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Home My WebLink About14708-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16525 Date March 28 198..6 THIS CERTIFIES that the building ~.e.q ~ ........................................... tie rty .435 ~t.w.~a.r.d C..t Mattituck Loca n of Prope .. ....... · .......................................... t~ouse ivo. Street H~rnlet County Tax Map No. 1000 Section . 1 .q ~ ........ Block 07 .Lot 09 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... I~ ~ r .c.t~. ~ 7 ........ ,198. .6. pursuant to which Building Permit No .... q.fi 70 ~3.~ ........... dated ..... ~Ja r.c.h. ~7 .............. 19.9.6, was issued, and conforms to all of the requirements of the applicable provisions of the laws The occupancy for which this certificate is issued is ......... .... R ea.~o ea. 4-~ ¢ k..ad ~1 g.t.£ ~..~.o. ex~Cs t ~.n~;. o~ ~..f.. a~,~.&Y...d 3q.o.], .~ .~.n.~: ........... The certificate is issued to . · g~d,61~14E..& · D.~,NE. I'£h~S~. .............................. [owner, ~ya~(~o~ Y,~grbOX of the aforesaid building. Suffolk County Department of Health Approval ......... ~q./.~ ............................. UNDERWRITERS CERTIFICATE NO ................. ~./. ~ ............................. Rev, 1/81 Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14708 Z County Tax Mop No. 1000 Section ....... ~..J...~ ........ Block ....... ~:::L..'~, ....... Lot No ..................... pursuont 1o opplicotion doted ..... ....~.~.....~...(~ ............... , 19.~..~., 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- 180?- APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I~ 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 pZoperty 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 3. Date of any housing code or safety inspection of buildings or premises tion required to prepare a certificate. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancv 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 Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property.., .~.~..-.~'. .... .~.~' .~. -~..(~ ~ ..... ~.; ,~¢.'~--4' .~/Z~, .~'., ............ House No. Street Hamlet Owner or Owners of Property ,...~..cr..?r~..4T..~...~/~.,~. · · .~p.T~. ~..~. ................... County Tax Map No. 1000 Section ...... [./..,5~- ..... Block ...... .'7. ....... 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~ regulations. Applicant .............. ~. '~ ¢4-r¢¢~c...,~, .~.~_4xcCcCPr, ........... Rev. 10-10-78 COMMENTS FIELD INSFECTION 1. FOUNDATION Ilst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: Examined. i~.~l..c~q..~.'~. Approved ..~ ~ . .~..~/. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180:3 ., ., 19~..~. Permit No./.~. ?..O.~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date ................... 19... INSTRUCTIONS .. a. This 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 befor6 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 of a/pplicant, or n corporation) · / (Mailing address of apphcant) State whether applicant is owner, lessee, agent, architect, eno~neer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~r-~....~.../~) ?'44~7'&-7...~g)~. .......................... (as on the tax troll 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 ...................... 1. Location of land on which proposed work will be done.. House Nmnber Street *,~, Hamlet County Tax Map No. 1000 Section .... //f~. ......... Block ..... 7'"'3 ........ 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 ...... /f~5 ~../~-t~F.;~ ............................................... b. Intended use and occupancy ........ /~. ~...ge~'-C<~..~. .................................... EE: :~'-"~ ,BY. __~'.. ' OTIFY BUILDING DEPARTMENT AT 65-1802 9 ,A~,~I TO 4 PM FOR THE ;T~TE CONSTRUOrION & ENERGY OD~ NOT ~SPON~IBLE ~R STATE OF NE~OgK,/ o o ov ..................... ~ (Name of individual signing contract) above named. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . . Alteration . .: ........ Repair .............. Removal .............. Demolition ........... i. · · Other Work ............... ~ . (Description) 4. Estimated Cost .. ,~.~ ................................ Fee ........ ' .................. ' ~ (to be ~aid 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, commerciai or mixed occupancy, specify nature and extent of eac~y~e of use ..................... 7. Dimensions of existing structures, if any: Front Rear, ~ : - . Depth ............... Number of Stories ................. ~ ..... ~ .................... Height ............... ' ..... ~J " .... Dim ensions o f same structure with alterations or additions: ~'~..'%.'~... ~ .~.'~..:d~a% ................ Depth ...................... Height .......... ~a~.~ [~ ,.~]~. ~o2~_~..~.'~.. . 8. Dimensions of entire new construction' Front i .~-a~. _S~Re~r~.~?.~/..~.~'~,[.~. v- ~ ,, ..... ,' '.'/ ....... . ~ , .... av .... ~'"a,~ .... Deeth ... ~., ....... Heaght .... 70~..'i~. Number of Stories . i .~...--t*_ .~....~ .¢.~.' .... 9. Sizeotlot Front . Rear ~.~.~.~,~': ~i~ ~J~l~h%l~ : :' ' . ¢ ............ ... ........ .......... lO. ate ofPurc ase ..... ,. a .................. ~~/~*~'JX~.. /~. e"2:~'A/&"~ .... 11. Lone or use uistrict in wnien premises are situated ..... /l~it~-~a~'~ .I. :i .................. 12. Does proposed construction yiolate any zoning law, ordinan~ ~, r~][~.....~fiL} .......................... 13. Will lot be regraded . . ./~///¥ ............ .~ ......! Will~[%ss~i"be r. omoved from premises: Yes No 14. Name of Owner of premisef' Lc'u~er~o-'.~t)~'~JtrFO~d~ddres~-Tcaw~. c~.. ~j~.,. Phone No. ~.~'~..-.c~/~ .... Name of Architect ........................... Address ............... !... Phone No ................ Name of Contractor .......................... Address ............... i · · · Phone No ........ ' ........ 15. Is this property located within 300 feet of a tidal wetland? * yes ..... 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. ~ ; APPROVED AS NOTED ¢ ~/~ being duly sworn, deposes and says that he is the applicant (Signature of applicant) Notary Public, . ./.~ . . - :~...~ ...... County (Contractor, agent, corporate officer, etc.) i 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 appilcation 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