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Home My WebLink About13804-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13956 Date OqtobCr 24 ., 19 85 THIS CERTIFIES that the building ..... .A.d..d.i.t.i.o..n ................................. Location of Property ...1.1.Q Q ................... .s. qu..n.d..B.'e..a.c.h..D..r... Mattituck i-louse No. Street Ham/et County Tax Map Ho. ] 000 Section . .0~9.9. ....... Bloc]< ...... 0..~ .......Lot ...... .0.0.4...~. ..... Subdivision Capt. Kidd Est. .Filed Map No..1.6.7.2....Lot No. 4 3 conforms substantially to the Application for Building Permit heretofore Fried in this office dated March 25 138.04Z ...................... 19 85 pursuant to which Building Permit No. dated .... M..a.r.c.h...2 .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 ......... ..... .-.-.~r .- r.-.-.r...A.d.d..i.tio, n...t.o..E..x.i.s.t..i.n~..O..n.e..F.a..m.i.ly...D.w.e.1.1..i.n.q. ......... The certificate is issued to .............. .C.Y.P..R.U.S.,..N..I,C,K,, .&, NIKI (owner, ~.see=~a~ of the aforesaid building. Suffolk County Department of Health Approval .... .N./..A .................................. UNDERWRITERS CERTIFICATE NO ............. N. 7 O .3.7.8.1. ............................. Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 13804 Z tO County Tax Map No. 1000 Section .,...,(~..~...~. ....... Block ....... ..~,..~. ....... Lot No ....... ..,~...,'...~ ....... pursuant to application dated .... ..~.~..¢~,,...~-. ,~, .................. , 19~...~..C and 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 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia I1~ 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 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. B. Submit Planning 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 f~) ./.q F~ .... ?., .......... New Building....~... ..... Old or Pre-existing Building ....... . . . .. Vacant Land ..... ........ Location of Property ................... , ............ . ............................ House No. Street Hamlet Owner or Owners of Property . ./Y.'.~.~,..~...~../..~./ .... .~..~/./?./~ ............................ County Tax Map No. 1000 Section ..... ~ ~ ~. ..... Block .... ~. / ........ Lot...~.~. ?. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./. ~'J.~..~. ~'Date of Permit ~/.2.~../~'~.Applicant...~..~ ~ .~.......L~.~../,~ .~..~.~: .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .~. ...................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~.~. ......................... Construction on above described building and permit meets all applicable codes and regulations. ~ 4~ ~q'~ Applicant ............................. FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION FERN. STATE ENERGY QODE ADDITIONAL COMMENTS: FINAL 76S.1802 BUILDING DI~pT, L INSPECTION FOUNDATION '~ST [ ] ROUGH PLBG. [/~OUNDATION 2ND [ ] INSULATION [~] FRAMING~ REMARKS: [ ] FINAL DATE iNspEcToR · THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~911~ 07~, ,[98~ 8D JOHN STREET, NEW YORK, NEW YORK 10038 Date /lpplication No. o~t file 3~5~[/85 only the electrical equipment as described below and introduced by the applicant named on the abo~e application number in the premlses of in tkefollowlnglocation; ~ Basement ~ 1st Fl. ~ 2nd FI. A~iC Sectio~ Block Lot wasexaminedon ~t 0~ ~5 andfoundtobeincompliancewiththerequirementsofthisBoard. FIXTURE OUTLETS 17 DRYERS FIXTURES RANGES ~.OOKING DECKS ' OVENS F~ECEPTACLES SWITCHES FtUORESCENT 23 10 17 FURNACE MOTORS FUTURE APPLIANCE PEEDERS TIME CLOCKS DISH WASHERS EXHAUST FANS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS= S E R V I C E NO O E COND. OF CC CONO OF Hi-LEG AWO. OF NEUTRAL ~ick Cyprus ~ound Beach Drive Ma~t~tuck, ~ 11952 This certificate must not be altered in any manner; return to the office of the Board if incorrect. MANAGER may be ~dentified by their credentials. ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~. I~.0~M~.~.\^~ ~.., 19'~.~' Approved · .~9,& .~..~.~. ., 19~.~. Permit No. ~ .~.~.~..~ .~.. Disapproved a/c ..................................... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~OLD, Application No .................. Date ................... 19... 