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Home My WebLink About14971-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15111 Date . . November 19 THIS CERTIFIES that thc building One family dwelling l.ncat~^.of~ .... r+. 1055 MARRATOOKA~LANE MATTITUCK . ............ v~ ~;, A'~,s~ ~oi ....................... street Ham/e: County Tax Map No. I000 Section ... ~.2~j ..... Block ...... 3. ........ lot , 14 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~1~-7..2.9 .......... 19.8..6pursuant to which Building Permit No...1.4.9.7..1.Z ............. dated June 10 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 ......... One family dwellinq. The certificate is issued to EDRICA MC CORMACK of the aforesaid building. Suffolk County Department of Health Approval ....... ~ fi:-.S. Qr 9.3 .......................... N774388 UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATE dated NovembeF 20, ~986 /? Rev. 1/81 86 1~01~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 14971 Z County Tax Map No, 1000 Section .... Z.?..~.. ...... Block ....~......~.... ......... Lot No.O./...~-. ........ pursuant ,o application dated ..... ...~ ...... ~'..~.. .................. , lC~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 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 featu res. -- 2, Final approval of Health Dept. of water supply and sewerage disposai--{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 (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 NewConstruc tion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~/~.....-/f~-~......~'/~,. ~/~..'~. · .~..~. · .~. · .~-. Street Ham/et Owner or Owners of Property ...~---,-~.~ .~-.~.... ~. ,~6~(~43-,C--~C~ ......................... CountyTax Map No. 1000Section t~,~ Block ~ Lot .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit !.~.~.~,l., ,App[icant .~. ~,."~.... ~.~.~(~.~.'~Y..'~.. ......... Health Dept. Approval ...~0.~.~-~ ............. Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ .............. Fee Submitted $...,~.~ ....................... Construction on above described building and permit meets~i~ applicable codes and regulations. ~,~ //", App,icant .... ~.~. - · L~ ........................ 765-1802 BUILDING DEPT. SPECTION [ ]~FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FRAMING REMARKS: [ ] FOUNDATION 2ND [ ] INSULATION [ ] FINAL DATE INSPECTOR /~¢ 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL DATE ~/~ ~INSPECTOR 7GS-1802 BUILDING DEPT. INSPECTION ~ /~OUNDATION ~ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS:, [ ] FINAL DATE,, ~//~-/~ ¢ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: [ ] FOUNDATION XST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FINAL looo] .l THE NEW YORK BQARD OF FIRE UNDERWRITERS [~C~. BUREAU OF ELECTRICITY Octo'bor ] 5, ] ~JOHN STREET, NEW YORK, NEW'YORK 10038 THtS CERTtFIES THAT o~y the electrical Hulpment ~ ~scrlbed below and introduced by t~ appl~ant ~ed on zhe a~ve application n.mber in ~he prem~es of Edrica McCormack~ Bungalow Lane, Mattituck, New York i. th~ fo~o~i~g Ioc~tion: ~ ~asement ~ t s~ FL ~ ~nd FL Sec~hm Bl~k Lot ~s exarnlned on OCt abe r 9,19 8 6 and found to be in compliance u'ith the requirements ef this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORE~CENT 3O 30 DRYERS TIME CLOCKS SYSTEMS DIMMERS NO. OF FEET OTHER APPARATUS: Motors-] -]H.P. G.F.C.I.-3, Smoke Detector-1 S E R NO OF CC COND] 1 2/0 C NO OF HI-LEG 2/o Paul Burns 275 Town Harbor Lane Southold, N.Y., 1197:1 lic.