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Home My WebLink About20402-zFORM NO. 4 TOWN OF SOUTHOLD BUII~ING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z- 20501. Date JANUARY 27~ 1992 THIS CERTIFIES that the building Location of Property 1000 BAYER ROAD House No. County Tax Map No. 1000 Section 107 Subdivision ADDITION MATTtTUCK~ N.Y. Street Hamlet Block 9 Lot 29 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 22, 1992 pursuant to which Building Permit No. 20402-Z dated JAR-gARY 23~ 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 EXISTING ONE FAMILY DWELLING AS BUILT The certificete is issued to (owners) of the aforesaid building. SUFFOI~ COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED EDWARD ~. & JUDITH H. LANNING N/A N/A Rev. 1/81 /BuildingInspector TOWN OF BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20402 Z Dote Permission Is hereby granted to: ~~.Z.~ ............... ~. ........ ...z..~......, .~...~.....~./.'.. .......... .... ~..~ ...... ~.~.~ , ...... .....~..~~..~~ ............................... ~ ............................................ at premises ocf~at;d at ~/,~....(/'.../~.. ......... ~~....':....~ .............................. Co.n~ Tox mop No. ~00o Sea,on ....... .../..~.Z.... B,~k ~ Lot No. ~. /*//~ ~ .... 19..?...c~.., and approved by the pursuant to application dated ...... ~. .......................................... , Building Inspector. Fee $,.C~...~ Rev. 6/30/80 J^i~ 221 , TOWN OF SOUTIIOLD BUILDING D£PARTMENT TOWN UALL 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. Fieal 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 Building Inspector shall state the reasons therefor in writing to the applicant. 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 $50.00, 2. Certificate of Occupancy on Pre-existing Building - $I00.00 3. Copy of Certificate of Occupaocy - $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 ~e~ Construcfion ........... Old Or Pre-existing 5uilding ..... .~. .......... Location of Property.../??~. f~¢~/~ ~.~. ~ ................................. d'.4~.' House No. Street Hamle~ ~er o~ o~ers of Proper~ .... . .... £~-~.~4.~....~../:'.~,.q??f..,f..Q~.~.<~.~ ............. . ..... :o~ut~ Tax ~ap ~o 1000. Se~t~o~.!q.??.:?.?...~loc~ ...... .~ ........ ~ot .... 3.~. ..... .' ........ ;ubd ivision .................................... Filed Map ............ Lot ...................... 'ermit No ................ Date Of Permit ................ Applicant ............................. ealth Dept. Approval .......................... Underwriters Approval ..................... !arming Board Approval ........................ cquest for: Temporary Certificate ........... Final Ccrticate ........... -'e Submitted: $ ............................. ~OUNDATION (1st) 'OUNDATIO;4 (2nd) ',OUGH FRAME & .FLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITIONAL COMMENTS: 7G5-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING DATE INSPECTOR JAN 2, 2 ~:" FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 l Examined .............. 19 ~\pproved ...... ."'~.. ...... 19 .~.'~. Permit No..~ ....... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTti ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK ................. ~.. SEPTIC FORH .............. CALL ........... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 3ts 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- ation. c. The work covered by this application may not be c~mmenced before issuance of Building Permit. d., Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit mil 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 mil gave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding 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. ~ame of owner of premises .......................................................................... (as on the tr~x roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... ther Trade s License No ...................... Location of land on which proposed work will be done ...................................... ' ........ ttouse Num her ,Street Hamlet County Tax Map No. 1000 Section /~ 7 Block .................. Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and in tended use and occupancy of proposed construction: Existing use and occupancy l{4~. ,.I.q ? ~.c. ~C /). ~4/C l~ · ............................~'~,,.~ ~.~, , ', f,,. ,.' ;'..," w.;~,~,.,., ~.~., ~ .... ... Intended use and occupancy " ... iW,,m ~,~ 1~;/O~.5-a/c~ /~x / Sq~,6~:. ., .l~ q, c~.~..~ Repair Removal 4. Estimated Cost ............ Nature 'of work (check which pphcable): New Building .......... Addition ........ Alteration .......... Demolition .............. Other Work ............... -4~ 5' (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ! Number of dwelling units on each floor ................ · If garage, number of cars ... i dlo ' ' p~c'ffy t~ ina 6 Ifb si ............................................................... 7' DiJ ness, commercial or mixe ccupancy, s na re extent of each type of use .................... · ensi°ns °f existing stmcturesl if any: Front ............... Rear .............. Depth H iglt N D of Stori .............. e ~ ............... um er es .......... Dim nsio f tru with It ado dditi 'F' ............................................ e nso seines Cturo a er ns ora ohs: font ...... Re Depth .................. ~ Height ' ' N 'b ........ ar .................. 8 Di iQ f ti itl F ...................... um er of Stories ................... · mens nso en re neweonstru on: ront ............... Rear ............... Depth .............. Hight N bl of Stori ' e ............... um er es .............. 9. Size of lot: Front ..... ~ .......................................... .................. Rear ...... D pth I0. Date of Purchase ..... i ................ e ...................... 11 Zo d ....... ~ .................. Name of Former Owner . · 'ct in 1' hp mi itu d ............................ · ne or use lStrl w lie re scs are s ate D Dpd rio i i ny i "''' ........... iii .................................... · oespr DSC construe nvoaea zonng aw, ordinanceorregua on: ................. 13. Will lot be regraded ............... ........ ;..,~ · ~ .~ · · ~ .....' ....Will excess fill be .removed from premises: .¥e$_, No 14. Name of Owner of premises . . (z ~ . ~X.q~i .t~.~,lE~. Address /o?~.,~'¢~L 0-~ Phr~n~Mr, ~'~]'~ ~'~..~ Name of Architect . ' Addres .......................................... ......... s ........... Phone No ............... Name of Contractor .......... ! ................ Address ................... Phone No ................ -5. Is this property within 3~0 feet of a tidal w~tland? *Yes ........ No ......... · If yes, Southold To: Trustees Permit may be required. wn ... i PLOT DIAGRAM Locate clearly and distinctly all bluildings, whether existing or proposed, end, indicate all set-back dimensions from property lines. Give street and block m tuber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. OCCUP^ , CY OR USE ]Si UNLAWFUL V'fllHOUT CERTE CAIE OF OCGUPANCY APPROVED AS NOTED ,,- NOTI~rY 'I~/JIL,[SING D/PART~ 7G5-t802 9 AM TO 4 PM FOR THE FOLLOWING ~NSPECTIONS: 1, FOUNDATION '~0 REQUIRED FOR POURED CONCRETE Z ROUGH - FRAMING & PLUMBING 3, INSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N,~ STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR CONSTRUC~ON ERRORS FATE OF NEW YORK/"/"//_.-, S S' OUNTy OF...~.T..'~. ~.%. · ~ - ' ~ame of individual signing bo~/a'c'ti ,ove named. .......... being duly sworn, deposes and says that he is the applicant ; is the .......................... ~. (Contractor agent corporate officer etc ) ................ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication; 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 se~ forth in the application filed therewith. ~om to before me this ............ .... Not~ry Publlo, Bt~ of New York . No. 4879505 ............................................... Qualified In Suffolk CoUnty 0;?.~-" (Signature of applicant) Comml~qon Ex~lr~m D~mb~'