The URL can be used to link to this page

Home My WebLink About21908-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF O~CUPANCY No Z-22927 Date MARCH 30, 1994 THIS CERTIFIES that the buildin~ Location of Property 2205 SIGSBEE ROAD House No. County Tax Map NO. 1000 Section 144 Subdivision ADDITION & ALTERATIONS Block 2 Filed Map No. MATTITUCK, N.Y. Street Lot 21 Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 10, 1994 pursuant to which Building Permit No. 21908-z dated FEBRUARY 10, 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 CELLAR, ALTERATIONS & ADDITION TO EXISTING ONE FAMILY The certificate is issued to DWI~Lr,ING AS APPLIED FOR. CA'£~t~RIME ~uit]l~M~N, DECEASED ( owner ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-306310 - MARCH 7, 1994 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 uilding Inspect~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 219O8 Z Permission Is hereby granted to: ..... ~/ ......................... ~ ................................... ~:~z:.. , ....~,~..~...'::.~,.~ ............................ ..... ~. '.X,.~.~ ....... ~..:~ ............................. ,o . . , ~ ~,, ,,. ?-. .f . . . . . ~.~. ~. . , ........ ~ ~/'~ ~,, . . ~,~ ~. ~,~'~, ............. ...;,,r' ' ,,,?- · ~....~,~.~,~:,,~ ............ ~,~,~,p, .......... ~,.~ ........... ~...~.,..,~..~:~ ............. CounhzTax Map No, ] 000 Section .,,../'..~.~U~ ...... Block ..,,..¢'~.... ................. Lot No...~.-~..~'~ ................... pursuant to application dated...'~/.7.,~,,~r~., .............................. 1~) ................ and approved by ~e Rev. 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. 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and J_nstallations, a certificate of Code Compliance f~om 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 in 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_~5~.~... 2. Certificate of Occupancy on Pre-existing Building - $1~_O0.p0 3. Copy of Certificate of Occupancy - $5.00 over 5 yeats - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . New Construction ........... Old Or Pre-existing Building...'] ............. Location of P~operty..~.~.~ ......... ~f.~.~9~...~%~. .......... /~J~'~i~~-~ ............ House No. Street Hamlet Onwer or Owners of Property..~ 4~{~/L. t~7~A/~ £ ~C'~: County Tax Map No 1000, Section..!~.V ........ Block...~ ........... Lot../..~./ ............... Subdivision .......................... Filed Map ............ Lot ...................... Permit No .... ~...%. ...... .Date Of Permit...~J:'~.~-.ff.,~../....Applicant.~,/,~,4 ._,Cl~i ..... z~l~.-~z.-.~.~, "~..~ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval . Request for: Temporary Certificate ........... Final Certicate....g~.. ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS pAc, s 3. '[~ §~.~ ? 7 BUREAU OF ELECTRICITY T-- 8S JOHN STREET. NEW YORK. NEW YORK 10038 /)at," MARCH '3'I,1')9~ Application No. oflfile 05615994/~+4 N 30631~ THIS CE~IFIES THAT ~y t~ e~t~ ~u~ment ~ ~ ~ a~ int~ by t~ ~t ~ on t~ a~ ~at~ numar ~ t~ p~s oy teasexami~don FF~B~(IgtR¥ ?5 , 1994 ROAD, MATT ll'{JC[, [] 2nd FL OUT .~,e~tion Block and found to be in compliance with the 2Vat~onal t~ectt~cal Code. RANGES OTHER ~MT. K.W. TIM~ CK)CKS BELl, UNIT HEATERS MULTI~)UTLET SYSTEMS V I C Lot EXHAUST FANS DIMMERS DEFECTS Rm. MOVED LE~YER OF 2/17/94-}. S[I{O K g DETZCYOR~-I ROSLAK ~LgCTRIC P-O.BOX 164 CUTCHOGUE, NY, 11935 LIC.)3677-E This ~a~ ~t ~t ~ altm~ in a~ manner; ~urn ~ t~ office of h ~rd if incorre~. Ins~ors may ~ identifi~ by their crede~ais. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. LU FIELD I?]5PECTI0~T FOU~mAT I0N ( 1 st ) FOU~mATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO E FINAL ADDITIONAL COMMENTS: 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. [ J FOUNDATION AND [ ] IN~TION { ] FRAMING [~/FINAL DATE I NSPECTO~/~/~ 765-~802 BUILDING DEPT. INSPECTION FOUNDATION JST f ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ F~INAL REMARKS: DATE INSPE FORM NO. 6 TOWN OF $OUTHOLD 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- dons, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land u~s: 1. Accb~rate 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 occupancv $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... .