#252B GENERAL MANAGER Per ~,, t':~ This certificate must not be altered in any manner; return to the office o{ the Bobrd j{ incorrect. )nspectors may be identified by their credentials, COPY FOR 6UjLDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST'NOT BE AL'~ERED N ANY i'~HNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO. l~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~ (plUmber, s~'g~a~ur~e) sworn to before me this ~ 19~. Notary Publi~ Notary Public ,~~nty INS P. ECT i-gN DATE COMMENTS FOUNDATION (1 st)~~~ '~'- ROUGH FRAME & __ ,, ~ ~ '~/~ FINAL ~ .~ ~ ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL P, OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined M'..O~..~'./..O. .... ,19 .~ , Approved ~t ./~..~.. IlO ...... 19~.. Permit N~...~.~...~..~.(/ Disapproved a/c .......................... //. .... /~y/ ................... ......... : ..... (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 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, housj~ cod% and regulations, and to admit authorized inspectors on premises and in building for necessary inspectio .n..~.. ~ [~ (Signature of applicant, or name,~/ffa corporation) ..--"~aT..~-~..t~bx&...h~..:q..o-.. ............ ...~s..~-v~--- ~.~- //z?,-~ State whether applicant is owner, lessee, agent, architect, engineer, e~~tectrician, plumber or builder. ..... .............................................................. Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If a~pliqant is a~orpor~tion, signature of duly authorized officer· . t5. . ...... "'~'" "' '(k'am~ and titl'e~f 'c~gr'ai4 ~}~i~r')' ' Builder's License No .......................... Plumber's License No.~.,.~. ~T'. (.~t~./~. ~J~..(--. · .--.. Electrician'sLicenseNo.{>~.~-~Og.~..~.. Other Trade's License No ...................... Loca, t~n_~d~which proposed work will be done. e/~. .... ~.0..~..~.~/.e. ~gfi'~)....~.~./~.~r'..;./~ .~. ~..' n~l;~ .... Street /:la let Count, Tax ~ap No. 1000 Section .Iata ............. Block. 3 ............... Lot..re.' .............. 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[b{G~. .l"D.~. . .o.~. . ~.~,q~.~.~ .T".O. ~.~. ..~.~,.~,,, OL.t~'.~g~M2~ .,'.~. .l(_ff.~ ~.ll~. . b. Intended use and occupancy .. ~.~. ~W (ql...U~*~...~.?¢~~ ............ 3. Nature of Work (check which applicable): New Building '2 ...... 'Addition .......... Alteration .......... Repair .............. Removal . ~ .......... Demolition .~ ........... Other Work ............ ......................... . ..... (to be paid on filing this application) 5.If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars . .~. i ..................................................... ............... 6.If business, commerciai or mixled occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctu}es, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................. !... Height ..... ,,.~ .............. Numbe~of Stories ........... t ......... 8. Dimensions of entire new construction: Front .,./~. .......... Rear..~-~.~ .......... Depth 3.~ .......... Hcig~ht . I.~. ~ ...... ,..,. Nu!mber of Sfories"/ 9. Size oflot: Front ..~.0:...; ............ Rear..8.q ................. Depth ::::::::::::::::::::: 10. Date of Purchase ......... ~ ................... Name of Former Owner ............................ .. 1 1.Zone or use district in which premises are situated .................................................... 1 2. Does pi0 osed construction violate any zoning law ordinance or regulation' No . 13. Will lot be regraded ' .~'1 ~. ·; .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~..~.'~..~..~..0~.[/l~.¥.'Address ~_ .................. Phone_No ................ Nam~ of Architectq~.. } .'~q414~JO~l.~....~.. Address ~'~0~,. .~..O~. . I~[~l~l~o. . ~. ~r~ : . ~.