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Home My WebLink About15430-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15373 Date March 18, 1987 THIS CERTIFIES that the building ADD & ALTER Location of Property 2890 BUNGALOW LANE MATTITUCK h3d*; '~'oi ....................... 's't/e~i ....................... h~iel County Tax Map No. 1000 Section 123 ...Block 08 .Lot 28.3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... 9.~.t.:..2.q, 1986 .. pursuant to which Btdlding Permit No. 15430Z dated Oct. 28, 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 ......... Construct and alter addition to existing one family dwelling. The certificate is issued to ANTHONY & BRENDA HELIES ..................... ?o¥,,'o;, ¥~ ~g;bx ..................... of the aforesaid building. Suffolk County Department of Health Approval ...... ~ [ A ................................. UNDERWRITERS CERTIFICATE NO .............. ~I [ A ................................. PLUMBERS CERTIFICATION DATED: N/A dl~uilding Inspector Rev, 1/81 Ir'OF, MC NO, O TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILIDiNG PERJ'4 IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. /.5430 Z Permission is hereby granted to: ...... .......~ ..... ~ .~. ~ ........ ~. .......... ...~. ................. .... A..~ ............ ~...~.~....~ .................... .... ~.~.....u.:~..,...u.~...r..~... · ............ .............. at premises located at ....~....~...c~.....~~..~..~O ....... )~~F,~r,n ............. County Tax Mop No. 1000 Section .,..l...~...~ ......... Block ....... .0....~.. ....... Lot No.....~....?..;...~ ....... pursuant to application doted C~ ~-~JL~au, '~0 19..~...~, and 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 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 unusual 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~Coperty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land CoO. $5.00 $15.00 Date...~,3, 1987 New Building ............. Old or Pre-existing Building × Vacant Land Location of Property . ,2.8.9,0...B.u.n. ga..19.w' .L..a.n.e.,....~.a.t.t. ~ .t.u.c..k. ~,..N...y.....1..1.952 House No. Street Ham/et, Owner or Owners of Property . .A.n.t.h..o.ny. & Brenda Helies County Tax Map No. 1000 Section 123 Block 08 Lot 02.8 .0,03 Subdivision ................................. Filed Map No ........... Lot No ...... D. ....... PermitNo.~.5.4..3,0..Z... Pate of Permit .~.0./..2.8/.8.6,Applicant ,S,t,a,,~.[.e~, J. Fliss. Jr: Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... .X ................ Fee Submitted $ .5...QQ ........................ ble codes and regulations. Construction on above described building an~permit m~eets all applic, a Applicant .......................... ,ev.,0-,0-,e 3 / 77/ 'OUNDATION (1st) 'OUNDATtON (2nd) IOUGH FRAME & FLUMBI.NG iNSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..O.~..~:.~...., Approved O ~.~s4 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a__~ceived ........... ,19... Date .................. , 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 used 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 code~ and regulatio.ns, and to admit authorized inspectors on premises and in building for necessary insp~ions. // A ,""~.~,~ x ;,..; .... '[Sig~ 'ature of ~l~plica~, or name, if a C6fpb atio ) · 5.6.5..Q .~.d..Ma. $.n..R.d.,.. M~ ~ l:.i.t.U~ .k...t'!. ,Y, ~.1.9 5 g (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Nameofownerofpremises Anthony~ & Brenda K. Helies (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...1.2. ~..9.8.5.~H..I ............. Plumber's License No ......................... Electrician's Liceuse No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...2..8.9.0..B..u.ng.a.l.o..~..L.a.: ./.P.r.i.v..a.t?..R.d... ............. East End of Park Ave. Mattituck. N.Y. 11952 House Number. Street Hamlet County Tax Map No. 1000 Section ...... 1..2.3 ......... Block 08 Lot.. 028 003 Subdivision .... .X .................... Filed Map No. ...X ........... Lot ....D ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Dwellin a. Existing use and occupancy ........... ~. ............ . ........... ........................... b. Intended use and occupancy . .D..w.e.l.l.i.n.g..7~ ........ '; ~:.-.'::. ;. !'.: .................. 3. Nalux~ 9.fwork (check which applicable): New Building ..... ' .....'Addition .......... Alteration ...~ ....... R~[II~ U...'~ ....... RemoVal .............. Demolition .............. Other Work .N.e.w.. ~.i.n.d. 9F.s.. (Description) 4. Estimated Cost ........ .~ .6.,.5.Q Q ....................... Fee ...................................... ~' (to be paid on filing this application) 5. If dwelling, number of dwelling uhits .... .1 .......... Number of dwelling units on each floor...1. ............ If garage, number of cars ...... ' .................................................................. 6. If business, commercial or m~xed~occupancy, specify' nature and extent of each t}~pe of use' ' ' ~ ............ ..... 7. Dnnens~ons of existing structures, ~f any: Front. 2.4..fi ......... Rear ...4;0 ......... Depth..~4 ......... Height ...... 1..5 .~ ...... Number of Stories . ~ ...................................................... Dimensions of same structure with alterations or additions: Front ...S..a.m.e. ......... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .~ ~ta.e. ......... Rear ............... Depth ............... Height ......... Number of Stories ...................................................... 0f 9. Size of lot: Front ..... ~ ................ Rear ...... .8.Q ............. Depth ...................... 10. Date of Purchase ..... S..ep.t...177............... Name of Former Owner . .P.a.r.k..e.r..~.~.9.k.h.a.m. ........... i 'hp m .... 11 Zone or use distr ct in whic re ~ses are satuated . 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .N.q ....................... 13. Will lot be regraded ...... .N.q :. .................. Will excess fill be removed from premises: Yes X 14. Name of Owner of premisesA.n.l~hOBy..~I~.~.e.~ .... Address45. ~J~ ~1], ~d, .... Phone No.6J-7~23~.-6873 ...... Name of A chite t ' Addr .k~...tqq .Y,~..s...0.21.9.3 Phc No Name of Contractor S t.a. nJ_.ey...~1~. F.I,$~ .4~: ,.. AddressQl~t. H~io. Rd,. [q~.[lChone No. 2.9.8.8z9.0 ..... 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 gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ............................ i ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sighing 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 said work and to make and file this application; that all' statements contained in this appl,ication aie true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this ~t9 .day 6f .... t~...e"~r-. ·... ., 19 .~?. (Signature of applic~t) I~m [xpkes Ma~h 30,~1~ - /