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Home My WebLink About15221-zFORM NO. 4 TOWN OF SOUTHOI~ BUILDING DEPARTMENT Offlce of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17118 Date OTJLY 27~ 1988 THIS CERTIFIES that the bulldln~ Location of Propert~ 365 FREEMAN ROAD House No. Street County Tax Map No. 1000 Section 139 Block 03 Lot 38 Subd~vzslon Filed Map No. Lot No. ADDITION MATTITUCK Hamlet conforms substantzall¥ to the Application for Building Permit heretofore flled in this office dated AUG. 12~ 1986 pursuant to which Building Permit No. 15221Z dated AUG. 26r 1986 was issued, and conforms to all of the requirements of the applicable provlsmons of the law. The occupancy for which this certificate ms zssued is DECK ADDITION TO AN EXISTING ONE FAMILY DW~,T,ING. The certificate ms mssued to THOMAS AND ~r~¥,mN FOX (owner, of the aforesazd building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Bulldmng Inspector FO~ NO. · TOWN OF $OUTHOL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERM;T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Of THE WORK AUTHORIZED) 15221 Z ~a~e ~....'~....~..~ .......... , Permission is hereby granted to~ ~.~.~.~..~....~ ............ ..~..~..¢?..~ ~ ..... ~.¥. .......... ~.~r~.....~ .¥.,....u. ~...r....~. ................. at premises located at ...~..~..~.,..,.,~.~: ................... ~.~~r~ .................... Counh/ Tax Map No 1000 Sect,on to application dated pursuant Building Inspector - ,..., 19..~./c~, and approved by the Building Inspector Rev 6/30780 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 typewmter OR ~nk, and submitted m ~ to the Budding Inspec- tor w~th the following; for new buildings or new use 1. Final survey of property with accurate location of all buildings, property lines, streets, and ,tqusua] natural or topographm features. 2. Final approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal). 3. Approval of electrmal ~nstallat~on from Board of Fire Underwmters. 4. Commercial buddings, Industrml buddings, Multiple Residences and simdar buildings and installa- tions, a certificate of Code compliance from the Architect or Eng,neer responmble for the building. 5. Submit Planning Board approval of completed rote plan requirements where applicable. B. For exmt~ng buddings (prior to Aprd 1957}, Non-conforming uses, or buddings and "pre-ex~sting" land uses: 1. Accurate survey of property showing all property hnes, streets, buddings and unusual natural or topographic features. 2Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buddings or premmes, or other pertinent mforma~ t~on required to prepare a certificate. C. Fees: Additions $25.00 1 Certificate of occupancv New Dwellzng $25.00, Accessory ,$~0.00 Bus,ness $50.00 2 Certificate of occupancy on pre-existing dwelhng $ 5 0.0 0 3. Copy of cert~hcate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 ~ ~ 5.updated C.O. $ 50.00 Date .... ?. 7 ....... NewConstructzon .... Old or Pre-ex~stmg Budding ......... Vacant Land ............. Location of Property ..................... ~ ............ House No. Street H. ~mlet Owner or Owners of Property .~:~ .~.. ~.. ~..~ ............................... County Tax Map No. 1000 Sect,on .... /. ~.. ?. ..... Block .... ~. ~. ....... Lot ..... ~.~' ........ · Subdwmlon ...................... Fded Map No .. -~..?.?..Lot No ............. PermltNo. /~..~.'~.~' Date of Permlt ~,~,; ,/,~.~Apphcant ~.,/,~f~,,~./~,~/~,~,/f, .~,,o~, ......... Health Dept Approval ...................... Labor Dept Approval ........................ Underwmters Approval ...................... P%anmng Board Approval ..................... Request for Temporary Certificate .............. Final Cert~hcate ....................... Fee Submitted $ ........................ Construction on above descmbed budding anc~ p~r~m~t meets all apphcable codes and regulations Rev 10 10-71~ b lELD I SFFCT COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING STATE ENERGY ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ["~AL REMARKS: DATE ,,INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] [ ] FOUNDATION ZND [ ] [ ] FRAMING REMARKS: ~, (~""'- ROUGH PLBG. INSULATION ~I~'INAL DATE Conditions if anyA suitable retain~nq wall 'to be g~h~gu~d~oTcomm~ at the retaining wall located on Lot 44 and to extend in an easterly direction parallel to the street line and that all fill be placed in area south o£ the retaining wall. Expiration Date Number of Inspections Required Inspection Fees Liability Policies in the Amount of The validity of this permit is or may be subject to the approval of other governmental or municipal authorities. The Town accepts no responsibility in applying for or obtaining such approval. In the event that such approval is necessary, the holder of this permit shall not commence operations hereunder until such approval has beer obtained in writing. The failure to obtain such other approval whez required shall subject this permit to immediate revocation by the Town Clerk upon receipt by the Town Clerk of written notice from su~ other governmental or municipal authorities of its refusal or disapi The applicant does by the acceptance of th~s permit, assume all responsibility for gperations undertaken pursuant to this permit, and shall take all precautions for the prevention of injuries to persons and property resulting from such operations. By such acceptance, the applicant also agrees to indemnify and save harm- less the Town, and its officers, agents and employees from any and all claims arising ~rom operations under this permit a~d any and all acts or omissions of applicant, his agent and employees. The applicant and the owner and occupants of the premises upon whic~ the operations authorized by this permit are being conducted, do, by the acceptance of this permit, give consent to the Town, and its officers and employees to enter upon the premises where such opera- tions are being