~. tl .... Name of Contractor G ....... Address ti~.[tOPr/~ .~'. g~--.: .~.rs~eu41~'o.. q.r~.."t~ ~.... 15. Is this property located withinti00 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 bloc ~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF... ~ ......... :. S.S ..... '~' b (~f ~' ~2~ .J~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual s~gning contract) above named. ~ (Co--agent, corporate officer, etc.) of smd owner or owners, and is dply authorized to perform or have performed the smd work and to make and file this application; that all statements coqtained in this application are true to the best of his knowledge and belief; and th~ht the work will be performed in the manper set forth in the application filed therewith. Sworn to before me this DATE T~ S_E~V_A.~E ols~os~ LOCATION i HAVE BEE FOUND TO FAMILY DWELLING ONLY ~0V ! ~'~ L AND t:IATER SUPPLY FAC:L.ITtES FOR THIS Y INSPEC;ED BY THIS DEPARTMENT AND OTOBY, .stewater Management ~ER~ VAN TUYL, P.C. LICE~D LAND ~URVEYO~S GREEN~RT N~W YORK SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT OF' ~HE WATE~ SUPPLY A~D SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL ¢ONFOR~ TO ~ ST~S O~ T~ 'SUFFOLK COUNTY DEPT. OF HEALTH SERV{CES -- FOR APPROVAL OF .CONSTRUCT{ON ONLY ~ATE' H. S. REF. NO.. APPROVED: S~JFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL, " ~AL SUFFOLK CO. HEALTH DEPT. APPROVAL h.S. NO. ~ STATEMENT Of INTENT ~ THE WATER SUPPLY AND SEWAGE DIS~SAL SUFFOLK CO. DEPT, OF HEALTH SERVICES, ~x. / APPLICANT SUFFOLK' COUNTY DEPT. OF HEALTH /~ SERVICES -- FOr APPROVAL Of CONSTRUCTION ONLY / . DATE: '- APPROVED: /,: SUFFOLK CO. TAX'MAP DESIGNATION: ,, / DIST. SECT. BLOCK PCL. ' / OWNERS ADDRESS: / ~F~' lT~jS.F.._ '~ST HOLE ~AMP m RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREEN~RT NEW YORK J SUFFOLK CO. HEALTH DEPT· APPROVAL ' H.S. ~0. I STATEMENT OF INTENT ~ THE WATER SUPPLY Af~D SEWAGE DISPOSAL SYSTEMS FOR THiS RESIDENCE WILL CONFORJ~ TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (s) APPLICANT SUFFOLK COUNTY DEPT~ OF HE2LTH SERVICES -- FOR APPROVAL EOF C(~NSTR UCT ION ONLY DATE: H. S. REF. NO.: I I I APPROVED~ suFFOLK CO. TAX MAP DESIGNATION: D157. SECT. BLOCK PCL. · :lc, O0 .... rz~ .. ' 3 ~£ST I~OLE I ~ / If copper tubing is used for water distributing syslem) piping shall be oF b/pes K or L only SOLDER USED IN WATER SUPPLY SYSTEM CANNOT ~XCEED 2/10 of 1% LEA.D,', I~LUMBER CERTIFICATIOI4' ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPAlgCY 2614. FEE Y: .... 1 NOTIFY BOIEBING DEPARTMENc4'?AT 765-1802 9 AM TO 4 P~ ~ THE FOLLOWING INSPECTIONS:' '. ". ,1, EOUNDATION - TW~' ~EQUIRED FOR POURED CONCRETE '2, ROUGH - F~MING & PLUM~ING ' 3, JNSU~TION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N, Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR 6ONSTRUCTIO~ ERRO~ M Unauthorized alteration or addition to this document is a vJo}at{on of s~c~'ion 7209 of the New Yorl~ S~ste Education Copies of th~s document not benring th. engineer's inked senl or embossed s~al shnll not be considered wild copies. -9 Unauthorized alteration or ~ddifian fo this document is violation o¢ section 7209 of the New York S,~ate Education Copies of this document not bearing the enginee/s inked seal or embossed seal shall nat be cansidered valid 1 Unauthorized alteration or ~ddifion fo this document is a ~he New York S,~ate Educatlon be considered v~lid ¢opigsa Unauthorized mlteratlea er -~;t on to this document is a , d~'on oE section 7209 of ~e ~v/ Yolk State Education Cop[es of this document not bearing the enginee/m inked seal or embossed seal shaJl not be considered valid