~./.-~. 1 ~./. ............ New Building ............. Old or Pre-existing Building ... ,~ ....... Vacant Land ............. Location of Property....~.~'~. House No. Street .......... ie't Owner or Owners of Property . .~x:2/~/~ ~... t~. ~._~.~.l. Af~-. .... /~. ¢P.~..J j?/./~. ~ ............. County Tax Map No. 1000 Section . . . ./.~..~. ....... Block ...~...~ ......... Lot....~.~/ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~/.q ~.~c.~. Date of Permit .,~/~.~/~../.Applicant ..~.~. ,.' '--~'7/~'/~' ............... 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 applicable codes and regulations. Applicant .... .~.~~'.../.~t~¢~¢1~,~. ............ Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hal~ 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 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. Cornmercial 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 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 inform& 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. Cop,/ of certificate of occupancy $1.00 $5.00 Date New Building ............. Old or Pre-existing Building ...~, ........ Vacant Land ............. Location of PropertyHouse' ' ' ~"~'(' O' ~5'-'No. ' ...... '~'l'~--'~" ~' (: ff' ' ' [~"(~l Street ........... ll~lLffs"l' q)~]'( "ff'~ie't Owner or Owners of Propertv. T~-~/-~ ~...,~. ~.~4~,.~/,~.J~'~ .... ~. ~/./,7/./.-.f~.,./~ ~ l~. ............. County Tax Map No. 1000 Section . . /.~// ........ Block . . ~..5 ......... Lot... ~.~7-! ........ Subdivision ................................ Filed Map No ........... Lot No .............. Permit No. //-°. ~.~'..~'XDate of Permit.. -~/,~.~.~ ~.Applicant . . ~:.~, . . . .~.~'/z:./~ .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for -Fempora ry Certificate ..................... Final Certificate~L ................. Fee Submittec~ .' ............................ Construction on above described building and permit meets all applicable codes and regulations. Applicant .... .~f.~ . . .~'~K--~"~,._J.. /..~.~.z,t~. e. , .--~.~' ............ Rev. 10-10-7~ FORM NO. 2 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) 11O75' Z Permission is hereby gronted to: / to ....~../.~.~7..../.~.~..c...~ ...... ~.~.~.~ ...... .~.~./.~.~..,.~......o.,,~,,v.~r~.....,~...~..:.~.Z.~.~,,,~... County Tax Map No. 1000 Section .... ../..?..'..,~7. ........ Block ..... ~...~.]] ........ Lot No....~...~..~i/.. ........... ;)ursuom' to opplication dated ..~../.../-~.'....~...../...¢7......./....Z ................. , 19...'.~'.../,, and approved by the Building Inspector. Fee $..L..-~... .............. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ kpproved t..,.~, t~;C/~. ...... , )isapproved a/c ................................... ,.. / (BuildYng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application Noz'./. (-? 7.~. ........ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building nspector, 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 ir areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 'ation. c. The work covered by this application may not be commenced before issuance of Building Pernlit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit .hall 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 .hall have been granted by the Buildi~xg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding 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. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to tdmit attthorized inspectors on premises and in buildings for necessary inspections. .,~A ~.~ '~t //') -' '"'"-~.q./~. .... ' · · · '~:':".r' · .-' · - ' · ~; ,t ............... (Signatu~ of applicant, O~name, if a corporation) · .,'¢..