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Home My WebLink About22005-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-22939 Date APRIL 12, 1994 THIS CERTIFIES that the buildin~ Location of Property 15805 MAIN ROAD House No. County Tax Map No. 1000 Section 115 Subdivision ADDITION MATTITUCK, N.Y. Street Hamlet Block 1 Lot 3 Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 11, 1994 pursuant to which Building Permit No. 22005-Z dated APRIL 11, 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 PARTIAL DECK ADDITION TO EXISTING OWE FAMILY DWELLING AS APPLIED FOR The certificate is iseued to RICHARD & SUSAN KUBIAK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM NO.$ TOWN OF $OUTHOLD BUll,DING DEPAI~TMENT TOWN HALL $OUTHOLD, N.Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZEDI z ............. ................................ at premises I t d at ................ ~ ............................................................ : .............................................. CountyTax Map No. 1000 Secflon......./.Z...~... ........ Block ......... ,,~,,/~.. ......... LotNo ........ (:~,~., ............ Building Inspector. ~ee $.....Z~ ..... and opproved by the Building Inspector Rev, 6/30/80 I~DG. DEPt. TEL.: 7654802 ' ,._3ow~ ~-~Qq~OLD ~, !.-' Examined ........ .~/{{.: ,, ~-'~ ..... ....... Disapproved a/c ......... ~ ........................... ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 APPLICATION FOR BUILDING PERMIT BOARD OF HE~TII 3 SETS OF PLA21S ......... SURVEY .................. CIlECK ................... SEPTIC FORt! CALL ..... . · · MAIL TO: Date .................. , 19... INSTRUCTIONS ~ a. Tlfis 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 sh~tl be kept on the premises available for inspection throughout the work. - e. No building shall be occupied or used in whole erin 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 th6 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 elterat~ons, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable taws, ordinances, buil¢/~ c..sde, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~.l~ / ~ ~ . (Mailin~ address of applicant) . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. NOTIFY BUILDING DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 S AM TO 4 PM FOR THE (Name and title of co;;~rate of,~cer)&'i,; i~,,,v no Builder's License No . ~.~ * .............. USE' IS UNLAWFUL .ina~o~,~'~i~.,~ No ................ ~ITHOUT CERTIFICATE ~.~,~an,s ~,~.,~ ~o OE O.CCUPANCY Other Trado's License No ...................... FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING S. INSULATION 4~ FINAL - CONSTRUCTION MUST BE COMPLETE FOR~C~O, ALL CONSTRUCTION ~IALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Location ofland'on which proposed work will be done. / :.:~:. . . L::! ~ ,,. . . . .:.~.<¢.. . ............... ................................................. ' . . . . . .//:. : .M> :.:.~. ~./<-. House Number ~ Street Hamlet .... County Ta~ ,~,ap ~o.',000 Scction..~//.~lock. ~ .': .!. :..~.,,, Lot ..... ~ ........... Subdivision ..................................... Filed Map No .......... Lot . (Name) ................... ~ State ex/sting use and occupancy of premises and intended Use and occupancy of proposed construction: ~ Ex' ' " - . .:L~\i~q ' a. IStmo usc and occupancy . .. ~ ,. ,..' 7 .' F / ' .., .,>x+ .cl~ . b. Intended use and occuvancv ' : ~ t .':?&:~;~ib0~,~l~g) 3. Nature of work (check whichiapplicable): New Building .......... Addition . .~.*..~,-.~,~' - · .. Repair .............. Rc:moval .., Demc~lltin, ~, ~lil ~.{~ltq~ration ..... (Description) 4. Estimated Cost ....... . .......... Fee .......... ~.l .i. j~ ............... 5 Ifd l/i ! (to be paid on filing this application) Cd lling its N mb fd · we ng, number o we un .............. u er o welhng un ts ~r.. Ifg b f ' · arage, num ero cars .... : ...................... . :rile?lQ',"' ............... 6 Ifb ' 1o mi,'{ doccu,~c- moor ........ '~ ;' "~ .......... :~;"~': .............. · USIIlCSS, Commerc a r e ' 7 ~. ..... q' ~-~.- J, ~..j nature anu extent ol each type of use .......... · ctfi ifa F ght Rear ..... . ......... D pth " uunenslons o! existing stru res, ny'. font ............... Hei ' e .............................. Ntt be f St i m r o or es ......... . ......... Di i f .............. ura ,with It ti lditi F ........................ D mens ons o same struct a era OhS or a~ OhS: ront ................. Rear ....... epth .................. i... Height ....... ' .......... 8 Di i of ntt Stm ti F ............... Number of Stories ........... · Hmensons e renewcon c on: ront ............... Rear ....... ~',,. ...... De ..,,;.. eight ' · ·. · Nu:mber of Stories ............... ., pth ......... Size of lot: Front .... / .....i ............ Rear 11. Zone or use district ir/which premises are situated late any zoning law, ordinance .......................... 12. Does proposed construction vi{) or regulation: 13. Will lot be regraded i ................................ ............................. Will excess fill be removed y~om premises: Yes No 14. Name of Owner of premises .................... Address .................. Phone No.... .......... Name of Architect ....... ' ................ Address ................... Phone No ................. Name of Contractor .......................... Address .......... ; ........ Phond No .............. 15. Is this property within~300 feet of a tidal wetland? *Yes ........ No.~ ..... · If yes, Southold~Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockl number or description according to deed, and show street names and indicate whet er interior or corner lot.,n,,]J, ,, /, . ,~, "~ STATE OF NEW(,YORK, ,. S S · ~/ -.,(r_..z ~;, .... ..... /¢.,.c.' rtA tNa',~: f,-'.' ~. '.5 ..' '. ic ..... ! ....... ' oein~ 12'~y sworn, deposes and says that he is the applicant t ~t: o~ InUlVlClUal slgulng contract) above named. , Heis the. .... .~d~.~ ' ' (Contractor, agent, corporate officer, etc.) of said ow.ncr or owners and is duly ~uth. orized to perform or have performed the said work and to make and .file this app ication, that all statements contained m 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. SWorn to before me this ...................... day of.. i. ............ '. co=.ty /7/7/ - ~ Pulilto, State of Now ', .'. . ,,' ........... ......................... ~ff~k~unty/~ (Signatare of applicant) ~mm~ ~r~ ~ne 16, TOZ