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Home My WebLink About14292-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13997 Date November 12 19 .8.5. THIS CERTIFIES that the building ... f~q ~.sb..2.n..d..s.~.o..:y... ........................ Location of Property .... 1..0~..R.~ .o:f:p:... Rhoda..R.d, Mat.t.i.t.u. ck House No. e. Cottony Tax Map Ho. 1000 Section . 10 .Block ............. Lot Subdivision Cal~t. Kidd Estates Filed Map No. ~.6.7.2. Lot No.. . conforms substantially to the Application for Building Permit heretofore fried in this office dated ...................8e~p. tember 19 ...... 198..5 pursuant to which Building Permit No ............... 1429.2~... dated . Septer~ber 20 198..5. , was issued, and conforms to all of the requirements of the applicable prov~ions of the ~w. The occupancy for which this certificate ~ i~ued E ......... Finish 2nd .story on an existing one-family .d~.el~ing,. The certificate is issued to .G.~..~..D W. ~ MON..LI_~...bi: PO.O.L~.. of the aforesaid building. Suffolk County Department of Health Approval .N./~. ............. N713114 UNDERWRITERS CERTIFICATE NO ............................. Building 1/61 ~01~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) NO- 14292 Z Permission is hereby granted to: ~ ~. ~~ .. .... z.~.~.....~ ...... ~ ....................... ...... ot pmml~ I~oted ot ...~..~..~ ........ ~..~ ........ Z.~.I .................... County Tax Map No. 1000 Section ...... J....C).....(~.. .... Block ........... I .......... Lot No ....... .~. ............... p.~uont to opp,,cot,on dated ...~~.~~' ~- ...... ~..?. .......... , approved by the Building Inspector, 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 BI.DG. DEPT. TOWN OF SOUTHOLD \~k.,~- Iq"] A. This application must be filled in typewriter OR ink, and submitted i ~ 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, ~ndustrial 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 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: 1. Certificate of occupancy SB.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ............. Old or Pre-existing Building $15.00 ......... ............ Vacant Land ............. House No, Street Hem/et Owner or ~r~.n_A[s of Property ..G~L'.....~ :...'-....~. ~..t'~t~t,. '~..Qt~IO ~ .... Countv Tax Map No. 1000 Section /~(~ Block / Lot.. .~.' Subdivision ................................. Filed Map No ........... Lot No .............. ~%.~..~.~ D ate of P ermit~,.~), ~t...~App,icant Permit No ...................................... Health Dept. Approval . .~.1~ ................... Labor Dept. Approval ........................ Underwriters Approval .~. ,~.~. t[~ .... Planning Board ApprovaJ ........... Request for Temporary Certificate ..................... Final Certificate ,. ~. ................... Fee Submitted $ ..................... Construction on above described building and perr~it/neets all F~plicab~ coagulations. '~-~,,~JV~ · 'D~-] x~0(oApplicant · · ~"~' ``% "4"/¢-4¢¢<¢''~''T~¢'7' · · · "'~'~' · ............. iooi3>~,7 THE, NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ October lyf i~ s5 ~0.~ STREET, .~W YORK, THIS CEffTI~IE~ THAT only the electrlcal equipment ~ described bel~ and int~duced by t~ applicant named on the above application number in tke premises of Jer~y ~ie, S/S Rhea R~d, 200 W/O ~1% ~attttuck~ in the /ollowing locution; ~ Basement ~ 1st Fl. ~ 2nd ~l. Section Block Lot was examined on and/ound to be in compliance with the requirements of ~his Board. ~tob(~ 10~ FIXTURE FIXTURES RANGES =OOKING DECKS OVENS DISH WASHERS EXHAUST FANS 10 2 3 ~rnfield ~d [his certificate must not ~e ohered n any monner; return to the office of the Boord if incorrect. Inspectors may be JdentlfJed by their creden/ioJs. NT, THII t~iELD INSFECTION COMMENTS ,UNDATION (2nd) OUGH FRAME & PLUMBING ~SULATION ?ER N, STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. i l qff'~ UN~WFUL USE iS .