The URL can be used to link to this page

Home My WebLink About13993-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~ 3938 Date October q7 ~..~ .................................................. 19. THIS CERTIFIES that the building atty. bldg. Location of Property ... ~.G.~. ....... Old Main Rd. Mattituck House No. Street Ham/et County Tax Map No. 1000 Section ~ 22 .Block 7 .Lot Subdivision X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... M..ay..2?. .......... 19 .~..ipursuant to which Building Permit No .... .'1.5.? .9.5.g. .......... dated ....~.qn..e. ~. ................. 19B.~.., 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 ......... .499.e.s.s. 9 .fy' building. The certificate is'issued to ..... STANI~EY J. & Jg2~ICE PLISS JR. ................ ?oY.'o; j ...................... of the aforesaid building. Suffolk County Department of Health Approval ........ UNDERWRITERS CERTIFICATE NO .............................................. Building Inspector Rev. 1/81 FO~II& NO. ~* 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) N9 13993 Z County Tox Mop No. 1000 Section .... l..~,,~w. ....... Block ...... ,.(~,...'], ........ Lot No ....... ~ ............ ,o opp,,co,,o, do,ed ......... --..~.....~...~.~ .................. .1,..~..~.~,- o.d opprov~ ~ ,~e pursuant Building Inspector. Building Ir~sl:~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOWN OF ,SOUTHOLD 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 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 $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ....0.c.t......8.~..~..9.8.5 ......... New Building ...~. ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .5.6.5. 0J-.d..bJ~i~ Rd.. .. Laurel House No. Street Ham/et Owner or Owners of Property .S.t.a.n..~ .ey..J. ;..~.1. i..s .s..J.r. ;..&..J.a..n.l.c.e...~.1.i.s. ~ .................. County Tax Map No. 1000 Section ... ,1.2.2. ........ Block ...0.7. .......... Lot ........ 2, ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 1:.3..9.9.3.~_..... Date of Permit .6./..3./'.8._5...Applicant .S.~a..n.l.e.y...J....F. 1..i.s.s..J..r, .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ .N.h. Ofl n 5 Underwriters Approval ................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... Ye.s... ............. Fee Submitted $..5.; .0.0 .... ~..:~..~..~..~..~ .... Construction on above described building and pq~mit mee)~s all applic~b~des and regulations. ..................... THE NEW YORK BOARD OF FIRE UNDERWRITERS 100077t BUREAU OF ELECTRICITY October 0~J~ 19~5 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment ~ described below and int~duced by tt~ applicant ~med on the able appltcatlon ~umber in the premises of St~k~y FI:Lz~ Jr~ S/S O1~ ~n Roa~, 400~/O Bzay Avenu~ Matt~tuck, ~Y was examined on OC~O~ 0~ ~ ~9~ and found to be in co.~pliance with the requlreme~tts of this Board. FIXTURE OUTLETS SWITCHES FIXTURES RANGES OVENS INCANDESCENT FLUORESCENT VAPOR 5 14 FURNACE MOTORS FUTURE FEEDERS DISH WASHERS EXHAUST FANS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E NO. OF CC, CONO R v I C A, W, G, NO. OF HI-LEG OF CC, COND. A. W.G. NO OF NEUTRALS OF HI-LEG Ruland Electric P.O. }~ox 143 This certificate must not be altered in any manner; return to the office of the Board ., C0~ FOR g GENEI~AL MANAGER Inspecto,rs may be identified by their credentials. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~e~'~'~.~oe~.' 2~, *[~g~ JOHN STREET, NEW YORK, THIS CERTIFIES THAT only the el~trical equ~ment ~ descrlb~d below ~d int~duced by t~ applica~t ~md on the able application number in the premises of in the following Iocationl [] Base,nent [] 1st FI. was examined on FIXTURE OUTLETS [] 2nd ~l. O~i~ Section Block Lot and found to be in compliance with the requirements of this Board· FIXTURES RANGES , OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS OTHER APPARATUS: E R OF CC, COND. I C E AWG NO A. W, G, OF NEUTRALS NO OF HI-LEG OF HI4EG OF NEUTRAL :~ . ~/o Llc~f242~ GEN~I~AI. MANAGE,~ This certificate must not be altered in any manner; return to the office of the Board if incdrrect. Inspectors may be identified by their credentials, FIELD INSIE~TION FOUNDATION FOUNDATION ROUGH FRAME & INSULATION (1st) (2nd) PLUMBING PER N. Y. COMMENTS STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FOR,~ NO, ! TOWN OF SOUTNOtD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ..... ..~....~......' ......... 19.~... ' , No. Approved .....'~..~.....~... ................. Permit Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT ................... , Dote INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate 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 ofproperty must be drown on the diagram which is part of this application. 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 issue 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of SouthoJd, Suffolk County, New York, and other applicable Lows, 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 oll applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...... ([~' "~O'l~'l~i icont' o;-' '~m e:' ',~' '~' ' ~'~';l~)'l~;i~l~i ........ .... (Address of applicant) State whether applicant is owner/ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ........... ........... C. ............................................................................................................................... Name of owner of premises ...... ./.~./~:..I/:...../~£'.:.......~.'.~ .~.../R~.......~..,.......~..//.'~"~....~..r'.: ............................................................ If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ............ ~ ,~,,- ................................ Plumber's License No ................................................. Electrician's License No ...... /~.~'.--~ ............................ Other Trode's License No ............................................... ~ ~'~7~w- Location of land on which proposed work will b~ do, ne. AA_~p No,: .......... _.., ........................... Lot No ......................... Street and Number ..~...~........{~./.D.....Z/~/./'%..~..~.~.~'. ......... ../'./,~'~,.¢.'~..~....¢<"...~. ......................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.~.~.././/,.~...,~. ............................................................................................... b. Intended use and occupancy ...... (,~..~t m 0{...., ~,~..O.p. ........................................................................................ 3. Nature of work (check which applicable): New Building, .....~... Repair .................. Removal ~ ................. Demolitior ..................... Other Work .................................................... (Description) (to be paid on fiti. ng 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 type of use ............................ 7. Dimensions of existing structu(es, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................... , .................................................................. Dimensions of same structureiwith alterations or additions': Front Rear ............................ Depth ................................ H~ight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~.~ ...................... Rear ..... 4~'.,~ ............... Depth ...... -,~,,~,..~ ......... Height ....... ~. .......... Number ,of Stones .......... .~.~,2.~ ............................................................................ 9. Size of lot: Front ......... ..~.0,..O.~ ..................................... Rear ....... L~../..,..~....~-. ................. Depth ...~,....~....~-.~.~,... 10, Date of Purchase .(..~./~...~.z/..,.:./,mv... ..................... Name of Former Owner ..¢:4~.~,.-t....~./.~r.,,Y....,w.,,,t.L¢4....~.C.:.~l. 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi&late any zoning law, ordinance or regulation: ........ ~..~ ........................................ 13. Will lot be regraded . ...... Z~..~.i ............ Will excess fill be removed from premises: ( )yes (~ No 14. Narne of Owner of premises ,.~.~'L/.C,,./Y..~.~.....~..~//..$,~...3...F;.. Address ,~.~ .~...~.,/~/.,~'J~,~./t.~d'. Phone No. Name of Architect ................ ] .............................................. Address ................................ Phon~ No ....................... Nome of Contractor ..... .O~k/~..~.,..,~::l,.~....~ .~..~.~.~-. ......... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions frorn property lines. Give street and bloEk number or description according to deed, and show street names and indicate whether interior or corner lot, STATE OF NEW YORK, COUNTY OF ................................ .......................................................... i ...................................... being duly sworn, deposes and says that he is the applicom (NaMe of individual sigoing controcf) above named, i He is the ......................................... : .............................................................................. ~. ......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du y authorized to perform or have performed the said work and to make and file this application; that all statement~ contained in this application are true to the best af his know edge and belief; and thor the work will be performed in t~e manner set forth in the application filed therewith. Sworn to before me this 9x - ................. ,~.... day ~f .................. ~ ................... , 1 ........ Notary PuNic, .....~rc~....~.:.~...~.:.(,~....~F~... ..... County .............. .,~,~tZ.~..~ ./.../.!..;.....~ .................... · "" HELEN K DE V0£ ~ // (Signature of applicant) NOTARY EL}Bt.lC, !State of New York ,, No. 4707878, jSulfolk Countl~ PROPERTY OF: STANLEY & JANICE FLISS JR, 565 OLD MAIN RD. MATTITUCK N.Y. 11952 MAIN ST~iTC RoAD 19L51 co. TAX H~/' ~r AP~;:D729 AS NOTED DATE'. ~/~'~' FEE:_)%%_-__..e',': NOTIFY BUiLDiNG DEPARTMENT AT 7554802 9 AM %O 4 PM FOR THE FOLLOWinG !N?ECT!ONS: ~. FOUM~,T~ON - ~O REQUIRED , FOR POURED CONCRETE 2. ROUGH - FRAMCNG g, PLUMBING 3. INSU FIN,~L - CON'¢~FL;CT]ON MUST BE C%t® 'F-:;' c~R C O. ALL COF.;~R:;C-qON SHALL MEET THE REO''~.'AE%'~S OF THE N.Y. STATE CONStrUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 't .,, N I~NNY LUMg~ MAIN ROAD -BOX ~/ GREENPORTo N.Y. 1I 944 ! :! 2X12 -.--' S, VI; ss