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Home My WebLink About15124-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z14728 Date .. July 30, 86 deck addition THIS CERTIFIES that the building ................................................ 385 Mary's Road Mattituck~ N.Y. 11952 Location of Property House No. Street Hamlet County Tax Map No. 1000 Section 1 6 0 .Block 0 2 .... Lot 3 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 21, 19 .~.6 1512'~z ....................... pursuant to wldeh Building Permit No ...................... dated J u 1 y 2 2, 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 ......... deck addition John & Jeanette Wilcenski The certificate is issued to ........................................................... {owner, lessee or tenenO of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SouTHOLD, N. Y. BUILDING PERJ*RIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15124 Z Permission is hereby granted to: .......%~......~..~.~.. ....................... .......... ..~ .......... :......~:....).~....~.~ ........ .~. .......... ,o .~.m....~..~..&...~.~.~....~..~~....~. ........ ............................. ot premises located at ...;~.%,.~ .........~.~...J.~;.~ ....... .~..~.-.~.~..,°t~. ............................. County Tax Map No. 1000 Section ...... J...~.,,,~, ........ Block ....... ,,~,,.,,,3~., ..... Lot No....,~ ............ pursuant to application doted ....... ..,~.~.....~ ................... , 19.~,.~., and approved by the Building Inspector. Fee $,.~..~...:...~... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, NoY. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 0LOG OEPT 'rOWl'~ OF $O[}T~IO _~ Instructions This application must be filled in Wpewriter OR ink, and submitted 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 natu rel or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposa{--(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 property showing all property lines, streets, buildings and unusual natural or topogrephic 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. 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. $15.00 Date.. ,~., NewCOnStruction ~.,. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~ ~,'~', .~,, ?'/" ? · .~', House No, Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section .... /. ~.4~. ..... Block ...... ~ ..'~. .... Lot... ~ .-~ ......... Subdivision .................................. Filed Map No ........... Lot No .............. Permit No.I. ,~./.~..~..~.. Date of Permit .., .~..6...Applicant . .~.~. ~..~4...~..4 ~.~4~-?~.~. ,~ ...... Health Dept. Approval ........................ Labor Dept· Approval ................... Underwriters Approval ..... /~//,~ .............. Planning Board Approval .. . ~ ............... ·. ~ ............ Final Certificate Request forttdTemporary~., o'-z~Certifica;t;e¢ ~)~'~'.. ~(~ ....................... FeeSubmi e $ .......... ~ ............... Construction on above described building ~mit meets all applicable cod~s and regulations. Applicant .......... Rev. 10~10-78 FIELD INSFECTION FOUNDATION (1st) COHME~ TS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL Ye ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 ', TEL.: 765-1803 Examined. · .~v~/· .~..~., 19 ~./? Approved..· ~...4~..~.*:., Disapproved a/c ~ ~ (Building Inspector) APPEICATION FOR BUILDING PERMIT BLDG, DEPT. Received ........... ,19... Date .................. ,19 ~ . INSTRUCTIONS a. Tkis 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 Bufldiug Permit to the applicant. Such permit shall be kept on the premises available for inspect[on throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATIO.N. IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tl~e Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances (~r Regulations, for the construction of buildings, additions or alterations or for removal or demolition, as herein describe& The applicant agr. ees to comply with all applicable laws, ordinance; )uilding rode, housing code, and regulations, and to admit authorized ~nspectors on premises and in building for necessary ?e~ions. / ,,q // ~ , ........ nature of applicant, or name, if a corporation) · (Mailing address of applicant) State whether applicant is_qwner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... : ...... ~ ........ (as on the tax roll or latest deed) If applicant is a corporation, sigr, ature 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[ ...... ~. ~ ~'..~..~.~ ......... . ............................................... - . ltouse Numoer Street / - ' Hamlet County Tax Map No. 1000 Section ..... J...~/..~ ........ Block ....... ..(~. ~ ..... 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 ................... · v .... .' ' ' U;~d:', ', '., ?,' · ' '.,'~;;,L'" ":~f'~ ................. b. Intended use and occupancy 4.. Estimated Cost ............ i, ....... ~ 5. If dwelling, ~umber o f dwellin~ units .......... r?o P ' : New Building .......... Addition ' ~ lqatu f work (check which a phcable) Alteration ....... Repatr ............. Re oval .............. Demolition ......... Other Work ............ -~ (Description) ....... Fee . ,~"O..'...TT'. ............................. (to be paid on filing this application) Number 5f dwelling units on each floor ................ If garage number of cars ' 6. If bumness, commercial or mixqd occupancy, specify nature and extent of each type of use ... 7. Dimensions of existing structures, if any: Front ............... R.eilg,, /'~,~.' ... Depth Height ............... Number of Stories ......... , ,~,nl~['_~ .~.~.~, .... ' ....... Dimensions'of same structure With alterations or ad~g~ll~c~t~.~?..~/~ a.~,i[~i[~ 'Rear' '"i"i'i ....... Deptl! ................... i... Height ....... . .~..~..~'~....tn..%~N~~s -~':'.". i.' i ...... 8. Dimensions of entire new construction: Front I [{~...l~R[[a~%.~. . ].,,,~l~'. If~ ~E-~[i, ......... Height ............... Number of Stones . .. .1~. - a."¢. 0~'~'~'1~ ...... . ~ ~, _ . . , ~'.'~txa a'~. · ~lbl %~' ......................... 9. raze otmt. emnt .......... ~ ............ Rear .%MI2[.~[lU.l, ~ ..... ,D, epth .................. 10. Date of Purchase .......... : .................. ~h~ot~ro~ae~.~lphf . . . ! 1. Zone or use dmtnct in whmh premises are muated .... ,,~.. 2. Does proposed construction vi'olate any zoning law ord~k~rce ~glfful~ttio'"n':' iiiiiiiiiiiiiiiiiiiii 3. Will lot be regraded ........ l .................... Will excess fill be removed from premises: Yes No 4. Nmne of Owner of premises " Address , ..................................... Phone No ................ Name of Architect ......... .; ................. Address ................... Phone No ................ Name of Contractor ........ i ................. Address .... : .............. Phone No ................. .5. Is thi~ property located!.within 300 feet of a tidal wetland? ~Yes ..... No .~.. · If yes, Southold Town TrUstees Permit maybe reouired. ... i ~ PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and. indicate all set-back dimensions from ~ropert¥ lines. Gi~atraaLandablack~number~nr. da~nrlntlon ~cahra;,,,, *,~ ~a ~.~ ~ ............................ ~ther FE~" "-'-'"- ' AT ~r~ BUILDING DEPARTMF:~IT F¢)L.Ip~IN.G-INSPECTIONS: : ' 1, F~Ui',JlYA'qON TWO ¢~EQUIRED qj ~ ......................... FOR~ i;~OURED CONCRET6 : .... ;*'"' ', ..... T~?~'" I 2 ROUGH FRAMING & PLUMBING ' . 3. INSULA¥1ON --'- ,~-, 4. FINAL. CONSTRUCTION MUiST ALL CONSTRUCTION SHALL ME T ' ' (i TH~ REQUIREMENTS OF THE N'.Y , ~$1GN o~ CONSTRUCTION EF~ROS~, 'ATE OF NEW'YORK~ ................... ~ )UNTY OF S,S being duly sworn deposes and says that lie is the applicant (Name of irldividual sign!lng contract) ove named. is the (Contractor, agent, corporate officer, etc.) Said owner or owners, and i~ dtlly authorized to perform or have performed the said work and to make and file this )lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in ~the manner set forth in the application filed therewith. ' 'urn to before me this ............... ~.;.. ,day of,. :., ........ z~x~_~ .... 19 .~..~. ta,,ubll , . C', · ....... C=n,y \ ... , -.. _.. 'v' ........................... · (Signature of applicant)