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Home My WebLink About15214-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z 1.5165 Date .... S..a.np.a.r.y...5 ......... 198..7. A.lteration .a.nd. r.e.nova, t.zoq THIS CERTIFIES that the budding ....................................... Location of Property .. .... .3...3 .2.5..R.T. :..#.4. 8 ........ M.A.T T.I T..U C K . I~ou~e Ivo. Street Hamlet County Tax Map No. 1000 Section 14 I .Block 0 .2 .Lot 0 j .5 Subdivision ............................... Filed Map No ......... Lot No ........ ...... conforms substantially to the Applicatton for Buxldtng Permit heretofore fred in tins office dated .... A..~,g..., 2. .9 .......... 19.8..6porsuant to which Braiding Permit No .... 1.5.2. ! .4 .z ............ dated .. Al[q:..2.9. ................ 19.8.6., was issued, and conforms to all of the requirements of the applicable provmtons of the law. The occupancy for wtuch ti'us certfficate is issued is ......... Alteratzon and renovation to existing attached garag.e. The certificate isissued to . JOHN J. HAAS (owner~&r~ of the aforesaid budding. Suffolk County Department of Health Approval N./..A .......... N785629 UNDERWRITERS CERTIFICATE BIO ...................................... Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. N9 BUILDING PERJ~41T (THIS PERJ'AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15214 Z Dote ~ ....................... ..~ ........... , Permission ~s hereby granted to: .... ~:~....~ :~.,...!.:.x..~..~.. · ~.....~~ ~. .... ~ ..... ~-..~. ...................... ~._. ................................... o, ,~,, ~,~ ~, ...~A.~.~ ............................ ~.~. ................. '~ ............................. County Tax Map No 1000 Section.._I"t/. Block . ...~...;,::'3...... LotNo .,..~...!X pursuant to apphcat,on dated ~-~... ~-:'.. .., 19~P, and approved by the Budding Inspector Fee $,...~..: Buildin~ I~tor 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. Thru apphcation must be filled in typewriter OR ink, and submitted m~,.~ to the Building Inspec- tor w~th the following; for new buddings or new use' I. F~nal survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwmters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed rote plan requirements where applicable. B. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-ex~sting" land uses' 1. Accurate survey of p~operty showing all property hnes, streets, buildings and unusual natural or topographic features. 2 Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3 Date of any housing code or safety inspection of buildings or premises, or other pertinent mforma- t~on required to prepare a certificate Fees 1. Cert~hcate of occupancy $5.00 2. Certificate of occupancy on pre-exist~ng dwelling $15.00 3. Copy of cert~fmate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date NewConstructzon .. Old or Pre-ex~stmg Building ...... Vacant Land ........... ....................... Street ' L~ Locat,on of Property I~tc~u.~No~. ~. . .1~.,. . .~.~. ............... .I~.~ TE ~Ha~/e.t ~/ )~]~ Owner or Owners of Property ...'J..0..~../N ...'-)~.../LJ....~..~..~ .............................. County Tax Map No. lOOOSectlon .. }.~// .. Block ....O.c~- ...... Lot..~./..~. ....... Subd~wmon ................... F,led Map No ......... Lot No ......... Perm,tNo /.~-~./.c/..~-DateofPerm,t ~/~'/~.Apphcant .. ~J.42./7.t:~..J../~.,~z~ ........ Health Dept Approval .................. Labor Dept. Approval ........................ Underwriters Approval ...................... Planning Board Approval .................... Request for Temporary Certificate .... F,nal Certificate ....................... Fee Submitted $ ..................... Construction on above descmbed butld~ng and permit meets all apphcable codes and regulations Rev 10-10-78 Apphcant. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons. /_~/An application fo~ Certificate of Occupancy ~ is not on file. /~/ No Underwriters Certiflcate on file. /~/-~- The check is~/not on file.) ~o ~ /~/ NO Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # & ~ c~ ~ ~ Z Building Dept. ***/~/ No Plumber solder Certificate on ( file. all permits involving plumbing being issued after April 1,1984 ) ~ FOUNDATION (1st) FOUNDATION 2. (2nd) CO: ' · ROUGH FRAME & ?LUMBING 3. INSULATION FERN. STATE ENERGY CODE ADDITIONAL COMMENTS: ]'6~-X802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL INSPECTOR Exam,ne~ ¢,.