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Home My WebLink About15422-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No Z-15133 Date .D.e.c..e.m.b.e.r. 2.9 19 8.6. Chimney to existing one family dwelling THIS CERTIFIES that the building ................................................. 2500 ~.rand. Ave.n. ue. : Mattituck, New York Location of Property ....................................... .... ... .. . . . .. . .. . House No. Street Hamle~ County Tax Map No. 1000 Section I 07 .Block 02. ........ Lot ...... I 6 Subdivision Filed Map No Lot No . . conforms substantially to the Application for Building Permit heretofore Cried in this office dated October I 7 19 .86pursuant to which Building Permit No .... 1.5.4..2.2.z. ........... dated.. .O.c t.o.b, er. . ....23.. ,..... ........ 19...8,6wasissued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Chi,re. ney to .e.xis, tin,g, one family dwelling. ROBERT & JOAN CHRISTIANSON The certifieat~ is issued to ........................................................... [owner, of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO N / A ...... Building Inspector Ray, 1/al FORM NO. ~ TO~N OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING 9 EEJ',RIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? !S4~ Z Permission is hereby granted to: ......... ~.,~.....~./ ............................................... .... County Tax Map No. 1000 Section ...... i....°....~. ....... Block 0 .~. Lot No. ) .~ Building inspector. Fee $ ........................ Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Towu Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTI~:ICATE OF OCCUPANCY Instruct|ohs A. This application must be filled in typewriter OR ink, and submitted ~a ~ to the Building Inspec- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unum~al 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 iprior 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 features. 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: I. Certificate of occupancy 2. Certificate of occupancy on pre-empting dwelling $15.00 3. Copy of certificate of occupancy $1.00 5. Updated C.O. $15.00 Date .............. NewC°nst'ruct'i°n ...... Old orPre-existing Bui(dJng ~,,.~/.h~t..~ .~..~... Vacant Land Location of Property ................. lYouse No. Street Hamlet OwnerorOwners ofProperty ,..~.O.b. h.'-......J ... ............... .... ... County Tax Map No. 1000 Section . .].~..7. ........ Block ...~.,,~ ........ Lot .... Z .~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ......... Date of Permit ,Applicant ......... 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 permit meets all applicable codes and regulations. A~plieant .... . ................ Rev. 10-10-78 765-~80~ BUILDING DEPT. INSPECTION [ ] FRAMING FOUNDATION 1ST []ROUGH PLBG. FOUNDATION AND []INSULATION []FINAL REMARKS: 'OONDATION ( ~ st) ~OUND&TION (2nd) iOUGH FRAME & PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 xamined . ~..~....~2:44.....'?..~ 19 .ff. J* pproved Z~.v~fT..otg, x$~...-~.~, 19 ~.(~ Permit No./. .~.~.~..~a..~...-'~. ,isapproved a/c ..................................... l~ecoJ, ved ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts of plans, acem'ate 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applb ~tion. 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 mil 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 ~ Cer'ifieate of Occupancy mit 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to hnit authorized inspectors on premises and in building for necessary.~'~ ~'..,~inspect'i°n~ .... ~Signatu~e of applicant, or name, if a corporation) '~ ' f ?ma~lSng address of applJ~cant) ...... rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) 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. ff. 0..~.~..~.~. ......... Location of land on which proposed work will be done. ~ ~..O.~... ~./7. c/ti ~.. ?4 .V~7.. ~. ~.t27k/~/' ]./4 C~?'. j .~.~. .... louse Nmnber Street ltamlet County 'Fax Map No. 1000 Section .../..~. 7. ......... Block .... *~ ............ Lot..] ~. .............. Subdivision .................. : .................. Filed Map No ............... Lot ............... (Name) · State existing use and occupancy of premises and intended u'se and occupancy of proposed construction: a. Existing use and occupancy . ./~ 19. DI.~. ............................................................ b. Intended use and occupancy Nature of work (check which applicable): New Building .......... Addition Repair'. ............. Removal ............ Demolition .......... Estimated Cost ..................... Fee ...... ...... Alteration .......... · Other Work .C.)I I. Ol fi.e,.)(... (Descripti6n) (to be: paid on filing this application) 5. If dwelling, nmnber of dwelling units ............. Number 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 ~ Depth I ' Height Number of Stories ' Dimensions of same structure with alterations or additions: Front .......... ..... Rear .................. ' Depth ..................... Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ....... i ........ Depth ............... Height ............... Number of Stories ........................... i ............................. 9. Sizeoflot: Front ....................... ............ Re?r ...................... i Depth ..... .............. 0. DateofPurchase .~¢~p.../.q,O./ .NameofFonnerOwner i.~)tW/.fit, l~P.(. ~te~. 1. Zone or use district in which premises are situated ....................... ' ............................ o- 2. Does proposed construction violate any zoning law, ordinance or regulation: . 21] O. ......................... 3. Will lot be regraded ... ~l.'O ......... .,..., ......... Will excess fill be removed from premises: Yes ~ ~) 4. Name of Owner of premises ~.~3T...~/lt?. (otc/.~.~t,Tp.q Address ...~R./at. [/t. et e./.~... Phone No. e~¢~.-t~.,~)( .... Name of Architect Address ' Phone No Name of Contractor . .:5..P~.V. ¢.~... ~O t-.ri ........ Address . ~o t~./:-~t o]~...: ..... Phone N~/~57~ ~7. -33 5. Is thJ_s property located mtth~-nTt.00 feet of a t~.dal wetland? * Yes ........ ~ ...... · If yes, Southold Town Trustees Perm:i.t: may be requJ_red. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions l¥om ~roperty lines. Give street and block number or description according to deed, and show ~terior 9r corner lot. ,' FATE OF NEW YOI: S.S OUNTY OF ............. ....................... 3o, e. . . C.l r./, : it (Name of individual signing contract) )eve named. being duly sworn, d~poses and says that he is the applicant is the ......................................................................................... elc ) (Contractor, agent, corporate officer, . said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of ork will be performed in the manner set forth in the application filed therewith, ,vorn to before me this ................ l. Zd. day ........... otary Public, '. ............................. his knowledge and belief; and that the . County , _ ,~ ~ J ~ '(Signature of applicant)