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Home My WebLink About15366-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . .Z. ~.4996. Date October ............................................ 19...86 THIS CERTIFIES that the building ......... ?.c.c..e .~.s.q ~. y..b.u. ~ ?_.d.~.n. $ ................. Location of Property 55 North Dr. ~ Mattituck, N.Y. . /Y3~$'e ~o~ ....................... 'S'tt~eet Ham/et County Tax Map No. ]000 Section . .1.0. ~. ....... Block ...0.~. .......... Lot .~ .~.'. ~..&..?. ....... Subdivision..N./.o. Shore Acres . .Filed Map No.41 Lot No.19., 20, 21 & conforms substantially to the Application for Building Permit heretofore filed in this office dated · 0..c .~.o.b.e. ?..1., .......... 19 .8.6. pursuant to which Building Permit No. 15366 Z dated 0c t o.b. er 6 ............. 19 .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 ......... ccessory Building The certificate is issued to ...q e..v.a.v.d...I'....~, e..o.h.~.J:..n.g.e.~. ................................ (owner, of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. 22 Building Inspector Rev. 1/81 lrOu'M' NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDi~IG PERi, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15366 Z Permission is hereby gronted to: g .(3 .....'7~.~..L~..I..~ ............................................... .....'b~..~.~....~.:~.:....L!..~ ~..~ ......... at premise, located at ....~.~...~..'~......t~...~.~.--~-,'....~~~ .................................. County Tax Map No. 1000 Section ...... )....0...~?.. ...... Block ....... ..~...(~. ...... Lot No..J..~...L..'...L.~. pursuon, ,o application dated ..... .~~....J .................... , 19'~v~., ond approved by the Building Inspector. 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 m =.------- to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusuai 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 featu res. 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: 1. Certificate of occupancy $5.00 2. Certificate of o~:cupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 New Cons tr'uc t, ion ...... Old or Pre-existing Building ............ Vacant ....... Location of Property .. J ~..Z~,,~,~,~ ............ Owner or Ow nets of P rH~;~rtNy°'.. ~;~/~/~..~,/~.. -- Count, Tax Man No 1000 Sect on - -~,~ ....................................... t .............. ?. Subdivision .%J(~/f~'.. ,~yc~.c/j'. ......... ~.,~...Filed Map No ........... Lot No .............. Permit No / .~.~..~'..~. Date of Perm t ./.~..~....Applicant .~..P~...~.~-.'./~.. .................. Health Dept Approval Labor Dept Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and~ all aptFd~le codes and regulations. Rev. 10-10-78 FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: BUILDIN~ DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~~] FINAL REMARKS: ~-~DATE ~ ~ Lot 19 Lot 31 lot 30': SURVEY FOR GERARD ~]. GOEHRINGER PARTOFLOFS /9, 30, 2/ 8 LOT 22, I~T MATTITUC~( TOWN OF SOUTHOLD SUFFOI. K COUNTY, NEW YORK ~UNAUTHONIZED AI.TERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OFTHE NEW YORK STATE EDUCATION LAW. " SHORE ACRES" SCALE *' NO. OCT, ~ I "-' 4~ 62 - 65 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .O...q,T_cr~......~..., 19 Approved .o..~..~ .... 19 ~,. Permit No./..~ ~ .~.~ .~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 shail 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, hous~code~ and~regulations, and to admit authorized inspectors on premises and in building for necessary insp/goet~, ~ /2y//// ~~:~ corporation) × 24. .............. (mai. ling address of: app J_cant:) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... .... (as ~h the tax roi1 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 ...................... 1. Location of land on which proposed work will be done .................................................. ...:.:.. .................... ................ .................. ttouse Number Street Hamlet County Tax Ma 000 Section /¢¢2~ Block .~.. Lot. ~..~.'../. Subdivision..kj//¢/'~..'~....~-~.~. ................ 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 ...................................... b. Intended use am~.eeeugumr4¢ ............................................. , 3. Nature of work (check which applicable): New Building ./~. ..... Addition..' ........ Alteration ........ :. Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4 Estimated Cost Fee (to be ipaid on filing this application) 5. If dwelling, number of dwelling units . ,,~..~.,,,~../r..~:... N umber 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 Rear i Depth Height ............... Number of Stories ............................ i ............................ Dimensions of same structure with alterations or additions: Front i Rear Depth ...................... Height ......... ;, ............ Numberer Stories ................... 8. Dimensions. ¢~.f°fentire new construction: Front .5.~: ......... Rear./(..~'./. i ' 'i ....... Depth ......... ~'.'~.' fl Hmght ............ Number of Stories ................... 9. Size of lot: Front .. o~..Z~. .............. Rear .. ~. ' . . iDepth .~//?.., ................ 10. Date of Purchase . .//~.~.~ ................... >~ Na~d ;~'F'd~ldr 6~v'n'e'r . ..... 11. Zone or use district in which premises are situated./~.. ,. ................... , .... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ............................ 13. Will lot be regraded ./-A~...: ...................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises k.,f?,~,~ .: ....... Address ' Phone No. Name of Architect ........................... Address ............... ~ ....Phone No ................ Name of Contractor .......................... Address ............... ~ ....Phone No ............... 15. Is this property located within 1~00 feet of a tidal wetland? ~ iyes ..... No ~... * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shox ~ street names and indicate whether interior or corner lot. - ~TATE OF NEW YORK, ~,~ ~ S COUNTY OF ,, .. ~'[~./~.CC:~......~.,.'.'. '.~. ¢.~..F.}..D.g ~ ........ being duly sworn, depe ~es and says that he is the applicant (Name of individual signing contract) above named. He is the ............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best of his~knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this l~-"~ .day of..,,.~.'ttD*--"/~.~ ..... , 19~ Notary Publ ~ X...~. ~... County NOTARY PUBLIC, Stale of N~'f,/York · No. 52-452477,1/f ' ~nature of apphcant) Quahfied m Suffolk 'County Cemmssdon Expires N, ov 30, ]988