HomeMy WebLinkAbout14456-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
z14770 August 6, 86
No .................. Date ................................. 19 ...
Accessory storage building
THIS CERTIFIES that the building ................................................
10450 Sound Avenue Mattituck, New York
Location of Property .............................. 'S't/~i ....................... h~t~/ei
House No. 1 2 2 0 2 0 ~ b~
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....D ?.c.o.m...b ?.v..9. ! ..... ,1985 pursuant to which Building Permit No. 144.56z
dated De c ember 9, 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 .........
accessory storage building
The certificate is issued to ...... Geraldine Worthington
............... ?o¥,,'e;', w ...................
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ............. N / A
Rev. 1/81
I~OBM NO. ft
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)
14456 Z
Permission is hereby granted to: ~'~/-~a~'L'~[ t~.(~ ~,.~'~o/f--T~l ~O~
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Building Inspector.
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Rev. 6/30/80
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND LATION
FRAMING ~] FINAL
REMARKS:,
DATE ~'-~/0~/ iNSPECTOR.,/~~
FIELD INSPECTION ~ COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
C,ODE
ADDITIONAL COMMENTS:
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1~802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted 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 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
3. Copy of certificate of occupancy $1.00
$15.00
4.Vacant Land C.O. $5.00
Date ...!..~ ...........
New Building . ~ ........ Old or Pre-existing Building ............ Vacant Land .............
Location of Property ..... ,[~/~--Jc.~, ..... '~Q.~..~-~.~../"~....~.1~. ...........................
House No. Street Hamlet
Owner or Owners of Property . .~-~.~..~.' .~. (~(~)'~..1.~,(~....~.~'.~ .-J~..-~. ~r~l .~..(~-~..-~.G./~J .............
County Tax Map No. 1000 Section [ ~ ~ Block O'~ Lot., .O..[ .~,
Subdivision... '--- : .Filed Map No....~-~-iL~.., ....Lot No, ~.. ;: .........
Permit No. I.~¥.~,., of Permitl.~l.~,f?-~..~.~, ,Applicant ,~.~:,,5,¢-,~-.%;
Health Dept. Approval ........................ Labor Dept. Approval ,, .~ ..............
Underwriters Approval...,..,~ ........ ........ ,Planning Board Approval ......................
Bequest for Temporary Certificate ,,, .., .................. Final Certificate
Fee Submitted $. ,¥.-~.. ~;.. 7..,,v. ,q..1~....q, J..
Construction on above described building and permit meets all applicable codes and regulations.
Rev. 10-10-78
co e. 1'4770
Memorandum from..,
BUILDING INSPECTORS OFFICE
TOWN OF SOUTHOLD
TOWN HALL, BOX 728, SOUTHOLD, N.Y. 11971
765-1802
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' FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
8OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined,~.~...O...,19 t.~.~t/~,~ -.~]~ Received ........... ,~9...
Approve~ ~...~ .... l~e~it No ...........
[
Disapproved a/c ..... ~.- ............ ~ .... ~. ·
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .~.~ :.
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter 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 Occupraicy
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
in building for necessary ' ctions. /9 _ .~
admit authorized inspectors on premises and ~~., .~:.~ .................
- (Signatd~ of applicant, or name, if a corporation)
,&
(Mailing address of applicant) ,f
State whether applicant is owner, lessee,~chitect, engineer, general contractor, electrician, plumber or builder.
.......................................... ¢' ..... ';. ......
(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 ...... ~ ..Z~-... ..........
Plumber's License No .........................
Electrician's License No...~..<:~..~4...~.--~. .........
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 .... ~ ........... Lot [ 4
Subdivision ....... :.,: .; ............ .............. Filed Map No .... ~ ........ Lot .. T-: .~ .........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... .~.. ,&~..~.... ~.. &~. ~[ .~.~%~... i~(~L~,~ iL~...~.--~.. ...............
b. Intended use and occupancy .. ~/~0 ~L.~....L~./c.?..~..~.....----~..L,C~'7.~ --'~" ~ --X .~4/_QjO..~.' · .~. · -c~..<TT. .........
3. Nature ~f work (check which applicable): New Building ' Addition i Alteration
pair '
..... ~ . Other Work .......
' Re ......... Removal .............. Demqlition ............ ..........
20,0.00 '
(Description')
4. Estimated Cost.. Fee
"~ (to be ~aid on filing this application)
5. If dwelling, number of dwelling units ............... Number of d~,elling units on each floor .........
If garage number of cars ',-
6. If business, commercial or mixed 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 .alte. r.ations or additions: Front ............ j .... Rear .; ...............
Depth .... ' .................. .H'ei~ ................ ' ...... Number of Stories' . ...............
8. Dimensions of entire new constmctio_~F~n~t, t ............... Rear ......... ...... Depth ..............
Height ............... Number of Stories .~. ......................... i ...........................
9. Size of lot: Front..: ................... Reht~. ..................... Depth ...................
10. Date of Purchase ............................ .X~ame of Former Owner .! ...........................
11. Zone or use district in which premises are situated ..... .~. ............ . .....i ...........................
12. Does proposed construction violate any zoning law, ordin,a,n.~x~r regulation ..... i ............................
13. Will lot be regraded ............................ Will ex'c~s~ fill be removed from premises: Yes NO
14. Name of Owner of premises .................... Address ................ J... Phone No ................
Name of Architect ........................... Address ................ I... Phone No ................
Name of Contractor Address Phone No '
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed,
property lines. Give street and block number or description according to deed,
interior or corner lot. ' -
ail set-back dimensions from
~t names and indicate whether
STATE OF NEW YORK,
COUNTY OF .................
S.S
............ ' ..................................... being duly sworn, deposes and says that he is the applicant
(Naive of individual signing contract) :
above named.
He is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the sa'id wor} and to make and file this
application; that all statements contained in this application are true to the best of his iknowle tge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
............. ?. ~ ..... day of .... ..~.)1.~%.. ............ 19 .~..~-
..,, _ .,...