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Home My WebLink About14952-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15479 Date ...l~.amber..~ .................. 19 .8.6. THIS CERTIFIES that the building. Addition · Location of Property ..... ?.3.5. ~ .D,~.~.r,, ?a.t.h, .. : Matt ituck House. No. ' ' ' Street Hamlet~ County Tax Map No. 1000 Section ...1, 0 .6 ...... Block ... 10 L 2 8.3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... May. 2.7. .......... 19 .8.6. pursuant to which Building Permit No... 1..4.9.5.2. Z.. ~ .......... dated . .'...J.u.n~e.. 7 ................. 19 13.6., 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 ......... .... .n~g..~q~x.~.~o..~..~.q..~.~.~?.~. ~...~. 3.-?..~.~..~.~.zy...a...e.~. z..~.5~... ........... . ......... The certificate is issued to .....5.O.S.~.?..~..~.....a..C?.?O.~Z.~..~. ~,?..O.X.S.~...Z.~... ............... of the aforesaid building. Suffolk County Department of Health Approval .......... .~[.A. ............................ UNDERWRITERS CERTIFICATE NO .................. .~/.~. ............................ Building Inspector Rev. 1/81 FOuwr NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 149 2 Z Permission is hereby granted to: ..... ~' '-- '~ot premises Jocated at .....~...~..~.....-....~..~..~.~...~-~'~ *~ ....... ~.~.~.. .......................... County Tax Map No. 1000 Section ..,.1..?.....~,. ......... Block ...... I..(P. .......... Lot No.....~.:...'~ ..... pursuant to appJication dated ..... ...~~...~ ............... , '9~.~.., opprov~ by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted m ~aa 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 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 property 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 oc_cupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vaoant 0.0. 5.Updated C.O. 0~$15.00,_ Date ....... ~ .... NewC°nstructi°n ...... OIdorP~e-exist~ngBuHding., ........ ~. Vacant Land ............. / Location of Property ............... ~ ~/~ Owner or Owners of Property ............ . ........... C°u nty Tax Map N°. 1000 Section/~l :/~ ~'~ ~ Block Subdivisio~ ................................. Filed Map No ........... Lot No~~, .......... Health Dept. Approval ~. .................. Labor Dept, Approvat ,~ ................... Unde~riters Approval ~ ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... .~ .............. Fee Submitted $ ...... ,~', .... Construction on above described bu ildin,g-a~'~rmit meets all applicable codes anti--ions. FIE ?~D INS£~ECTION FOUNDATION {1st) C O~M E~'~ TS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: J FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1803 ..~ 19 ~ Permit No. j L~ C~ ~',~, .~ Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 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, bujldgog code, housing code, and regUJ[a.tjons, and to admit authorized inspectom on premises and in building for necessary i ons. .... ......... (~ature.,gf applicant, or, l~ame, if a~corporation) · ............... .. (mailing address/9~f app±ican State whether applicant is,~.wnq.~, lessee, agent, architect,' enmneer,~,' general contractor, elect~fcian,' plumber or builder' . .... O..~.~.4' .,&.../... ~_'~u. zz_.z:>..z'...,~..-.. ~ ...................................................... Name of owner of pre~nises .'~..t~.,?.~: .~../L/....~'/...' ,~....~.,/.,~..Z,{......~. [~..,, ................................. (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.. ~.~.x~. ............. ? Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be/4~ne ................................................... ............. .......... ....... ". ......... House Number Street Hamlet County Tax .Map No. 1000 Section ~../.~.~.. Block ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................. b. Intended use and occupancy ...~.~. ~ .... 'D .~_o.~].~ ............................................. 3. Na!tfire ofwork (check which applicable): New Building ... ....... Addition .......... Alteratit~n .......... R~?hir ......... ~ .... l~enioval .............. ' Demolition ............. Other Work ............... _ ~ p~.', ' ~ ? 'r ...... (to be paid on filing this application) 5 If dwelli tuber of dwelling ~t Numb r of dwelling units on each floor If garage, number of cars .... ~ .................................................................... 6. If business, commercial or mixed occupancy, specify nature ~d extent of each type of use .... ~; .............. 7 Dimen io s of exi ti g stmgtu~es jf any Front '- Rear Depth Height...............~. NumberofSto~es...n-} ................................................... ,D~ensions of same structure ~ith alterations or additions: Front .. ~' Rear Depth ................... ... HeiSt .......... ./ ............ Number of Stories ............ t ......... 8. Dimensions of entire new construction: Front.. ~f~ ......... Rear .... ~.~. ...... Depth . ~.( .......... ,,mght .............. Number o Stone ....................................................... 9. Size of lot: Front .... [~. ............ Rear, .Z~ ................. Depth ~ .............. 10. Date of Purchase ../.~./~ .............. .Name of Fo~er Owner Z~,~,..~a*~5 ......... 11. Zone or use district in which Premises are situated, . ~Ti ~...' ............................. 12. Does proposed constr~ction vi61ate, aCy zoning law, ordinance or regulation: ... ~ .................... 13. Will lot be regraded ...... ,,..i..~, .~. ..... ~.. Will ex.ss fill bx removed from premises: Yes__ Nme of Architect ....... ~.~ .............. Address .......... Phone No ................ N~e of Contractor ..... ~ .................. Address ................... Phone~ a ........... 15. Is this property located; ~ithin 1,00 feet of a tidal wetland~ * Yes .... { N~ .... · If yos, SouChold To~ Trustees Permit maybe required. 2 [ , PLOT DIAGRAM Locate, clealy ~d distinctly al bufld~gs, whether existing or proposed, ~d, indicate all set-back d~ensions from property ~nes. Give street and block number or description accord~g to deed, ~d show street nines ~d indicate whe~er integor or corner lot. STATE OF NEW YORJ¢, COU.N. TY OF ...... .. ~9~f~ ~4~..~ .................. being ~uly'~w'orn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the ................................... . .................... ........ ~ ......... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dully autho~zed to perform or have performed the said work and to m~e and file this application; that all statements conlained h this application are true to the best of his knowledge-and belief; and that the' work will be perfomed in the m~ncr set forth in the application filed therewith. Sworn to before me this ........... ~ .~ ....... day o~.. ~/ ............ 19~ Notm~ Public, . ............... , ~ ~'~ (Si~ure of applicant) "MILLERs' R/ght of Way ' -r f.°r erly oOW ; ~IfOl~ ~.set (_..Test ~'' 00' sand grave/ ....... HFALTH DEPARTMENT- DATA FOR APPROVAL, TO CONSTRUCT a = MONUMEN~ SURVEY FOR dOSEPH B, MO/SA, dR, 8 CATHERINE' MO/SA ~T M,~TTITUCK O,~T~ : :.N. OK $~ 1979 TOWN OF SOUTHOLD SCALE, /%50' SUFFOLK COUNTY, NEW YORK NO su~v~ ~s ~ WOL~rm. O~ sr. cr~o. z~o9 o¢ ~ND I_~ND SURVEYOR N,~S,LICENSE.NO, 12845 . V HOWARD W YOUNG, LAND.~URV~YO~. F.