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HomeMy WebLinkAbout15033-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building hispector Town Hall Southold, N.Y. Certificate Of Occupancy No Z14847 Date September 3, 19.86. deck addition THIS CERTIFIES that the building ................................................ 1245 Ruth Road Mattituck, N.Y. Location of Property ............................................................... House No. Street Hamle~ County Tax Map No. 1000 Section 10..~ Block 0 ? .... Lot Subdivision..~./..% .C.a.p.~..a.i.n..K. ~.0.d.E.s ts... .Filed Map No..1.6.7.2....Lot No. 20 conforms substantially to the Application for Building Permit heretofore filed in this office dated June ~6, 19.~6. pu ttowhichBuildi PermitNo '~5033Z ..................... , . rsuan ng ...................... dated .4 ¢~a.e..~ ?., .................. 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 ig ......... deck additio.n, to .existin. g one. fa.m. il.y. dwe. l.li.r!g. ~.. The certificate is issued to Chris Lazarides of the aforesaid building. Suffolk County Department of Health Approval ........ i....N./.A, .......................... UNDERWRITERS CERTIFICATE NO .................... .iq./.[ .......................... Rev. 1/81 FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDIIqG P ERJ,AIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15033 Z Permission is hereby granted to: ~~..~ .,..¥, )./.~.¢..7... ~ . et premises located at County Tax Map No 1000 Section '/ ~ .(a, Block .... ..~...~. ....... Lot No ..... /...~. .............. pursuant to application dated ...... .t.~.[..~. .................. , 19.~...~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CertiFicate O[ Occupancy Date ................................ 19... THIS CERTIFIES that the building · ..... ' .............................. Location of Property/:/ous~ Nb. ' .... Street [F].,~..77~./ZTd ~.ff,/.~ t4emte~ County Tax Map No. 1'000 Section . /.~) ~ ..... Block . .O.'~ ......... Lot ]. d Subdivision (~tt°Y"~ ,P/')~'~ ~ Filed Map No ...... Lot No.. . conforms substantially to the Application for Building Permit heretofore filed in this office dated d.b/.f~..s~. /ff. ~.~pursuant to which Building Permit No dated . d~,t4f. ~.o~:. ~'..'? ............... 19 ~9,d', was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued ig ......... The certificate is issued to . , ,4~,' ,~/~/'.,~ ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEPT, TOWN OF SOUTHOLD Instructions 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 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: I. 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. 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 Date ...................... New C on s t ruc t. i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........................... ,~.q · ./~. .............~../?...7~..,..~., House No, Street Owner or Owners of Property C~ )¥,~, I.~' /',/~- ~-.f'~,~; )~r~' .... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.j.~O~..~.~.. Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .., i~/~... .............. Request for Temporary Certificate...., .................. Final Certificate ....................... m'te ,..~,o0 V~- FeeSub ,t dS ............... .~...I .~..~... Construction on above described building and permit meets all .applicable codes and regulations. App,icant...~'....~..~~ .................. Rev. 10-10-78 C0 '~ TO~NN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 To Whom This May Concern, TEL. 765-I 802 Please complete the enclosed application for Certificate of Occupancy and enclose a check for $5.00 (the fee for the C.O.)'and I will be able to Complete the Certificate of Occupancy. Thank you so much for your cooperation in this matter. .o~.F I0 I'~ ~ :lq I 76S-t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [.] IN_/SUI. ATION []FRAMING .FINAL REMARKS: FIELD INSPECTION FOUNDATION (1st) COiI~4ENTS FOUNDATION 2. ROUGH FRAME & (2nd) PLUMBING INSULATION PER N. Y. '' STATE ENERGY CODE L ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180'2 Examined . · .~ ~. ;Z~'] .... 19~. [~. Approved · .~J,d,~a...&,..~.., 19~.~. Permit No./~ .~.-~:l*.~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG, DEPT. TO. _WE O.~F Received ........... ,19.. , INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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. e. 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 inspections. (Signature ofhapp~cant~.pr name, if a corporation) ................... '' ii~ilin~'gaaress of app~ic,ant) · State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, pmmoer or ouilaer. Name of owner of premises . ~ff/.-~.'. .......................................... (as on the tax roi1 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 ...................... I. Location of land on which proposed work will be done .................................................. l . ,b. ...... A. .o., .c_. .................. ' ............. House Number Street Hamlet County Tax Map No. i000 Section ...... ]~. ~. ....... Block ..... .7. ........... 'Lot .... !.¢ ...... "2 .... . .~.~a3~.....~.'.4~.... ~ ............... Filed Map No .... /. d. .7. .27. ..... Lot... ~ 9. t Subdivision. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~¢-~ //~. ~f"/Pr C ' ~,1 r ~ b. Intended use and occupancy ................. , ,;.; ,..~,..,: ,.. ;. · t. .............. 3. Nature of work (check wh~i0pplicable): New Building .......... Addition .......... Alteratior~. .......... Repair .............. ,.'gomoval .............. Demolition .............. Other Work... 1~-,~-'(.. . ~ ~ [ ~ J ~! i (Description) 4. Estimated Cost· .'..'~..~. ,¢[{ ?..: ?. ¥ ................... Fee .................................... ,. [ (to be paid on filing this application) 5 If dwelling number of dwellin~ units ,-'--- Number of dwelling units on each floor If garag umb r of ca ' ' e, n e rs ...; ..... ~ ............ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ... · .~-:-~.. .............. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ........... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth .................. ~... Height .......... 27? ......... Number of Stories ...................... 8. Dimensions of entire new construction: Front ....... ~'.t~ ..... Rear ............... Depth ....~..o. ........ ;~, . ...... Number of Stories ...... ' ........................................ ~ ......... He,~ht ........ 9. Size of lot: Front ..... ~. ~../..~..~. ...... Rear ..... .~./~..~. ...... Depth .../.~.,~-.,. ~ .......... 10. Date of Purchase ......... + ................ Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viglate any zoning law, ordinance or regulation: .... .t~..° .............. ~ ...... . 13. Will lot be regraded ...... /k',_O. ................... Will excqs fill be removed fro_m~remises: lYes) No 14. Name of Owner of premises . ,c.~.~(r....&~.2.*~t~!~..~¢'... Address .//.~.r.~..~ .,pl.. ~.~ne No .... ~ ...... :, Name of Architect ........ ~ .................. Address ................... Phone No .............. f~. Name of Contractor ....~{<~..~5....~. *#.o.~..~. ..... Address . _h~,C',t~.r,~r~fi .... Phone No.. 7~..2,.: .~.q .~.... 15. Is this property located within 1.00 feet of a tidal ~Ydtland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be required. : , PLOT DIAGRAM Locate clearly and distinctly all building% whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc k number Or description according to deed, and show street names and indicate Whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................ (Name of individual signing contract) above named. ,J-' e~tP~_-,-.. 4' ¢ -, ' . '1 '"~ being duly~, deposes and says that he is the appli/ant He is the .......................................................................... .¢ ........ . ...... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ dy authorized to perform or have performed the said work and to make and file this application; that all statements con rained in this application are true to the best of his knowledge and belief; and that' the work will be performed in the manOer set forth in the application filed therewith. ^8,w~.m-to before me this xfF 'i r,-, i ........ .... //.~ ......... day 0f ..... ~ .......... 19"'~'" ' ~ ~1 , ...................