~.~ 11.~ , 19~)~ ApprovM-~l~.V ~,~ , 195~* PerrmtNo D~sapproved a/c .. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.. 765-1803 (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Budding 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 glvmg a detailed descrlptmn of layout of property must be drawn on the diagram which is part of this appli; catson. e. The work covered by tins application may not be commenced before issuance of Building Permit d. Upon approval of this apphcation, the Building Inspector will issued a Budding Permit to the apphcant Such permit shall be kept on the premises avadable for inspection throughout the work· e. No budding shall 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 Bmlding 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 demohtaon, as hereto described. The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m budding for necessary inspechons ,~ r, /')~ (Slgj~re- of apph(.,.a/nt, or name, if a corporatmnj (Malhng address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. b Name of owner of premises ~,.Jcs> ]-/A/ d, /thtd~' ,~.-~ ..................... (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No ~ Plumber's L~cense No Electrician's L~cense No .~ff-a--aw~1 Other Trade's License No Locahon of land on which proposed work will be done House Number Street County Tax Map No 1000 Sectmn Hamlet Block (~. .. . Lot ~.2.67 Subd~v~smn (Nain~) ..... Fried Map No .. Lot .. . State existing use and occupancy of premises and intended use and occupancy of proposed construction a Ex~st~ng use and occupancy b. Intended use and occupancy ................... 3. Nature of work (check which applicable) New Budding ..... Addtt~on ...... Alteration Repmr ........ Removal ......... Demohhon ........ Other Work ....... (Descnpnon) 4. Est~matedCost ?q/./~.~<9 ...................... Fee ............................ ' (to be prod on fihng th~s apphcanon) 5. If dwelling, number of dwelling units ..... Number of dwelling umts on each floor ........... If garage, number of cars ................................................. 6 If bus~ness, commercial or mixed occupancy, specify natU/e and extent of each type of use .... ? ....... 7. Height .? "--"Number°fs°nes '-- Dnnension~o/ex~shngstructures, lfany Front :/.. . .l ? :t :..Rear .. '/-~ ...... Depth .c~. ....... · ............. i i.i.i Danensions of same structure with alterations or additions Front ./. ........... Rear Depth ~. ......... Height .. '::ff .......... Number of Stones .. ~. .............. ~- 8. Dunensions of entire new construction' Front ........ Rear ........... Depth ........ Height ........ Number of Stones ...... ._. ............................... 9. Slzeoflot. Front ..oq~.~.~ ....... Rear.. /5..c/.,.~'~. ..... Depth. ~....., ........... ................ 12 ...... 13. Wall lot be regraded . ~/(3 ........... Will excess fill be remove~from premises Yes N 14 Name of Owner of premises .-tP. bOt..~./~ /'{-4A$. Address .~7~'~ gfl.. ,g./~jrT~.l~.~./(Phone No. ~.~?.'7.~..~.,~'-'3~-- Name of Architect .................. Address ............ Phone No .......... Name of Contractor ................ Address .............. Phone No .......... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ...~.. *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all bufldmgs, whether existing or proposed, and indicate all set-back danensions fro~ property hnes Give street and block number or descnphon accordmg to deed, and show street names and indicate whetN interior or coruer lot. STATE OF NEW YORK, S.S COUNTY OF .. ............. being duly sworn, deposes and says that he ~s the apphcai (Name of md~wduaI s~gmng contract) above named He is the ................................... (Contractor, agent, corporate officer, etc ) of smd owner or owners, and is duly authorized to perform or have performed the smd work and to make and file th apphcat~on, that all statements contained m this application are true to the best ofhm knowledge and behef, and that tt work will be performed m the manner set forth m the apphcatmn filed therewith. Sworn to before me this .. ./~. ..... , .day of. . . ~ ...... 19..~. Notary Pubhc, . ~ ..~'...h?..~.~.g. County ~. 4~/W~ ~ ~/~'~ L/ (Signature of apphcan