conducted to make such ~nspect~ons as the Town may deem necessary to insure that such operations are being conducted in conformity with this permit. This operation will not substantially: A. Adversely affect the wetlands of the town. B. Cause damage from erosion, turbidity or siltation. C. Cause saltwater intrusion into the fresh water resources of the town. D. Adversely affect f~sh, shellfish or other beneficial marin organisms, aquatic wildlife and vegetation or the natura habitat thereof. E. Increase the dan~er of flood and storm-tide damage. F. Adversely affect navigation on tidal waters or the tidal flow of the t~dal waters of the town. G. Change the course of any channel or the natural movement or flow of any waters. Weaken or undermine the lateral support of other lands in the vicinity. I. Otherwise adversely affect the health, safety and general welfare of the people of the town. SEAL T~wn Clerk, Town of ~o Date August 7, 1979 ToWN OF SOUTHOLD TOWN CLERK' S OFFICE S OUTHOLD, N.Y. WETLANDS PERMIT This Wetlands Permit ~ 26 has been granted by the Southold Town Board according to information furnished in Application ~ 38 filed by Applicant Thomas E. Fox on May 1 19 79 be kept on file in the Town Clerk's number given. A map of the proposed work will Office under the application Permit granted to do the following work fill in back yard (marsh area) Location of property on which work to be done 365 Freeman Road, Mattituck, New York Creek, Bay or Harbor fronting property 3 ft. over flow ditch (LILCO) 38 Size of work: marsh land from property Length 17 ft. west side, 14 ft. east side Width 100 ft. Height Above High Water 3½ ft. Depth Below Low Water none Yards to be Excavated none Yards to be Filled~, Manner in which material is to be 200 sq. yds. removed or deposited Intended use of propert~ Residential Exammed~A**'~r' Approved C~ Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N Y. 11971 TEL.: 765-1802 , d}~ , 19~ Permit No [ ~l ~ (Building Inspector) APPLICATION FOR BUILDING PERMI'[ tgLDG DEPT TOWN OF 50UTHOLD Recezved ........... ,19.. Date~.c' 2 / ~'' , 19~-- INSTRUCTIONS a. Ttus apphcatlon must be completely filled m by typewriter or m ink and submitted to the Buddmg Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showmg location of lot and of buddings on premises, relationship to adjoining premises or pubhc stre. or areas, and g~vmg a detmled descnptmn of layout of property must be drawn on the dmgram which ~s part of ttus app cation c. The work covered by flus apphcahon may not be commenced before issuance of Budding Permit d Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant Such peru shall be kept on the premises available for mspectlon throughout the work. e. No bmldmg shall be occupied or used in whole or in part for any purpose whatever until a Cerhficate of Occupan, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the ~ssuance of a Bmlding Permit pursuant to t Bmlding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws. Ordinances Regulations, for the construction of buddings, addmons or alterations, or for removal or demohtmn, as hereto describe The applicant agrees to comply with all apphcable laws, ordmances, budding code, housing code, and regulatmns, and admit authorized inspectors on premises and in bmldmg for neces~/.~.~pectlons (Slgnatur~c, of apphcant, or,~me,ff a corporation) · ........ "F adaress 'of State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or buflde Name of owner of premises (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 N6 . ~ff4x>'w. g4.~ Plumber's License No Electrician's License No Other Trade's License No 1. Location of land on which proposed work will be done House Nmnber Street County Tax Map No 1000 Section [,-~ 2 Block Hamlet .. . Lot . ..~. 3f Subdivision Filed Map No ff'7~7 Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy /"/oq S £ ........ b.. Intended use and occupancy .0e,C~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .. ............. Demolition ............. Other Work... ~.~.~..~... (Description) 4 Estimated Cost ' Fee (to be paid on ~ing this application) $. If dwelling, number 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 .... . ................ ?. Dimensions of existing structures, if any: Front '. .............. Rear .... ........... Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimension~ of enow construction: Front ............... Rear ........... Height ......... --;,~... Number of Stories ............................. ~ i i i' Depth .............. 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Ownar ............................. 1 1. Zone or use district in which premises are situated. ,~ "' 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .. ~(~ ............. 13. Will lot be regraded ...,. ~/.~? ..................... Will excess fill be removed from p_remi~.. ~c, Yes -.~ 14. Name of Owner of prem~ .................... Address ................... Phofie No ....... ". ........ Name of Architect ........................... Address ................... Phone ~No.~ .............. Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property located withinl~0 feet of a tidal wetland? * Yes ..~... No ..... · If yes, Southold Tovm Trustees Permit may be required. ,- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate an set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ~ ing d ly appli ................................................. be u sworn, deposes and says that he is the cant {Name of individual signing contract) _- .. above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or o.wners, and is duly authorized to perform or have performed the said work and to make and file this application; tha~ all~st~a~uems ~contalned in this appli~t~o~ ar~ true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me'th/s,. ........... /4 ....... ~ .day of ..... ~ ........... 19 .~. ..... County (Signature of applicant)