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Home My WebLink About21888-zFORM NO. 4 TOWN OF SOUTHOLD BUIIf)ING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22848 Date JANUARY 26, 1994 THIS CERTIFIES that the building. Location of Property 715 LEGION AVENUE House No. County Tax Map No. 1000 Section 142 Subdivision ADDITION MATTITUCK~ N.Y. Street Hamlet Block 2 Lot 4 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated J~iqUARY 20, 1994 pursuant to which Building Permit No. 21888-Z dated JANUARY 26, 1994 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 ENTRY WAY ADDITION ON TEE REAR OF EXISTING ONE FAMIL¥ DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. LOUIS LESSA~D (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 2I~ 1994 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FOBM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. NB 21888 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: Coun~ Tax Map No. 1000 Section ...... ~ ....... Block ............. ~.... Lot No, ,.,~ .............. pursuant to application dated .................... ;~...'..; ................ 19 .... Bulldlng Inspector, ~ee ~....Z~ ...... and approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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. F£nal 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 1% 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 Vpre-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 in.writing to the applicant. 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.OO Date ~999~K~ ~q' 1994 New Construction ........... Old Or Pre-existing Building .... {~ ........... Location of Property %~ ~g~qq ~qR~ Mattituck, N.Y. House No. Street Hamlet LOUIS LESSARD Onwer or Owners of Property ................................................................ .. 142 2 4 County Tax Map No 1000, Section .............. Block ................ Lot ...................... Subdivision .................................... Filed Map ............ Lot .................. . .. . Permit No..~l~'~.......... .Date Of Permit..~ ~ ~ .A ' 1° . ~ ~ ~JWM!. .... ....... pp zcant .... ~.c~f$ .......... ~ .. Health Dept. Approval .......................... Underwriters Approval ........ ..~.... .... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate....~.....o Fee Submitted: * .... ..... ......... ~ APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ,. TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... .~.~..~..~. .... 19f.~ Approved .... ~.' .~.'; ...... 19~../~. Permit Nod/.~.~. 4~...~. Disapproved a/c ..................................... ................................ . ild~g J~pec ) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURV£Y ................... ClIECK CALL ................... MAIL TO: Date .. .. a. This application must be completely filled in by typewriter or in ink and S'ubmitted to the .~uilding 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 promises 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 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 aH applicable laws, ordinancep,,building code, housing 9od'¢, and regulatism¢, and to admit authorized impectors on premises and in building for necessa~s, k x,,,.~ ~ ~, , /~.~ · '. ' '*'' '" '.2 ~ ¥ ....: ..... - (Sagnature of ap~li[~n~;;; ~e, ~f a corporation) .... 9/.97. (Malting address oz applicant) / State whether applicant is owner,.lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. ..................................................... Name of owner of premises .../n¢¢'~ A. g .................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. APPROVED AS ~0TED .............................................. FE .. (Nameandtitle°fc°~°rate~~CY 0~ NOTI~ BUILDING DEPARTMENT AT Builder's License No. . ~ ~. 765-1802 9 AM TO 4 PM FOR THE .......... USE S"UN ,WFUL Plumber's License No. 1, FOUNDATION ~ ~O REQUIRED . ROUGH .. FRAMING & PLUMBING Electrician's License No . INSU[ATION OE OCQ PANCY - Other Trade's License No. 4, FINAL CO .k> RdCTiON MUST ........ e~ COMPLET~ FOR C,O. , UNDE~WRffERSCERIIFIOAfE ALL CONSTRUCTION SHALL MEET 1. Location of land on which proposed work will be uone .... RE~glR[B ......... TI~E. REQUIREmeNtS. OF..T~..N,~,. . ¢¢ .......... ...... ................ House Number Street County Tax Map No. 1000 Section .... t.~.~ ......... Block ...... ~ ......... Lot ....... ~. ' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ ~. b. Intended use and occupancy ........ ~ .......... ~x..,~. ~,. .....~ - ,-.v,., · r~ .... ~ ....... 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration . Repair .............. RemoVal .............. Demolition .............. Other Work ............... I (Description) 4. Estimated Cost ....... .ff~..~.:iO~ Fee ~ (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.type of use 7. D~menmons of existing structures if anv' Front ~ Ra~r _- ................................ Depth .............. Height ............... NumBer of Stories ................................. . ....................... Dimensions of same structure width alterations or additions: Front ................... Rear .................. Depth .................... i' ' Height ..................... : Number 0fStories. ~' .... 8. Dimensions of entire new constr~ction: Front ............... Rear ....... :~,. .... .. Depth ............. Height ............... Number of Stories ......................... 2...~;. ........ '~. ................ 9. Size of lot: Front ........... i ........... Rear ...................... Depth ...................... 10 Date of Purchase ~ · Name of Former Owner Z .... hp ~' ' 1 I. one or use district in whlc remlseS are situated ............... l~t g 1 gui 12. Does proposed constructionvio e any zonin aw, ordinance or re etlon: ................................ 13. Will lot be regraded ......... I .................. Will excess fil! be removed from premises: Yes No 14 Name of Owner of premises.' Address ' Phone No Name of Architect .......... ~ ................ Address ........ ........... Phone No ................ Name of Contractor ......... ! ................. Address .......... ': ........ Phon~ No ................ 15. Is this property within 3100 feet of a tidal wetland? *Yes ........ No...~. .... · If yes, Southold Tiown Trustees Permit may be required. -. i PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, end. indicate all Set-back dimensions from property lines. Give street and block flumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~. I?~ / ti/ ~t ~ COUNTyOF¥,-~/,fI~,~'./fl.:. ~'~ ) (Name of individual signing contract) above named. [ ·.. being duly sworn, deposes and says that he is the applicant Sworn to before me th~}~.~ ........... .... CLAIRE L. OLh'W No. 4879508 ' York/q / f, 'Qualified In Suffolk Cou~ t ~ (Signature of applicant) Commission Expires Daoembl i ~ ~1~) He is the ....................... I .......0(o/,~'1~ .C ............................................. i (Contractor, agent, corporate officer etc.) of said owner or owners, and is dulyI 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. B~ NANCY LESSARD oU~RA~TEED TO~ GUANANTEED TITLE DIVI$10N O~ AMERICAN TITLE INSURANCE CO , NOR~HPO~T FEDERAL SAVINGS AND LOAN ASS N, LAND SURVEYOR~ N.Z $. Li~NO.I ~845