approved by the Building Inspector. Rev. 6130/80 FORM NO. 6 TOWN OF $OUTHOLD 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 ~ Ilmm~ee~a 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 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 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, 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, 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .... ,~./.l,'~, ~?, ............. NewOOns t;ruc tion ...... Old or Pre-existing B, uilding ............ Vacant Land ............. , HoU.~ No. t , | 4"'~ / /~ -,~ Strsezt gU Owner or Owners of Property ...... ~ ~ ~/~ ~ ;~, t, ~..)?~'~j. , (.0,-U/J~ ........................... County Tax Map No. 1000 Section .... [[.~.. ....... Block.til! ...... Lot .... .~l~...?: ./. Subdivision .......................... ~...,...Filed Map No ........... Lot No ....... . ...... Permit No..l.~,J~.f~ .ffDateofPermit. t.. .lS.?.Applicant ..... . CJmf& .......... ' Health Dept. Approval ........................ Labor Dept. Approval ..................... · .. Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ....... ' ...................... Construction on above described building and permit~s~ all applicable c~odes and regulations. Applicant ........ .~../Lz~.~L <,,. ~..'~.. .................. ,.,.,o.,o.,s TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~/3J~ Owner/~ ~~'/ ~~~/~_ ~lease pri~.t_~ . (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s si~ature) Sworn to before me this NOTARY PUBLIC,STATE Ol= NEW YORK (luallfied in 8ur folk Co., No 5245~8 Commission ix~i~'e~30, 19 ~--.~.-- Notary Public,~J-~/~/~Z/~ County UNDATtON (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Z KZ 4'21'C0~Z. · - KOUROs BOARD OF HEALTH "' TOWN OF SOUTHOLD C~C~ ~.~ BUILDING DEPARTMENT SB2~[C TOWN HALL ...... y . ~O~THOLD, N.Y. 11971 ,,u~[~ (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 throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buil,~i.tt.g/Pep'nit, pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other'applicable'LaW-'g~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolitjon, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code~, and regulations, and to admit authorized inspectors on premises and in building for necessary in§pections. _ ~ . ,.~ .............. .... . . . . :&. .j,.. ............ (Signature of applicant, or dame, 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 ..... '('1' · ..... : ...... (as ontthe tax ¥oi1 or latest deed If applicant is a~J~poration, 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 ....................... 1. Lg~ation of land on which proposed work will be done: !,.~..;g:...d~. ...... . ...... Ho ?,' ..... ~,"tHamlet ~ .... ; ............. 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: Existing use and occupancy~. ~:~ ~;~ ; }~ ............ Intended use and occup~. · · /~e 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .; ........ Alteration . .)f~. ' Removal Demolition Other Work Repair ................... , .................. : .................. ~/--~ 0O0 ~ ' Fee (Description) 4. Estimated Cost ........................................................................ " (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 ............. % ............................. : ........ '.er~,~ .,. · .,,~ ~2..,~ 6. If business, commercial or mixed occupancy, specify n~at~are and extent of each typg,of~ use ~t ~ ..~.t .7.o ~.~. 7. D;menmons of exmtmg strUctures, If any. Front .... ~.~t. ~.. ..... R~ar ~... ~'.~..., ..... Depth ... fi6.. z ....... Height ..... ](~ ......... Number of Stones ....... 1~/4 ~.~. r~[,~ ·. D,~$¢~14 ~. ......................... Dimensions'of same structure with alterations or additions: Front ..... ~'~lkl~.i ...... Rear .... g~.¢. .... ~.. Depth ..... $~4/¢.q~ ........... Height ....... SaX4~.e~ ......... Number elf Stories..O.~ ¢.. p../)/~..~?~(4,¢ .... · ' ' F ... ~....~lfi~.... .... Rear ... ........... ~-8. Dimensions of enbre new construction, rent . ~13S./gf,~. Depth .. Height .... ~,~'¢¢~ ...... Number of Stories ...... tl14 ~. gr.. ~).4Sg ~ ~.~.' ............................... 9. Size of lot: Front ...................... Rear ...................... pep,th ~ ..... t~ ............. 10. Date of Purchase 1 1. Zoae or use district[ in which pr~mises are situated ........................ ............................. t 12. Does proposed construction violate any zoning law, ordinance or regulatmn ................................. 13. Will lot be regraded ........ ~o. ................. Will excess fill be remoxtCd from premises: d~; No 14. Name of Owner of premises..Att b~ .~it~ .~,af, q,.. Address ~./],~ d. ~cJ, .~//~ql .~4q(4. Phone No...~ ..... Name of Architect .... ~ ~l]~//~ J~*, gL6m~e~..~.. Address ~/~ ~/gi/,g. Phone No.. g~??. ?/7 .//. .... Nmne of Contractor ...... ~r3.~P.?ollO ....... Address//~7~fa l~.dt ~.~a/~f ~~. ~.. Phone No.. ~-.q .~.-.~.~ 5. .... 15. Is this property located within 300, feet of a tidal wetland? *Y,es ..... No ~fl(... · If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly ~ll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or deschption according to deed, and show atreet names and indicate whether interior or corner lot. STATE OF NEW,5~O~tI~ ~ ~ COUNTY OF..~1~44~d51~ .... ~.. ~'~ ............ .~.][~lA .~..~(t.~q~4~ ................ being duty sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~ · ,, ~ -, · . .e Ell o r, ,'o ...... ', .... .,,,, ¢...¢.r .................. ,.-t ..... ................. , ......... V . (Contractor, dent, cor~oratehfficer,;~.~ of said owner or owners, ~d is duly autho~zed to perform or have perfonnedlk~ls~or~.~o m~e and file this application; that all statements contained ~ this application are true to the best,o~h~ s knowledge and belief; and that the work w~l be performed in the m~ner set forth in the application filed therewith. Sworn to before me this ..... · ..: ........ .~. ........ day of ..... [. ...... 19 ' . . NOTA~Y ~OSUB,~SIATfi 0~ fl[W Y0a~ (Signature of applicant) 0ual~fled ~fl Suffolk O0,, ~0,52~510~58 o mission Expires M ........ 9 ~,~