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Home My WebLink About14332-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-]5306 Date Februar~ 26, ]9..87 THIS CERTIFIES that thc building DECK ADDITION Location of Property 4835 Oregon Road Matti'tuck, N.Y. House No. Street Ham/et County Tax Map No. 1000 Section 95 ...Block I .Lot !. 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated September 17, 1985 pursuant to which Btfilding Permit No. !4332z dated October 7, 1985 . 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 TO EXISTING ONE FAMILY DWELLING MORRIS ISAAC The certificate is issued to ........................... ~ ~'o ~,.er, ~,,~&~;~ .................... of the aforesaid building. Suffolk County Department of Health Approval N/A N/A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: Rev. 1/81 FORM' NO, ~ TOWH OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14332 Z Permission is hereby granted to: .......... ~,~r~ ....... ~ ................................. ..... ~!.~, .....~, E ....... at premises located at ........~ ............................. ~. ........................................................... ~ ................... pursuant to application dated .................... [[...~.'.//.7. ...................... , 19...~...3~., and approved by the Building Inspector. 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 am,~mm 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: I. Accurate survey of property 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. 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.O. $5.00 5. Updated C.O. $15.00 $15.00 New Building ... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....................................... .~.. ; ..... ~ ........ House No. Street Hamlet Owner or Owners of Property .... ,~ .o.,1~, ?r,( ~..., .'~,. ,~?,, .~. ,c~-, ............................. County Tax Map No. 1000 Section ~/~"' / ./'. /' ............... Block ............... Lot ............... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo.//'/~'z Date of Permit ~/~..z'V~£ .Applicant ~.,~,~/, .~..~,,~. Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .....4-¢~... .............. Fee bu~mitted $ ............................. Construction on above described building and perpg~pplicable codes and regulations. Applicant....~...'~.~'~/ ...... ~.~. '/.~.~. ............................ Rev, 10-I0-78 ,'OUND~TTO~ (1st) ,'OUNDATION (2nd) ~OUGH FRAME & PLUMBING iNSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18,02 Examined .... /~.~. ....... ,19 Approved ...... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEFT, TOWN OF SOUTHOLD Received ........... ,19... Date c~//7 19 ~J'~ 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 wi/1 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 ~t 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, j~,~ ___ . (Signature of applicant, or name, if a corporation) ...... (Mailing address of applicant) ~ electrician, plumber or State whether applicant is owner, lessee, agent, architect, engineer, g. ~.. , builder. Name of owner of premises .. ~..o..~....~-. ~.'.~. .... . .~'...~..~..~.+~.. .......................................... (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. -~ ~'~J) 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 Number Street Hamlet County Tax Map No. 1000 Section .... . .~....~.~.~. Block ..... ~ .q~..F.... Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premise~ and intended use and,occupancy of proposed construction: a Existing use and occupancy.....~r~.~_.......~....~.. ~.~ ................................... b. Intended use and occupancy ~t~. ~ ~,,~,:~ ~,,,;~,-~ ' h applicable): New. Building ........... c . 'Addition ........ Alteration .......... l j I', Repair ....... v,~. ~.i Rembva ............... · I ....... Demolition ....... Other Work ............. 4.~ Estimated Co t ...................... Fee .~ '~ ~' (to be paid on filing this application) ~5':"'If I1Welling, number of dwelling': units' ............... Number of dwelling units on each floor ................ If garage number of cars , 6.If business, coinmereial or mixed occupancy, specify nature and extent of each type of use ..................... 7 .... ' if any: Front ' Rear Denth · Dimensions of existing strtlctures, ....................................... Height ............... Number of Stories ..................................................... Dimensions of samet structure with. alterations or additions: Front ................. Rear .................. Depth ~ Height Number of Stories ' 8 ..... Front ' Rear Depth · Dimensions of entire new construction: .......... , ................................... ~ ' Height . .. ............. Nuraber of Stories ........................................... . ............. 9. Size of lot. Front .......... ~: ............ Rear ...................... _Depth ...... .~ ........... .... 10. Date of Purchase .......... i ................... Name of Forrg~r Owner .,~--~e~d/.~'~'.. ff,~~.t'... 11 Zone or use district in which p emises are situated ' ~ X/F,Z~' 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ' ............... 13. Wllllot beregraded ....... , ......... ~ ......... , .Wlllexces~fillberemoved from premises: Yes 14. Name of Owner of premises .~...Z.~?~. Address ~ ~...~.~.g'f.C.~.. ~ ..... Phone No ............. ." Name of Architect ........ Address . .'~'.~.w../'(~.~..~.~.~. ~c~'Phone No Name of Contractor ' Address l~ .°~.° Phone No PLOT DIAGRAM Locate clearly and distinctly ~1 buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl: number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ~ S.S COUNTY OF ................. 1 (Name of individual si~ning contract) above named. being duly sworn, deposes and says that he is the applicant He is the ................... of said owner or owners, and is dl~ly authorized to perform or have performed the said work and to make and file this application;that all statements cogtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man~er set forth in the application filed therewith. Sworn to before me this j , ~~~ (Signature of applicant)