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Home My WebLink About14139-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy THIS CERTIFIESthatthe building Renovate and add to existing dwelling Location of Property 2.7.9..5.0. le Jule Lane Mattituck Ho~,se No. ' ............ 's'de~i ....................... h&~l'oi County Tax Map No. 1000 Section .... .1.2.2. .... Block 05 . .Lot 15 Subdivision .......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. J. ql~y..8 ............ 19.8.5. pursuant to which Building Permit No. 14139Z dated aul.y. 3. 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 ......... R~f%qv.~tion and addition to existing one family dwelling. The certificate is issued toAL LANE ..................... ?o¥,,'o;,~i~'~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ..... .N./..A ................................. UNDERWRITERS CERTIFICATE NO.. N 734403 Building Inspector Rev. 1/81 FORM' NO. ~ TOWN OF $OUTHOLD 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 14139 Z pursuant to application dated ........ A..~,,~.....~ ...................... , 19..~...~..'~., and approved by the Building Inspector. ,~'-'~)...~ Fee $ ........................ 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 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 natu raj or topographic featu res. 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 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topograph ic 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: (~)Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~/3-~ 5. Updated C. O · $15.00 Date ..... ~ .~. ................. New Building ............. Old or Pre-existing Building / Vacant Land Location of Property., .~. ?..d/~,.> ........... ~..~/..~...M..~.~.~/7~....~../~./.~..~. ....... /~..,.....,...~/~Y,~?/~4~ (~%/(' House No, Street Ham/et Owner or Owners of Property ./~. .~../? ./.U.~.~., County Tax Map No. 1000 Section .. ~. ~..,~. ....... Block .,, ,//~.~ ....... Lot../.'~.-.~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /..~./.~.?... Date of Permit ~.-/~. 7 ?.~ .Applicant ..... .~.Z...,~../~../~'.~.~. .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate J./.. ................... Fee Submitted $ ............................. Construction on above described building and permit meets~le codes and regulations. Applicant ...................................... zooo343 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC TY ,L~,i,7%,j~t~_t¢ ~,¢]~JOHN STREET, NEW YORK, NE~ YORK 10038 only the electrlcal equipment as &scribed ~elow and introduced by t~ applicant n~med on the ab~ application number in the premises qf Sound Sho~e Bt~.lders~ ~o1~ ~90Id Ju~.e Lane, ~'raus Rd.., Hattituck,. was examined on aud found to be in compliance with the reqhlrements of this Board. FIXTURE OUTLETS RECEPTACLES SWITCHES 11 5 1 DRYERS FURNACE MOTORS Goodale Elect. Cont. 7355 Main Rd. Mattit~ck~ N.Y., li952 FIXTURES !IME CLOCKS J BELL UNIT HEATEBS MULTI-OUTLET R I V ~ C NO. OF H~-LEG A, W O FUTURE APPLIANCE FEEDERS OTHER APPARATUS: certificate must not be altered in any manner; return to the office of the Board if i, .9783E EXHAUST FANS DIMMERS A. WG OF NEUTRAL Inspectors may be identified by their credentials. ) IN ANY MANNER INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1803 !Disapproved a/c ................. .................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. · 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 tiffs 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 g 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, buliding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections~,.f ,,~, ~ ~ . . ~.,c : ¢~. : .~ (Signature of applicant, or narr~,-.i~ 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 ...,~.z{- .... ,~/~ .~.~..~ ...................................................... (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 .......................... Plumber's License No ......................... Electrician's License No .... t~,..,~,~...~. ......... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ..... g,..qg.<5 House Num bet Street Hamlet County Tax Map No. 1000 Section ..... J.~'..~-. ........ Block ....... ~ ........ Lot .... ./~.'~. ........... Subdivision ..................................... Filed Map No ............... Lot ..... ,. ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~.~.~.U.~. ~.... j~.,~q/.,t.~j...~../~.~.~..(_~.~ .,~.~....., .......................... b. Intended use and occupancy.. ~../.,~d~ ~.~.-~... ,/.~../~./~/t4 .~'...df.dq..~...~...~. j'.: ,,, .w~,:ii~:~!(f~ ~.. 3. Nature of work (check which applicable): New Building .......... A tdition . ~ Alteration ...~-~.. Repair Ren~ovai Demolition Other Work Est~ [ ~ ,~ ~' i (Description) 4. mated Cost ..... /~,n~'~ ~9.<0~ ........................ Fee ...................................... j ~' (to be paid on filing this application) If dwelhng, number of dwelling units ..... ,/ ... Number of dx elling units on each floor. If garage, number of cars .... : ......... ~ ......................................................... 6. If business, ommercml or m~xed occupancy specify nature and extent )f each type of use' ..... ~ ............... 7. Dimegsions of existing structures, if any: Front ...... f~,ff.. . Rea:' ....~.o. ..... D~pth.. ?. ~ ........ Height Number of Stories ./ Dimensions of same structure With alterations or additions: Front .... . .o~.,~. ........ Rear ...c~.~. ............ Depth ... ~.'. ........... i. · · Height ...................... lumber of Stories ' 8. Dimensions of entire new construction: Front ............... Rem ............... Depth ............... Height ....... , ....... .3X!,u~ber of Stories ................ :.. .. ................. ............... 9. Size of lot: Front ...... /.~.~. ........... Rear ..... ~.o.~. ......... · Depth .. ~:,~'~.o. .............. 10. DateofPurchase .... ~.-f.O:.~fff. .............. Name of Forme Owner .f./g~.,~:~....~.~,.'~.ff.,~. ..... 1 1. Zone or use district in which ppemises are situated .................................................... 12. Does proposed constructionV_iglate any zoning law, ordinance or regulal ion: ..../~'..o ........................ 13. Will lot be regraded ...... ,~.O. ........... Will excess fill )e removed fromm l~r~.m_j~,~;,_,. ~ No 14. Name of Owner of premises !.~....,~.ff.,~..~. ..... AddressJ.~.~.Z.. ~ ~¢d~.~...JT./.~??-. p~o.~.~, r~,.~.~. ~.~..~.o~.. Name of Architect .... ,~t/~.. ~./~./¢.A/~.~.45-. .... Address ./. ,/ggq4/;. ~. f~..J~'T.? ,~, ,~o~ne No.. Name o f Contractor .fi.~ ~.~../9... ~//.~. q..~.W.~.~.c~./(,J Address /~ (~<4~. ~/..~./.~bne No.. ~'~.~. 7'. t~./-~./... PLOT DIAGRAM l,ocate, clearly and distinctly all buildings, whether existing or propos, ~d, and, indicate all set-back dimensions from property lines. Give street and bloc]: number or description according to deet and show street names and indicate whether interior or,comer lot. STATE OF NEW YORK ~, COUNTY OF ..... ~.~j/.~./~..O~./.(. ,~ S.S · · ........................ ~.. · .~t'~/~.~¢'~............. being duly s~ ~m, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the ........ . ............. ..................................................................... (Contractor, agent, corporate et ricer, etc.) of said owner or owners, and is duly authorized to perform or have perfot ned 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 forth in the application filed therev ith. Sworn to before me this ........ ............... day of... ~ ......... 19 .~.°.''- .... ount. __ . .......... .......... ~Su.o~k ~u?/~,.~./ (Signatm~-~Lapplicant)