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Home My WebLink About15490-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. z16297 Date. ~t?be.[.!?.,..!9p.7 ....... THIS CERTIFIES that the bu,ldmg A .1 .t .e.r. a t 1 o n ....................... Location of Property 640 Ma.y.f.l. ow..er. Road Mat t i tuck House No Street Hamlet County Tax Map No. lO00 Section . 1.0.7 .Block .. 0.8 ....... Lot .. .0.26 ....... Sub&wmon .......... .... Fried Map No. Lot No ............ conforms substantially to the Apphcat~on for Building Permit heretofore filed in this office dated ....... ~9.v...1.0~ 1986 pursuant to whtch Bml&ng Permit No...15.4.9..0.Z ........... dated. ...N o v ....' 13 ,.. l..986.., was issued, and conforms to all of the reqmrements of the applicable provisions of the law The occupancy for wluch tlus certfficate is issued is .... Convert attac, h.e.d, ga.rage to The certificate is issued to .C~A.R. L .E.S of the aforesaid building living area as applied for & MABEL LEY (owner,~F~b~K[Xr~trn,Yu~X X X X Suffolk County Department of Health Approval ... N/A ..................... UNDERWRITERS CERTIFICATE NO N 8 3 5 2 4 9 PLUMBERS CERTIFICATION DATED: Alan Seib 7/6/87 Rev 1/81 TO%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiHG PER'AlT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15490 Z County Tax Map No 1000 Sect,on . I,Oq... Block ...... .C~..~ ...... Lot No ..... .Q..;"~.. ~.. pursuant to c~pphcatio, dated . J~. ~-~L,. I (~ .... , 19~.~., and approved by the Building Inspector Fee $ ........... Building Inspector Re~ 6/30/8D FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APP/~CA'r~ON FOR CERTiFiCATE OF OCCUPANCY- Instructions A. This apphcat[on must be filled in Wpewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topograph m featu res. 2. Final approval of Health Dept. of water supply and sewerage dmposal--(S-9 form or equal}. 3. Approval of electmcal ~nstallat~on from Board of Fire Underwriters. 4 Commercm[ buddings, Industrial buddings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed rote plan requirements where apphcable. B. For existing buddings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1 Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or prewous owner as to use, occupancy and conditton of buddings. 3. Date of any housing code or safety Inspect~on of buddings or premmes, or other pertinent informa- t~on required to prepare a cert~fmate. Fees' Addztions $25.00 1. Cert~hcate of occupancy New Dwellzng $25.Q0, Accessory ,$10.00 Business $50.00 2 Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certifmate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 ~[~ .~ 5.Updated C.O. $ 50.00 Date ...... %. ~ ............ NewConstruction ...... Old or Pre-existing Budding ......... Vacant Land ............. Location of Prop erty ~u~N~ ........... ~ (~ -~.L .~L~ V' ..... ~ ............ [~ , '~ ~. Street . Hamlet Owner or Owners of Property . ..~ .L(~,~.3~.~ ~L~ ................................. County Tax Map No. 1000 Section .... \6.~ ..... Block .... .~.~ .... Lot ..... ~.~ ........ Subdlvlmon .......................... Filed Map No .......... Lot No ............ Permit No. ~.~..q~ .~.~ Date of Permit ......... Applicant..~t-.).-%~...~.. .................. Health Dept Approval .................... Labor Dept. Approval ........................ Underwmters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ............... Final Certificate ..................... Fee Submitted $ ...................../'~//,//" , /u/~ // ~/// ...... z THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001071 BUREAU OF ELECTRICITY YORK 10 38 [----~ 85 JOH~N. BTREET. NEW YORK, NEW 5062317~7 ..,. oc~obe,~ ~, 198, A..,,~.,,o. Noo. f,,. N '~'~'~9~'00 THIS CERTIFIES THAT only the electrical equipment a~ de~crlbed below and ~ntroduced by the appl~can~ named on th~ above application number ~n the premises of Charles Ley~ 640 Mayflower, Off Bro~er Rmed, Matcituck, N.Y m thefollowm~ h,eatton. [] Bm, ement [] I~t Fl [] 2nd ~1 qe~t,on Block Lot FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS DIMMERS SYSTEMS OTHER APRARATUS 1-G. F. C. [, Electric Room Heaters: 1-2.0k~ S E R V I OF CC COND NO OF HI lEG C E S Electric 215 $o~thold, N.Y. 11971 Lic..57 BE Per__ Th~s cerhflcate must not be altered m any manner, return to the ofhce of the Board d incorrect Inspectors may be ide~nhf~d b~thelr credenhols COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST HOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N Y. 11971 TEL. 765-1802 CERTIFICATION BuildlngPermit NO. ~ ~ ~ ~ Owner ~ ~vtJ~ ~c~2 ~ (please pr ln~c ) (please prxnt ) I certify that the solder used in the water supply system contazns less than 2/10 of 1% lead. Sworn to before me thms /~ -~ day of Notary Public, No. ~65831 (plumber's signature) County Notary Public OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [~/~NSULATION FRAMING FINAL INSPECTO~ 76~-1~02 BUILDING DEPT. INSPECTION []FOUNDATION XST [ ] ROUGH PLDG. [] FOUNDATION ZND [ ]INSULATION [ ] FRAMING /~[ ] FINAL REMARKS: ~//~ 7GS-XS0~ BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL PLUMBER CERTIFICATION ON LEAD cONTENT BEFORE CERTIFICATE OF OCCUPANCY OCCUPANCY OR USE IS UNLAWRJL sOUreR USED,N W,~E~ SUPPLY SYSTEM CANNOT Wl'rHO~ CERTIFICATE ~EO ~/,o 0~,~ ~AD. OF OCOUPANCY ,~..,~.,..