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 inspect[on 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 necessary,j~pecti, ons. .~ (Signature of applica~it, or name, if 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 /~[1-~ .~... ~...~. ] ]~} ..... (~.]~ Ye .... (as on the ta'x' ;o'li ;; ilt; t'fi/id) ......................... If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No ........ .~.:..~.?../~. ........ Plumber's License No ....... T,....~.J.. ·~· ....... Electrician's License No ..... T'...~..'. b ....... Other Trade's License No ...................... 1. Location of land ol>,~hic.h propose~;l~,~r~ will be done. //ta .~. ·. :z ...... ..... : . ': .... x .... ' ..................................................... ., .... ~/0' · · House Num~ ' ~] '~' ~'.~' ~treet Hamlet ~ q.z- q3. ,z c~ b'{,q) ,' o0 s c,io ...... ....... ......... Su6aivision }'~~..~.~.. ~)(?:'~.'t. ~.~ Filed Map No..]~. ~.~ Lot .~ , (Name) 2. State existln~ pse~nd o'ccupancy of premises and intended use and occupancy of proposed construction: a. Existing use and ~ccupancy ...... ~.q .... { '~ ............ . ..................... b. Intended use and occupancy ......... ~.~.~. ~ .... ~/.~ 3. '.Nature of work (check which:a~plicable): New Building .......... Addition..._~. ..... Alteration .......... :Repair ~J~] ~'~g~'i' · ' Removal .............. Demolition ... ~ ...._..gh~o~rk... 4. .shmave4 ,Cost ..... , ......................... Fee ...................................... [~_,~[? ~:" .: , , '! ': [ (to be paid on filing this application) 5. If dwelling number of dwellinglunits .... .~ ...... Number of dwelling units on each floor.. ~ ...... If garage, number of cars . %.. ~ ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u~..~../. ........ 7. Dimensions of existing structures, if any: Front.. ~ ~ ......... Rear .~ .......... Depth ~.~. g/... ..... ~.... Iteight ..... l .t,] .......Number of Stories .... O. PI.~ ...................................... ':7. x..;..'.. Dimensions of same structure w)th alterations or addit'i~)ns: Front .. g .~... ......... Rear .~ff ........... ~i" Depth...~.~. ............. i.. Height... ~,, ~ ............... Number of Stories ...... ~f/g ~r.//. ..... 8. Dimefisions of entire new construction: Front . ..,.-~,-,.._~.~ .... Rear .~-,- ..... ; ..... Depth .t.../..2- ......... Iteight . .'--~-~..~_.,--..~, .... Nu_mber of Stories ......................................... ,,...,..., ..... 9. Size of lot: Front ../gg~ '.7 ........... Rear .... /~.~, .~... . Depth 2 .~.//'~.~.~..~./.t,'$.~r j~ / , 10. Date of Purchase .. ~.O.~.~i. f' ~' '~'~' ......... NAme o,[ Former,Owner ...~'~ ~ & ........... ' ........ 1 I. Zone Or use district in which promises are situated .... /'.~... ,h(.~'. 5.S J.p. fJ,~.$/. ~/...,~ ....................... 12. Does proposed construction vio,la,~e any zoning law, ordinance or regulation: ..... /J(..O .................... 13. Will lot be regraded ....... ~..~. ................ Will excess fill be removed from premises; · Yes 14. Name of Owner of premises . .'/~rl gfi~... ~.~../~/~ ~2.f. Address ./'/.~cZ ./f~'.~J'~/~K OA/'J.~j~"Phone $o[~ Name of Architect ......... i ................. Address .~'/k'.~.f./~/. . j~.00~.. Phone Ng(.i · · .~. ......... Name of Contractor ........ i ................. Address ..... /fl.~. ~.~/) .... Phone No ................ 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?umber or description according to deed, and show street names and indicate whether interior or corner lot. ' ' STATE OF NEW YOJ?~K, . I- ~ ...~.~,~...k~..~... 'i .................... being duly sworn, deposes and says that he is the applicant I (Name of individual signing contract) '. above named. He is the O.(-O'C~Y''~ i . ; (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 performed in the manner set forth in the application filed therewith. Sworn to before me this ! Notary Public, . 2g~..~~. .... : .... County SALI~I~LADOS j ~ f No. 47999~5 , ' ' ' : (~uaJi[Iod in Suffolk Couni}* f (Signature of applicant) 1. FOUN~?,'ION - TWO REQUIRED DESIGN OR CONSTRUCTION ERRORS. If copper tubing {s used ~or water distributing ' 'n shall be system; p~P~ g of types K or~ o~ SOLDEF~ USED IN WATER SUPPLY SysTEM CANNOT EXCEED 2/lo of 1% LEAD. ,/iv 'I .t -.9 I- "1