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Home My WebLink About14740-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. zi6026 Date ...A. Dgu. s.t..7., 1987 THIS CERTIFIES that the building .. 0. qe...f .am. '.z [. y. d.¥e..l ]:. ~n.g: .......................... Location of Property 3615 Cox Neck Road Mattituck ~s~ ~oi ....................... ~r'e~ t' ....................... ~/~r~/'e~ County Tax Map No. 1000 Section .. ! ! .3 ....... Block .... .0.3 ......... Lot ..... .0 ! .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemit heretofore fried in this office dated April l, 1986 pursuant to which Building Permit No.14..74.0..z ................ dated April .............. 5, 1986 . ..... . ....... 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 ......... One family dwelling, garage and decks. The certificate is issued to BARBARA BERGMAN ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ...8.67.S.0~'.2.5..J.u.l.y..6:..1.9.8.7 ................... UNDERWRITERS CERTIFICATE NO .......... .P.ep.d.tpg...A.ug....7.,..1.9.8.7 ................... PLUMBERS CERTIFICATION DATED: John Deacy July 13, 1987 Permit amended to include decks. R~v. 1/81 FOEM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) IV? 14740 Z County Tax Map No, 1000 Section ...... J./...~. ........ Block ...... .,.(~.....~ ...... Lot No ........ ,O,..J ........... pursuant to application doted ................................... , 19~,.~...., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 765-1802 BUILDING DEPT. FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION AND [ ] INSULATION FRAMING ~ r/ [ ]3fINAL FIELD INS~ECT~0N ~ COI~MENTS ...... ~__ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION FER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: STATE OF NEW YORK) ) COUNTY OF SUFFOLK) TOWN OF I, JOHN DEACY, being duly sworn, depose and say that I am. licensed as a MASTER PLUMBER in accordance with the Occupational Licensing Law of Suffolk County, New York, and have been issued License Number 2501-P, having an expiration date of January, 198~. That the material and work installed with Building Permit Number /~ issued by the Town ~ Building Department for the structure located .umber . S E W full compliance with in conjuncition of at , State of New York, is in the State Building Construction Code and all other applicable laws. That this affidavit is made pursuant to the requirements of the Town of ~ Building Department in connection with the issuance of a Certificate of Occupancy/Compliance for this structure. Sworn to before me this /~q~ day of J.O~, )~ NOTARY PUBLIC C~ DEBRA ANN~ O~R~Y NOTARY PUBLIC, Bt~te of New York Ne. 4815621, Suffolk County Commmmon Expires ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 :ATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m 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 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 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: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$I0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $~0.0~/ / .~.(~./Z/'~' 4.Vacant Land C.O. $ 20.00 5.Updated C.O./ $ 50.00 Date ............. NewConstruction ...... Old or Pre-existing Building ............ Vaunt Land ............. Location of Property....~..~..].~..'~.....~. ?..~. ....... · .~..~..~. K .... ...~....~ ......~..~...7~'-..~.--~. ~.~..~ House No. Street Hamlet g ,q ......................." Owner or Ownars o~ Property ................................ .~. County Tax Map No. 1000 Section ... I I .~. ....... Block ...~,..~. ........ Lot.. P..' ........... 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 $ ............................. 7GS.'1802 BUILDING DEPT. ~ INSPECTION []/FOUNDATION ~ST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ] F/OUNDATION 1ST [ ] ROUGH PLBG. // FOUNDATION 2ND [ ] INSULATION 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: ~,.~ ] FINAL DATE , INSPECTOR :, 7GS-J.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ~,ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: FINAL INSPECTOR 7GS-Z802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION 765-1802 BUILDING DEPT. INSPECTION. [,~F/~NDATION 1ST [ ] ROUGH PLBG. [//J FOUNDATION 2ND [ ] INSULATION 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved..~ .~.... ~S.., i9~..~. Permit No. !.~.~..¢~. ~. Disapproved a/c ..................................... (Building Inspector) APPL!CAT!ON FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOLD 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 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~ _ '' iSignature of appli~r~ne ~orp~[a'tio'r~) .A'..