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HomeMy WebLinkAbout14529-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupancy No. Z-15663 Date April 21, 1987 THIS CERTIFIES that the building Addition to existing accessory building Location of Property 2855 Westview Drive Mattituck, New York House No. Street Hamlet County Tax Map No. 1000 Sect[on I 07 .Block 08 ...Lot 6 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated February 3, 1986 pnrsuant to which Building Permit No. 14529. Z dated . .F..e ?.r.u.a..r .y..6. ,...I.9,8.6. ........ was issued, and conforms to all of the requirements Suffolk County Department of ttealth Approval ...... UNDERWRITERS CERTIFICATE NO ............... PLUMBERS CERTIFICATION DATED: of tile applicable provisions of the law. 'File occupancy for which this certificate is issued is ......... ADDITION TO EXISTING ACCESSORY BUILDING AS APPLIED FOR IRENE BIALESKI Tile certificate is issued to ..................... [o~'n'o'r, ~e~'X'fef~O'XX__ ................... of the aforesaid building, N708867 ,' N/A Iluitding mspector Rev. 1/81 ~OR~ NO. l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Couniy Tax Map No. 1000 Section ...... 1...0...'~ ......... Block ..... ..t~....~ ......... Lot No ....... ~ .............. pursuont to application dated ...,~,,.,~,~,...,,~.. ........ ;. .................... , 19,~.,~., and approved by the Building Inspector. Fee $,~,4.~ .... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLO~-L 0,.'~ ~ TOWN OF S£)~,~ ' 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 property showing all propertv 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 $25.00 ccessory ~$]0 1. Certificate of occupancy New Dwelling,S25.00, ~ . Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5. Updated C.O. $ 50.00 Date .. ~///~./.o~..~. NewConstruc%ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property House No,, , , /~ _ /~19/~ Street Hamlet Owner or Owners of Property . .'A¢.~,¢~,../,~z~¢¢~.~ ........................... County Tax Map No. 1000 Section ./?..~. ......... Block . Z~o~'.. ......... Lot... O~..~. ...... Subdivision ................................ Filed Map No. Z~ ........ Lot No .............. Perm t,ol..C. .. ... ..Z'DateofPermi .... Applicant .... __ ........... Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporarv Certificate ..................... Final Certificate ....................... Fee Submitted $ .... /g~.,5 .~2~... ................ Construction on above described building a~d permit meets all applicable codes and regulations. Applicant....k~..~'~..~~.o .......................... Rev. lO.10.7a FIELD INSpECtION FOUNDATION FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 3. Nature of work (check which applicable): New Building ' Addition . ./...'T~..... Alteration · Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Nfimber of dwelling units on each floor ................ If garage, number of cars .... /. ~,.~..,'~- ........................................................... 6. If business, commercial or ]nixed occupancy, specify nature and extent of each type of use ..;... 7. Dimensions of existing structures, if any: Front..~. ,Z.~ ..... Rear . .~./'~t .... Depth . .~',~'.Z~. ........ Height .... /. ......... Number of Stories ..... ./ .................................................. Dimensions of same structure with alterations or additions: Front . .,~.. ~. .......... Rear .. ,,~L, ff~ ........... Depth . . .~ .~._.-, .............. Height ..... ~. ~.. ............. Number of Stories .../.' .................. 8. Dimensions of entire new construction: Front ..... /. ~.. ....... Rear .... /P. ........ Depth . .,~. ?.~ ........ Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ............................ Does proposed construction violate any zoning law, ordinance or regulation: .. ~..~? ....... iii.. Will lot be regraded ............................ Will excess fill be removed from premises: Yes ' ' Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .... ......... ~' :'~~ · · ./7 .......... ..... Address ................... Phone No ................ Name of Contractor 10. 11. 12. 13. 14. 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 ,~OTIFY I~UILDfl~IG O~iPART~NT AT 765-1802 9 AM 70 ,~. P~,~ ~;~R THE ~f ALL ~LI,~ ~t ,~. ~C,-~ ~--~LL STATE OF NEW ~ o S THE flEQOF~E:~./~S~N' f ~ATE CON~'rR~C'r~O~ ~ ENERGY . COU~Y OF. ,~,.... , ~gS. NOT ~SPO~E (Name of individual signing contract) above named. He is the ......... ~~& ................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perfom or have perfomled the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that ~e work Will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this MECIS~US WINIA~ ) ~ No. 52-9703725 SuffolkCoun~ (Signature of applicant) ~m. Ex~l~ Ma~ 30, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c .................................... : (Building Inspector) . APPLICATION FOR BUILDING PERMIT a, This sets of plans, b. Plot plan or areas, and giving cation. d. Upon shall be kept on the e, No building Received ........... INSTRUCTIONS typewriter or in ink and subn ~itted to the Building Inspector~ with 3 > 3o adjoining premises or pubBc streets must be drawn on the diagram which is part of this appli- be commenced before issuanceiof Building Permit. ' · ; Inspector will issued a guildia~ P~rmit to thc applicant. Such permit whole or in part for any purpose whlatever until a Certificate Of Occupancy .shall have been granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordin~mces 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 eode,.housing code, and regulations, and to admit authorized inspectors on premises and in building for necessar~ins~tions.. '"~~ ''~~~~~-/} ~; ;-' ;;a'tit~n"~ .... (Signature et applicant, or name, ' (Malligg address of applicant) State whether applicant is owner, .lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .Ow. .~.~,5~....&-.. c wz~:r. ,e ~ o~..~.. ................... :~ ............................. ~E~./ X. ASl. g~_r~'l. ' Name of owner of premises ....... (as on the tax roi1 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 .................. $.~.~. . . . ~,. i~ f .-~. f ~ ~/ .... ,~. .............................. /~,~. .~. ./:. .~. .¢.,,7~. . House Number. Street ! Hamlet County Tax Map No. 1000 Section ..... ....... Block ...... ~.~' ....... Lot .... ~ ............. Subdivision ........................... . .....Filed Map No .... ' ........... Lot ............... ' (iq'a~) State existing use and occupancy of premises and intended use and o~cupancy o£ proposed construction: a. Existing use and occupancy....~ ........................................................ b Inte d d d up y · n e use an occ ant ./..,~.,~: ............................ . ............................