The URL can be used to link to this page

Home My WebLink About21175-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22081 Date JANUARY 5, 1993 THIS CERTIFIES that the building. Location of Property 775 LEGION AVENUE House No. County Tax Map No. 1000 Section 142 Subdivision ADDITION MATTITUCK~ NEW YORK Street Hamlet ~Block 2 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 4, 1993 pursuant to which Building Permit No. 21175-Z dated JANUARY 5~ 1993 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOI2< COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED LOIS BARKER & ANO N/A -~~B~spector Rev. 1/81 TOWN OF soUTHoLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ~'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gran~d to: __~ ~ . ~~~..~~ ......... .~.Z~...~~_~ ...... ....... ,o ...... ......... .................... ....... ~ ....... ~~......~~ ............ ~ ................................................. :: ,~m:::: ,~:t:~ --Z~....~~.....~ ...................................... ............................................... ~~~....~.~...~ .................................... Coun~ ToX gap No. I000 Section ..~..~.~.... Bl~k ..... ~.~ ..... Lot No ..... ~.~ .... ~:.: :o ~.~,,:..o. ~:~ .... ~ .............. .~ ......... ,,~.~ :.~ ~:rov~ ~ t~: [ulldlng Inspector. Fee $....~....~..~...~......~. ..E,~L..././~ Building Insl~ector 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. 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 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 B6ilding Inspector shall state the reasons therefor in writing to the applicant. C · Fees i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinnning 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 $15.00 Date .... . .................... · ............ New Construction.. ~ ......... Old Or Pre-existing Building ................. c Location of Property .... ~.Y~ ............... , ....................... "~: ~,/~ HouMe No.~~ Street Dnwer or Owners of Property...~e~..~..~.~..~..~..~... $ounty Tax Map No 1000, Section ........ Block ........... Lot .............. Subdivision .................................... Filed Map ............ Lot ...................... ~eglth ~ept. lpprovat .......................... Underwriters Approval ..... ~.. ~..~ ........... planning Board Approval ........................ ' [equese for: Temporary CertSf~cate ...... 2 FSnal Cert~cate. APPLICANT FORM NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT ~ ,//__.~.~.z~ SOU~FHOLD, N.Y. 11971 (~/ TEL.: 765-1802 Examined ................ , 19... ^pprove 9¢.7'Pe it No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOAKD OF H~ALTH 3 SETS OE PLANS SURVEY ................... CIIECK .................... SEUTIC FORH .............. CALL ................... NAIL TO: a. This application must be completely filled in by typewriter or in ink and st{bmitted 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 shall be kept on the premises available for inspection throughout the w6rk. 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 ali appl/cable laws, ordinances, building code, housing code, and regulat, igns, and t~ admit authorized inspectors on premises and in building for necessary i/~spections. /'In/~ ~1~ (~o,,~*,,~- ,,(Sionature of applicant, or name, i~tf corporation) .~.?.5../:..~2~.o~ ~,e_ , ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.StL Name of owner of premises ~'~D-~rz'O (..,Oe.L(--~' '%L~O~. (as on the tax roll or latest deed) If applicant is a corporation, signatur~ of duly auth~orized officer. .(Name and ntle of~:o¢orate officer) Budder s Lmense No.. ............. Plumber's License No .......................... E ectri mn s License No .................. Other Trade's License No ...................... OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY Location of land on which proposed work will be'done. ...-/.~ ....... ~.~.).~,.~.... 0 ~ fr),o'~:b~c',~.t'c House Number ' Street Hamlet County Vax Map No. 1000 Section /.~ 7~ Block' O '2_-.- 'Lot...C_)..0. ~ Subdivision Filed Mhp No Lot ' (Name) State existing use and occupancy of premises and intended use and occupancy of proposed conskruction: E isti d ' a. x nguse an occupanc ................................" · · ...-..a4,,.v.,:.,..z.,., ................ b. Intended use and oc ancy .......... ., .. 3. Nature ofwork (check which applicable): New Building .......... Addition .......... Alteration ...... Repair .............. Remloval[ ............. ~ ,Demolition .............. Other Work :c~ tr~ .O,e~ ............... 4. Estimated Cos ' ' ' ~ ........................... Fee ............................ (to be paid on filing this application) 5 If dwelling number of dwellingiunits '~'"'~ · ' ............... 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 Dimensionsofexistingstructur6s if any: Fr'ont Height ..'?77. Numl~er of Stones .......... 2 .... Rear Depth Dimensions of sa~l~ ...... ' ....................................................... structure with alterations or additions: Front ~ Rear Depth .%77-.. i Height ...... 8 ...................................... Number of Stories ..... ~ .... '( ~ ...... Dimensions of entire new construction: Front ' ' · .77 Rear ~ Depth Height -- Nmb bet of Stories ........ 9. Size of lot: Front ....... TT..i ......... Rear ..'-77- .. ~ I0. Date of Purchase ' ,---- ' ............... ~' .....i(-~i.~.i.~...~i~..~...' ....... .... v~.' - . ... :'. ........ Name of Former Owner ~ c.>. ~..~.. 11. Zone or use district in men premmesaremtuated ............. · ................... ' ~ "'. 12. Does proposed construction violate any zoning law, ordinance or regulation ..... ~ ~. 13. Will lot beregraded ... A/O. . .. ' .............. 14. Name of r, ...... '~'e~n-~' ', C~' 'F. ..... Will excess fill be removed~rom premises: Yes ,-,wnero~premtses~..l..,::;..~...~.:%,.,.~. AddressT.~. ~e~.~O~ ~9~PhoneNo Nme of Architect . . '~i " · ~ · ................ ...... ~ ............... Address '~ . Phone No...~ .......... N~e of Contractor ~ · ' · ~'" ................. Address ..... ~- .' .......... rhone~o ............... 15. Is this property ~h 3:00 feet of a tidal wetland* *Yes.'. ...... No..~ ..... · If yes, Southold T;own Trustees Permit may be required. .... PLOT DIAG~ Locate clearly ~d distinctly MI bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~ensmns from propegy Hnes. Give street ~d block ~umber or description accord~g to deed, and show street nines and indicate whether ~tefior or comer lot. ' OCCUPANCy OR USE IS UNLAWFUL ........... , ................ WITHOUT CERTIFICATE '"" OCCUPANCy Na .... h, ~.~,~ ,.~... Being duly sworn, deposes and says that he is the applicant ( me of,nd,v,Sual bore named. . ... tis the ............ ~ .~.~ (Contractor agent corporate officer etc ) ................. i . said owner or owners, ~d is duly acthonzed to perfom or have perfo~ed the said work and to m~e and file this ~plication; that all statements containe~ ~ this ~ppl cat on are true to the best of his knowled e and ' · rk will .be~perfo~ed in the m~ner se~ forth in t~e application filed therewith. . g behef, and that the ~om to oe~oreme thisr ' i ~ . ............or