~ ~/.os'! ~v: ~'~-~-,.,. ~5-180~9 A~ TQ/:. ~M ~R THE :~L[ OwiNG INSPECT, ~NS: FINAL CONSTRUCTION lUST ~: CE,~%~E FOR C.O. ;TATE ~NSTAUCTION & E tERGY -3DES, NOT ~S~NSIBLE :OR USE IS UNLAWI~L: i i~ ' WITHOUT CEI~IFIC~IE ~,t~ROV~9 A$ ~OTSD 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Examined .~-~..~...~. 9., 19 .~.~.~ 19~.. Pe~it ............ Disapproved a/c ..................................... .. (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ts 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 ~ar areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 hail 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary insp.,te~ions. ~ iSignhture-of'/-~1 a~n~, o'f'l~a~ne-, i; a c;r3;;a'tidd) .... .rr (Mailing address of applicant) grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' lame of owner of premises ......................................................................... (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. ,'~1~.'~.~. ........... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ............... ....... '.r.r.g.u.ce .......... ............... House Number St r, eet! O G Hamlet County Tax Map No. 1000 Section ~~'.. Block .................. Lot ............. Subdivision..~.,.r~d..~'. ............. 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 .... (.g.~.[.[.~..vl~ .¢ l~ ......................................... b. Intended use and occupancy ............. T .................. ~ ~.~.~.~::,,t ~,.~ · .............. 3. plicable): New Building ...... '....' ition .......... Alteration .......... ...... ~ ~moval .............. Demolition ........... Other Work ............... ~ ~i~ ~07, ~ (Description) 4. Est~ a~ted Co ~t ........ Fee ~ ~' ,~, :~,~ i~ ' ~' (to be paid on filing this application) 5. If dweliing, n ~mber of dwelling units .......... [ ..... Number of dweiling units on each floor ................ If garage, nun ~ber of cars ...; ..................................................................... 6. If business, cc mmercial or miged occupancy, specify nature and extent of each type of use ..................... 7. Dimensionso!existingstructt~res, ifany: Front ............... Rear ................ cDepth ... Height .............. Number of Stories ~ ~ g-~ ~ t~m-ro*~--,~ ........... Dimensions of same structure iwith alterations or additions: Front Rear ....... Depth ................. i ....Height ...................... Number of Stories ...................... '-~8 Dimensions 'entire new con~trnction: Front Rear Depth Height Nt~mber et Sto~es . 9. Size of lot: ont "'iii' .~..'f-':'~ .......... Rear ...................... Depth ?. .................... I0. Date"of Purchase ...... ...... Name of Former Owner .... f~... .'U....~.. 11. Zone or use strict in which premises are situated ...... 12. ' ..................... ...................... Does proposed construction v$olatq gny zoning law, ordinance or regulation: ............. ~_~ 13. Will lot be reg[aded ....... '.. · · ~. .... Will excess fill be removed~r~m premises: Yes 14. Name of Owner of premises . i?...~.~ ............ Address/.O. ~.~..~ .g.&.~.~.~.t..~l~one mo~q~,.e~.7$.~. .. Name of Architect ........ i ................... Address ................... Phone No ................ Name of Contsactor ....... i ................... Address ................... Phone No ........ r~. ...... .. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Giv. ~ street and bloe,k number or description according to deed, and show street names and indicate whether interior or corner 1~ ,t. i ' STATE OF NEW Y~ )RK, COUNTY OF ..... S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name af individual sighing contract) above named. He is the ................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or o vners, and is doly 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 perforr ted in the man~er sbt forth in the application filed therewith. Sworn to before me this /.q c' : .............. ~ ....... day of ................ 19. Notary Public, ... · g~. ....... County ....... ................ (Stgnature of applicant)