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Home My WebLink About15445-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building fi, qc,?,s.sqp,¥ building . Locati ofP operty 680 Bu'ngalow Lane. ' Mattituck N.Y. House IVo. Straet Harn/e~ Cou ty Tax M p N 1000 Section 123 Block .2. Lot 9 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .Op,~,obep ...... 2, yj ........ ................... 19 8. .6pursuant to whfch Building Perm[t No ... ~.5445Z . dated ...0. c. ~..o .b.e.p...3.0., ............. 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 i~ ......... as appli, e.d fo.r: THOMAS J. a CLAIRE G. FIS.H.ER. The certificate is issued to .. ~ .................. io~n'o;,'l~'~&~){2 ................. of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................ ~/...A ............................. . Rev, 1/81 '" 'l t]i i g Inspecto'" - ~ ~. ..... ~'0~ NO. ~ TOWN OF SOUTHOLD [~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. [~UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15441~ Z Permission is hereby granted to: ...... ~.~ ...... ..¢,. ...... ~.~ .............. ...~..,t.~....~...~......~ ............ .....~.~ ........... ,~- .v. ............. . *~,~ ............. ~-- at premises located at .,~g..~,.Q....~.~......~...~ ............... "~ ............. County Tax Map No. 1000 Section ...L..~.....~. ......... Block ..... ..~...~.. ........ Lot No ..... ..~...~ ............ pursuant to application doted ....... .C)...~..~ ...... .~..'~ .......... , 19..~.(p., 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 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: I. 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 completod 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 topograph ic 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: 1. Certificate of oc~cupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.0 0 3. Copy of certificate of occupancy $1.00 5. Updated C.O. $15.00 Date ............. New C OhS truct i on ...... Old or Pre-existing Building ............ Vacant J. and ............. Location of Property . .~. ~..~. .................... K~/~-~4,~...~.,~. .......... .~.,,~'. ~:~,~" House No. · Street ''~" '~~ L/~. Hamlet Owner or Owners of Property ~ ................... County Tax Map No, 1000 Section ... Z.~....~'. .... Block .... .~.. ........ Lot... ~.. .......... Subdivision ................................. Filed Map No ........... Lot No ............... Permit No./'..'-~/..~ .~..~'. Date of Permit ~?~.....Appl,cant~.~. ~.~ ~.~..~'~ .......... Hca th Dept A~rova '///'/'~ · P~, ..................... Labor Dept. Approva .......................... Underwriters Approval ........................ Planning goard Approval .................. Request for Temporary Certificate ..................... Final Certificate ....................... Foe Submitted $ ............................. Construction on above described building and permit meets all applicable codps"~[~j~egulations. Rev, 10-10-78 76S-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL [ ] FRAMING REMARKS: DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLO, N,Y. 11971 TEL.: 765-1802 Igl' 27 Received .......... ~19... >isapproved aJc ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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, accurate plot plan to scale. Fee according to schedule. premises, relationship to h. Plot plan showing location of lot ~.f buildings on adj~oining premises or public streets : areas, and giving a detailed descril~t~n ~L~a'~o,~t~ proper_,Jy must be drawn on the diagram which is part of this appli- 'tion.~'~, -.~l'~J~'~ ~_',~-- t'lkJi'~ , C. The work covered by,,l~j~l'~'a~i~r~l~l~l°t,~~ced before issuance of Building Permit. cl. Upon appro~'C~t[~J ~u~l,~l~ll~ctor will issued a Building Permit to the applicant. Such permit ,all be kept on the l~[~s~'[va~i~l~ ~n~fl~rou~hout the work. e. No building s .l~all. l?~.~,c_c .~..d, q~s~ll~lll~,~vk,~oJ~ or in part for any purpose whatever until a Certificate of Occupancy ~all have been granted ~k~t~l~mld~ ~e~o~%'~'~ '" APPLICATION 1S Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance ~'~l~ql~,~h~thold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the constnlcJ~ ~[,.