HomeMy WebLinkAbout15133-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
ZI5147 December
~To .................. Date ................................. 19..
Inground pool & fence
THIS CERTIFIES that the building ................................................
200 Center Street Mattituck, New York
Location of Property .......................................... ; .................. · ·
House No. Street Hamlet
tyT pN 123 oc 2 22
Coun ax Ma o. 1000 Section ............ B1 k ............... Lot .................
Subdivision Filed Map No Lot No .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
July 23: 19 8.~p t which Building Permit No 15133Z
.................... , .. ursuant o ......................
dated ... J.u. .1.Y._. 2...................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 .........
· . Ingrou. nd sw. im.m.i, ng..p, ool.... ........ ..... ... .. ....&...f.e.n.c.e. ............................. . .........
The certificate isissued to ... RICHARD & BARBARA MATTHEWS
of the aforesaid building.
Suffolk County Department of Health Approval ........ f..N../.A ...........................
UNDERWRITERS CERTIFICATE NO N 7 7 5 0 ] 9 . .
TC~VN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERA,,~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15133
Z
Permission is hereby granted to: ~ .--. ^
..........
~,~..~_?~; ..................................................
.~.oZ~:z~.~.....~..:~.,....~.~..~.?- ..... --~
County Tax Map No, 1000 Section ...... ~....~,.?~ ....... Block ....... ~ ........... Lot No ..... ...e~.....~... .........
Building Inspector.
and approved by the
~..~~;.......-~. .....
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted m lamammmm 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
natura~ 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
topograph ic 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.
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 ohs t ~ uc t ion ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . ..~:...~.....~ ................ .~..~../~..7~/.~..~'.. ~ .~ ...................
Owner or Owners of Property ~~ ~~ '~'
County Tax Map No, 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
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.
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~10~,,~013~1 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
~,.,e 0~.e,~ w, ~m~ .'p,.,~a,io. No.o./ife ,mw84/ne N 775019
THIS CERTIFIES THAT
ordy the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
tlichawd watt.yin 209 Center Street, ~fattituek, N.Y.
in the follmvlng location; [] Basement [] ~t ri. [] 2nd FI. O~side .%~ti,,. ~toc~ Lot
tc~s examined on Al~1[ll~t ~ ~ 1~ and found to be in co.tpllance with the req.irements of this Board.
FIXTURE FIXTURES RANGES
OUTLETS SWITCHES OVENS DISH WASHER EXHAUST FANS
FLUORESCENT
1 1 2
DRYERS
FUTURE APPLIANCE FEEDERS
TIME CLOCKS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT
OTHER APPARATUS=
i"'G. F.C. I,
S E R
NO O~E~CONO
A, WG
OF CC COND,
I C E
NO OF HI.LEO
A W,G [NO OF NEU'[RALS A.W G
OF H)-LEG/ OF NEUTRAL
_~i_n~[_P¢?__].)~ This ce2ificate (overs compliance at the date of inspection only.
Because of un. ual environments it is advisable to have frequent test/~d or ~pairs
made by a qu[~lified person.
Jody Punillo
Pat Irene
l{attituck, N.Y. 11952
GENERAL MANAGER
Per~
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credent,als.
COPY FOR BUILDING DEPA NT. THIS COPY OF 3,,ATE MUST NOT ERED IN ER.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because,of the following reasons.
/w/An application for Certificate of Occupancy
No Underwriters Certificate on
/i/ file.
/_~ The check is(~ted/not on file.)~
/5/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # / ~/ ~ J Z
Building Dept.
***/5/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765A 802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because,of the following reasons.
/_~An application for Certificate of Occupancy
No Underwriters ' ' f
/~' The check is(~d/not on file.)~~'~ ~
/5/ No Health Dept. Approval on file.
/--/ No final ihspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit ~ ~ ~_ ~ 3 Z
Building Dept.
***/~/ No Plumber solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
765-1802
BUILDING DEPT,
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL.BG.
[ ] FOUNDATION ZND [ ] INSULATION
[ ] FRAMING
REMARKS:
[ ] FINAL
FORM NO. 6
TOWN OF SOUTHOLD
Buildlng Department
Town Hall
Southold, N.Y, 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A, 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:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic 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 $ [ 5.0 0
3. Copy of certificate of occupancy $1,00
4.Vacant Land C.O. $5.00 ~ - '
5.Updated C.O. $15.00 Date ..U.L~.~...?~L-.~.,.(.c~(O. .....
