HomeMy WebLinkAbout15348-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17691 Date
JANUARY 18~ 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 935 BAY AVENUE MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section i43 Block 04 Lot 27
subdivision GEO. H. RILEY Filed Map No. Lot No. @
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPT. 24~ 1986 pursuant to which
Building Permit No. 15348Z dated SEPT. 27, 1986
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 GARAGE.
The certificate is issued to
HARRY & BARBARA JACKSON
(owner,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building .~nspee~r
Rev. 1/81
I~OB, M NO, ~
TOWN OF SOUT~OLD
I~UILDING DE~ART/~AENT
TOWH HALL
SOUTHOLD, N. Y.
BUILDinG PE~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 15348 Z
Permission is hereby granted to:
.... ..........................
......'~..x....~..~.-..~ .................................................
.
County Tax Map No. 1000 Section .... l...?..~. ........ Block ...... ..~.....IT/. ....... Lot No ..... .~1~..']. ...........
pursuant ,o application dated .... ..~.~.~.~......~....~.. ...... , 19..~..~..,-- and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ....~...OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........
HOUSE NO. ' ''/STREET HAMLET
County Tax }{ap No. lO00 Sectiou .//~. Block .~.~... Lot .~.~. ....
Subdivision. ~0~. ~ Filed Map . ..Lot.
Permit No../.~.~..~...Date of Permit .~.~.Applicant ...,-~./~.,~.,~-~. ..........
Health Dept. Approval .................. Underwriters Approval ..............
Planning Board Approval ................
Request for Temporary Certificate ....... Final Certificate ...Z ..........
Fee Submitted: $ ..................
APPLICANT.
rev. I0/14/88
LD INS[JECTION COMMENTS , ,
JDATION (1st)
~DATION (2nd)
FRAME &
PLUMBING
JLATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [] ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
FRAMING [ ]FINAL
DATE:
INSPECTOR,
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
LI' L_
BI.DG, DEl>T,
TOWN OF $OUTHOLD
Approve~ .X~..~.?., 19~.~.. Permit No. }..~..&.~..~..~..
Disapproved a/c ..................................... e_~d~[ [ ~O~'
.................................... ............ ......... a
(Building Inspector)
APPLICATION FOR BUILDING PERM IT /~ /
INSTRUCTIONS
Received ........... ,19...
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 us~'d 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 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 cod~, and regulations, and to
admit authorized inspectors on premises and in building for necessary insp ions. ..... 1'~' ~&'~'' '~' ~~' ~ '~a' io'~ ....
(S~gnature o~/p~ant, or name, if a o p t' )
· ' ' ~(mailing address .°f. applicant) .
7r builder.
~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
ltouse Number Hamlet
County Tax Map No. I000 Section ../..~..~. .......... Block . .~. ~.'.~.~. ....... Lot..C~.q~ .~.,. ~..O.O. .....
Subdivision .... .~..~..~....~.~'-/f.-....~.,{./'~.~ .......... Filed Map No ................ Lot ..... ,~ ........
(Name) /
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~ ........ ~. · .~'~..~..~..~.jf:~..~.. ~,t~TX~. ~. ~ .................
b. Intended use and occupancy .......................................... ~..~ ~7~0 ~..~.~. · /f~. ,~.. .
3. Nature of work (check which applicable): New Building .....~..... Addition.. i ....... Alteration '
Repair .............. Removal ............ Demolition .... ~...'.. Other Work .....
4. Estimated Cost .......... ?.~_,2... ................ Fee..c~-. ~.~ .~..~. 16../.~ .~..~. ....... .z'.,.[..
(to be ~aid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................
If garage, number of cars .... l ........ ............................... i ...........................
6. If business, commercial or mixed occupancy specify nature and extent of each typle of use ........... ~ ........
7. Dimensions of~?xisting structures, if any: 'Front .... /.~ ( ....... Rear .../. ~. ...... Depth ... ].~. .........
Height .. '.Tfi. '. ......... Number of Stories .... l ....................... I ............................
Dimensions of same structure with alterations or additions: Front ......... i Rear ..................
Depth ...................... Height ...................... Number of :Stories ......................
8. Dimensions of entire new construction: Front ..... ~ ~.~ .... Rear .... ~,~.t?.~.-F.... Depth . .~Q.~. ?.'(.'....
Height Number of Stories ........
9, Size of lot: Front.· .~./. ~,.q; ........... Rear...~./. ~..~.~.' i i i i. ii. i ii 'b~i~'i i~'.'~
10. Date of Purchase ...... ~/./~/..7~'. ............... Name of Former Owner .!..~¢.~/~..i~J"~fi. 9~'~'.e/ff .....
11, Zone or use district in which 15remises are situated ......................... i ...........................
12. Does proposed construction viol~te any zoning law, ordinance or regulation: .../~. ................. ~ ......
13. Will lot be regraded ~.~.o.c~.~;.~.7~._~_C.-~.~,~ .... Willexcessf~ll~erc/ngye~[frqfnpremises: ~ No
14. Name of Owner of premises fi.f/fgg~f~.. ~. ¢,f;~a~l~.. ,. Address ~:1~. ~t~.~?./~'/~.77~ .7.Z~ l~ Phone No. g.'~.~'..~.-r z.../~ ~.~...
Name of Arc~hitect .~ ~¢%~/x~t~h~.q..~.~ Address ............... I .... Phone No ................
Name of Contractor. ;~..~.~.~...t] .~..~..../<l~/t. ......(Address ...'~..~.~...~-....j .... Phone Nol . ..~.~...~:. ......
15. Is this property located within t.00 feet of a tidal wetland? ~ ~es ..... No .~..
* If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from
property lines· Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. '~ '
NEW yORK 2.--..
COUNTY OF...~.~.~.'-~ ..fir. . S,S
........... /. ~. .fiR~.t] . ~,,qo~. ~ ........... being duly sworn, deposes
· ' '(Name of indMdual signing contract) ' ' '
above named.
and says that he is the applicant
mid work and to make and file this
s knowledge and belief; and that the
He is the .............. z3 .C~..A/.C..I~. ..................................
(Contractor, agent, corporate officer, etc.
of said owner or owners, and is duly authorized to perform or have performed the
application;that all statements contained in this application are true to the best of h
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
........ ~.~. ~q. ........ day o f %~.~. ¢.r2~..f4~... 19 .~.~.
Notary Publi~, ........ ' ...~..~/~. County / / //~ l
r .....
COOE,S NOT ~$PON~I~I.E FOR
~6SIGN Ofl CONSTRUCTION ERRORS,
0
OCClJ?~NC'I OR
CEos$. SEe_anoN
REVISED