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Home My WebLink About15094-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspectnr Town Hall Southold, N.Y. Certificate Of Occupancy TFIIS CERTIFIES that the building b ~i.d.~ ~ i p.n. · 670 DEER DRIVE MATTITUCK Location of Property ............................................. . . .. ... . ... . . .. ... House No. Street Hamle~ County Tax Map No. 1000Section 1 ]4. .Block ,., l0 .Lot 5 Subdivision Filed Map No . Lot No. . conforms substantially to the Application for Building Permit heretofore filed in this office dated July 8, ., 19 .8.6. pursuant to which Building Permit No..1.5.0..9.4.Z, dated ..... .Iu 1 ¥.. ~8 ............... 19.8.fi, 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 ......... · Add.ition.to..an existing .o.n.e.fa~il.y dwelling including deck. KAREN ANN VOLINSKI The certificate is issned to ...... M.AR.K. &. ..................................... ............. (owner, I~A of the aforesaid building. Suffolk County Department of Health Approval ...... .N./.A. ................................ UNDERWRITERS CE RTIFICATE NO .~ 7 8. 6. .7 .9 8. ............. f~ Building inspector Rev. 1/81 FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER'AlT CCH[S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NC 15094 Z Permission is hereby granted to: .~.~.~.:~.~ ............................. .L~~.-~....~.:~.,...~.t..~..~ .......... ,o ......... .................................. ot pram,sas located at ..~...~7 O., ~)..,~ ......... ~ ....... ..~.~ .~.... .......................... Coun~ Tax Map No, '000 Sec,on ..... I,L~ ............ 8~o~k ....... l.~ ......... Lot ~o...~.~... .............. pursuant to application dated ....... ...~. ~...~ ......................... , 19,?...~... and opproved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ia ~ to the Building Inspec- tor with the following; for new buildings or new usa: 1. Final survey of property with accurate location of all buildings, propertv 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 (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all propertv 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.Oo $5.00 New Building ............. Old or Pre-existing Building $15.00 Date...[~.~..~...../.ff.'/.~. .... ............ Vacant Land ............. t. ocation of Property .................... · · · .. ' ............. .. ... ............ · Hou~a No. Street Ham/et Owner or Owners of Property ~. ............................... County Tax Map No. 1000 Section . / / .~. Block ./o Lot .~..'~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ?..~?. ?..~..~. Date of Permit~/~....Applicant...~..~/.. L¥.~.k..~..~..~q ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval, ....................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ,. ./)~ ~./.M ................. THE NEW YORK BOARD OF FIRE UNDERWRITERS Jm'ms.'cy 6, 1¢7 App,,.~.,io.~'o.o..fif,~ 417702/86 N 78G798 in the follo~c~ng h,catio,: ~ Baset, r~,~nt l~t~t FI. ~ 2nd FI. Section Block Lot t~s exo~nlned on ~ec~Pi°~Y~l~ ~ ~ at,d found to be in cotr pilaf ce u'ith the req~iretnents of this Iloard. FIXTURES FIXTURE SW~TCHE$ DRYERS FURNACE MOTORS FUTURE APP[IAhtCE FEEDERS RANGES OVENS TIME CLOCKS IUNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS SERVICE DISCONNECT S E R V t C OTHER APPARATUS: E AW, G, OF NEUTRAL G~ ~lectric ~o× 215 So~[thold~ N.Y, ]1971 Llc. 578E GENERAL MANAGER This certificate must not be altered i~t any manner; return to the office of the Board if incorrect, Inspectors may be identified by their COPY FOR BU~LD(NG DEPARTMENT. THIS COPY OF CERTIFICATI BE ALTERED IN ANY MANNER, FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING ¸ 3. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 7GS.'1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ~.ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~'~'~//~ '~ DATE 765-~802 BUILDING DEPT. INSPECTION FOUNDATION FOUNDATION 2ND [ FRAMING REMARKS: ROUGH PLBG. INSULATION FINAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 ...... ..... permit ,o Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. OEPT, TOWN OF SOUTHOLD Received ....... ~~9~ Date .~.....~. ...... 19qO.'~. a. Tlfis 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, h~yj~sing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. //' ~ (Signature of applicant, or name, if a corporation) ...... d .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~..~..¢7./~..¢..../~.~..~./.3, d..tq../f~t .... .~..°.//. ( ./4..4..~..~: .......................... (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 ...................... Location of land on which proposed work will be done .................................................. ........................ .,4..7.0. ....... ............ ............ House Number Street Hamlet County Tax Map No. 1000 Section ..... ././.~. ........ Block /o Lot. ~ 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 ....... ~. ~:za[4-¢~. '..~... ¢~~..'. ........................... b. Intended use and occupancy ........ ~.~. ............................................... 3. Nature of work (check which applicable): New Building ' .... Addition . Alteration .......... Repair .............. Removal .............. Demolition ........... ... Other Work ............... .~..//~0~..~ ' (Description) 4. Estimated Cost .... o...O.~..0 ..................... Fee ......................... (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, commercial or mixed occupancy, specify nature and extent of each ty~e of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... i ....... Depth ............... Height ............... Number of Stories ............................ ............................ Dhnensions of same structure with alterations or additions: Front ............ i ..... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ........ ~ ....... Depth ............... Height ............... Number of Stories .................. ' .......... . ............................ 9. Size of lot: Front ...................... Rear ...................... !Depth ...................... 10. Date of Purchase ............................. Name of Former Owner .! ............................ 1 1. 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 fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ............... i ....Phone No ................ Name of Architect ..,:~ ................ ..n~ .....Address . .~];~...~-....... · ,~ · ~ .,~. ~. i~).~i . Phone No ................ Name of Contractor ~?.q .~.._t~.c~ .-~. ~.'? ...... Address . Phone No..~-.*.~...~..'(?..¥7. 15. Is this property located withinl.00 feet of a tidal wetland? *iYes ..... No ..... · If yes, Southold Town Trustees 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 block 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 ................................................. 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.1 of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in fl~is application are true to the best ofhi~ 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 ................. of ..... .......... ., . .... Notary Public, . .... l.'4~q-~4~.~.. ..... County ~ * (Signature of appl~eant)