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Home My WebLink About14057-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ,No. Z15446 .December 3 - 19 .8.6 Date ............................... , . Accessory THIS CERTIFIES that the building ................................................ Location of Property . .356.0 New Suffolk Ave. Mattituck - - hoJ~ bio: ......................'S't/e~i ....................... County Tax Map No. 1000 Section ...1.1.5. ...... Block 9 .Lot 5.2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ' .41¢D,~. 3-.4 ........ 1~9 .B..Spursuant to which Building Permit No. 14057Z dated . June. 1 8 ................... 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 ......... ...... ~.c.c.e..s.s.o.r.y.g.a.r.a.g.e..a...s.t.o.r.a. 97..b.u..i.~.d.i.n..g.. ............................... The certificate is issued to HARVEY & GAY LYNN BAGSHAW (owner, ~I[oxoxx~qt~ of the aforesaid building. Suffolk County Department of Health Approval ........ .N/.A. -. ............................. UNDERWRITERS CERTIFICATE NO ................ .N/.A. .............................. Building Inspector Rev. 1/81 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14057 Z Permission is hereby granted to: /~ ~~....~ ......... ~.~....~........:: ........... .....~. ~.....~.:~.:....!./..~.~..~ .... .~..~...~ ...... .; ........... .~...~...~...:.~....~....:.....¥~.~.~..~ .............. o, premises located at ....~..~ .......... ~ ............ ..~/~/.~..~ ...... Z.~.~...~.....: .......... ............. Z~ ................ ~ ............................................. ;~'~' ....................................................... ..~..~ ...... ~.~ ........ ~.~~.~ ........................................................................ Co. nV Tax Mo~No. ~000 S'e~t,o.' ...... J.L~.C......~,ock ........ .~ ........... Lot No ........ ~.:.....~...... pursuant to application dated ...... ....~~....~L..~ ................. , 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- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter OR ink, end 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 approva~ 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 P~anning 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: 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 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 // // NewConstruction ...... O,Id or Pre-existing Building ............ Vacant Land ....~...> ..... o, "" "' ' ' ' '7: ............... County Tax Map No. 1000 Sectie/n .... ~/~'.~. ...... Block ....~. ......... Lot .... ,~..'...~ ...... Permit No././?/.~...~'..~Z. Date of Permit .~/~.~-~licant....~-~'. Hoalth Dept. Approval ........................ Labor Dept, Approval ........................ Unde~riters Approval .... .~ ............. Planning Board Approval ...................... Request for Temporaw Certificate ..................... Final Certificate ...~ ................. Fee Submitted $ .... ~.~ .~ ................. Con,ruction on above described building and ~t,,~eets all ~ codes and regulations. FIELD'i~S~ECTION FOUNDATION FOUNDATION 2. ~ROUGH FRAME & COMMENTS (2nd) PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL IONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION' [ ] FOUNDATION 1ST ~ [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ~"]'FI~kMING ~-FINAL REMARKS: 765-'"802 BUILDING DEPT. INSPECTION [ ] FOUNDATION '"ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION DATE ~/////~ INSPECTOR TxOWN OF SOUTHOLD BUDDING DEPARTMENT -- TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined . ~[~ .~a,~...}..~...., 19~.~.'f , Approved . . . _~.~,~...l ~.., 19*.ff. Permit N;.~-.'~.t?..~.7...'~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 nec~ess~~ _/c,-~. ~J~ ]o~ ~ (Signature of applicant, orname, ifac'OrpOration) ~. i"~. o,..<~...x..%,....~..~.%.~ .V ......... (Mailing address of applicant) State whether applicant is owner, lessened en~ architect, engineer, general contractor, electrician, plumber or builder. ................................ .q.q .~...~. .................................. ................... ·· .u. .................... Name of owner of premises .. (as on the tax roll or latest deed) ~_.,at~l~i~~~~ly authorized officer. '~<~'~-~e'~O~ ~'o/V'o~;) ......... Builder's License No .......... Plumber's License No ....... .'.~.~. · .~. · · ......... Electrician's License No. A".o...~.'9.~.~.~...~.. Other Trade's License No ...................... 1. Location of land on which proposed wor~k will be done .................................................. ..... ...... ............ .............. House Number Street Hamlet County Tax Map No. I000 Section ...... fl./..~.'~. .....Block ......... ~. ....... Lot ..... . .~".: ~ ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ...... .~..~q .~. ~...~..-~C[.(~...~-~... i .......................... 3. Nature of work (check which aPphcable): New Building ...... on .......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work .............. ...~..~.O..o. ~ t~....~ _(Description) 4. Estimated Cost ............ ~ ............. Fee ................. i ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ......... .~.Q4% .~-~ ................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuies, if any: Front ............... Rear ........ ./ ..... Depth ............... Height ............... Number of Stories ............................. ~ ........................... Dimensions of same structure wiih alterations or additions: Front ..... .'~. ~...J... ~... Rear .... ~'.~ ........... Depth .... ~Q~ ........... :... Height ..... /.~. ............. Nu~nbe~ of Stories .... g~)~qO_~ ........... Dimensions of entire new construction: Front ............... Rear '. .............. Depthj .........,.~.. ...... Height ............... Number, of Stories ............................... 9. Size of lot: Front .......... i ............ Rear .............. /./-f/./... Depth ................... 10. Date of Purchase ........... ,i ................... . Name of Form~wner ........................... 11. Zone or use district in whtch premises are situated ............... :., .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... ..~ .................... Will excess fill be removed fspm premises: Yes No 14. NameofOwnerofp~mises .F/a.c._~.,..c(....~:k..~.~..(~-~....Address ...[~Fa-....<:~....~.-.~'-.Tt. ui\~Z Phone No ...... L ....( ..... Name of Architect -.'~--~~ .~.~.~ ..... Address . .'~..~' ...... Phone No..c~%.~..~'. 7. !. Name of Contractor ........ i .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions from property Hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STA TF.~EW YORK, C OIJ~NTY OF') ..... ~ ....... (Name of individuarsi ~g contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements co,rained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this NOIARY PUBLIC. State of Noir Yo k ....... '~ ........... ~"%0 ............... No, 4707878, Sulfolk C0u~at~.~ (. (S'i~hature of applicant) lerm Expires March 30, i~XJ