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Home My WebLink About15003-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No..z. 1.5..2.44 Date . ..F.e.b.r..u.a.r.y. 4, 1987 , THIS CERTIFIES that the building Addition to an accessory Lo cation of Property ..... 5. 5. .5.0..$. e..r ~.e.n...A y.e.. ....... M a t t i t u c k House No. Street Hamlet County Tax Map No. 1000 Section . ! ! .3 ........ Block ....0 .7 .......... Lot 05 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Bnilding Permit heretofore filed in this office dated J u n e I 1 , 1986 .. pursuant to which Buildiug Permit No. 1500 3 z datedJ u. p.e..2. 0. ~.. 1.9. 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 ......... .... ~ ~.i.t.i.o..~..t.o., .a.~..e..~.i.s.t.i..~g..a.q .c.e.s.s.o..r y. ?.~..i3.~.i.~. ~.. ......................... The certificate is issued to LEO D. & MILLICENT RUSSELL ..................... ?o~4.'o'~,~g4~;I~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~ ./.~ ................................ N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A ''~"'~iding Inspector .... Rev. 1/81 lrO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING P EIbM, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 'N°. 15003 Z Dote ......... ~ ............................. , .. Permission is hereby granted to]") ............. ot premises Iocate~ at ..~.....~...~.~..O......~.' t'¢~....~..: ............ ~P,,q~. .................................. County Tax Mop No. 1000 Section ....... ,!.!...~. ........ Block ...... ..~.'~1. ....... Lot No ..... ..~...~.~. .......... pursuont to oppJication doted ..... ...~..~ ...... ~..J .................... , 19.~..~., and approved by the Building Inspector. Fee $ ~'. · .'~.~.. ?.~.. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY r Instructions A. This application must be filled in typewriter OR ink, and submitted ~mlJmammm~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy New Dwelling. S25.00, 'Accessory ,,$ tO.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50. 00 3. Copy of certificate of occupancv $ 5.00, over 5 years $20.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50. O0 Date ...//3~.~.~. ............... NewConstruction ..... Old or Pre-existing Building ............ Vacant Land ..... Location of Property .5',~) ~-~c,~/,~ ./~u.~.,,,. House No. Street Ham/et Owner or Owners of Property ~z~'o D ~ ./.~/.~.~._4'c.;,¥~.~. ~ County Tax Map No. 1000 Section ... ~./.~ ........ Block '7 Lot. Subdivision ................................. Filed Map No ........... Lot No .............. /~P ~' ~ ~,/.-~/~4 Appli ~.~:(~ Permit No. ¢! · . .... Date of Permit .... cant ............................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $./~. ,.~ .C.).., ~ ~..z/?,~ ....... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~ /~.; .z~'f.~.· d.,/.¥. . . 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: FINAL DATE INSPECTOR FIELD INSI'ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .20 , 19~. Permit No..]..~..~ .e~...~..~ Disapproved a/c ..................................... BLDG. DEPT. TOWN OF $OUTHOLD Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 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 tkis 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 throu~out 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 necessaw~in.sp~io,~ (Signature of applicant, or name, if a corporation) ... ?. ~?.,,, ././3..<C.~...~..~:4.......<~.: ............. ,,.,.~-~, ~-~..~..~, .//. f~'..~.... · . .Z'f~.~J.: .....7. · /; ' r ~' 'n~ ' ..... (mailing address or app±ica State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ..... (2..~...~..a~. .................................................................................. Name of owner of premises ~ ~.-q...O...~....,ff/.~.~/.c..~.~.tT.. -~ ~ f~a 5'$- ~'w~c ................... (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 ...................... ,S-~-t9 1. Location of land on which proposed work will be done.. ]c3..g~?..~.~..'5<...~...t(.. .... .~..~.r.r?..~f~( ............... :C ~ .5'.o. .......... ~. g~.~c.a. ~-:<~.. ,,q .v: .................. .~../,.cr~.r~c.,¢ ........... House Number Street Hamlet County Tax Map No. 1000 Section ......... /.[ ~ ...... Block ........ q ......... Lot... ~ ............ 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 0~-o~/1 ~ Sa-g~/v ,~'~/.~/a~ . 3. Naturb of work (check which applicable): New Building .......... Addition .. ....... Alteration ...I ....... ~ Repair .............. Removal .............. Demolition ............ i' ' Other Work. . .z~ 4. Estimated Cost .... ~ ?..c) .................... Fee ........... I ........................... (to be paid on filing this application) 5. If dwelling,.number of dwelling units ............... Number of dwelling unitsI on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each typd of use ..................... 7. Dimensions of existing structures, if any: Front .... z'~ ........ Rear ..../.O...i ...... Depth.. ?. ........... Hight c~ f N b f St ri ( ~ e ............. um er o o es ............................ ~ ........................... Dimensions of same structure with alterations or additions: Front ...2..0. ....... i .... Rear ...g,.o. ............ Depth..~ .................. Height .. ff. .................. Number of Stories .... ./ ................. 8. Dimensions of entire new construction: Front. ./O..t. Rear ../~../... ...... Depth ...O ........... Height .............. Number of Stories ............................ i ........................... 9. Size of lot: Front .... /CP. .............. Rear ..... /. ¢.~. ............. Depth ... 2_00. ............... 10. Date of Purchase .../. ~.~>. .................... Name of Former Owner . .i..G~rg.q4 .,M ................ 11. Zone or use district in which premises are situated ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation' .I ................. ' ...."' ' 13. Will lot ,be regraded .... //t'-~. ..................... Will excess fill be removed] from premises: Yes No 14. Name 6f Owner of premises .................... Address ................ i' · · Phone No ................ Nmne of Architect ........................... Address ................ I. · · Phone No ................ Name of Contractor .......................... Address ................ i. · · Phone No ..... ,,K. ......... 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, ind property lines. Give street and block number or description according to deed, and show interior or corner lot. [cate all set-back dimensions fi:om t names and indicate whether · ..... [[aEDI'NG DEPARTMENT ATi 9 AM TO ~ P~ FOR THE~ R.1OWl NG ffJSPECTIONS: ,FOUNDA%ION - ~O REQUIRED~ FOR POURED CO~CRETE : 2. ROUGH - FRAMING & PLUMBING~ STATE OF NEW YORK, S.S :3. INSUI ATION :I COUNTY.OF ................. 4. FIN^I_ - CON%TRUCTION MUST' ..................................~ ('~a~signing contrac¢l~!~I .. .. RC~i~)(~/~t2. .: -2. ' ' N~. y~.lies and says that he is the applicant ' above named. STATE CONqTRUCTION & ENERGYi CODES, NOT RESPONSIBLE FORI He is the ............................. .1, 'D~oeIGN UR CONISTRUCTIOI~ ERR'ORS,I ............................ (~zomrac~or, agent, a'brporare o'fficer, em.). of said owner or owners, and is duly authorized to perform or have performed the slid work and to make and file this application; that all statements contained in this application are true to the best ofhL, 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 r. f¢ ' ' .............. day of. .. ....... ,19 : ,. ,~: .. Notary Public, ........... :.......... County Term Expires M~reh 3~ l'&,-,,,~ , ..... ~.~*r~:,:~,~.4~.~;