¢./.6x. (Mailing address of applicant) / t q ~ ~ 5rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. irene of owner of premises .... .uL. S.h~ .... cs .~ i .L.~a~ lq-. ..................................... (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ['~' -7 ................. Plumber's License No ......................... Electriciau's License No. ' Other Trade's License No... ~.~... g~' .... ]}l ~ ~ ~ on which proposed work ,,'ill be done .... .-~'.,.~'.b.~: ~-..~. ~...~.~./~]~..~'.~....~.. :~...~. ....... 1. Location of land .... ................... .5 ,:1... ............... on. ........... House Number Street Hamlet County Tax Map No. 1000 Section . . . ,4. 4,/~ ...... Block ~'- Lot Z- / Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiou: a. Existing use and occupancy ......... [~a.~.. $. t ~ ¢ .~, C-, ~ .................................. b. Intended use and occupancy ......... c_ ~ , ?. B ~2..~... 3. Nature of work (check which applicable): New Building .......... Addition ....~.. .... Alteration ........... Repair .............. Removal .............. Demolition .............. Other Work ~./,O~.~ (Description)_ I. Estimated Cost ... ~'~ c. ~ ............................. Fee ...................... -~. (to be paid on tiding this application) i. If dwelling, number of dwelling units ...... ~. ...... Number of dwelling units on each floor...-,-~- .......... If garage, number of cars ........... / C.-~-~ ...................................................... 3. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...: ................. 7. Dimensions of existing structures, if any: Front .... --Trs ......... Rear . ~-~ ~'. ......... Depth .5.?6: .......... Height ....... ./'~. ..... Nmnber of Stories ..... /: ................................................. Dimensions of same structure with alterations or additions: Front . .5. ,;'. ........... Rear .. ~.<2 ............ Depth ..... ff.d. .............. Height ...................... Number of Stories .... ~'. ............... I. Dimensions of entire new construction: Front ....... .5/.6- .... Rear ...~.~.d~ ........ Depth . ~.'.': .......... Height ..... /.&. / ...... Number of Stories ........................................................ L Size of lot: Front ...... 7..fi- ............ Rear ...'2.37 ................ Depth,~.¢:~... · .............. ). Date of Purchase ............................. Name of Former Owner L-'-~)~.-. ~ ............ !. Zone or use district in which premises are situated ...... O}. t~//.t..7'k/-~.( .... .~.ct,~/~. ·/'/~ ...... !. Does proposed construction violate any zoning law, ordinance or regulation: ................. v. ....... ~ ....... i. Will lot be regraded ...... t~.~_-. 5~ ................ Will excess fill be removed from premises: Yes~'" No L Name of Owner of premtses ~... J~o.~%~. ?',~..~q.~..~.~.. Address ...~.,,iL.g3.~:..~q(. ?c--. Phone No. ~.~. ~ :: .~'.Sr.~.~'.. Name of Architect ........................... Address )//t~rf' .; ....~ ............. Phone No ................ Name of Contractor (~c.a ....ry.,~. ~..T'.,~... .... Address~ .4.~1. '~,.',z/. ~ ........Phone No.2.¢. $: .¥.¢. ~7~ .... j~, ~ ~'-2/V PLOI DIAGRAM Locate clearly and distinctly all buildh~ga, whether existing or proposed, and indicate all set-back dimensions from 'operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. ~ota~ Public, . ................ 'O<~Y~-.. IdOTAR~'~BLtC, State of New York Ilo. 52-$125850, SuffoLk Term Expires March 30, 19.~:'?.~ rATE OF NEW (t'~RKf w. ~ ~ S S ~~,s-,,,s~ ,,-,~,~~~s~':~('o~;~~' .. being duly sworn, deposesand says that he is the applicant )ore named. ~ { ~ (Con~ac~agent, corporate officer, etc.) , f said owner or ownem, ~d is duly ~uth~ed t~perform or have performed the said work ~d to m~e ~d file ~is *plication that all statements contained ~ thi~pplication are true to the best of his knowledge and belief; mhd that the ,ork w~l be perfomed in the manner set forth in the application filed therewith. worn to before me this ......... ~ ..... day of ..... ~~., County