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HomeMy WebLinkAbout13842-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ...... 9?.e.e..n.h.°.u.s..e .............................. Location of Property .......... .7.2.5...R.O.S.E..Wg.0.D...D.R,I.V.E. .............. .M.A.T..T .I.T.U.C, K. ...... House No. Street Hem/et County Tax Map No. 1000 Section ...... ~.1.3....Block .... 9 .2 ......... Lot...8. ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 6 ,19 8.5. pursuant to which Building Permit No. 13842Z dated .......... .~.p.r. $ ~..8. .........19 b.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 ......... Greenhouse addition t. 9 ,e.x.i..s.ti.n.~ .o.n.e. family dwelling. The certificate is issued to ..... .G.R.E. ~..O.R.Y..q....s.q ' ............................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ............. .N./.. 6 ......................... UNDERWRITERS CERTIFICATE NO ..................... fi./.g ......................... Building Inspector Rev. 1/81 FORM NO. ft TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ..... ' ..... ~ ........... 13842 Z Dote .~ ................ Permission is hereby grQnted to: ......... ,o at promi*~* I~tod ot ............................................................................................................................ County Tax Map No. 1000 Section ...... L)...~. ......... Block ..... ..~ ............. Lot No. pursuant to application dated ................................. , 19 ...... and approved by the Building Inspector. Fee Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 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 in duplicate 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. 5. Submit Planning Board approval of completed site plan requirements where applicable. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic 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 requ ired to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $:~5 o 0 0 3. Copy of certificate of occupancy $1.00 Dat~e~ ................. New Building ............. Old or Pm-existing Building ............ Vacant Land ............. Location of Property ............................. ; .......................... House No. ,, ~-~ Street Hamlet Owner or Owners of Property ...... O/~ . County Tax Map No. 1000 Section ..... ~ ./-~. .......Block .... ~. ........ Lot ................ .....d~././,.~..?c. ~.c~....~.'?~..1~. ...... , .... ~.Filed Map No...~.°)..L//.~....Lot No ............ SubdivisionPermit N°' '/'~/~'~'~' '~''' Date °f Permit'' '~'~'~?'j' 'Applicant ' ' ' ~.~. !~2__ ,.::..!! ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... ~-~-- Planning Board Approval ~ Request for Temporary Certificate ..................... Final Certificate ....................... Fee S bitted $ ~',00 Construction on above described building and permit meets~a~l aJ~'~able codes and regulations. Applicant .......................................... Z I37Z FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C.?DE FINAL ADDITIONAL COMMENTS 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ~..~...., 19~?. Permit Disapproved a/c ..................................... ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. Tiffs 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 °f 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, bu~g co/d~,/Eo~ng code, and regulations, and to admit authorized inspectors on premises and in building for ... // ~Y'~gn?U~O'~ ~plicant, or name, if a co p ' ) /. . . . . . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name 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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..CF.. ......... ................. .................. House Number Street Hamlet County Tax Map No. 1000 Section ..... '"~//(..~. ........ Block ...... '~'..~/..' .c~.. ..... Lot .... · .~..~..~. · ....... Subdivision ......... //~.. ~.j~..~Co~ .-- ~'.~.~. ?.?'.7~..5~Filed Map No...~.~,~..~..~. ..... Lot .... ./(/f. ........ (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 occnpancy ....................................... ? ....................... 3. Nature of work (check which ~pplicable): New Building ..... ' ........... Alteration . Repair .............. Removal .............. Demolition ~... Other Work ...... [% " ~© (D ~ pt ) 4. Estimated Cost .......... ~....~.'. ..................... Fee ................. ' ............ t"""' ' i . *" (to be paid on filing this application) 5. If dwelling, number ofdwellin~,~s ...... ~ 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 use ..... ~ ..... ! ......... 7. Dimensions of existing structures, if any: Front ...... .~. · .(-~.u ·~. · Rear ...~ .~x.~. ....... Depth . .-.g~..~ .~.., ...... Height ............. Number of Stories ............ .//./.2~. ........ [ : .... Dimensionl ;f same structure with alterations or additions: Fron'/[' iii ii i ~i i i i i i 'l~ear . . . .~..~ Depth, ........ .~..~.. ........ Height ...... .~..~.. .......... Number of Stories .... ff..F?~m.. .... I. · ...... ' ' 8. Dimensions or_entire new construction: Front ..... ~. · . Rear .......... Depth . . ~. I .. Height .. i/. .... .~Number of Stories.. ~ ! 9. Size of lot: Front ..... .//.~ ............... Rear ...... Z.o.2. Depth f~.~... ! .... 10. Date 0feurchase ~.x../..~?.g.i ............... Name of Eormer Owner . .I.~..~q...~.o(qc..~.X:. / .... ! ........ 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction viglate.~any zoning law, ordinance or regulation: ......... /~f. 0 .................... 13. Will lot be regraded ........ i/'~f. ................. Will excess fill be removed from premises: Y~ No Name of Contractor ........ , ......... Address . Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimeqsions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STA'rE OF NE~QR,K, ~ i ,~ o COUNTYI3F_~ .... [ a a ~ (Name of individual signing contract) above named. He is the ~ ~'ff.~Oz./~(_~ ! (Contractor, agent, corporate officer, etc.) of said owner or owners and is dt~ly authorized to perform or have performed the said work and to make and file this application; that all statements con!tained in this application are true to the best of his knowledge and belief; ~nd that the w. ork will be p.erformed in the manfier set forth in the application filed therewith. / Sworn to before me this , · ..da2/ f ................ ,19.. Notary Public .......... County ~,,,,o, ..~,,., ~,,~ ao, ~* (Signature ! applicant) ?ormor/y Chor/es I~urph~ /74./0' I~ $.67 ~$$'10 Lot ~ HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT · e MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JAN. E4, 1969 A6 FILE NO, 5240 SUR%'EY FOR GREGORY SCH6LAND LoT I1~ "ROSEWOOD ESTATES" AT MATTITUCK TOWN :OF $OUT~OLD SUFFOLK COUNTY, NEW YORK MUHAOTH~O~IZEO ALTK~AT~ON OR ~DDITION ~ ~IS NEW YORK:STATE E~CA~I~ LAW MCOP~S ~ ~iS ~V~Y HOT KAR~G TH[ LAND SURVfE'~R'S iNKEO SEA~ OR [MBOSSE~ NOT K C~HSIO[REO TOBE A VAk~T~E COPY ~GUAkAN[EES INDI~TE~ HEREON ~ACL RUN ~LY ~E ~ FOR WHOM ~THE SU~EY IS PREPARED SEPT. 7, 198:5 DATE: JAN. II, 1983 SCALE: I" = 40' NO. 82-816 GUARAN1 TO: ~- _ ......... TITLE INSURANCE COMPANY YOUNG & YOUNG ALiSEN W. YOUNG, PROFESSIONAL ENGINEER AN~ LAND SURVEYOR N.Y.S. UCENSE NO. 12845 4004 RIVERHEAD, NEW YORK ~0' 11 12 13 ~ ~ TED FEE ~HE '~ c ~=~-'lOb ~: tON -WO RE')UI~ ED -- 7?-'( . . , . COt ~STf .UC' ION ERG ORS