The URL can be used to link to this page

Home My WebLink About16499-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z16753 Date March 30, 1988 THIS CERTIFIES that the building ...A.d. .d .i.t.i. 9 .n .................................... 1155 MARLENE LANE MATTITUCK Location of Property f/~ds~ ~oi ....................... ~/e~t' ....................... f/~4~/~i County Tax Map No. 1000 Section . 1.4. 4. ........ Block 3 .Lot 3 Subdivision ...................... ......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated $ e p t. I I, 1987 pt~rsuant to which B~.lilding Permit No. 16499 z - dated 0 c t. 5, 1987 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 ......... P~gplacing a cement patio to an attached wood deck. The certificate is issued to LYNN P. LENNON ' "?o'~;n'd~,~isy~&Itif~Ifib~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~./..~ ................ ' UNDERWRITERS CERTIFICATE NO ...... N/A PLUMBERS CERTIFICATION DATI~D: N/A Building Inspector Rev. 1/81 TO~H 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) · -~..~....~.-~j...~.-.~....-//~ o at premises 'ocoted ot ...... 1../....~.,~.....~..~.~.....~ .......................... co~ ~o~ ~o~.o.,ooo Se~,,o~.~....*...~ ...... ~,~ .... .~. ............ ~o,.o ...... .~ ............... pursuant to application doted ..... ~/.~ ......... /..~ .............. , ,9..~and approYed 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 ~ ~ to the Building Inspec- tor with the following; for new buildings or new use: !. 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 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre~existin9 dwelling $ 50.00 3, Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4. Vacant Land C.O. $ 20.00 .~./.~/..~,, 5.Updahed C.O. $ 50.00 Date .................... NewtOns truc%~ on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property //~ House No. Street Owner or Owners of Property .... .~, .~ ¢l. CZ...~..~ ¢d~/.~.m,¢) ................................ County Tax Map No. 1000 Section .... /. ~.~Z, ...... Block ,....~ .......... Lot .... .'~,, ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No/~.~].C,~?Z. Date of Permit?.O/5~//~.z ..Applicant. ,Z,¥,/~,~),,, . .'~, ~ . .~/~,., .~.. ,o..~. ....... Health Dept. Approval ........................ Labor Dept. Approva ........................ Underwriters Approval , . /~V,..~. ............. Planning Board Approval ..................... Request for Temporary Certificato ..................... Final Certificate .... ...~'¢~...,.. ......... Fee Submitted $ ~.~ oc~ Construction on above described build ng and perm t meets a applicable codes and regulations. FOUNDATION {1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: BOARD OF HEALTH .~.~.. 3 SETS OF PLANS .... -~-.. FORM NO. 1 SURVEY .......... /OWN OF SOUTHOLD CHECK .... .~J~- - - - - BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL $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 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 Department for the issuance of a Building Permit pursuant to the Buildir/g 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 Rremises and in building for necessary insp tions. ~ ~,,T~,'**-'?~'C'~x4 '''iSign reofaR licant, orname, if a corporation) r)^~u} t V ~nloo,rl! gign~/[e,of ~p,n .o'r .,' ,.;- .......... "' (Mailing address of ~plicanCJ Qualified in Suffolk County ~ ~%mm~sslon t:xpkOs ~ 3Crt' 1~ State whether apphcant ~s_o~'~ter, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (/ - (/(as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Nameandtitleofco~orateofficer)· ALL CONTRACTOR'S ~ .BE SUFFOLK COUNTY LICENSED Builder's License No ............ Plumber's License No ......................... Electrician's License No ....................... Oiher Trade's License No ...................... Location of land on which proposed work will be done ..................... ~ .................... ~ ....... :' ..... County Tax Map No. i000 Section J..~. ~.~. 5..~..~3.... Block .................. Lot ................... Subdivision ..................................... F!led Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b~d occupancy . .'.~_..' .... 3. Nature of work (check which a~plicable): New Building . ' .... Addition ..'. ....... teration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ ~/ ~ (Description) ~/ ~:..a-~. ..................... Fe~ (to be paid on filing this application) ....... ,., ......................... 4. Estimated Cost / 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 nature and extent of each type of use ..... ................ 7. Dimensions of existing structures, if any: Front .~ f./P.:... Rear .. ~/. ......... Depth ....~? .~). ....... Height ............... Number of Stories ...? ..... /. ..... ........................ ; ............... Dimehsions'of same structure with alterations or additions: Front ~ .g'.d..t Rear i ;7. ~../ e th O?. ' i . J~'-, ', · t' D p · ~ ............... ... Height ...................... Number of Stones ...................... '-8. Dimensions of entire new construction Front.~/'d~5~....~./. Rear ~.~.~'~.~J . Depth Height ............... Number of Stories .//..3'..d~ ................................................. ' 9.Sizeoflot: Front ./.~.~D.l g' _~.Sf7 . Rear,_ ..... ~. . Depth .., 10. Date of Purchase ... 7../.i .... ~~. · . ~a(~e of Former Owner ~5~.~.. ,~.: 1 I. Zone or use district in which piemises are situated ..................................................... 12. Does proposed construction vi61ate any zoning law, ordinance or regulation: ................. /ff~.. ~. :'7' ....... 13. Will lot be regraded .... . ./t~)..~O ......... ~ .......... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~ .ff~... ~.' ~~Address ................... Phone No ................ Name of Architect ........................ Address ................... Phone No ................ : Name of Contractor ........ ' .................. Address .... : .............. Phone No .... ..~ ........... 15. Is this property locatedI within 300 feet of a tidal wetland? *Yes ..... No ...of.. · If yes, Southold Town Trfstees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whether interior or corner lot. ! STATE OF NEW YORK, ! S.S COUNTY/J)F ..... g57t. ,¢2 ...... .... ~~..'-~'~ .~..--~. · ............... being duly sworn, deposes and says that he is the applicant '(J (Name of individual signing contract) above named. 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 l applk:ation; that all statements contained in this application are true to the best of his knowledge and belief; and that the l work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ ]..~....~...day o~ .... '. ......... 19?.7 .~- - /] Notm~ Pubiic, . ..... ~...~.......~.. lk .~..~fT.. Couniy~---L_ /-~ ,.~c ,~(~ ~ ~.p~ ~TL£t~ I( DE rOE ' ..... &"~) '//': ..... : '" .... / ................... , ~ ,0~'~', :~i'f~t~,~ -(jo (S!gnature of applicant)]