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Home My WebLink About19958-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19999 Date JUNE 20, 1991 THIS CERTIFIES that the building. Location of Property 1620 GRAND AVENUE House No. County Tax Map No. 1000 Section 107 ADDITION MATTITUCK, N.Y. Street Hamlet Block 3 Lot 9.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 19, 1991 pursuant to which Building Permit No. 19958-Z dated JUNE 20~ 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 DECK ADDITIGN TO EXISTING ONE FAMILY ~WELLING AS BUILT The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A GEORGE & ADRIANA ROHRBACH · ~Uilding Inspector Rev. 1/81 l~M' NO. I~ 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) Permission is hereby granted to: ..~.,....~.......,,'z~ ........................... . ...~/'.~..,.....~.~ ........ .,.~.~x'.~ . . ? ~.~,,x~-...~ ::...~x-"../,.. ................................... County Tax Map No. 1000 Section .......... ~ ......... Block ..................... Lot No .....~., ............... pursuant to application dated ..~..././...~... ...................................... , 19...~Z, and approved by the Building Inspector. Rev. 6/30/80 Form No, 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT. TOWN I~LL 765-i802 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 I% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from archiuect or engineer responsible for the buf. lding. 6. Submi~ 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: 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 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 et! Construction ........... Old Or Pre-existing Building ............ Itouse No. Street Hamlet ~wer or Owners of Property.. ~ ~/v~ ~unty Tax Map No I000, Section...(~ '7 -~ ......... Block .......... Lot .... ~bdivision ........... ...................... Filed Map ............ Lot ...................... *rmit No ................ Date Of Permit ................ Applicant ............................. .alth Dept Approval · · ......................... Underwriters Approval ......................... anning Board Approval ............ quest for: Temporary Certificate ........... Final Certicate I '73 ~ /~ ~/ APPLICANT YOUNG &,,YOUNG '/ . ia / TOWN OF SOUTHOLD J,~ '"' ~. TOWN HALL ';:~mincd ........... ~9 Pproved . ~ ........ , 19~Peruut No. . ....... i~approved a/c ..................................... .. . BOARD OF HE,\I. TII . . 3 SET-g OF' ?I.2,;~S fiURv£Y .......... CII F_ CI~ S £ ,r'T I C t' 0 r',:l .............. ,,O, ,.p'!; CALL HAIL TO: D INSTRUCTIONS "' a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shoxving location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property .must be draxvn on the diagram which is part of this appl/- iOU. e. The work covered by th/s 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 II 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 11 have been granted by the Building Inspector. !ding Z'~no ~'dm,mce of tl~ town ct Southold, S~fol ~n~.~.e APPLICATION IS HEREBY MADE to the Buildin De ..... L . - ' ' ' ~rrait pu..rs,u~nt to the :ulations. for the construction of bu;idings, additions or alterations, or for removal or demolition, as here/n described. : appl/cant agree~, to comply with al/ appbcable laws, ordinances, building code, housing code, and regtdations, and to ',it authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, ~f a corporation) ........ .~- /V* (Mailing address of applicant) :e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the t~t roil or latest deed) ;plicant 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 ....................... Olher Trade's License No ...................... OCCUPANCY OR USE JS UNLAWFUL OF OCCUPANCY ocation of land on which proposed work will be doue .................................................. ........................................................ ~1~4, ' ¢ ~ C ~ ~use Number . , , Street ............ · ................. Hamlet mnty Tax Map No. lOOOSection ~ /D7 Block ~-~ ~.~ ............... Lot bdivlsion ........ Filed M p No (Name) .... · ............ Lot...- ............ to existing use and occupaucy ofpremlses and i. tended use and occupancy of proposed construction: Zxisting use and occupancy . ~o ~- .~. . ntended use and /~fi.~ 5 ~ ............................ occupancy .......... 3. Nature of~vork (check which a i . Repair Pphcahle): New Building .......... Addition ..... \Iteration .......... .............. RcmdvaI Demolition ...... Other Wurk ............ 4. Estimated Cost ~ ~ ~ ~. ~ ' (Description) "' ' ' ..... 5. If dwelling, number of dwelling 6nits . . Numhe~ (to be paid on filim: this npplicahon) . If garage, number of cars . ; ..................... °f dwelling un,ts on each floor ................ x tent of each [ype of use Hei:ht /~, ~ ., · y:~ront .... ~i: . , '~ (ear a~*~ ~ ''_'"O'~'a ........ ~e~SlOllS oI sa~me st~cture with alterations .... ' ' ' Dent, O~. ~ . . oradd,/~ons Front Oo-,~ ........... S. . e., ....... ~ . . . . ............ Um~ens~onsofennrenewconstn~tion.~.~., ~ ~ '/'% ..... Numbero Stores..k~, Height ...(~:% ....... Numhbr of Stofiss . .< <~7', .... Rear . .<~.~ ......... Depth .~ ...... .... 9. Sizeoflot: Front ...((ef'-~& I ....... Rear '/4~ )~ .......... : ...................... .......... ' ' · ..... t~ame of FOrmer Owner &. ~e~&~ .............. ~. Zone or usc distr]ct'in which pren{ises are situate /O -. Does proposed construction violatb a W zonin, la~' ord '~.', ' ' ' '. ...... .' ' ' ....... 3. WUI lot be regraded /VD I ,. , ~nance or re ~ulano~ ~0 '~ . ' .... Name of Owner of prem scs ~ ~w~ ~,~ ~lj~x till be remove fromp~¢mise=. Yes Name of Architect ............ ~ .... · ............... ,'none No ~,o N~e of Contractor ......... [ ........... Address ................... Phone No ................ · · "' .............. Address ................... Phone No ........ 5. Es th~s property ~zthzn 300 fe~ DE a ~dal wet,and? ~Yes ........ ~. ........ ' ..... · IE yes. Souchold To~n T~ustees Permit may be required. · -. [ PLOT DIAGR~I Locate clearly ~d distinctly ~I b~ildbgs, whether existing or proposed, and. indicate all set-back d~ensions from rope~y lines. Give street ~d block number or desc~ptio~ according to deed, and show street n~es and indicate whether [eNor or co, er Jot. APFROV, ED AS NOTE[ii /? N,.O~TIFY 'BUILDING OEPARTr~T, AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION 'rvvo REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN' OR CONSTRUCTION ERRORS TE OF NEW YORK ' , aTV o~: .O..,¢~?./~.Z.'/.<. ...... s,s ' .......... ~ ............... being dtdy SWorn, deposes and says that he is the applicaut (Name of indivklual signing codtract) named, i Ibc i . [ (Contrnctor agent ..................................... , , corporate officer, crc ) d OWner or owners, and is duly aud~Srized to perform or have performed the saki Work and to make and file this ation; d~at all s~atements containedfin] this application are true to thc best of his kuowledgc add belief; ami dmt the .vdl be perforated in thc manner set o~rdt in [l~c aPplica[ion ~lcd therewith. ~obefore,ne(,,i)~ ~/~ ~ , .......... ~ ........ ¢~a~ or .... ~.: ~ ,o 0 / '-' ' '~ 'n~r r.=~...v~o,~¢~ ~. ~qo~... County . ' ,. ............ .[ . (&gna~rc of applicant)