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Home My WebLink About20734-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20815 Date JUNE 19, 1992 THIS CERTIFIES that the buildin~ WOODSTOVE Location of Propert~ 1125 PRIVATE ROAD #2! (POINT PLEASANT'RD) MATTITUCK, House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 1 Lot 3.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16, 1992 pursuant to which Building Permit No. 20734-Z dated JUNE 18, 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 INSTALLATION OF WOOD STOVE IN AN EXISTING ONE FAMILY DWgLLING AS APPLIED FOR. The certificate is issued to JOHN & VICTORIA MOLLER~ JR. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2kLTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 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) N-°No. 207~Z Permission is hereby granted to: ...... ~~.;....~.:.~..~.. .................. ...... ~:....?~..;..;.~..?..~/~.~~. ..... ~~.....~......'../~.~ ~ ~o .~~..~....~~:~....~..../..~~ .~.........~ ................ =================================================================================== ................ /../~... ................ ~.,,.~~ ....................................................................... County Tax Mop No. 1000 Section ..... ./../..~... ......... Block ...... C./.. ......... Lot No ........?..'.~ ........ pursuant to application dated ................... ..~.,~..../..~,. ..................... , 19,..~..~.,~, and approved by the Building Inspector. Building Insl~ctor Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 ail 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and · pre-exzsting" land uses: i. 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 i. CertificAte of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swirmming 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 - $10.00 4.Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~Ob S~C~ Date .... .~.~ ~ .~ (~ . / ~ ~... ~w Construction ........... Old Or Pre-existin~ Boilding~ .............. ocation of Pro.ert~ //~lJ'~ ' 0,~ ~-- ii ,- - ........................ ~ P~ ~S~ ~ z'~77~, ~ ~ IIouse No. Street Hamlet lwer or Owners of Pron~, /%{0~%~ ~,~7~m_~ J .3-~ " 'unty Tax Map No 1000, Section... II ~ .......... Block.. ' ~.% & · · ............. Lot ..... .... bdivision .............. ...................... Filed Map ............ Lot ..... . rmit No '" ......... Date Of'Permit Applicant ' alth Dept. Approval ........................ · - Underwriters Approval ......................... arming BOard Approval ........................ quest for: Temporary Certificate ........... Final Certicate. itt $ ~'_ ~ Subm ed: .... . co : ao8 I$ FORM NO. '1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTII ,3 SETS OF PLAN_q SURVEY ClIECK .... HAIL TO: ., (Burl'ding Inspector) APPLICATION FOR BUILDING PERMIT Date fits, ~. /.6. ?..~ ................ , 19. · ! INSTRUCTIONS , a. This application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 ~e, ts 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 >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :a¢ion. c. The work covered by tkis 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 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 Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary.inspections. (Signature of applicant ............. , or name, if a corporation) (Mailing address of applicant) :tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. r~ 'Jot./,,; 0',4. ....... /~t ~cr~R l/, ct-oft ' lame of owner of nremi~o~ O , ~t (as on the tax roll or latest deed) 5 applicant is a corporation, signature of duly auth.,orized officer. · (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electric. Jan's License No ....................... Other Trader's License No ...................... Location,.of land on which proposed work will be'done. Il tao,',,,,- to .................... ; ........ l. ~,~ g,...,'w' House Number Street Hamlet County Tax Map No. I000 Section /I ~ .................. Block .................. Lot .................. Subdivision ..................................... Filed Map No. Lot (Name) .......................... State existing use and occupancy of premises and intended use anti occupancy of proposed construction: a. Existing use and occupancy .. ,q~$, .D~,OT-,,*L ~o,mZ ...................... . . ;'..{'2; .......... b. Intended use and occupancy , ~,~,~ r-. ,~- 3. Nature of work (check which applicable): New Building . . Addition Alteration Repair · Remloval ........ ' ................... .............. ! ........... Demolition .............. Other Work. ~?f.~..~.7'q ~.~. ' (Description) 4 Estimated Cost i · · ' Fee If dwelling, number of dwelling[ I (to be paid on filing this application) 5. units ............... Number of dwelling units on each floor · If garage, numher of cars ' · ............... 6 If business '" ' ............................................... · , commercial or m~xed occupancy specify nature and extent of each type of use ............. j ..... · ~menslons ot ex~st~ng structures if any: Front ................... Hei,,ht Numl~er of Stories ............... Rear .............. Depth ............... Dimensions of same structure wlth alterations or additions: Fro~t Depth ' Height ................. Rear ......... ........ ~' Number of Stories ....... 8 Dimensions ..... ' .............................. ; ~: ..... · of entire new construction: Front Rear ' Height Number of Stories .............................. Depth .............. 9 Size of lot: Front .................. Rear .. I0 Date of Purchase -, ' ................... ... ' Name of Former Owner ~..4,~d ~t.-l.. .......... Z di ictin tichp i isesa it d ................................. one or use str w i rem re.s uate · e ru n ny zon n aw, or nan gu n . .. .......... 13. Will lot be regraded ..... ~.~.. (.. : 14. Name of Owner of premises : ................ Will excess fill be removed from premises: ' Name of A hit '.' ·: ................. Address ..... Pro No Add Pro N ' Name of Contractor ......... ¢ ................ Address ............. ¢.~;... Phone No ................ 1.5. 'rs t:his propert:y wit:h-in 3'00 feet: of a t:±dal wetland? *Yes ........ Iqo ......... · If yes, Sour:hold T'own Trust:ecs Perrait may be requ±red. ... ! PLOT DIAGRAM' Locate clearly and distinctly all buildings, whether existing or proposed, and,, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. aTE OF s si ......... " '~' '\~'~"~)J' ~ '~ .... ~' ' '~" ' '~' ....being duly sworn, deposes and says that he is the applicant , (Name of individual signing ~contract) ore named. - , (Contractor agent corporate officer etc ) ' ' s,~id .owner or owners, and is duly arithor zed to perform or have performed the said work and to make and file this 'mcatmn; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manner seti forth in the application filed therewith. om to before me this Notary Publlo. State of New York .......... No. 4879505 .................. ; .... Qualified in Surfak Couaty ,~"~ (Signature of applicant) . Commlaaion Expires Dq'oamber 8~ 11~ .L~,