~ dl.tflbutlng Ihall be only. Exammed ./0 .aTu.~v~[L~, }.~., 19 ~(O Approved JO~ Ib Dmapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y. 11971 TEL.: 765-180:2 (Braiding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... , I 9 · Date .......... , 19 ? a Tlns apphcation must be completely filled in by typewriter or ~n ~nk and submitted to the Budding Inspector, wltl sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locatton of lot and of bmldmgs on premises, mlatmnshtp to adloinmg premises or pubhc stm or areas, and g~vmg a detmled description of layout of property must be drawn on the diagram winch m part of this ap, cabon. c. The work covered by tins apphcahon may not be commenced before ~ssuance of Building Permit. d. Upon approval of this apphcahon, the Bmldmg Inspector w~ll msued a Bmldmg Pemut to the apphcant. Such pen shall be kept on the premises available for mspechon throughout the work· e No budding shall be occupied or used m whole or in part for any purpose whatever untal a Certificate of Occupa_n shall have been granted by the Bmldmg Inspector. APPLICATION IS HEREBY MADE to the Braiding Department for the ~ssuance of a Bualdlng Permit pursuant to Bmldmg Zone Ordmance of the Town of Southold, Suffolk County, New York, and other amMmable Laws, Ordinances Regulahons, for the constructaon of buddings, additions or alterations, or for remov~ or ~J~n~c/htapn, asiherem descnb. The applicant agrees to comply with all apphcable laws, ordmances, building code/b/o'u~g ,c~d/r/an~/~egulahons, and admit authorized inspectors on premises and m building for necessary ~nspectlons./ 'f,,~/~/~,/f/~ (S~gnaturetof ap'plicant, or namg if a corporation) ............. . r ......... ..... ............ ...... '' (mailing~ addres~ of applicant) ~ether apphcant m owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmld~ x~'01 ~1.~¢ ........... State Name of owner of premises ~ ~".[-°).k'-&x~--~ 1J (a~s o~n/~e If apphcant ~s a corpomhon, mgnature of duly authorized officer tax roll or latest deed) 2 (Name and title of corporate officer) Bmlder's License No Plumber's L~cense No Electncmn's License No ...... Other Trade's L~cense No ...... Location of land on which proposed work will be done House Number I t County Tax Map No I000 Section ~,,h ~ ~ .... Block .. Lot ~+,~ ~0 a. Exmtmg use and occupancy b Intended use and occupancy Subd~vlmon ' (Nan~e) ....... Filed Map No . . . Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction 3 Nature of work (check which applicable) New Building . Repmr .... Removal ......... Demolition . 4. EstlmatedCost~ ~ h u'G ~ 5. If dwelhng, number of dwelhng umts Addition ........ Alteration ~- x... ·. Other Work (Description) Fee ............... (to be paid on f'flmg thru apphcatlon) · Number of dwelling un]ts on each floor ............ If garage, number of cars ...'7 . .-- ............................................. 6 If business, commercial or mixed occupancy, specify n~,ture and extent of each type of use . .~ ............ 7 D~menmons of exmtmg structures, if any Front (<-q .... Rear . ?. ~. .... Depth ~-.~.'. Height . ~t~' Number of Stones ... [ . D]menmons of same structure with alterations or additions Front q: 5 ...... Rear .. % ~ ..... Depth g-.'4[ ....... Height . k¼'. .. . Number of Stones. .. t ............. 8 Dlmenmons of entire new construction Front -~ Rear ..... --T. ..... Depth ....--- Height ~ . Npmber of Stones ...-7--- .... 9 S~zeoflot Front . ~ ¢~ . . Rear . t..~ ...... Depth .X.o' . ..... 10. Date of Purchase ~0~.,~...i~ [c[~.g ...... ~Name of Former Owner .~yw..%~_...T~l.~.~.~. ........ i.. 1 1. Zone or use d~stnct in v~hlch l~remmes are mtuated. · ~t,, h(~ .u t ~. 12 Doesproposeaconstructlqnvlolateanyzomnglaw, or~h'nanceorregulatio]~ '~.i''."i ii 13. W~I1 lot be regraded . ~'~ 9~, ,.. ~... , ..... Will excess fill be removed from premises ~es 14 Name of Owner of prem~s~.es ~ .~,r\p~...~. ...Address .~% PhoneNo ~.VG. 4 q~.:.$..~l.tT. Name of Architect ........ ~." . . .t.. Address . . ~.. ~.,v ~,f.,,, ~. . Phone No .......... Name of Contractor - . Address ............ Phone No ......... 15. Is thzs property located withinl00 feet of a txdal wetland? * Yes ..... No .~-~.. · If yes, Southold Town Trustees Permzt may be requmred. PLOT DIAGRA~ Locate clearly and d~sttnctly all buddings, whether existing or proposed, and. indicate all set-back danenmons from property hnes Give street and block number or descnption according to deed, and show street names and indicate whether mtenor or corner lot. STATE OF NEW YORK, S S COUNTY OF .... (Name of lnd~wdual signing contract) above named bemg duly sworn, deposes and says that he m the apphcant He ~s the .... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application, that all statements contained in this apphcahon are true to the best of his knowledge and behef, and that the work will be performed m the manner set forth in the application filed therewith. Sworn to before me this /~7 .day of '~... ,19 Notary eubhc .... ~ .~ . .~..~*:..~?'? . . ..County 1~ Exmms March 30,19