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HomeMy WebLinkAbout15089-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16644 Date July 15 .................................................. 19 86 THIS CERTIFIES that tile building . do.v.m~ v. add± Lion Location of Property 1000 Knollwood Lane Mattituck House No. Street Hamlet County Tax Map No. 1000 Section 1 0 ? ....Block 1 .Lot 1 Subdivision ....... × .... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.u. J: .y..1.1 .......... 19 .8.6. pnrsuant to wt~ch Building Permit No. 1 5 0 8 9 Z dated ........ J.u..~ y..1.4. ............ 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 ......... Dormer addition to existing one-family dwelling. The certificateisissuedto ALFRED & MARY SKRYZPECKI (owner, ~o~ of the aforesaid building. Suffolk County Department of Health Approval ................ N../..~ ....................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FO~ NO. ~ TO~ OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOt. D, N. Y. BUILDING PER}AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is hereby granted to: .... ...... ...~~~....~.;~..,....u.s.~.~ .... a,"~m,,,~oca,ed o,.Z.~ ....... t~~-~..*,,~..:.~.~ ......... County Tax Map No. 1000 Section ...... ~....~......~. ..... Block ....... ..(~...1 ...... Lot No ...... !...~.. ............ pursuant to application dated .... ..~...~...]./. ....................... , 19.,~.~., and approved by the Building Inspector. 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 BLDG, DEPT. T,OWN OF $OUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted m I~mmm~m 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 disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and sihailar 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: 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 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 $5.00 2. Certificate of Occupancy on pre-existing dwelling $15.0 0 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ?/// 5. Updated C · O. $15.0 0 Date .... y. ..... /, ................. New Building .......... Old or Pre-existing Building .... ~ ....... Vacant Land . .,.... ........ House No. Street NataNt Owner or Owners of Property ~?.'~,,~&..~ ./~/C~.. .'.. ;?~.-~(~.~;: ;:~'~. Z ........... County Tax Map No, 1000 Section ,/~ ~ Block / Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No }~,~ Date of Permit 711.~/.~ Applicant ............................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... ~equest for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted ........................... Construction on above described building and permit meets all ~ppticable codes and r~g?lations. ~ , '-- Applicant k.~ ~.~ /~-;~ ~,} ~.... ,-~ ~.~-~.,:% Rev. 10-10-78 - '~ [~ " ?'IELD INS~ECTM FOUNDATION (1st) FOUNDATION (2nd) 2e ROUGH FRAME & PLUMBING INSULATION PER No STATE ENERGY CODE FINAL CO~' ,.m., 1 3 ADDITIONAL COMMENTS: 765-XSOZ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND ~NgULATION FRAMING ~' ] FINAL INSPECTOR ,, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved...~J.~/. ·., 19~..~. Permit No./..'~...~.q...~':'. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .................. , 19... INSTRUCTIONS a. This application must be completely fliled 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, ~s here:in described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to nece inspections. ~/Signature of applic~it, 6~name, if.a corporation). .... / (Mailing addre~ of applicant) State whether applicant is_o_wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. l~:~).t.~.¢. ~ ................................................................................. i< .c. cJ l Name of owner of premises . ; .... ~. .................................. (ag oh 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 ...................... I. Location of land on which proposed work will be done~ ............... . .................................. / .r:' . , c: .... cK.'. ............ , ............. House Number Street Hamlet County Tax Map No. 1000 Section .../.~.'..-ff.. ........ Block ..... l ............ Lot .... .J..~. · .......... Subdivision "'-- Filed Map No ....... : Lot ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of prol~Osed constrUction: a. Existing use and occupancy....~..~..~.. J ~..~r_~.~. ~.<~.' ....... b. Intended use and occupancy .......................................... Nature of Work (check which applicable): New Building ..... ' ..... Addition ~1 [~..~.~.(~. Alteration .......... Repair ..; ........... Removal .............. Demolition .............. Other Work ............... ,~, ~--~~ (Description) 4. Estimated~,C~s ............................ Fee ...................................... (to be paid on fding this application) 5. If dweiling, number o f dweiling units ............... Number of dwelling units on each fioor ................ If garage, number of cars ........................................................................ 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 ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... . ..... Rear ........ Depth ........ Height ............... Number of Stories ........................................................ 9. Size of lot: FrOnt ..................... Rear ...................... Depth ...................... 10. Date of Purchase .......... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................... ; ......... ,13. Will lot be regraded .......... -~ ................. Will excess ~l be removed from premisas: Yes No 14. Name of Owner of premises (-~. ~ ~t~.a.~f.¢'.¢.~. Address/~)~.©.~'/V..r~/./~o.o.~.'~Phone Noc~. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address .... : .............. Phone No ................ 15. Is chis p~coperty located v~ithin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Tovra Trustees Permit may be reauired. 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_ Y(}l~ . COUNTy OF .'-" K... S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .~.~,~ ............................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements'contained in this application are true to the best of his 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 .... day of ................ ~ "~" ~" ant _._.EAST EkEVATlo~ ILo CUT AWAY w~,~- ~ I T~.,14 F~d WALb 2