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Home My WebLink About15447-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou/hold, N.Y. Certificate Of Occupancy December 9 8.6. Date ................................. THIS CERTIFIES that the building FO..U.N.D. ATI.ON ' 935 Meday Av,e... ' Stree,Mattituck Location of Property//~t~s~ 3Jo~ ..................................................... Hem/er County Tax Map No. 1000 Section 1 ~ 3 ..... Block 09 . .Lot 2.1 Subdivision Filed Map No Lot No .. conforms substantially to the Application for Building Permit heretofore filed in this office dated 15447Z Oct. 30 19 8.6. pnrsuant to which Building Permit No ................ d Oct...30 19 ~.6. i d fo Il fth i date ........................... ,was ssued, an con rms to a o e requ rements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Foundation wall ad.d.i, tion t,o. a.n.e.x.ist, i.n~..on.?, family dwelling. GERAL..D W.~ YE.L.L. EN The certificate is issued to ..................................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ..... .N./.$ ................................. UNDERWRITERS CERTIFICATE NO ............. .N./.A. ................................. ~ng Inspector FON, M NO. ~ TOV~'H OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15447 Z Permission is hereby granted to: at pr~mi~o~ I~tod at ..~~...~ .......... ~.~ .................... co~ ro~ ~p so~ ~00~s~.o~ .... l.~.~. .......... ~k ..... ~.~ ........ Co~ ~o ....... ~.~..l ........ ~Ursuont to applicotion dot~ .... ~.~~.-..~ ........... , 19~..~., ond opprov~ by Building Inspector. Fee $.....~.....:..~ Rev. 6/30/80 'OUNDATION (1st) 'OUNDATION (2nd) ~OUGH FRAME & FLUMBING iNSULATION FER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: g FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~ 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 thb 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~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: 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 C.O. $5.00 5. Updated C.O. $15.00 NewCons%z*uction ...... Old or Pre-existing Building $15.00 Date .... /~2 ~/. :..?..~ ......... ............ Vacant Land ............. Owner or Owners of Property..~..~ . ~. ~ .................. : ....... ::m. ,:: County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~.~.~f$.~ Date of Permit /~.~,/o~&~ppJicant .~-~...~¢v..¢~.'.~-.:~¢-X~.. ........ 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. ..................... ,,,.,o_,o.,a ,¢/¢¢ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ~ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS.- DATE Examined .O..~'...~Z'~.... ~O.., 19 ' FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ............ .~..., 19~.k. Permit .......... Disapproved a/c ..................................... (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 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premis~elationship to adjoining premises or public streets or areas, and giving a detailed description of layout of projp~l~,.~nt~ drawn on the diagram which is part of this appli- cation. -, ~'t~l ~ . .. c. The work covered by this applicatio~'~~e~~ce ofBuadmPermit. d. Upon approval of this application, thl~l~i~Ii_h'~p~il~lu~l a'~_~il~l~'~rmit to the applicant. Such permit shall be kept on the premises available for inslle[~th~l '~tl~,h~ t~'Z~,~'~t%I'.lk% ~' e. No building shall be occupied or used~l~eldo~ilt ~*~rt ~'d~l~r~o~'~vl~atever until a Certificate of Occupancy shall have been granted by the Bmldmg InspectoL,,,~.~[~k~M~l%t I'1~ ~ ' . ~ ~1~'~1 _.. Building Zone Ordinance of the Town of Soutl~, S~fl~[j~i~t~;New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, ~t[fiot~ 15'r alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) (Name and title of corporate officer) Builder's License No... ~.~.. .................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State, whether applicant is owner, lessee, agent,~_,~chitect, engineer, general contractor, electrician, plumber or builder. '?' ....................... ...... ...................... (~z;~ ;~; ;;x' ;;,i ;; i~¢~s)' ~ '.z' · ;¢~' '2;~ z'.' · · If applicant is a corporation, signature of duly authorized officer. NOTI~ ~UILD]blG ()EPA~TM~NT AT 706-1802 9 A~ TO g PM ~R THE FOkLOWIN[3 INSPECTIONg: FOUNOA'rloN FOR ~BIGI*~ Off C6,~lST~tiC"f'K;k /;~RORS, 1. Location of land on which proposed work will be done ................ = ................................. House Number Hamlet ~jjj3~7~2 ~a~ ~o. ~000 ~t~o, .../.Z.~ ......... mo~k ...... ~. ........ [o~.~..7.~... 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 ~ .....................................~j ........... b. Intended use and occupancy .. ~5~. ~' .... ~~ ......... ~ ~'~?]g~}~}~:~; ~..~:~:,¢ ....... 3. Nature of work (check which applicable): New Building ..... ' .....'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work .~..~:~p.7~..~/~... 4. Estimated Co ..... '. · i ....................... Fee ...................................... ~' (to be paid on filing this application) 5. If dwelling, number of dwellingiunits .............. 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.. lteight Nuober of Sto~es D~ensions of same structure with alterations or additions: Front ............... Rear .................. Dep~ .............. ~ HeiSt Numbe of St fi Dimensions of entire new const[uction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Size of lot: Front ' Rear Depth 10. Date of Purchase .......... [ .................. Name of Fomer Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ~ ..... ~ .................... Will excess fill.be removed from premises: ~ Yes No Nme of Architect ......... , ............. N~e of Contractor~.~O/~ ~..~..~/.~ ~'" Address ................... ~Phone No. . ..... Address ~rT~Jfi~. ~Phone No. ~}¢~ ~ ~ ~} Locate cle~ly ~d distinctly ~1 bufld~he~ ~i ~ proposed ~d. indicate all set-back d~ensions from propeay gnes. Give street and bl~ak,~ m~,~}*~?a, gc~[hi~}.l~'eed) md show street nines and indicate whether '8. STATE OF NEW YORK, C O UiX2 Y f~ -~7.LOF ........... --r_ ' ,' ' ' i' s.s ..... 4~"(~am~ of in4,1vidual sigfi~g co~tract) 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 application are true to the best of his knowledge and belief; and that the work will be performed in the mannbr set forth in the application filed therewith. Sworn to before me this ................ day o ......... , .. .................... ~.. County .~ Notary Public, '" ............ Term ~u(I)lt'e,a O~ 31, 1~.