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HomeMy WebLinkAbout15287-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bulldmng Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17897 Date MARCH 29f 1989 THIS CERTIFIES that the bulldmng. Location of Property. 13175 MAIN ROAD House No. County Tax Map No. 1000 Sectmon 140 S~bdmvlslon ALTERATION MATTITUCK Street Hamlet Block 03 Lot 38 Fmled Map No. Lot No. conforms substantially to the Appllcatmon for Building Permit heretofore fmled in this office dated SEPT. 5, 1986 pursuant to which Building Permit No. 15287Z dated SEPT. 20~ 1986 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate Ks issued is ALTER EXISTING BUILDING. The certificate ms issued to ROBERT & CORNELIA WADDINGTON (owner, X~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING SLIP 3/29/89 PLUMBERS CERTIFICATION DA'rE~ N/A Bumldlng Inspector Rev. 1/81 TOW'H OF SOUTHOLD BUILDliqG DEPARTM, EIqT TOWN HALL SOUTHOLD, iq. Y, BUILDING PERJ'AIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15287 Z Permlss,on ~s hereby granted to' .... ........ ....~.~.~,....~ ................... · ~~ . County Tax Map No 1000 Sect,on ..I ~...~.. Block ..... .(~J....~. ..... Lot No......~...~ ........ ~ursuon, to ~pphcot,on aot~ ~~ ~ .... , 19~b, ond opprov~ by the Budding Inspector. Building Inspector Re~ 6/30/80 BLDG DEPT. L. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 Instructions A This spphcat~on must be filled in Wpewmter OR ink, and submitted ,~ ~=~==~ to the Building Inspec- tor with the following, for new buildings or new use: 1 Final survev of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water suppIv and sewerage dmposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwmters. 4. Commercial buddings, Industrial buddings, Multiple Remdences and similar buddings and installa* tions, a certificate of Code compimnce from the Architect or Engineer responmble for the building. 5 Submit Planmng Board approval of completed s~te plan requirements where applicable. B. For existing buddings (poor to April 1957), Non-conforming uses, or buildings and "pre-exmting" land uses' 1. Accurate survey of p~operty showing all property hoes, streets, buddings and unusual natural or topo§raph~c features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings 3. Date of any housing code or safetv tospect~on of buddings or premmes, or other pertinent tnforma- t~on required to prepare a cert~fmate. C. Fees' Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certlficate of occupancy New Dwellzng $25.00, Accessory ,$]0.00 Buszness $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 3. Copy of certCmate of occupancy $ 5.00, over 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 NewConstruction ...... Old or Pre-exlstlng Building . Locat,on of Property ........................ O0 5 years $]0.00 Date ...///.~?/~..~..~'~? ....... .... Vacant Lahd ............. .......... Street ~.~. H. ~. . ler Owner or Owners of Property .... ~. ......... County Tax Map No. 1000 Sect,on ...(4¢ .... Block .... ~ ....... Lot... ~. (~. ........ Subd~wmon ...................... Fded Map No ........ Lot No ........... Permit No ........ Date of Permit ......... Apphcant .................................. Health Dept. Approval ...................... Labor Oept Approval ........................ Underwmters Approval ........................ Planmng Board Approval ...................... Request for Temporam/Certificate ................. ~/j..Final Certificate .... ~ ............. Fee Subm,t ed $ .. Construction on above described budding and per~X~f~ts all apptlcable codes and regulations. Appheant...~/~..':" .~,~r'~ .... ~ ................... Rev 10 10-78 F1ELD I~S['E~TION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ~DDITION~L COMMENTS: ~ ~,~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~--- E5 JOHN STREET, NEW YORK. NEW YORK 10038 Date ~R(~ THIS CE~IFIES THAT IE I h'O RENI~L, ~ examin~ on andfound to be in compliunce with the requirements of this ~rd. RXTURE RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUO~EF~-'~NT OTHE~ SERVICE DISCONNECT S E R MOTORS:I--I C 7~55 MAIN RO~D I. [C.#78L~; E This certificate nmi not be olter~d in any manner; return to the office of the Board if incorrect. Inspectors may be identifi~cl by their COPY FQI~ BUILDIHG DEPARTMENT. THIS COPY OF CERTIFICATE MUST HOT BE ALTERED IN ANY MAH~ER. Disapproved a/c .... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL: 765-1802 , , I9~¢ Permxt No l ,~,¢~-./..a~. