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Home My WebLink About20874-zFORE NO. 4 TOWN OF SOUTHOLD BUILDING DEPART~NT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF No Z-24027 Date NO~EMBER 15, 1995 TEIS CERTIFIES that the building Location of Property 700 MART~NE LANE House No. County Tax Map No. 1000 Section 143 Block 2 Subdivision Filed Map No. ADDITIONS MATTITUCK NY 21 Street Lot Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 6, 1992 pursuant to which Building Permit No. 20874-Z dated AUGUST 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 INSTALL A BILCO CELLAR DOOHAND A NEW CHI~'EY AS ~-~PLIED FOR. The certificate is issued to GREGORY C. DICKERSON of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) N/A N/A Rev. 1/81 IvOR~ NO. ~ 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°-N,o 20874Z Permission is hereby granted ~..~....~,..~~...~, .... ~......~~_...~ at premises located at ..........~...,,~...~......~...~~~ ........................... County Tox Mop No. lO00 Section ...Z...~.....~-. ...... Block .~...,~..~. ....... Lot No ...... '~...Z. ....... ~u~uon, to o~p,,cat,on do,.~ ..... Building Inspector. Budding inspector Rev. 6/30/80 Form No. 6 TOWI~ OF 5OUT'dOLD 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 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/I0 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-existing" land uses: t. 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. d. 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-existinK Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 .............. ate ......... New Construction ........ Old Or Pre-ex¢sting Building .... Location of Proper y..q.~--~ ....... ~..?y..4~.~..L.~. .... House No.~ /'~-~..~JYt~'¢,,~/' Stree~ Hamlet Onwer or Owners of Pronertv . County Tax Map No I000, Section ..... /..~.?....Block ..... .~ ........ Lot ..... I. ................ PermitSubdivisi°n'"'~.~-~4 .C., ·~- ........ .'~ace u im~u'""'d ..,.l~..~.oApplicant.~...~...~.~ ..... ~..~ NoC~.~.~-~. .]_;..~;.;i;.;:.~;.Filed Map ........ ,.Lot ........... (~.-, ..... Health Dept. Approval .......................... Underwriters Approval Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ....... Fee Submitted: $ ..................... ... : ..... -~OU~;DA~ION (1st) ~OU~4D~TIO~'I f 9nd) ~OUGH FRAME & -PLUMBING :I;SULATIO~! PER N. STATE ENERGY CODE FI;;AL ADDITIO~;A'L COMME~;TS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ................ , 19 ... ,,pproved..~,~..~...., ,9?~-~ermit No..2-. ~F. ?~/~- Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY .. ~ ............... ClICCK -~;~--~--~.~.~--. SEPTIC .. NOTIPY: CALL NAIL TO: a. Ttds application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 2ts 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, ando~vmoo' ' ~ a detailed description of layout of property must be drawn on the diagram which is part of this appli- at/on. c. The work covered by this applidation may n~t 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 :roll 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 ~all 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 ,uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .egulat'ons, 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 Jmit authorized inspectors on premises, and in build/ng for necessary ins_~ections. ¢~, ~'~-~ [) .. - · ...~.~~__ .... ~)~ ........ -- i ( ignature ~1~ a~SIicant, or name, i.fa co~iporation) ' ' (Mailing address of applicant) 'rate whether applicant is owner', lessee, agent, architect,, engineer, general contractor, electrician, plumber or builder. ;amc of owner of premises ....... . .... F~/ /(as on the tax roll or latest deed) ~ .................. ." applicant is a corporation, signature of duly auth?rizcd officer. (Name and title of corporate officer) Budder s Lmense No ................ Plumber's License No ......................... Electrician's License N[~ ....................... o,,,e~ Trade's ~icen~e No ...................... Location of land on w~ich proposed work will be'done. · ~.~. .... ~.¢.~..~¢.~.. ~Io.~ Xmu~ S~r~ ........ fi~;,'~t ..................... Co,,.,~ ~ M~ ~o. ~000 S~io~ .... t .~ ...... ~lo~...~. ~ ........ ~o~ ..... ~ t ......... Subdivision .............. Fil d Map No (Name) ............. ot ............... State exlsfing use and occupancy of premises ond intended use and occupancy of proposed construction. ,~,~,,. ,~, --.... ........ ,..... ..... ¥... ~. ~,.fi~ u.~ an~ o~.~an~ ......... b. Intended use and occupancy . "'-''''~ 3. Nature of work (check which ~pplicable): New'~Bufl~ling .......... Addition .......... Alteration~ . Repmr ...... 'M .... Removal .............. Demolition .............. Other Work ............... st /r / ~,t~'9 ' ' (D ipti n) 4 E ti d C~ ~..ff~. ~....~'. escr · s mate u '''/~ ....... , ................. F , (to be paid on filing this application) . 5. If dwelling, number 6f dwelling units ............... Number of dwc~lling units on each floor ............ If garage number of cars 6 ' If busine'ss commercial ........................................................................ · , or mixed occupancy, specify nature and extent of each type of use ' 7 Dimensions of existing stmcturles if any: Fron~ ............... Rear Depth · Height Numl~er o f Stories ............................. ' .......... Dimensions of same structure with alterations or additions: Front Rear Depth ! Height ................................... 8 ............................................. Number of Stories ............ · Dimensions of entire new construction: Front ' ' Rear Depth Height Number of Stories ............................................. 9 Size of lot: Front : ......................................... 10' Date of Purchase ...................... Rear ......... ; ............ Depth ...................... ' ' Name of Former Owner 11' Zone or ............................. ' ............................ , use district in which premises are situated ' 12. D°es pr°p°sed construction vie!ate ~ny zoning law, ordinance or regulation: ..................... ..... 13 Willlotbe egraded . . . ~ ............ Will ~ ' ' ' · r · · ! ....... excess fill be removed from premise: Yes ' ' ' 14 NameofOwn ofp mi ' . No · er re scs .., .................. Address .............. Phone No Name of Architect .... ..................... ....................... Address ................... Phone No ................ Name of Contractor ........ ............. . .... Address ................... Phone No ...... : .......... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southoid Town Trustees Permit may be required· 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 humber or d~scription according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK.. , SiS (Namer ifidividual signing contract) ~bove named· ~le is the , : , (Confractor agent corporate officer etc) ff said owner or owners, ~d is duly huthorized to perform or have perfo~ed the said work hnd to m~e sad file-this :pplicafion:/hat all statements contained ~ this application are trne to the best of his knowledge and belief; and that the york will be perfo~ed in the~a~3er set forth in the application filed therewith· ;worn to before me ~his ~ , ..... being duly sworn, deposes and says that he is th~ applicant ,~Ol~j..LJ.J'¥1fi \\