HomeMy WebLinkAbout15555-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No, Z15758 Date May 18, 1987
THIS CERTIFIES that the buildkng Addition to accessory
8500 SOUND AVENUE MATTITUCK
Location of Property/2/~ ~ h/o .........................................................
s . Street Hamlet
County Tax Map No. 1000 Section 12 I .Block 05 .... Lot 4. 1
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
D e c. 3, I 986 pursuant to which Building Permit No. 15555 Z
dated D.e.c. :..8.,.. ! .9 .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 is .........
Accessory addition to an existing accessory building.
The certificate is issued to MICHAEL ADAMOWICZ
..................... .................
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
N/A
UNDERWRITERS CERTIFICATE NO ..................................................
PLUMBERS CERTIFICATION DATED:
N/A
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.o 15555,z
Permission is hereby granted to: ~ -
......
....~..~......~.:..~.:....!.~.~.~:~. ............
County Tax Map No. 1000 Section .... ~....~...f ........... Block ...... .~..~.".. ...... Lot No......~..,..[ ............
pursuant to application date~' i~......,.~., .......... , 19.,~,.,~.,, and approved by the
Building Inspector.
Fee $~...:..~.,
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 ~ ~ 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 Enginber responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate surveV of p~perty 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 New DwelIin§.$25.Q0, Accessory ,$I0.00 Business $50°00
2. Certificate of-occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date 3/17/87
NewConstruC f'ion ....... Old or Pre-existing Building ............ Vacant land .............
8500 Sound Avenue Mattituck, N.Y.
Location of Property ........................................................... ... .
House No. Street Ham/et
MICHAEL ADAMOWICZ
Owner or Owners of Property ............................................................
CountyTax Map No. 1000Section ..
............. Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
J .55.5..5 Zo it } .2/.8../.8.6App Ii Michael Adaraowic z
Permit No ...... ate of Perm .. · cant ..........................
NA
Health Dept. Approval ......... ~.A ............. Labor Dept. Approval ........................
NA NA
Underwriters Approval ........................ Planning Board Approval ......................
XX
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ 25. O0
Construction on' above described building and permit meet~?[ app~ica, b~le codes a~D,d r~tgulations. '
Rev. le-10-TB
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate of Occupancy because
of~.e following reasons.
(~)An application for Certificate of Occupancy is not on file.
)No Underwriters Certificate on file.
w/~The check is (*~/not on file.)
)No Health Department Approval on file.
)No final inspection has been made.
.Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # I ~ ,~ ~ $ . Z
)No Plumber Solder Certificate on file.
(all permits involving plumbing being issued after
April 1, 1984)
OUNDATION ( ls t)
OUNDATION (2nd)
OUGH FRAME &
PLUMBING
iNSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
- ADDITIONAL COMMENTS:
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate of Occupancy because
of/~e following reasens.
(~)An application for Certificate of Occupancy is not on file.
)No Underwriters Certificate on file.
u/~The check is (e~d/not on file.)~
)No Health Department Approval on file.
)No final inspection has been made.
.Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # I ~ _~,~._ ~ Z
)No Plumber Solder Certlf~cate on file.
(all permits involving plumbing being issued after
April 1, 1984)
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
gOUTHOLD, N.Y. 1'1971
. TEL.: 765-180:3
Approv~-~..~.., 19~.~>. Permit No. ) .~..'-.~.q.~ ~
Received ........... ,19...
Disapproved a/c ................................... .~.'/~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS~'~
Date~.~......~. ......... 19cftc
a. Tkis 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 premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building 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 Building 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 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 inspectionsTX, _ ,.~., ~
' ' ' i~i'g~l~it~r'e'(~~~lame, if a c~ '~
(mailing address or app±lcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder·
· .~'~ ' '* --.~..~~~'~.,~ ..... " .... .< .............................
Name of owner of premises., '~~deed)
If applicant is a corporation, signature of duly authorized officer·
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .............. - ...........
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..........
............................. ....... ....... .....................
House Number Street Hamlet
County Tax Map No. 1000 Section ...... (.~..! ........ Block ..... .5.~. .......... Lot....~.:/. ...........
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 .......... /3 ~ ..................................................
b. Intended use and occupancy ...... J~.L{. ( ...'T/?. ...................
3. Nature of work (check which applicable): New Building ... ' 'Addition ..... .?ff.,., Alteration ,..
Repair ......... ,~?.. Removal .............. Demolition .............. Other Work ...............
4. Estimated Cost ....................... Fee ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... ~ .... Number of tJ~elling units on each floor ................
If garage, number of cars .... i ......~. ~t0..]~,~ ~.~ ................................................
6. If business, commercial or mixed occupan~, ~pec~-f~°4 and extent of each type of use .............
7. Dimensions of existing structuJes, if any: Front .... ~ ....... Rear .... ~¢_,2~. ..... Depth ..,_:,:,:,:,:,:,:,:~. ,-~ ........
Helgh ...... ].~k ....... Number of Stones ...... ~.~ ............ ~ ~,. ~ ................ ~,..~ ............
Dimensions o~&a~ structure with alterations~ il~it~Fro~ .... .~, .o. .......... Rear..~.~, ............
Depth . .-~.-..w . Hei~ ~l~.]~d/'.~li%~.~.. Number of Stories ....... ~. .............
8. Dimensions of entire new constrtu~f0~;' ~ .... ,.~. ~1~... ~.~-. ........... Depth ...............
.eight .............. ............... ...........
9. ~;;Oof;;tu:rcF~:t ...... .~.(.~ ~ ~'~ar .~e~F.~o.r~r., ...... Depth. /./,.~:o...~-~. : .....
10. t' . .......... ,me, wrier .................
11. Zone oruse district in which prem~se~8 ~.l... [~\~.,'~ .... ~.~..~.~...o~.~.rT.~ ~(2~. ...................
12. Does proposed construction vi01at~h~ qlh~'~ljt~ .~.....X~r regulation: ...... /'(..~ ........... ./. ..........
13. Will lot be regraded ...... ...~ ...~ i~ 4 I'~?lt,~.~O.*.. Will excess fill be removed from premises: ryes -- NO./
14. Name of Owner of premises . )~.,.~ ~.~dress ....... d~&/~C?. ..... Phone No..~/.~....~[.~....~.
Name of Architect ................. i' ~ 7 ...... Address .......... ......... Phone No ........... . .....
Name of Contractor ........ : .....,O~4,~: ..... Address ................... Phone No ..... /t'ff~ .......
15. Is this property locate~ withinl,00 feet of a tidal wetland? * Yes ..... No ..
· If yes, Southold Town T~ustees Permit may be required.
~ PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all 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 comer lot.
~OTWY BO}LD{NG D~:P~Ite~41BNT, AT
FOUNL~A'r[oN 5~O
FOR ~OOR~O CONC~~F'~ ~ ,~ , ~ ,
STATE OF NEW YORK, S.S
COUNTY OF ................. .
........................... ~ ..................... being duly sworn, deposes and says that he is the applicant
(Name of individual si~ning contract)
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 cot}rained in this application are 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 this
............. 3 ......... day of ...... .~.. · .~. · ........, 19 .?.~.
Notary Public .... ,...',>-'~-~. ;."-:. ...................... County ~ e
I HELEN K. DE VOE ......................................
NOTARY PUgLIC, State of New Yol'k .... ~ ~of applicant)
No. 4707878, Suffolk Countyo '7
Term Expires Ma/ch 30,19 /, f