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely f'flled m by typewriter or in mk and submitted to the Building Inspector, wltl sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing location of lot and of buridmgs on premises, relationship to adjolnmg premises or public stre. or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this ap: catton. c. The work covered by ttus apphcatlon may not be commenced before issuance of Buridmg Permit d Upon approval of this apphcatlon, the Building Inspector will issued a Bufldmg Permit to the applicant. Such pen, shall be kept on the premises avariable for inspection throughout the work e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. / APPLICATION IS HEREBY MA~DE to the Bufldmg Department for the iss~anp/e o~ Bmldmg Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New Yorl~ndffiher applicable Laws, Ordinances Regulations, for the construction of bufldmgs, additions or alterations, or fo)-~Ffno;(~l or demolition, as herem descr/b, The apphcant agrees to comply .with all apphcable laws, ordinances, bufldtr~fodg(/housmg co~, and regulations, and admit authorized mspectors on premises and m bufldmg for necessary '.'.'.'.'. ''' Calling adare ~s~' ;~' &~lzcan[5 ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build. 8 u.~ a ~/~ APPROVED A~ ~v~/) ¢ (as on the taX~ollffi~g~ates~aeed) .BY' }/' ~ .~' If apphca~ a~tmnl~,a orporatlo 1 nat e of duly thqnzed officer ~OTl~t BUILDING DE~RTMfilqT AT ]/ //(N~me and t~tle of co~/~alte officer) r-~l~ ~O0~EO ,~.ONCRETE Buflder's L_~9~si Nt~g_ ;-e/a... 2,,- i,;~ ·. · ~ tea.~ULA~tOr~ ' Electrician's License. I~ t ~ 1 ~'~. ~-' ~ ~r.,, THI~ R£OUIREMENT$ j_~ ~,. ,,. ,j- .- . '" ' ,'~rATE cONSTRUCllON & ENL~tiY Other Trade's L,cens~-. o. tc .... ' ..... COO~, ,OT ~sm~S__~-_~..m2........ Location of land on which pro'posed work will be done· House Number Street County Tax Map No 1000 Section ~. / 7.~ Hamlet ..e .... Lot. - Subdivision Fried Map No. Lot (Name) a. Existing use and occupancy .State existing use and occupancy of//~]~/p;?lses and lntended/use/~l/__,~___..and occupancy of..proposed construction b. Intended use and occupancy .... .~..~-- ........... . ~. a" ," 3. Nature of work (check which applicable). New Budding Addition ...... Alteration . Repmr ....... Removal ........... Demolition ...-'~- .. Other Work.. ,~ (Description) 4. Estimated Cost ...~r.~©..C-)r.--- ............. Fee ............................... (to be pad on filing thru application) 5. If dwelling, number of dwelling umts ........ Number of dwelling units on each floor ............ If garage, number of cars ......................................................... 6 If business, commerczal or m~xed occupancy, specify nature and extent of each type of use ............... 7 Dnnenmons of existing structures, if any. Front ....... Rear ........... Depth... Height ...... Number of Stones ........ Dimensions of same structure w,th alterations or addmons Front .............. Rear ............ Depth .............. Height ..... Number of Stones ........ 8. D~rnenslons of entzre new construction Front .... Rear ........... Depth Hezght ........... Number of Stones 9 S~ze of lot Front ....... Rear .............. Depth ............. 10. Date of Purchase ............... Name of Former Owner ................... I 1 Zone or use dmtnct in which premises are situated ........ 12. Does proposed construction violate any zomng law, ordinance or regulation ..... 13. Will lot be regraded ........... Will excess fill be removed from premises. Yes 14. Name of Owner of premises ............ Address ........... Phone No .......... Name of Architect . .. Address ............. Phone No ...... Name of Contractor ..... Address ................ Phone No .......... 15. Is this property located withinl00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and chst~nctly all bufldmgs, whether ex~stmg or proposed, and, indicate all set-back dLmenslons fro property imes Give street and block number or descnphon according to deed, and4how street names and md~cate wheth interior or comer lot STATE OF NEW YORK, S S COU1XrFYOF, . . ..~ ~ · .... (Name of ~n&vldual slgmng contract) above named He is the .... (Contractor, of said owner or owners, and m duly authorized to perform or have performed the work and to make and file tl apphcation, that all statements contained m this application are tree to the best knowledge and behef, and that t work wall be performed ~n the manner set forth in the apphcatmn filed therewith Sworn to before me thru Notary Pubhc,.. ~...~..~...~.l~...~.~-~. ..... County IiOt~ ~ a~s V~ .... //' ] (Signature of apphca, / '4) k%//q ~ £~ 1,'v' L5 7'0/',/ BLDG DEPT TOWN OF SOUTHOLD C/6. 6,3