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Home My WebLink About23004-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCuumANCY No Z-24096 Date DECEMBER26, 1995 THIS CERTIFIES that the building Location of Propert~ 9255 MAIN ROAD House NO. County Tax Map NO. 1000 Section 122 Subdivision ADDITION Street Block 6 Filed Map No. MATTITUCK N~ Hamlet Lot 19 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST Sl~ 1995 pursuant to which Building Permit No. 23004-Z dated SEPTEMBER 8¢ 1995 was iasued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is AN ADDITION TO AN EXISTING ONE FAMILY DWR~J.ING AS APPLIED FOR The certificate is issued to MURIEL WILSON of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N373076 PLUMBERS CERTIFICATION DATED (owner) N/A DECEMBER 15~ 1995 N/A ~ilding Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUff. DING DEPARIM~N1 TOWN HALL SOUTHOLD, N.Y. N? 2300,4 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL Cour~tyTaxMap No. 1000 Section ......./....~.,.~.. BIock,,,,,,~... ................Lot No..../,..~., ................... pursuant to application dated ..................... ~:o/~...~. '/" ...... 19...~.~.,/" ....... and approved by the Bulldin~lnspector. ~... ....... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~PLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor ~l writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $i5.00, Commercial $15.00 Date . .D.~/]?~ .~°.~..~/ ~.~.../.~..~..~.~. .......... New Construction ........... 0la Or Pre-existing Buildi~. ~.. ........ Location of Property....~.~'Z~. ...... : .... ~..~.,]7.~. .... ~.¢~.~. .... ]~ ~...'.'~.~...~... House No. Street Hamlet Onwer or Owners of Property... .P.~ .... t(2~.../..~'~.~. ..................................... County Tax Map No 1000, Section.../~~. ....... Block .... ~. .......... Lot ..... ./..~ ............. Subdivision .................................... Filed Map ............ Lot ...................... Health Dept. Approval....~.~. .................. Underwriters Approval ......................... Planning Board Approval...f~/~/.~. ................. Request for: Temporary Cert~ificate ........... Final Certicate...~.. ..... Fee Submitted: ' ' " .............. THE NEYV YORK BOARD OF FIRE UNDERWRITERS PAGE 1 10~0121 BUREAU OF ELECTRICITY / BS JOHN STREET. NEW YORK, NEW YORK 10038 DECEMBER 15,1995 Appllcatlo, No. o,fii~ 10808495/95 N 373~76 THIS CE~IFIES THAT LOUISE WILSON, in ~he followi.5 loc=tion; [] Sazen,en~ [] I.t FI. u~sexuminedon DECEMBER 16,1995 ROUTE 25, MATTITUCK, N.Y. [] 2nd FI. Section Block and found to be in compliance with the National Electrical Cod~. SERVICE DISCONNECT I"o, oF s RANGES R COOKING DECKS OVENS J DISH WASHERS I EXHAUST / TIME CLOCKS ~it UNIT HEATERS MULTi-OUT~T DIMMER~ V I C E I PAUL R. BURNS P.O.BOX 1061 SOUTHOLD, NY, 11971-0932 ~ ~O~ Ptr ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified ~Jr credentials. DEC 2 I L°~5 BLDG. DEPT. ~,WN OF SOL~" ~ Town Hall, 53095 Main Road P. O. Box 1179 Southold, New Yolk 11971 Fax (516) 765-1823 Telephone (516) 765-t802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD November 24, 1995 Stanley Fliss Jr. 565 Old Main Road Mattltuck, NY 11952 Re: Prem: Muriel Wilson - SCTM#1000-122-6-9 9255 Main Road, Mattituck NY To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has ~een made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 23004-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FOUNDATION (2ND) F I ELF/~ISP~.CT t ON REPORT DATE COMMENTS ROUGII FRAME PLUMB [NC, II II INSIII.ATION FERN. Y. STATE ENERGY CODE ~t ADDITIONAl. COMMENTS: 765-1B02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. / FOUNDATION 2ND [/INSULATION [ ] FINAL [ ] FRAMING REMARKS: INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [~FRAIV~ING FOUNDATION 1ST [ ]ROUGH PLBG. FOUNDATION ZND [ ]INSULATION [ ]FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ,,] .~4D~,TION 2ND [ ] INSULATION [/-~ FRAMING [ ] FINAL [ ] FIREPLACE&~CHIMNEY 76S-1802 BUILDING DEPT. INSPECTION [/~/]/FOUNDATION 1ST [ ] ROUGH PLBG. [ ,r/] FOUNDATION 2ND [ ] INSULATION [ ] FRAMII~G [ ] FnNAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ _.-~,:~**~ ~ DATE UNDERWRITERS CERTIFICATE A~" P, RO~'Ep,AS NOTE/D.., .,/..Z/' ~',OTIFY ~UIL£,ING O~"P~ 4, FINAL CO~STRUCTION MUST 8E COMPL~E FOR C,O. ALL CONSTRUCTION SHA~ THE REQUIREMENTS OF THE N.~ STATE CONSTRu~ION & ENERGY CODES. N~ RESPONSIB~ DESIGN OR CONS~uCTION ~X8 "0 AX6 I~ ~/¢ CIo, Cio. e¢ I1'1o Examined Approved FORM NO. 1 I'OWN OF SOUTHOLD ]OWN ri,',,~,. · N.Y. 11971 SOUTHOLD, TEL.: 765-1802 BOARD OF NEALYH ...... 