New C on s t r u c t i o n Old or Pre-existing Building Vacant Land
Location of Property ...~/.O..C) ........ .~.e,. ~. ......... C-.., ......... ~.~.o. ......
House No, Street Hamlet
Owner or Owners of Property ... ,~.,'.C~cC~...~...'t...~::7:;:~, ~....~'....~..C~.J~0.e~.~ ...........
County Tax Map No. 1000 Section ............../';2-'~ Block .. ................... ~-' Lot ~, .D~. ....
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ......... / 5~/~) ~ 2,- Date of Permit . . .Applicant . .. ..... ~/. ?. ........ , .............
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 ............................
Rev. 10-10.7a
FIELD INSi~ECTION
FOUNDATION (1st)
IlDATE !1
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
Ye
FINAL
ADDITIONAL COMMENTS'.
':0~ occuP,~C¥'
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined..~ .~..~...., 19.~.~.
Approved...~. ~..~. ~..., 19... Permit No./.~.].~ ~..~
Disapproved a/c .....................................
BLDG, DEPT.
TOWN OF S,9~mOLO ,
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. Tiffs 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, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary in~ections.
.... Dm:... .........
(Signature of applicant, or name, if a corporation)
.z?..~.. ~.s.q....~.o. 77. z:..//.~., ce'.. 4 .'f. ~.7.
(Mailing address of applicant)
State whether applicant is_qwner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.............. .6;.~ .~. ~ .z~..~.c.....e...o~....v?3.. ~...~. ~ ................................................
Name of owner of premises .... ~/.C. lq. ./q..~.~....~. .... .~..~.../~.~./~.~ .... ~./~. ~77-. ff.~LT~-~ ..~ ................. (as on the tax roll or latest deed)
If arm'l~hmhis a corporation, signature of duly authorized officer.
Builder's License No ...... /.~. ................
Plumber's License No .........................
Electrician's License No. /~dJ/'~J..... ~.~./~. (
Other Trade's License No ......................
Location of land on which proposed work will be done~ ' . .~...~. ~...7~../...Sr~...C./~.....~...~.. ............
.... .02.90 ............... .C ~..~. ~ .... ~77,. ~.r. ............ /h.~.rr./...~..c.~.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 ......... /'~'/' ~' ~' "~'' 'rT']' '//] ~ .................... r~' "" ..................
b. Intended use and occupancy ........ .~.~.~.. ! ]'~./.~-.(~.17. ....... ~.q. 77.'J./~.~-... ~. 15.~ ..~. .............
~ Nature of work (check which a plicable): New Building .......... Addition .......... Alteration ..........
Repair ..............Rem:oval ..............Demolition ..............Other Work
? a (Description
4. Estimated Cost
: ....... Fee .................
, '. ~' ! ' (to'be paid on filing this application)
5. If ~welling, number of dwellinglunits ............... Number Of dwelling units on each floor ................
If garage, number of cars .... ~ ...................................................................
6. If business, commercial or mix6d 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: Fr~[nt ..........; ........... Rear Depth
Date of Purchase · i ~
......... i .................. t~a,,~ m comer uwner .............................
11. ~one or use district in which premises are situated .......... /~'/..~rr'~/..~..~..~. .......................
12. I ocs proposed construction vio!ate~,~zoning law, ordinance or regulation. .~. O . · .
13. Will lot be regraded ........ i · .~..".? ............. Will excess fill be removed from premises: ~ No
14. Name of Owner of premises . ./'PJ~t. 7.'~"/-,-,~.~'p~q~? .... Address .~. ~. :J- .):--/. 2'ff-,A_~/t,~Phnna
Name of Architect ..~ Address -- w..t. -- - - ---~ ~)~;~; ~ .................
,Nan}e, o.f Contractor %../~/... ~__~?'~/~..~.'~ ,.~ .~F~... Address. ~.~.'/~/~..~.<'. Phone No. ,, _,q~>./~ .~.d. ~.~
15. ~.s un:s property ±ocated !within 300 feet of a t±dal wetland? ~¥es ..... No ./,~ ''
· l:f yes, Southold Town Trdstaes Permit may be required.
i PLOT DIAGRAM ,.,-
Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from
description according to deed, and show street names and indicate whether
property lines. Give street and block inumber or
interior or corner lot.
STATE OF NEW YORK,
couIvrY OF ........... S.S
............................. i .................... 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 dul~ authorized to perform or have performed the said work and to make and file this
application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manne~ set forth in the application filed therewith.
Sworn to before me this
.............. .~..~ ....... day of ! .~j ~. ~.. ......... 19 ~.~./,~
lerm Expires Me,ch