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Home My WebLink About19536-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z195 70 Date DECEMBER 10, 1990 THIS CERTIFIES that the buildinq. Location of Propert~ 1150 House No. County Tax Map No. 1000 Section Subdivision RENOVATION SOUND AVE. MATTITUCK Street Hamlet 120 Block 03 Lot 05 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV. 26, 1990 pursuant to which Building Permit No. 19536Z dated NOV. 26~ 1990 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 RENOVATE EXISTING AGRICULTURAL STRUCTURE. The certificate is issued to FRED JENS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Bu~ldJ_n~ Inspector Rev. 1/81 l~OZl~ NO, ~ TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 19536 Z Permission is hereby granted to: :.. ....~.~...)..~..~.~ ............................................ ..~........~._~ .......... ~ ................... /._....~ ........... ~ .... ~,.:..% ..................... ot p~m,,,,,=ted ot..l../.~.....~~...~.: ........ ~~..~, .................. purSuant to application dated ............. ~ ......... .(R....., 19.~....O.., and approved by the Building Inspector. .5~; .~-~-~ Fee $ ....................... Building Insf~tor 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~, ~ to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 1. Certificate of occupancy New Dwelling 525.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $ ]0.00, 4.Vacant Land C.O. $ 20.00 [~ '~.~'.~ 5.Updated C.O. $ 50.00 Date ............... New 7 :: :t: t '.~u c t i on ...... Did or Pre-ex isting Building ............ Vacant Land ............. Location of Property..~. ~ .~.~..~. ......... .~ .fi~..~-:...~h/.~ ....... ~.lt~ .~..~.~.q.-~..~.. House No. Street Ham/er Owner or Owners of Property .. ...~... ....... County Tax Map No. 1000 Section ...I..~.. ....... Block .... 5. ........ Lot....-~.. .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit I'~o..iq..~..-.~.~.. Date of Permit ~ ~)~'"~'~7 .... Applicant .0 Health Dept. Approval ' ...Labor Dept. Approval ........................ Under~vriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate .... ' .Final Certificate Fee Submitted S .~"'~.~.. ¢ ...................... Construction on above described building a~,mit meets~ ~jpplicab~..~es and regu ,ations' ?iELD I:;S'2 ECTiON FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL IIDATE II COM~gNT~ 4 ADDITIONAL COMMENTS: -~,, F~,~ ~. ~ · .... ~.~ ~ . ~.,. 4 FINAL CO~ST~CT~O~ BE COMPLET~ FOR C 0 ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONS~u~ION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONS~UCTION ERRORS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y, 11971 TEL.; 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... · CtlECK ............ SEPTIC ..... Disapproved a/c .................................... (Building Inspector) APPLICATION FOR NOTIFY~ CALL HAIL ..................... TO: Date .................. 19 INSTRUCTIONS a. Tlfls application mt:st be completely filled in by typewriter or in ink and submitted to the Building l~spector, with sets 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 or areas, and giving a detailed description of l~yout of property must be drawn on the diagram wifich is pail of this appli- cation, c, The work covered by this application may not 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 shall be kept on the premises available for inspection throughout the work. shalle'haveN°beenbUildinggrantedShallbybethe°CCupiedBuilding°rlnspector.USed in whole or in' part for any. purpose whatever until a Certificate of Occupancy APPLICATION 1S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for bemoval or demolition, as herein described. The applicant agrees to comply with all applicag]e laws, ordinances, building code, housing code, and regnlations, and to ' admit auth_0riz~ed inspectors on premises and in building for necessa~.i~spections. ' . (Signature of app icant, or name, if'a corporanon) ' ' (Mailing address of apphcantJ ' ' ' State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownero£premises. (as on the tax roll or latest deed) ' ' ' If applicant is ikcttrporatioa, sianature of duly authorized officer. ......... (Name and ti~e of corporate officer) ' ' ' ' Builder's License No ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done: ' ............... .... llouse Number Street, Hamlet County Tax Map Nol I000 Section .. /.q~.L79. .... ' Block ... ...... · . .. Lot .~.~. ...,. Subdivision ..................................... Eilcd Map No ~ (Name) ............... Lot .... State existing use and occupancy of__ (premises and intended use aud occupancy of proposed construction: a. Existing .u occupancy ............... '.: ~ ~ .............. ' 3. Nature of work (check which applicable): New Building .......... Addition . · Demolition ........... ;.',~ i ~1~ I~ O. ~'~ ..... Repair ........... Rbmoval .............. '£enn£s Court ~:'. ...... Accessory Building .......... Fence ...,..~.Other i~ork .......... Fee . ,; ....... 4. Estimated Cost .... ~ ..........(to be S. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ lfgarage, numberofcars . ........ ..... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ............... Depth ............... Height Number of Stories · Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... 8. Dimensions of entire new construction: Front.. ........... .. Rear ............... Depth ............. Height . .' ............. Number of Stories .............. : ....................................... Size of lot: Front Rear ....... Depth Date of Purchase ............................. Name of Former Owner ........................... Zone or use district in which premises are situated .................................................... Does proposed construction violate any zoning law ordinance or regulation: - Will lot be regmded.. ............. ... . .. ... ... . Will excess fill be removed from premises: Yes .... No.. ' Phone No Name of Owner of premises Address ........ Name of Architect Address ............. Phone No ................. Name of Contractor ' Address Phone No 15.Is this property located within 100 feet of a tld~.l wetland? *YES .... NO .... · If yes, Southold 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 number or description according to deed, and show street names and indicate whether interior or coruer lot. 10. 11. 12. 13. 14. STATE OF NEW YORK, S.S COUNTY. OF ................ . (Name of individual signing contract) above named./ ~,o,~ · ...' ........... :.. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this application: that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application qled therewith. Sworn to before me this ...... d~ .day of. .~., . .0~.. ., 19 ~..q ................................. County HELEN K. DE VOE NOTAA~Y PUBLIC, State of New Ym'k No. 4707878, Suffolk Ce~ t Term Expires March 30, 19 la' (Sionarure of applican )