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Home My WebLink About20185-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20369 Date NOVEMBER 21~ 1991 THIS CERTIFIES that the building ACCESSORY Locution of Property 6285 NEW SUFFOLK AVENUE MATTITUCK~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 6 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit here%ofore filed in this office dated SEPTEMBER 27~ 1991 pursuant to which Building Permit No. 20185-Z dated OCTOBER 4~ 1991 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 ACCESSORY STORAGE BUILDING AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JOSEPH B. & MARYANN SIECZKA Building I~pector Rev. 1/81 lv~ NO, II TO~VN OF SOUTHOLD BUILDZNG DEPARTMENT TOWN HALL SOUTHOLD, No ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_~ 20185 Z Permission is hereby granted to: ,~ , ........ ...................... .... , ,...~..~..~,..~,~:,.:-...~.¢.~ ~, ~, ~....~~..... ........ ~....~. .................................... .~ ..................................................... at premises I~ated at ...~.~.~..~..~.....~Z~ ...................................... .............................................. ~~ ............................................................................... County Tax Map No. 1000 Section ...... ~,,~',~.. Block ........... ~'. ...... Lot No ...... ,,,~,,,,C~, ......... pursuant to applicotJon ~3ted ......... ¢/.~......~.. ............................. l 19.~./..., ond approved by the / Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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. 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. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. e 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. 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 $I5.00 Date .~..~.. ..................... .~.l~ /~/ ,.ow Constructzon ........... Old Or P[e-existiFg Building ........ ~ ........ Location of Property..~ ~7 .~..C~J..~.~.~.L~,~,~V, ........ ~.,T~V. ~.O.~ .................. .. House No. Street Hamlet Onwer or Owners of Property..~0~.~.~. ~..~. ~.~..F~ .......................... County Tax Map No 1000, Section..~..~. ....... Block..~ ............ Lot...~..e ................ Subdivision .................................... Filed Map ............ Lot ...................... Permit No..~..~. ~?..c~. ~...Date Of Permit...~./~/~...Applicant..~...~.~./. ~..~..~...~Z .~.~.~.... Health Dept. Approval .......................... Underwriters Approval ......................... Pl~inuing Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate....~. ...... ,oe Submitted: $ ...................... ' APPLICANT .... 765-1802 BUILDING DEPT. : INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ,, FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE INSPECTOR :OU~__;DA._TIO__N --... ( 1 s t ) 'OUNDATION (2nd) :OUGH FRAME & -PLUMBING :NSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS 765.1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [/__~NAL REMARKS: DATE ///[ ~/~/ 76S.1802 BUILDING DEPT. INSPECTION / [/FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: INSPECTOR Disapproved ~/c ..................................... ...................... APPLICATION FOR BUILDING PERMIT FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 INSTRUCTIONS BOAKO OF HEALTH SURVEY SEPTIC FORH .............. C^L~ . g]~tW~/Oq$ ......... HAIL TO: a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,ets of plans, accur0te 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- :at[on. 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 &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 3uilding 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. Fhe applicant agree8 to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :dmit auti~orized inspectors on premises and in building for necessary inspections. ........ ^ ~ ~ (Mailing aOdress of applicant).._ State whether applicant is owner, lessee, agent, architect, enoineer, general contractor, electrician, plumber or builder. ....... 6)..ad..~.e..r-7 ...................................................... : ........................ X,'ame of owner ofpremises . J.o ~ ~_~. .h. . .~. . , . . . . .O~. '. . . .~. ~. ?.I. . . .(~. .~. .t,,t. . .4.t.'.ew. .~' .2:.~. . .°W/ .......... (as on the tax rt~ll or latest deed) ~I' applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~..t~.../~. ~ ....... Plumber's Licens~ No ........ ; ................ Electrician's License No ....................... Other Trade's License No ......... _ .......... Location of land on which proposed work will be done. ' · / ..... ........... r7 t llouse Number Street ..... County Tax Map No. 1000 Section ...J.~..~.~. .......... Blo~k .... .~. ............ Lot....~...(~. ........... SubdMsion ..................................... Filed Map No ............... Lot .... ; JfJ,':- (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: "' a. Existing use and occupancy .................... ~ ..................................... b. Intended use and occupancy .~ dtTep ~,ct ~. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ... ~Q~"'d.: -~ Other Work.., 4. Estimated Cos 3~..,~.~.~. · ' · , ...................... Fee 5. If dwelling, number of dwelling 0nits (to be paid on filing this application) · Ifgarage, numberofcars .. , "' Numberofdwellingunitsoneach floor ................ Ir business, commercial or mi~'e' ! ............... ' ...... ' 6. d occu,,ancv .... ir .... ~ ...... ~ : ; ,' ~'-' .... : ...................... 7. ~-~mn~iunS O~ e~s[mg structureS, if any: Front ..... Off. .... Re~- &~ .................. Height ...I. [..'>.' ....... Number of Stories ....... It .... ' ................ Depth ...7...~' ......... Dimensions of same structure wiih alterations or additions: Front ................. Rear .................. Depth . .............. l ...... a"' ...... · .....> .......... Number of ~tories ..................... 8. Dimensions of entire new construction. Front c~ '- ' ' / (o" ' ......... , ...... ~ear ............... Depth . ..~. He~oht ...t j ......... _.. Num, bet of Stories ...... / . ' .......... 9. Sizeoflot: Front ..q~..?.~'! ~, '"k",~"2; ....................... ~, ........... 10. DateofPurchase .. ~/ 3~'~.'~ .... mear"i.c~"Q'~2' ........... De.j.pth ....,t.~..-~.,., ............ Zoneoruse-,=,-:-~.' .. ;'"r'.' ............ r~ameo~vormerOwner ..~'~.e-~.~.{!...LJ.~.>?..... 12 ..... Does proposed construction violate any zonino law or · · .,~ 't-' ........ ex ess e remov nreemises: Yes 14 r ...C~. ..... Address~ Name of Architect ......... ' . ne No . ................. Address Name of Contractor ......... I ................... Phone No ................ ................. Address ................... Phone No ......... . ....... 15. Is this property within 300 feet of a tidal wetland* *v~ · If yes, gouthold T~wn Trustees Permit may be required. .... i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an&indicate all set-back dimensions from property lines. Give street and block nhmber or description according to deed, and show street names and indicate whether interior or coruer lot. TATE OF NEW YORK, OUNTY OF . ' (t~ame of individual sigffing contract) being duly sworn, deposes and says that he is the applicant' )ore named. J (Contractor agent ............. t .............................. , , , corporate officer, etc.) said owner or owners, and is duly aluthorized 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 s~t fortl~ in the application filed therewith· ~orn to befo~r¢ me this ...... ~.¢~ ...... day o ...... ,19 ..~./ FP, o~TLINE PF, Ec~T ~5,TUD HE, IC~HT