The URL can be used to link to this page

Home My WebLink About20460-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20558 Date MARCH 3, 3.992 THIS CERTIFIES that the building. ADDITION Location of Property 2922 RIGHT OF WAY OFF PARK AVE. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 8 Lot 16 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 27, 1992 pursuant to which Building Permit No. 20460-Z dated M~CH 2, 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 FOUNDATION UNDER AN EXISTING DWELLING AS BUILT. The certificate is issued to RUTH HANLON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A '~//Bu~il~ing Inspector 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~ 20460 Z Permission is hereby grant, p~l to:,, / /' ., / ~ ..................................... ........... ~~.....~....~ ........................................................................... at p~mises I~ate~t ....~..~..~....~.~.~ ......... ~.~ ................................... ............................................ .~~ ................................................................................... County Tox Map No. 1000 Section ..../~..~. .......... Block ....... ~. ........... Lot No ........ ./....~.. .......... pu~suont ,o appIication~ed ....... .~../;.~../.. ................................. , 19..~....~., and approved by the Building Inspector. Fee ~' ~ Rev. 6/30/80 *ow _o sou Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 >LICATION 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 Building Inspector shall state the reasons therefor in writing to the applicant. C, 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 - $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 Date . . .~.~. ~ . .~. ~ .... [..~.~ .~.. .................. New Construction ......... Old Or Pre-exi~sting Building....~. ........... Location of Property... i i ................ .~.~ ........ 0~'7 0 ~...~.~.~. J.~. ~.~. .... .~..~ ~.~[_~ ~y.[~"~ House No~\/~ kl StDt Hamlet Onwer 0 of Property .,. ~.~..,.~.~ .~.%~.L ~ County Tax Map No 1000, ,Section...l.~: ..... Block...%~ ....... Lot..l..~. ................ SubJivision...~.~ .~..~.~ .~.' .0.~..~..~...P' '~]..~. F ~led Map ............//z/~ ~z~,~/~' '~' '-~-~' ..... Per'alt No ............. ~...Date Of Permit ................ Applicant././~../~..~../~.~.[ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final~Certicate ........... FeeO)%"P'"~' ~ -~ L~ ~ "~ Submitted: $ · ' '~'~' ' ~" '0' ~ .................'~' '~* '~' '~** ~~ ' '~' ' FOUNDA~TION (1st) FOUNDAT!O~4 (2nd) ~OUGH FRAME & -PLUMBING 3. INSULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITION ~'L COMMENTS BLDG. DEPT. Examin ~ ......... Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY CllECK .................... SEPTIC FORH .............. CALL ................... HAlL TO: APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 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 ~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. A,PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [-~ eg t 'a;t~.~ Sa ~1 tf %rg rteLes ct%n ;to%;tli~ nwi°t~ Ual ~ da pinp~Si; a%~de i tlia%nss, ~ ~ d~lnt: ~tt~ sln; ~ .~f°gr c'; ~3vha 1o ~ od; c%Cdlieti,' i; ~ ar% gL6lr;t i5 ndse, S ~ ~ etd~ ',dm it authorized inspec tots on p re mi scs and in building for ne ce ssary i~/p~./~/~~_~.~-. (Mailing address of applicant) (as on the t,ax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ........ ..-777.. ............. Electrician's License No. Other Trade's License No ...................... · I. Location or' land on which proposed work will be done. ~.¢\V.~..~.~...~.%;.~: .['?.. 0.~. ~.~.. ~.~. ~.1!.~ · .'. ........... ..... ............ .............. House Number Street Hamlet Subdivision..'~ ~,_A~..~. ~i~¢..¢/~.~¢/-,,~... Filed Map No ............... Lot '.. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ....................... 3. Nature of work (check which applicable): New Building ......... Additio ...... Altera~on .... ~ ...... Repair ............ Remov:al .............. DemohtJon ........ :_.. Other Wp.rk ~.Q~..~.~.~.{.'L/:~-. ! .... ' .... (Description) 4. Estimated Cost ....... ~ ........................ Fee ......... ..~'.~-v. ~..,...:::. : [ (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ............ umber of dwelling uniti on each floor...x ........ . If garage, number ofc~s .......... '~...~ ........ ) .... " ~ ....... If business, commercial or mixed 9ccupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories .... ]. ..... ' D~ensions of same structure with alterations or additions: Front ................. Rear ................. Depth ..................... ~. Height ...................... Number of Sto~es ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Numb¢r of Stories , . 9. Size oflot: Front ~ ~ n~.. ~ ................ &' ~,'"'~"l~i ......... ~, "' ~'~ ........ ,-~-...o~ ................ ~epm .~..4~/ .......... 10. ~ate mrurc~s.e.: .... t:tJ..~.~ ........ ........ ~ame of Foyer Owner ~ ~~ ................. 11. z~one or use aismc[ in which premises are situated...~/J] ~/~.~ .., .1. ~.~ ~ ....... ' 12. Does proposed constructio~vjolate any zoning law ordinance or regulation.. ~ .... ~ ' . . ' ..... 13. Wflllot beregraded ~ ; . . ' ~ ......... . ............. . , ~ ' · · · ~ ' ~'l' ·., .~ .... · ........ Wall exc~s filLbe removed ~rom premises: 14. ~e o~ uwner of premises ~ .~~.. Address . ~g. ~ .~.[Phone No. ~me o~rchitect ..... ~ ............... Address.. ~ ..Phone No..~ .... 15. Is this property within 30~0 feet of a tidal wetland9 *Yes ..... · rf yes, Southold ToFn Trustees Permit may be requir~ ~ ......... ~.. i PLOT DIAG~ Locate clearly and distinctly E1 b~ild~gs, whether existing or proposed, ~d, indicate ~1 set-back d~mnsions from prope~y ~nes. Give street ~d block n~mber or descfiptioh accordEg to deed, and show street nines and indicate whether ~tefior or corner lot. ~ / ~ 76~802 9 AM ~ 4 PM FOR THE .~ ~1 71; . ~4hfN L FOUNDATION - ~0 ~EOUIDED ~ I~i ~,~ ~ I 4, FINAL - CONSTRUCTION MOST / ~ ~E COMPLETE FOR C,O, ~ ~ ALL CON,'.;'TRUC~ION SHALL MEET' TH~ REQUIREMENTS OF THE N.Y. ~VFATE t, ONoTRUCTiON & ENERGY DESIGN O~ COI~IS'FRUCTION ERRORS UNDERWRITERS gTATE OF NEWX~ORK, ,~ ,9 o ~ .......... ~ ~'~ '~~ .~.q )~. ..... being duly sworn, deposes ~d says t~at he is t~e applicant (Name of i~dMdua] sig~ia~ co~t~ct) $o~e named. {e is the ........................ . .... ] (Contractor, agent, corporate officer, etc.) f sa~d owner or owners, ~d ~s duly a,uthonzed to perform or have perfo~ed the said work and to m~e and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be perfomed in the m~ner s~t forth in the application filed therewith. :worn to before me this . ~ ~_ . nea in Suffolk Chh.*. -- . //~ ~ ~ tough ppllcan[) 0 LEAF~ ~ I MAP su~____v~¥___~ 14F_VI' ~4'ATT i Tl..l~ G,PIPE ['3, t,-lON U M'EI~T