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Home My WebLink About16518-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Euilding Inspector Town Hell Southold, N.Y. CERTIFICATE OF OCuumAR~Y No Z-24239 Date MARCH 26, 1996 THIS CERTIFIES that the building Location of Property 390 ALOIS LANE House No. County Tax Map No. 1000 Section 123 Subdivision Filed Map No. MATTITUCK, N.Y. Street Hamlet Block S Lot 4.13 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 7, 1987 .pursuant to which Euilding Permit No. 16618-z dated O~TOBEH 11~ 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 ALTERATIONS FROM GARAGE TO DEN IN EXISTING ONE F~MILY DWELLING AS APPLIED FOR. The certificate is issued to UhU(ISTOPHER M. & ADRIENNE M. ~ (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FOBM NO. 0 TOWN 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) N*_16518 z is hereby granted ·-- ..~a....~....u.. ................................................ ...~.~~..~.:.~....!i.!..~..~.~ .......... ,o ......... at premises located at ...~..l~ ......................... ~...~ .......... ~ ..................... County Tax Map No. 1000 Section ..../....~...~. ......... Block ......~.....~.....[.. Lot No.....~..f..! ............ pursuant to application dated .... .~...~...~.....'J ..................... , JO.,~....~..., and approved by the Building Inspector. Fee $.,~)..;..:~ ..... Rev. 6/30/80 TOWN OF SOUTBOLD B~ILDING DEPARTHENT TOWN HALL SOUT~OLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY DAT~. 7.f/.~. ~.'.... NEW CONSTKUCTION ...... ~OLD OR PRE-EXI, STING BUIL~NG....~..VACANT LAND ........ ~o~,o, o~ ~o~.,,...7.~. ..........~ ~/;~.~...~.~.~.~: ..... ~.~~.~.. Perm No... ... ate o£ Permit - - oo icant Health Dept. Approval ................ Underwriters Approval Planning Board Approval ............... Request for Temporary Certificate ....... Final Cert££icare ................ Fee Submitted: FIELD i }~St~-CTiON FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & ,PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. I SURVEYV TOWN OF SOUTHOLD CHECR BUILDING DEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD, N.Y. 11971 , ' TEL Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT ~t~ ................. 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. ¢. 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, artd//regp~ations, and to admit authorized inspectors on premises and in building for nece~/~~ .... (Sign'fiture of applicant, or name, if a co po uti ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... ............................................. .................................. Name of owner of premises C. */.Z'[ ~.. './.~//,¢.~'. ~..~..o/~./..~.~'Z4...~ .... /d.~..~..: ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL COIITRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. -'-"-' Plumber's License No. --'---- Electrician's License No ........ .'77-:. ........... Other Trade's License No ...................... 1. Location of land on wbich proposed work will be~le ........................... i ...................... House Number Street Hamlet County Tax Map No. 1000 Section . .:~.~. ~. .......... Block ..... .~. ........... Lot .... .Z-~/... .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~.. :.,; ~,~ ..... )) ................ /.,; .... .............. 3. Nature of work (check which New Building ..... ..... Addition .. Repair .............. Removal .............. Demolition .............. Other Work ............... '~ (Description) 4. Estimated Cost .... ¢. ~i t:7., ...................... Fee ...................................... / (to be paid on filing this application) 5. If dwelling, number o f dwelling u:nits ............... Number of dwelling units on each floor ................ If garage, number of c~r~ ~ ,.r ...... ~. ...... ' ............................................................ . ; ....... ,.. ~, 3cY, spemfy nature and extent of each type of use ................... 7. Dimensmns of ~xisting structures., ifgng> Front ............. Rear ..... Depth ............... Hmght .... : ..... ~. N~er~f~tories ............ : ........................................... D~enslons bf same srm~ure~n ~lr~ations or additions: Front ............... Rear .................. Depth ...................... [. Hgi~t ...................... Number of Sto~es ...................... Dimensions of entire new const:ruction: Front .......... . ..... Rear ............... Depth ............... Height ..... i ......... Number of S~ofies ......................................................... Zone or use district in which premises are situated...:... ~ ~qO.f~S( .............................. ~,. Does proposed constructmn wolate any zoning law, ordinance or regulation: . .~ ........................ 13. Will lotbe regraded ....... ~. (~ ............... Will excess rill be removed from premises: Yes No 14. Nme of Owner of premises ... :~t. t ............ Address ................... Phone No ................ Nme of Architect .......... '~7 ................ Address ................... Phone No ................ Nme of Contractor ......... ~ ............. Address .... : .............. Phone No~ .............. [5. Is thSs propergy iocaCed ~thSn 300 feet of a t~dai wetland? ~es ..... No ~.~.. ~Z~ yes, Sou~hold To~ TruStees PermS¢ maybe PLOT DIAG~M Locate clearly ~d distinctly ~1 lbu~d~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from property ~nes. Give street and block humber or description according to deed, ~d show street names and indicate whether inte~or or corner lot. 9. I0. 11. 12. STATE OF NEW YORK, , i o e COUNTY OF~ ..... i ~'~ o ,: ........... ...... .~/'~. (~ ~. ~. ~. ~ . ~.. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abow~ named. ' He is the ............ ~.~ ~.~.~ ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~Eer set forth ~ the application filed therewith. Sworn to before me this ..... County /~ /," // -- //~.// (Signature of applicant) 'N 765-1802 BUILDING DEPT. SPECTION [ ] FOUNDATION 2ND [/.~,4NSULATION FRAMING FINAL DING DEPT. / NSPECTION FOUNDATION 1ST FOUNDATION 2ND [ ] FRAMING REMARKS: /~//~ ROUGH PLBG. IN~.~LATION f/~NAL INSPECTOJ~/~/~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. INS.~TION [~AL R£MARKS: ~~----~ INSPECTOR SUFFOLK C6. HEALTH DEPT. APPROVAL H.S. NO. ~5.~'0;~ STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS fOr tHIS rESIDENCE WILL CONFORM TO ThE STANDARDS OF THE SUFFOLK CO. DEPT Of HEALTH SERVICES. (si APPLICANT SUFFOLK COUNTY DEPT· OF HEALTH SERVICES -- for APPROVAL OF CONSTRUCTION ONlY DATE: H. S. REF. NO. APPROVED: ~5'50- 25 SUFFOLK CO. TAX MAP DESIGNATION; DIST, SECT. BLOCK PQL. !O, DO' ' ', =~ .... O~NERS A~RESS: TEST HOLE LICENSED LAND SURVEYORS GREENPORT NEW YORK SEAL . OCCUPANCY OR USE IS UNUkWTUL' Wi~'HOUT-CEP,'flTtC~TE OT OCCUPANCY