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HomeMy WebLinkAbout13986-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfificnte Of Occupancy No.Z15736 Date Ma7 6, 1987 ssor THIS CERTIFIES that thc building ....A.c.c..e ..... y .................................. Location of Property 800 Theresa Drive Mattituck House No. Street Hamlet County Tax Map No. 1000 Section . .I.I. 5. ....... Block . 13 . .Lot 18 Subdivision..D.e.e.p...lip. i.e...C.r.e.e..k..g.s.L~: ...... Filed Map No. ??.5.6,,, ,Lot No. I/4 conforms substantially to the Application for Building Permit heretofore filed in this office dated .M.a..y..2.,.. ! .9.8.5. ........ pursuant to which Building Permit No. 1.3.9. J~ ~) g ............... dated J u n e 3, 1985 was isstled, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Accessory building tn rear yard. PHILIP & HEATHER LORIA The certificate is issued to ..................... jo~'n'~'r,'~,~s~dyok'l~'O ...................... of the aforesaid building. Suffolk County Department of Health Approval lq / 3, UNDERWRITERS CERTIFICATE NO... Iq / a PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEFARTM£NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO ~3986 Z Permission Is hereby gr<=nted to: /~ ._ o _ /~ , ..... ~....~'%..~2~ .......... .~.~....~..:.~.,...~z.~.~.~. .... ,o ...~~......~.~~~ ~0~'~ ~,, ...... ~....~...~-~..~f.~ ot premises located at .....~. .......... ~...c~..~... ~141~....,...)~~ .............. County Tax Map No. 1000 Section ....... ~.../..~.. ...... Block ....... ]...~,~ ....... Lot No ......L.~.. ............. pursuant to application doted ....... ...~..~....~.. .................... , 19.~1~.~..'-, and approved by the 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 A. 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 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, 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .......................... New Building .. VC'-5 Old or Pre-existing Building ....... Vacant Land Location of Property . ~O..o. ...... . .~.~..~.P,..~.~. ~ ....... .'~.~'.i.U.. '.~,. .............~}~.~,./~. ~.~.~.~ House No, Street Ham/er ''. ...... ?.¢: . Owner or Owners of Property ...... /. ............... ,~..~. ........... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. ¢ 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 applicabl~codes and regulations. ~pplicant .......................... FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL REMARKS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined .~fl.U-'Y~..~. ..... , 19~. .%5. Approved . ~4-~. ~. ...... 19~.~.. Permit No. ). '.~.c~ .-~.~...~. Disapproved a/c ..................................... (Building Inspector) & !;:;~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,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 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 9ccupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building PermitASursuant 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, ahd, to admit hath°rimed inspect°rs °n premises and in building f°r necessary i~i~ns~'it7 ~ ' (~i~n~t~r'~of~plicant, or name, ifa corporation) (Mailing address of applicant) ! State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ©co e .... '.p.. \, .... .............................................. Name of owner of premises .~.X.\.. 1. ~. (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. ~O0 ~-~-~ e ~ e~/~ ~i~/~ .... ...................... .... ........ ........ House Nmnber Street Hamlet County Tax Map No. 1000 Section ..... ://..'~...-- .....Block .... ./..~. .......... Lot ..... / ~ .......... Subdivision./~.~a.~ .~.4~./4.. ~.~.~,~.]~...' ~/~. ~./P.~4.. Filed Map No..~..~.~...~. ....... Lot ...... .].~. ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. ~Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... i (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 . .., 6. If business, commercial or mixed occupancy, specify nature and extent of each tripe of use .......... . .... 7. Dimensions of exmtlng structures if any: Front ....... ~.. Rear ...~ ..... ' ........ ; x '~'~' ' Depth../.q~ .......... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ~... Height ................ Number of Stories .................... 8. Dimensions of entire new consiruction: Front. iii ).~ ! .O.e...., Rear.. ]~ t..O.* ...... Depth .. J~ ~..~. ~' ...... Height .... ] ....0 ..... Number of Stories ........ ].. ~q..~..~f. ....................... ~ ............. 9. Size of lot: Front ..... /. ~. ~ .O ........... Rear ....... /./..0,[0 ......... Depth .... l..~t.,.Q .......... '. 10. Date of Purchase .......... ! ................... Name of Former Owner . .~.~.~.~qn · · ~ e?.q ~ .......... 11. Zone or use district in which p~emises are situated ......... [~ .~.,q ................. ~. ..................... 12. Does proposed construction vi01ate any zoning law, ordinance or regulation: ........ .t5/.°. ................... ... 13. Will lot be regraded ....... ~.....,, .~. P..., ........ Will e_~cess fill be removed from premises: Yes ~) 14. Name of Owner ofpremise~ . ~.~3.\.~.~0....K¢..~.~. Addres~.0.?.h.e.~.e$~ ~/~ Phone No o,..5';~.: .~?..q.~ .... Name of Architect ..... 47.~ ................. Address .... .3. 4~ .~. )icl .8.~.~hone Nol ~.~..~._..~'~.O.~..~... Name of Contractor ... ~'¢ ................. Address ..... ~.. ~ ....... ?.. Phone No..o{.~. ~..O~. ff. ~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blo'ck number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. , (Name of individual si above named. He is the ............. , ..... S.S ....................... being duly sworn, deposes and says that he is the applicant ning contract) (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 applieation~ 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 man,er set forth, in the application filed therewith. Sworn to before me this ] NOTARY PUBI.IG, Stale 6I Nev~ V~rk ..... No, 47078?8, Sutlol~ Cmh)ty (Signature of applicant) O^T : "l l r NOTtFv P/' (Lq'lNG DEP~-~'~, AT 765-)802 D AM TO 4 PM FOR T~E ,I FOLL~OTI~ :INSPECTION~: , : ,' l, FeUN~ATION - ~O '] REQ~IRE~ F, 'R POURED CONCRETE , ~, ,, 2. R 'UGH'- ERAMINq & ,PLUMB NG 3. ff SULAT!ON ' ~ 4. FI JA~ CqN'Sz[~ln'rl!qN MU~'~, B O'~m~ rTE FOR c.O, ALL C~NS~RUCTION SHALL MEET THE REr~'U~rMFNTS OF THE N,. Y. STA~: CONSTRUCTION & ENERGY co~. N.T~, ~SPONSmbE ~OR DESId,N OR CONSTRUCTION ERRORS, , M'o'"T~~~~