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Home My WebLink About15314-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy December 9 Date ................................. 19.8~ Accessory THIS CERTIFIES that the building ................................................ 'o, of Property St3d~bh/o!.4q pg.n.n,a. p.r~ye. Mattituck Locat, ........................................... Street I-iamle~ County Tax Map No. 1000 Section 11.5 .... Block .1.5 ...... Cot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~.o.p..~.:..8 .......... 19..8.6pursuant to which Building Permit No. 15.311,tlg .............. dated .... .S.op.%:..2.4 ............... 1 9..8.6, 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 ......... Accessory building . JAMES LILLIAN ROGERS The certificate is issued to ....... & [owner, of the aforesaid building. N/A Suffolk County Department of Ilealth Approval ........................................ UNDERWRITERS CERTIFICATE NO iq/A . Rev. 1/81 · ~glnspeetor ' 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) 15314 Z Permission is hereby gronted to: ....-~..o..X....q...o...~ ............................................... _ ....~x~.,.....~.:..q.:.-.-U..~..~ ....... premises located at ............................... County Tax Map No. 1000 Section ......... .LL.~. ...... Block ...... .I,...~. ....... Lot No ......... ..~ ............. pursuant to application dated ...... .~...~.....~...~..~.. .......... 0 19.~..~..., grid approved by the Building Inspector. Building Inspector Rev. 6/30/80 FOUNDATION FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE COMMENTS ADDITIONAL COMMENTS: 7GS-S802 BUILDING DEPT. INSPECTION FOUNDATION SST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL REMARKS: DATE /~//~/~:::~- / INSPECTOR 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19~. ., 19~.(o. Permit No..}..~.~ .~/..~...~ Disapproved a/c ..................................... (BuiI~ng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by tYl~eWriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale~e accel[ding ta~h~edule. b. Plot plan showing location of ~?ici~l~d_~a&t~ premises, relationship to adjoining premises or public streets or areas, and giving a detailed desor~ti"~ tt~v'~6~I~"l[~operty must be drawn on the diagram which is part of this appli: cation. c. The w~rk covered by t~li~t~'n~,'~ be commenced before issuance of Building Permit. d. Upon approval of tl~t~8'~lic~a~k~"[hl~klit~Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the pre~l~agabT*JGr i~tlq~t'~'~ughout the work. e. No building ~h~'~oco~d o~se~i~ of in part for any purpose whatever until ~ Certificate of Occupancy shall have been grant~ APPLICATION IS HFq~y,~IC~J~'W l~Uilding Department for the issuance of a B~lding Pemit pursuant to thc Building Zone Ordinance ~~thold, Suffolk County, New York, ~d other applicable Laws, Ordinances or Regulations, for the constm~b~ .b~m~, additions or alterations, or for removal or demolition, as here~ described. The applicant agrees to comply ~all app~cable laws, ordinances~ufld~g co~, ~s~g code, and re~lations, and to admit authorizeS inspecto~ on prepaid and ~n~ ~plicant, or name, if }f~o[poration) (Mailing address of applicant) (Name and title of corporate officer) . Builder's License No...'&..-/.~ .................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises . . .~.~ ~.. ~ .~ ~ I ..................................... (as on the tax roll or latest ~~ NOT~ If applicant is a corporation, signature of duly authorized officer. D,TE:~&~ 76G-1~2 9 AM TO * ~ ~R THE FOLLOWING FOUNDATION ~10 ~QUIRED FOR PO~D CONCRET~ 2 ROUGH FRA~iNG 3~ INSULATIOH 4, FINAL CONSTRU~ION ~UST BE COMPLETE ~OR ALL CONSTRUCTION SHALL MEET l. Location of land on which proposed work will bc done. ~H~ ~Ut~ENTS OF TH~ ~Y ....... ............... cd sT bU b ' ENERGY ~0 ~o~ ~... ~.,. ~T~//~ '~NOT~NSI~E.~R House Num bet Street County Tax Map No. 1000 Section ....... ~ ~ ~ ....... Block ...... [ .~"~. ....... Lot .... ~.~ ............ Subdivision .D~.~ ~/¢9~ ,~.~ ~ ~. ~ '.~ .~., Filed Map No. , ~.~.~ ....... Lot .. P~ ......... (Name) 2. State existing Use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , . ~ ~. ¢,q ~.. ~ ......... ~ ~ .................................. b. lntendeduseandoccnpancy ~'/~E. ~j~. ~o~E ~'~-/ Ou'/ 3. Nature of work (check which applicable): New Building ~..~.p.L/z. (~. Addition, Alteration ........ Repair .............. Removal ............ Demolition .............. Other Work ......... ~ .... ~ ' oo ~ (Description) 4. Estimated Cost ....... ~.~' .......................... ' ................................ ' (to ~e paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling uhits on each floor .............. If garage, number of .cars .......................................... ~ ........................... 6. If business, commerc'ial or mixed occupancy, specify nature and extent of each fype of use .................. 7. Dimensions of existing structures, if any: Front ...... (o.5/ ...... Rear ... Q. ~. ....... Depth ...~.~. ?. · · Height Nmnber Of Stories ! : Dimensions'of same structure with alte~rations or additions: Front Rear Depth Height Number 6f Stories .... 8.Dimensions of entire new construction: Front ..... /. g.. · .' ..... Rear ..... /..2.. ....... Depth ../.Q ........ Height Number of Stories ! /.o. ! ' pth 9. Sizeoflot: Front ...... //O ' Rear / 10. Date of Purchase ............................. Name of Former Owner i ........................... 11 Zone or use district in which premises are situated 12 Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ............................ Will excess fill be remo9ed from nremises: Yes N 14. Name of Owner of premises-T~m...~ .~. ?.....~p.¢.~.~$., Address~.~.°.~?.~?.~..O.~,, .~.~'?,,~cfl. l~ne No..~.~..-:.~..a~.... Name of Architect ........................... Address ............. i ..... Phone No ............... Name of Contractor ~47..'~4. o..~ .~.p...~ ~$p.~.~.. ~.. Address/.~.~/.~op.,.~..~.~.c.~. Phone 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No . · If yes~ Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, :ndicate all set-back dhnensions fro; property lines. Give street and block number or description according to deed, and sh >w street names and indicate wheth~ interior or corner lot. I10 ' 31' STATE OF NEv/~ORg,~ // ~, ~ ..... ~ ........ ~J;2:~qe... .... being duly sworn, deposes and says that he is the applicat~ (Name of ihdividual signing contract) ~ ' above named. Heis the tra agent, corporate officer, etc.) of said owner or owners, ~d is duly auth rm or have perfomed ;he,said work and to m~e and file thi application; that all statements contained ~ this application am true to the best of his knowledge and belief; and that th, work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this . .......... ..... .