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Home My WebLink About14375-zFORM NO. 4 TOWN OF 50UTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14179 Date J.a..n.u.a.r. 5/ 24 198..6 THIS CERTIFIES that tl~e building ..... .Rp.o.m...A.d.d.i..t.i.o.n...&..D.e..c.k.s .................. Location of Property 1200 East Mill Rd. & 4205 Grand Ave. Mattituck h3~s'e hio~ ....................... Ytie~i ....................... h~r~iel County Tax Map No. 1000 Section . . .19.7 ....... Block . .. 9.1 .......... Lot . . .09.2 ............ Subdivision ............... .X ............... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...O.c.t.o..b.e.r.. 2. ........ , 19.8. 5. pnrsuant to which Building Permit No....1.4. 3, 7 .5.Z ............ dated ..... o.q .tg.b.e.r....1.7. .......... 19.8.5., 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 ......... --- Room Addition & Decks to Existing Dwelling --- The certificate is issued to ................... C. 9.H.I.L.L. f' JAMES of the aforesaid building. Suffolk County Department of Health Approval ........ N.[.R. .............................. · UND ERWR ITER S CE RTIFICATE NO ................ .N 7 .3.0. 9. 9. .1 .......................... Building Inspector Rev. 1/81 ~OBl~ 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) NO 14375 Z Permission is hereby granted tL ........................... ,o at premises located at ........~..R~,..T~.....~.......~ ........... ...~.~ .................. County'~'l'Map No. 1000 Section ...... L...~....-~. ...... Block ....... ..C~....[. ........ Lot No ...... ..~,....)....? ....... pursuant ,o application doted ..... .~..~.....t~. ................... , 19.~..~.../, 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- 180Z APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLDG. DEPT. TOWN OF SOUTH_OLD 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-iS~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 Apri{ 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 $15.00 4.Vacant Land C.O. $5.00 Date ....................... ~ ' ' gB 'ldin9 New Building ..... ,Old or Pre-ex~stm u~ ............ Vacant Land ............. Location of Property .............. .~ ........... House No, Street Hamlet Owner or Owners of Property .................................... : ...................... County Tax Map No. 1000 Section ..../.e...~. ...... Block ....~. ~ ........ Lot....~.~-~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo...7.~.~7.~..~DateofPermit 0. ~c~ Health Dept. Approval ..... q..~' ............... Labor Dept. Approval ........................ Unde~riters Approval ............. Planning Board Approval ...................... · Request for Temporary Certificate.. ,Final Certificate .................... Fee Submitted $.. ~.~ .... '~ ~. t~ ........ Construction on above described building an~eets all applicable codes and regulations. ~ to~r~ · Applicant.../.,~..."-; .~./~.~. ............. '... .................. ~tooo66:~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ]~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10058 ..,e 730991 THIS CERTIFIES THAT only the electrical equipment ~ ~scribed bel~ and int~duced by the applicant named on the able application number in the premises of irt the following Iocat~on~ ~ Basement ~ 1st Ft. ~ 2nd FI. Seczion Block Lot was examined on ~'~Ll128,~y ? ~ ~" ~) ~ ~ and found to be in co~npliance with the require~ents of this Board, FIXTURE OUTLETS DRYERS ~ECEPTACLES 5 SWITCHES FIXTURES RANGES OVENS MERCURY FLUORESCENT VAPOR FUTURE APPLIANCE FEEDERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Hotors- 1~ IH. ~. G,F~C,I,-~ 3, S E R V NO, OF CC COND. A, W O. NO` OF HI-LEG PER ,e' OF CC COND. C E A. WG OF HI-LEG NO OFNEUTRAI OF NEUTRAL La~rel, NoY~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by ~ I I ~ R 1FI T M STN ,BEALT REDIN~AANY,~rM__A~NNER.,. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~373' ~ Owner ~3 C~ ~_M/~/~__~ (please print) Plumber ~6/~~/c ~- /~'~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn t6 before me this Notary Public, County Ng(a Public NANCY Noto, ry Public, State of New York No. 48~9969 Qualified in Suffolk County ~mmission Expires M~ch 30, ~9~7 FIELD I§S['ECTION COMMENTS FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examined ~..t.-/..., 19 .~?.'~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .e:¢~ .1.-]...., 19~?. Permit No. !.~..~..~..~..~7 Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 1 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 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 ~ 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 cod,~ 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) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~.~..~. · .&( ..... .~..4 e.'.(;. ............................................... (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....~...~..a° ................ Plumber's LicenseNo ......................... 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. I000 Section .... ~..o. ?. ........ Block ...O./ ............. Lot....O. ~ .L.~-7... ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing occupancy ... ~ ..... .cha~...v. ......... >;'; ?.-~? '~,f * ',4 .................. a. use and b. Intended use and occupancy property lines. Give street and bloc interior or corner lot. 3. Nature of work (check which~a~0plicable): New Building ..... ' ..... Addition. j......... Alteration .......... epmr ............. :'t Re~noval ............. Demolition .............. Other Work ............ i.. .4 ~., J,.!-' i (Description) 4. ~,_ .~. ~t,*. --:~ i , ~' (to be paid on filing this application) 5. If d~e~ng} nu~nber of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ... i .................................................................... 6. If business, commercial or mix'ed 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 .................. i · · · Height ...................... Number of Stories ...................... · 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ~ 9. Sizeoflot: Front ......... ! ............ Rear .............. ........ Depth 10. Date of Purchase ......... ~ ................... Name of Former Owner ............................. , 11. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed eon~struction violate any zoning law, ordinance or regulation: ................................ 13.. Will lot be regraded ....... i .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . ~ .................. Address ................... Phone No ................ Name of Architect ....... -,L~,,'/ .. Address ................... Phone $o.~:,hla.~ .......... Name of Contractor ~ ,r~.t.~.:~. ' ~.~/'~iJ ....... .. Address . .. Phone No.*4~.[.~. .~.~.3..2~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ................. S.S .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sigiaing contract) above named. He is the ..................... : .................................................................... ! (Contractor, agent, corporate officer, ere..) 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 application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~,th in the application filed therewith. Sworn to before me this ........................ day o? ................ Tern Expires M~eh 30. l r~.,.,~/