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Home My WebLink About20367-zFORM NO. 4 TOWN OF SOUTHOLD BOILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPAlqCY No Z-20452 Date JABU3ARY 8, 1992 THIS CERTIFIES that the building Location of Property 195 MATTHEWS L~E House No. County Tax Map No. 1000 Section 84 Subdivision ADDITION CUTCHOGUE~ N,Y. Street Hamlet Block 1 Lot 15 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 6~ 1992 pursuant to which Building Permit No. 20367-Z dated JANUARY 6, 1992 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 ~ OF EXISTING ONE FAMILY DWELLING AS BUILT The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2ILTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MICHAEL FINNICBN N/A -- ' - ' " fns~e'~"tor "Y Rev. 1/81 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne- 20307 Z Permission is hereby granted to: ...... ~....¢~......~.. ~~..~ __..__Z..~/....'2/.., ~.. // ............................................... ~.._~..~~,~....~..~......~ ............ .............................................. ~.~~.~z/...~.....~.z.~...~.~.~.....~. ...... co,,,,~, Tox Mop No. ,0oo Sec,on - .~......"/C'____ B,o;,¢ ......... ~ ..... Lot'~o ...... /....~. .......... pursuant to application dated ..~ .......... ~. ............... , 19..~'.~, _nnd approved by the Building Inspector. // Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN UALL Y65-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 ali buildings, property lines, streets, and unusual natural er 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) eon-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 ~uilding Inspector shall state the reasons therefor in writing to the applicant. Fees ~. 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 ~.` Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50,00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ow Cunst=uct on .......... re-existing Buil ..... ] ...........· House No. ~ ~/' ............ ~reet , Hamlet ~nwer or Owners of Property .... , 'caleb Dap: Approval ........ Underwriters Approval fanning Board Approval eqnest for: T'cmporary Certificate ........... Final Certicage .... ee Submit ~ed: $ .... ]~.~. ~PLICANT : ~ j , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined ................ ,19.., Approve~--4'~.. ~ ...... 19 .~ermit No..~.~. 3..~. Disapproved a/c ..................................... BOARD OF HEALTH ...... -... 3 SETS OF PLANS .......... SURVEY ................... CI1ECK ..... ,, .............. SEPTIC FORH .............. CALL ................... HAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 ~iving a detailed description of layout of property must be drawn on the diagram which is par~ of this appli- cation. c. The work covered by this application may not be cbmmenced 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 al/ apphcahle laws, ordinance~wao~ding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessaryXins~.Jion~, ~ ~ .... (Signature of aptvl~Sant, or name, if a corporation) .... ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ,//~Ct~-~/~&.~/ ~-'/~/w~//~.,-fi~/ (as on the t.a~ roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) uilder's License No ....... ........ Plumber's License No .......... / ............ Electrician's License No ....... ?, ............ Other Trade's License No ..... ~.~. ............ 1. Location of land on which proposed work will be done ................. . ................................. ./q...x7 ..................................................................... House Number Street Hamlet County Tax Map No. 1000 Section ... ~...~. .......... Block ....... t .......... Lot ..... .]..q~l~... ....... Subdivision ................................... ... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy ofmroposed construction: a. Existing use and occupancy ..... /~e{. .'. . . ; ................. b. Intended use and occupancy .................................................................... 3. Nature of work (check which appiicable): New Building .......... Addition ../~ ...... Alteration .......... Repair ............../~ ~Rem°val .............. Demolition .............. Other Work ............... 4. Estimated Cost ............................. 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. Dimensions of existing structures, ~fany: Front ............... Rear .............. Depth ............... Height ............... Num b~r o f Stories ........................................................ Dimensions of same structure withi alterations or additions: Front ................. Rear .................. Depth ...................... [Height ...................... Number of Stories ...................... · D~mensmns of enttre new construction: Front Rear Depth Height Numbek of Stories 9. Size of lot: Front ............. ]., ....... Rear ...................... Depth ............... I0 Date of Purchase " Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate[any zoning law ordinance or regulation: 13. Will lot be regraded ~ . ....... :... · ,, ................ Will excess fill be removed from premises: Yes No Name of Contractor ........... , .............. Address ................... PhoneoNo ................ Is th±s property wSt:h~n 300!feet of: a ~:idal wetland? eyes ........ No..~,~ .... ·If yes, Southold Town Trustees Permit may be ~required. ", i PLOT DIAGRAM Locate clearly and distinctly all buiidings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descriptio~ according to deed, and show street names and indicate whether interior or coruer lot, STATE OF NE~7"~RK.~ · . ~ ..........~t.~.~.~.~. · '~ t'~.~/....~ .~/~ .... ~ ~. being duly sworn, deposes and says that he is the applicant (Name of individual s~gmng contract) lbove named. ~e is the ....................... ~ .................................................... :(Contractor agent, corporate officer, etc.) )f said owner or owners, ~d is duly authorized to perform or have perfumed the said work and to m~e ~d file this ~pplication; that all statements contained ~ ]this application are true to the best of his knowledge and belief; and that the york will be perfumed in the m~ner set forth in the application filed therewith. ;worn to before me this ;Otaw Pu~ic ~Co t ( 'g ature of applicant) No, 52-81258~ i, Sfffolk~o~ty ~rm Expires ~ ~ her 31,