~.. ,'~ ~ / ~B-y. ~,,~ ~ ~/.qz ?.~'... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .c-2. ~. ~ ~ ................................................................................ Name of owner of premises . .~..~..,~.~..~..z~.~.....~"..~..6-~...~?.~. ............................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of;corporate.of, ricer) .,. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .... 't ........... ~ ................................ ............ x .~.,.?.. ........ .c.~. ~.. ~.~.+(c.,..rd..d.~ .................. ~..~z~ ................. Itouse Number Street Haml~} ;~ .~ County Tax Map No. 1000 Section . ..//;~. ........... Block ~-~ Lot'. . .~/. .......... ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~×istin~ ~se and occupancy ..................................................................... b. Intended use and occupancy ...~.~:~'...~..~.~?.~...~.~...~J/~?0.~ ............................................ 3. Nature ofwork (check which applicable): New Build,ing Addition .. i.. Alteration ..i.. R pair R I' ' De olitlo [ Oth r Work e .............. emova ..... , ........ . m n ............. e ............... ~ , . (Description) 4. Estimated Cost .O't~o ................................ Fee . . ' · * (to be paid on filing this application) 5. If dwelling, number of dwelli~g units .... ~. ......... Number of dwelling uniti on each floor ..~.~ .......... If garage, number of cars . .,¢ ......................................... 6. Ifbus~ness, commercmlorm~xedoccupancy, specify nature and extent of each type of use ...?Z~ .......... ,... 7 Dim i f iti gstmct ifa Fr nt Rear ' D pth · ensonso exs n ures, ny: o ...................... '..... .... e ........ . ... Height Number of Stories Dimensions of same structure with alterations or additions: Front ............ 1 .....Rear... , ....... Depth ...................... Height ...................... Number of ~tories ........ .. ............. 8. Dimensions of_entire new construction: Front ~'~.. . Rear .~..;~. ,: . Deoth ~. . . 9. Sizeoflot: Front .-~2G . Rear 'O/or ........................................... D~epth .-'? .~..~. ................ 10. Date of Purchase . . ?.Z .a.-~..~..~ ............... Name of Former Owner . .q,~A.~?.~..~.'r~....t~.. ............... 1 1. Zone or use district in which premises are situated .... , 12. Does proposed construction violate any ~oning law, ordinance or reouiaifo'n"' '~/~ ................... ........ 13. Will lot be regraded ... ~J.O ...................... Will exces}°fill be removed from premises: Ye~ ~ No 14. Name of Owner of premises ..................... Address ............... [... Phone No ........ ; ........ of A " '~'~ ~ .. Name rcmtect ............. . ............ Address .......... i Phone : ' ' ~ Name of' Contractor tt~ .~.~.~..~ .~$.~. ~.C.. ............. Address/$~t ~.4~'~] .~'.~."~..t~hone.. No.N° ..........3~.~.2'.. ~.~q~.~.*.."" PLOT DIAGRAM. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bl~ck number or description according to deed, and show street names and indicate whether interior or corner lot. COUNTY O~ .~ ~.~ ...... S.S ......... · ~..~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc. )' of said owner or owners, ~d is duly authored to perform or have perfomed the sa'id,work and to m~e and file ~his phcahon; that all statements contmned m this apphcat~on are true to the best of ~s ~owledge and belief; and that the ork will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this : Nota~ Public, ...................... Count ~ ? 'NOIARY PI)Gl, lC, State of New York .................. T~'~ ~ f, ..................... No. ~7L~94G, S~*ffolk County , ~ , , (Signature of ap~QOapt) EXCAVATION I~P£CTt~ iEINIRED APPROYAL OF CONSTRUCTtON OF Single Family Res~deace APPROVE~ L. The water supply and sewaEe disposal ~ ~~U form to the standard of th? Uuf£olk~ Sour//oz4 nf. ~. OWNER3.' SUFFOLK COUNTY HEALTH DEPARTMENT .,,.': SINGLE FAMILY DWELLING ONLY THE ~WAGE ~SAL AND WATER SUPPLY FACILITIES FOR THIS L~ATtON HA~ 'BEEN INSPECTED BY THIS DEPARTMENT AND FOUND TO BE ~FACTORY~ C~R'~C~r~ O~ EXCEEDSUPPLY SYSTEM CANNOT2/10 of 1% LEAD. USE IS UNBWFUL WITHOUT CERTIFICATE OF OCCUPANCY APPROVED AS NOTED FEE: ;~ ~9' G o BY~ Y, ~' b, NOTI~ ~ILDING DEPARTMENT AT 76~-1802 9 AM TO ~ PM FOR THE FOLLOWING INSPECTiOnS: 1 FOUNDATION ]~0 ~QLIIBED FOR POURED CONCRE ~ -- I I ,/ _ :(