3 SETS OF PLANS ...... SURVEY ............... C~EC~: ....... ' ......... SEPTIC 70¢tt .......... CALL .... Disapproved a/c ....................... /~... ~..;. ... Date.. ..... INSTRUCTIONS a. This ap~Iication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wi 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 st~ or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this a, 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 pe shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used -~n whole or in part for any purpose whatever until a Certificate' of Occup~ shall have been granted bY the Building Inspecto::. . . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of South01d, Suffolk County, New York, and other applicable Laws, Ordinanc, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descry The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an, andin b~ilding f°r necessary i~%s~ ' r'-'~/]. ,,- (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, generaJ ~contractor, electrician, plumber or bull, .' ....... ~.~¢~, 1....L;,~,~_7~ c .............. ' .............. . ........................ N~ne of owner of premises . fl.7~r,'~.t ~..,:ls¢~,...cu?d.. O~z~e.c.. ' ... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriied officer.' (Name and title of corporate officer) ' Builder's ~icense No ..... /a~..?~...,Y../.... Plumber's License No.../~./'23~.-..~. .... Electrician's License No .... .~...~.~.~..'~. ....... Other Trade's License No ...................... Location of land on which proposed work will be'done .................. . .... ....... · ...... ' .......... House Number Street Hamlet Cou'nty Tax Map No. I'000 Section ' .~. ~.. Block ............ ' Lot ...... : ...... Subdivision ..................................... '. Filed Map No ............... Lot ............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. £×,s ing use and ................... b. Intended use and occupancy ..... ~'.O.~...~. ............... ................... .3. Nature of work (check which applicable): New Building ~.ddition ....... Alteration .... ~... Repair .............. Removal .............. . Demolition ..... : ......... Other Work...- .......... ~/~d ..... (Description) 4. Estimated Co** ... gDO0 ................... Fee ....................... : .............. (to be paid on filing this application) $. If dwelling, number of dwelling units ....~.,~J~ ...... . Number of dwelling units on each floor....(~.~ ...... · If garage, number of cars .................................................................... .... 6. If business, commercial or mixed occupancy, specify natur~ and extent of,each ty~petof use .............. ,/ .... 7. Dimensions qt~qx~isting structures, if any: Front .... ,t.//l~' .t ...... Rear ..... ~.'~. ...... Depth .... ~'~. i .... Height ... ]."/ ......... Number of Stories .......... .e~../7.~ .......'~ ;' '~' ............... ; 2~.' ~' ......... Dimensions of s'.a.me structure with alterations or additions: Front ..... ~..(~ ......... Rear ...)'.{.d ........... Depth ...... ('t/~ ......... Height ... / ti..'.. . ,. Number of Stories .. O./3.~ .......... 8. Dimensions of entire new construction: Front ../].. ! ....... ~ Rear .../ .... O. ...... Depth ... ~. ......... Height .... lO-..~. .......Number of Stories .... I~..P/. ~....., ............ >.; .... O t Rear ...... ].O.-~ ........ ~... Depth .... 7,~ ~.,..' ....., ..... 9. Size of lot: Front ..... / ~ Q ............. I0. Date of Purchase ......... ........... ~ ........ .. Name o f Former Owner ~m e 5..~..~ O/.I.,~e. 11 Zone or use district in which premises are situated . 12. Does proposed construction violatg.any zoning law, ordinance or regulation: ..... '/~.~ ......... : · ·. ~ ...... 13. Will 16t be regraded ....... :. d~f.O. ~ ........, ...... Will excess fill ke re, mov~..4 .from premises: - 14. Name of Owner of premises f/ObLf'J.~ ~/./X([~.~(~//'/Address .~..~,.,5'5.~. ,/~aA/?-. ]I'~,.. Phone No.. ~/.~ .~.~.'~__~. Name of Architect . ..,... ......... _~..., .......... Address ............. , ...., Phone No..,..., ..,.. Name of Contractor ....... Address~,~'~/,5~'..O/~. ff~9/~ ./41~, Phon. e No. ~.~..~. ~..~,~3 ~5.' I~ this property within ~OO feet of a tidal wetland? ~Yes ........ No..~'~ ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and. indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicate whethe~ interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ........ ~"je'O,~/~'.)/.. '.,~.:./7./. 4 ~..~...'-~.. r,.'.. ........ being duly sworn, depose9 and says that he is the applicanl (Name of individual signing contract) ~bove named./'~,.. -Ie is the .x~.ca]Tl . ~. ~. .............. ' (Contractor, agent, cor'porate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi: tpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that th{ v0rk will be performed in the manner set forth in the application filed therewith. ;worn to before me this .......... ... ~lola~ Public, State ot NowYork t/' ' (Signature of applicanl No, 4951364 Gualified {n Suffolk County Commission Expires May 22, 19 I I