HomeMy WebLinkAbout18891-z
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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY ~i
No Z~19096 Date JUNE 1, 1990
THIS CERTIFIES that the building ACCESSORY
Location of Property 2100 PARK AVENUE MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 08 Lot OS
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 16, 1990 pursuant to which
Building Permit No. 18891-Z dated MARCH 19, 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 EXISTING ACCESSORY METAL BUILDING AS APPLIED FOR.
The certificate is issued to DONALD E. & DOROTHY L. SWAHN
(owners)
of the aforesaid building.
SUFFOLK COUNTX DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
i
B ilding Inspector
Rev. 1/81
rows xo. s
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 ~ ~ CJ O ~ ~ Z Dote .........!..f ..J..G.'~?x~s!1.......~...<..........., 19.9.
Permission is hereby granted to: /
ta ...~,~*^•:1v~'rWS~S~.:......c~......~7 .S~.G?...~.~?SR?:q..:.....0.A...~-~?~Y~l... .
. \ ~l vU
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at premises located at .'~^~`4.................:......... S~,&3~:~?^:-....................
County Tax Map No. 1000 Section ~..~~...~3.......... Block ........Q..~..... Lot No......Q..~'.........
pursuant to application dated .....~.GZ.A..S:Y..i....i!.~i 19.90., and approved by the
Building Inspector.
Fee $.~,e5.:.~/.
~t.~~-
Buil ng Inspector
Rev. 6/30/80
Ifiy^
'9'~ y ~ ~S~~~d
U _ TOWN OF SOUTHOLD ~ j
cJ ~4 `p BUILDING DEPARTMENT ~rl.~i? 3
Q~ ~1
TOWN HALL
BLD(;, iiEPT.
SOUTHOLD, NEW YORK 11971 FOWMOFSOUTH04D
-----,._e...~_,
7b5 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE.?/.3 u l~9_ . _ - •
NEN CONSTRUCTION .......OLD OR PRE-ERISTING BU[JI.fLDING. .VACANT LAND....(....
Location of Property....:~'to~?..._.~~~K...!IVr
.............~t/1.7.~L~.~:rLl:..
HOUSE~~NO. STREET ~ HAMLET
Owner or Owners of Property!.~~~"-~.:1-- - ~w~-~~-`~• GN`°-T - • •~W/~~'~~
County Tas Map No. 1000 Section Block Lot
Subdivision Filed Map ....._..Lot..........
Permit No. ..........Date of Permit ..........Applicant
Health Dept_ Approval Underwriters Approval.........._...
Planning Board Approval
Request for Temporaryee Certificate Final Certificate
Fee Submitted: ~°1Y~............
rR GYM
APPLIGAN rt~
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1cLD II:S1'ECTIUN ~~UAiF. ~ ~OMMENT°
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FOUJJDATION (1st) ° ~
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FOUNDATIOIJ (2nd)
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P,OUGH FRAME &
PLUMBING
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IIJSULATION PER N. Y. '
STATE ENERGY
CODE
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FIidAL
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ADDITIONAL COMMENTS: ~
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t2 (l ~ ~ BOARD OF HEALTH
D L5 a 3 SETS OF PLANS
~FORMNO.1 SURVEX
TOWN OF SOUTHOLD CHECK • • • - • • • .
BUILDING DEPARTMENT SEPTIC FORA
gt,pG.DEPT. TOWN HALL NOTIFY
p EOUTHOLD, N.Y. 11971 CALL y5
n TEL.:7U5-1802 MAIL T0:'•-•••.••-
Examined ~4v~~, 19 ~ D ~ ~I""
Approved ..~tY~, 19c1'~. Permit No. ~
Disapproved a/c ~
- (Building Inspector)
APPLICATION FOR BUILDING PERMIT
' Date 19 ,
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 layout of property must be drawn on the diagram which is part 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 kl, ~tt~he premises available for inspection throughout the work.
e. N' buildniDg~~~rl^b~!~ecupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have~`6#e`~e#;'~tant d;}`~yygt(~e~~uilding Inspector.
€ `C o, ~ ~:r( ,f:,~-~
~'~LwI~~~L~~;I:,~S HE~REB,Y, IvfADE to the Building Department for the issuance of a Building Permit pursuant to the
~
Building~t`el~r ~t~c~e, of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations,'fb Ca~bhs~iuction of buildings, additions or alteratitfrSs, br for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances b ~lding code, hou " ,code nd re lions, and to
admit authorized inspectors on premises and in building for necessa ion .
Q~~~Q ~
~~.~M w tom, Si nature of applicant, or name, if a corporation
......»,...,,.~.~.........:Y9 _ tai .