~ltr'dings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to com[l~itKall applicable laws, ordinances, building code, housing code, and regulations, and to ~ectors on~remises and hnit authorized insl: in building for necessary inspections. ...... ;.:;.;...;; .... (Signatul~ o[?j~or name, if up rati ) .. ........... ''~ fmailing addres~ .e.f app ic,a t) · . . late whether applicant is owner, lessee, agent, architect, euginecr, general contractor, electrician, pmmoer or omlum. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... (as on the tax roll or lat~.~e..d)~o~ / applicant is a corporation, signature of drily authorized officer. ~FEE:._,~_5~d__~B¥ NOTIFY BUILDING 0EPAR'rMENT AT 765~1802 9 AM TO 4 PM ~R THE ~FOLLOWING INSPFCT~ONS: ~UNDATION ~WO ~QU~RED , ',~FOR POUREO CON(~E.'f~ ' 3. INSULA ~, FINAL CO~IS'TROC'I'K~t~ ~ COMPLE'T~ ~0~ C O Location of land on which proposed work will be done .................. GOOE~:. NBT ghg~lNSi~4Lf.~f0~ ...... House Number Street Hamlet County Tax Map No. 1000 Section .... ~.~. ~ ...... mock ...... ~ .......... Lot ....2. ............. Subdivision .................. : .................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ,~..~.~. ~.~)2~.&/~..~......-~../fi~. F~-~ff....~.~2.~.~'.~.. ..................... use and occupancy .... ~..~..~..,~..~...,~.0.,~. ~/ff....~..~ .~.~ ....." -- -- C ~ .,~?..~.,~..~..~'.~ .............. b. Intended ./ 3. Nature of work (check which applicable): New Building . .~'~..~.~..~?AdditJon i Alteration Repair .............. Removal ............. D6molition .............. Other Work .............. (D ripti ) 4. Estimated Cost .... .~...~.! ~ .................. Fee .. ~..,~.', .......................... (to bel'paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... If garage, number of ea~ ........... ~ ............................. [ ............................ 6. lf bus~ness, commerc~al or m~xed oecupaney, spee~y nature and extent of eaeh t~pe of use ................... .. 7. D~mens~ons of ex~st~ng structures, af any: Front .... ~ .... Rear . .~J~ ...... Depth: ............. Height ......... Number of Sro es ......................... ~ ............................ D~ensions of same st~eture with alterations or additions: Front . .~. j ..... Rear ..~ ~ ........ Depth ..... ~ ......... HeiSt .... ~ ~ .......... Number of Sto~es .. ~ .......... 8. Dimensions ofentir~ new construetiom Front ............... Rear ....... ~ ....... Depth ............... Height ............... Number of Stories ......... ~ 9. Size of lot: Front .... ......... ~ ...... Rear ~'~]~ ~ ~ ~ ~ ~ ~ ....................... ~ Depth . .~.o.. .............. ~ ........ 0. Date of Purchase .. '.. (~T .................. Name of Former Owner ~. ~/~ ............. 1. Zone or use dlsmet m which premises are s~tuated... ~.. ~ .......... ~ ...................... 2. Does proposed construction vi91ate any zoning law, ordinance or regulation: . .~ ............................ 3. Will lot be regraded ..... ~ .... _.~ .~ .......... Will excess fill be remov~ from premises: Yes N~ 4. Name of Owner of prem~se~C. ;~ ....... Address ~/~ .... Phone No~.~ q ./....' ' ~ Name Of Architect Address .' Phone No Nmne of Contractor .......................... Address .............. ~ ....Phone No ................ 5. Is this property located withinl.00 feet of a tidal wetland? *~Yes ..... N~.. * If yes, Southold To~ Trustees Permitmaybe required. PLOT DIAGRA~ Locate cle~ly ~d dist~ctly ~l build~gs, whefl~er existing or proposed, an& indicate ~l set-back dimensions from ,roperty lines. Give street and block number or description according to deed, and shdw street names and inc ~eate whether ate~or or corner lot. FATE OF NEW YORK, OUNTY OF ........ S.S ................ ' ................... being duly sworn, depbses and says that tie is the applicant (Name of individual signing contract) ~ove named. : e is the .......................... i (Contractor, agent, corporate officer, etc ~) ~' said owner or Owners, ~d is duly author~ed to perform or have performed the ~aid work and to m~e and file this ~plication; that all statements contained ~ this application are true to the best of h: s knowledge and belief; and that the ork w~l be performed in the m~ner set forth in the application filed therewith. ~orn to before me this ...................... day of ...................... ota~ Public, . .................. County . ~ __ /)~ .... ..... ..... .......... : .... ~ ~ ~ ~ 1~ ~ (S~gnature of apphcant)