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Home My WebLink About14912-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. zl. 5075 Date November 7, 86 THIS CERTIFIES that the building .... .D,e.c,k. ....................................... LocationofProperty 6.4..0 .M.a.y.f.l.o.w..e.r .R.d.:. Mattituck House No. Street Ham/et County Tax Map No. 1000 Section 107 .... Block 08 Lot .2.6 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... /~i~tZz..], 6 ........... 19..8.6pursuant to which Building Permit No.1.4.9.1,2. ~. ............... dated .M.a.y.. ,2.3 ..................... 19.8..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 ......... Deck a.d.d, ition to an existing one f.amily dwelling. The certificate is issued to ARNOLD BLAIR AND KAREN BLAIR {owner, of the aforesaid building. Suffolk County Department of Health Approval ......... ~/.% ............................. UNDERWRITERS CERTIFICATE NO ,N/ Rev. 1/81 I~OEM NO. ~ TOWN OF $OUT~OL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N'.) 14912 Z Date ..................... ...~~ ..~....,~... ............ , 19.~...~. Permission is hereby grant~ to' ~ ~ ~ ~ ~.' n~ ~ , ~ ~_ , ~ ..................... ~.....~ .......... ~.~.~..~.~ ..................................................... .G..~.~ ...... ,.....~.., ...... 1....3..~..~ ...... ,o .~...~...~..~~.~....~...~ ............. . ..~.~....~.~.~...~...~....~d...~., .................. ~ .................. ........ ........... County Tax Map No. lO00 Section ..... J....O....-). ........ Block ..... .~.~ ........Lot No...~../~:3 ............ pursuon, to ,application dated ........ ..~..~..L.~. .................... , 1'.~.~., and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Ha~l Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in 'b/pewriter OR ink, and submitted ~a ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Fina[ 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 d|sposal--{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 the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings iprior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pz~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 bu ildings. 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~. !.~.~ 5.Updated C.O. $15.00 Date .... !\. ~9 .............. New Cons truction ...... Old or Pre-existing Bui{d{ng ............ Vacant Land ............. Location of Property q .~. 9 .W~. ~. ............. .~ ~ ~.- House No. Street Ham/et Owner or Owners of Property ........................................... County Tax Map No. 1000 Section .~,q~..~.. ....... Block ...0..~..L~, ....... Lot..t~ .?~.~...t~.. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .......... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .............................. Constructmn on above descmbed budding and per codes and regulations, Applicant Y.~~'c~' . ~ ...... ~ ............................. ~.6. 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION ZND []INSULATION []FINAL DATE INSPECTOR %d~9, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18(32 Examined ................. 19... Approved ................. 19... Pennit No ............ Rece±ved ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 Connty, 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~inspections. ,~~ ~(Signatureo appican,orna e,' p ' ~ ........ ............. . Y (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~.~..o/~...~./~{.~., p... ~..F.~..~-:.. ~ ./~../.f.. ................................. (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 No .......................... 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 Number -- Street Hamlet County Tax Map No. 1000 Section ..... /..~..~. ........ Block ~ Lot -7-~ 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 ..... ~../'/?...~,../~.... ~..~/t~./7~ ./..~.. ................ b. Intended use and occupancy i~'t?~......~...,.'.~.~. ~.~..~:. .......... ~ .............. 3. Nature 6fwork (check which applicable): New Building .......... Addition .. ........ Alteration ~ .... .... Repair .............. Removal .............. Demolition ........... ... Other Work...2~.. · · ~... i (Description) 4. Estimated Cost ...................................... Fee .......... ~ ........................... (to be ~aid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage, number of cars ............................................ i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front 157.~e. ~.~..t?.~..-~.. Rear ....... i ....... Depth ............... Height ............... Number of Stories ............................ ~ ........................... Dimensions of same structure with alterations or additions: Front ............ ! .....Rear .................. Depth ...................... Height ..... z~. · .;- ........... Number of iStories ...................... 8. Dimensions of entire new construction' Front ~.q6- ~.~r,-' .~.. , ........... Rear ........ i ....... Depth ............... Height , Number of Stories ...... ~ ........ 9. Size of lot' Front l~.e~ .~.?.f~/~'"7 Rear ......... . ...... ' .................... 1 1. Zone or use district in whicfi premises are situated .... 4t.'. 73:~*~ ?tt .*-. / ! ........... ' ' ' ' 1 2. Does proposed construction violajle any zoning law, ordinance or regulation':' j 2 J~ J J J J J J i J i J i J i J '" 13. Will lot be regraded ....... ~ ................... Will exces~ f~ be remc~ved from premises: Yes 14. Name of Owner of premises dt~e{~'.~.~5.afe~. ~/,,~..f... Address ~.}f..7~.~.~.~.~[. Phone No.'gt~z YlE.~- .d~..:.~.~. Name of Architect ........................... Address ............... [... Phone No ................ Name of Contractor .......................... Address ............... i · · · Phone No ................ 15. Is this property located withinl~00 feet of a tidal wetland? * yes ..... No ...~'~.. · If yes, Southold Town Trustees 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 corner lot. STATE OF NEW YOR, I~//_ COUNTY OF77 . s.s .....-- ">'-- .,~.,~/~"*'.. ff.,..~'~'"'..ff.~. t.~...~--r..----..~...-~:~w.. ........ being duly sworn, deposes and says that he is the~ applicant (Name of individual signing contract) above named. He is the ..... (C ' )i ontractor, agent, corporate officer, etc. of said owner or owners, and is duly authorized to perform or have performed the shid work and to make and file this application; that all statements contained in this application are true to the best of h~siknowledge and behef; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of.. (. 5..~'XS~.,. ............ 19 Notary Public,z~.~~~"~ t' County '~'~' ~ ' '~ (Signature of applicant)