'tR. 7WtYRA~~tB A~1+BJitt~ Yit6UY} (Mailing address of applicant)
~!!}t' Wt3i 4~§~'d N ~'8Y KAY A tOEf•D~Y
State ~I~r~ti~~('~~~ ~~i11~ agent, architect, engineer, general contractor, electrician, plumber or builder.
i'!P!t>i~9 D~RUD'~ R
.....~!ltPalbt'1'$'$141iAilAN'Y • • ~ltKtllt •,y
. t,v, /
Name gf~A#Y+n4Ft~~'19T~~~~'~.e...,t~s}3: ..d+
,p :5 Y4Cey ,,try,±~3t1N<]J a~ (as on the tax roll or latest deed)
7 ,,t eS:liE 17e?t ri:} i "
If appl~ct~~~}~s~~~~o~~~~o~~,~~p~~~yfte of~~uly authorized officer.
Yt:P4]HLt A t;c)if'>:~'~;:^.t~4:1 tTA<':"
- •RCJ Sirr .ti'i z?t'tYr'it~n-~~~ 7'e:?ti'i ' 'i'~i~3^l i
~ (aN~i~~1ia~1'U~'~'Ft~~':~o4?~°ryate'pi$ficer) .
ALL ~0 TRACTOR S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. 1?6*1.~~I~.......... .
Pluntbcr's License No . .
Electrician's License No . .
Other Trades License No . .
1. Loca/lion of land on wtrich/~proposed work will be done . . , , ,
°~-l.~ ~ .~.9 1. U.G.' ~C
House Number Street Hamlet ,p
County Tax Map No. 1000 Sections . Block ~ Lot ..CJ , , , , , , , , ,
Subdivision Filed Map No. , Lot .
(Namel
State existing use and occupancy of premises and in [ended use and occupancy of proposed construction:
a. Existing use and occupancy • j,l .
b. Intended use and occupancy . ~ ' .
{
amm.~~
pm~..ugs.w» ,,.a~.a
.ww.narn.rvv..wm..•w...
5t tiil ~ t~l 4) 5.
Repair gable): New Building Addition Alterattoi~~-tip
' 3. Nature of work (check which appli
~ th~o~~~~..
. Removal , T
Demolition ~
4. Estimated Cost .~~G::.~ ~ Fee ....,,..~...,,.,,,,,,.,.~,t .
to be aid o ~ ~ i ~ lion)
~ ~.,.,...1
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars '
6. If business, commercial or mixed oficupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, iC any: Front Rear Depth .
Height ...............NumbecofStories...............,......................,.................
Dunensions of same structure with lalterations or additions: Front Rear .
Depth ......................',Height Number of Stories .
8. Dimensions of entire nett' construction: Front Rear ...............Depth .
Height .....,.".........NumbedofStories.
9. Size of lot: Front Rear...................... Depth
10. Date of Purchase Name of Former Owner "
1 1. Zone or use district in which premises are situated :
p p b any zoning law, ordinance or regulation : y
13. Rill lot be re raded truction violate, Will excess fill be removed from premises: Yes No
14, Name of Owner of,premists ...............Address ...................Phone No................ .
Name of Architect ...............Address ...................Phone No............ t`.. .
Name of Contractor .
15. Is this property .located wi " " '••Address ....:..............Phone No.
thin 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit may be reqyu~ired.
PLOT DIAG1tAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block nu{ttber or description according to deed, and show street names and indicate whether
interior or comer lot.
OCCUPANCY OR
Q'-•
~ USE IS UNtAWFUI
W~TOF OCCUPANCY
~E
~ ~ e~N~
7SlFt$O! $ AM TO 4 ?M FOR TNB
1. FOLINDA~ REDWRED
~ FORFOlM~00N1'd1ET!
R. ROUON - lR/tMINQ D FiJIlbMINfi
` INSULATION
4. FINAL CONSTRUCTION MUST
SE COMPLETE FOR C.d.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
, CODES. NOT RESPONSI$LE FOR
DESI(4N OR CONSTRUCTION ERRORS
II
STATE OF NE~V YORK, S S
'OG1TY OF
. . . . . . . : being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
Dove named, I
(c isthc
I (Contractor, agent, corporate officer, etc.)
f said owner or owners, and is dulyauthorized to perform or have performed the said work and to make and file this
pplication; that all statements contairjed in this application are true to the best of his knowledge and belief; and that the
ork wAl be performed in the manner ~et forth in the application filed therewith.
worn to before me this
~~7~/.~.,.....da~yj/of ..f.~fYl/a/-,t-p~~:......., 19p~ /
otary Public, . !.':...:^!h::!.".~-..... County C-~~
NOTIIRYPUB410E~~~~ • . • • • • • , • • - • • • • • . ' (Signature oC applicant)
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