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Home My WebLink About18769-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19415 Date OCTOBER 4, '1990 THIS CERTIFIES that the buildin~ Location of Property 300 PVT. RD. #17 House No. Street County Tax Map No. 1000 Section 123 Block 06 Subdivision Filed Map No. MATTITUCK ADDITION Lot Lot No. 16 Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JAN. 30~ 1990 pursuant to which Building Permit No. i8769Z dated FEB. 2~ 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 CLOSE IN TWO EXISTING PORCH AREAS. 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 ROBERT & SHIRLEY ANDERSON In~p~ Building Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 18769 Z Permission is hereby granted to: ...... ........ ~/ /~,~/ ~,~ ,, · . . ............. ( .... at prem~es I ated at ..... .~;....~. ....... ~.....~; ....~f..~.../.~. ............ ~ ........... ,..,,.~...,..~,. ....... ,...~.~....,.~.-.~..,.,~.~.~...~..,..,.....~ ....... :: ................................. County Tax Mop No. I000 Section ...../.~,...~ ...... Block .....~'.. ............ Lot No...Z...~.. ......... pursuant ,o application dated ~ ............. ~....~.. ....... , '9..~..~----~, end approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 i' ' APPLICATION FOR CERTIFICATE OF OCCUPANCY ,!t~ .. '%- 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 %lectrical 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. 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 "pre-existing" land u (.P lot to April 9, 19~7) non-conforming uses, or buildings and 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. C. 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. 2.CertificAte of Occupancy on Pre-existing Businesses $50.00. Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated C~r~ificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ::ew Construction .... ~ ...... Old Or 'Pre ex~'s l~gD~ute '~~./~ .~.. .................... House No. , , ~ . t,r,e ~ Hamlet y ~ax Map No lOnn , _ / ~ ~ '~ ~ , .............. ,. , ' ............. Underwriters A~ r~__. ' lannzn BOar Approval ........................ / ',{'..' :equest for: .Temporary Certificate ........... Final Certicate .... ee Submitted= $ .... " FO UllD A__T I 0:! ( 1 st ) ROUGH FRAME & 3. iNSULATI0~; .?LUMB!NG PER N. Y. STATE E}JERGY CODE FI~;AL ADDITIO~IA'L COMMEI;TS: /-% Examined ................ , 19... No.:..:. Disapproved a/c ..................................... '~FORM NO. '1 TOWN OF SOU~HOLD BUILDING DEP,~R~TM ENT TOWN HALL SOUTHOLD, N.Y:11971 TEL.: 765-1803 Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue a Building Permit to the applicant. Such permit · shall 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 ~s, hall 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 Building Zone Ordinance of the Town o£ Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspecti~. .................... (Signature of applicant, or name, if a corporation) If applicant is a col~oration~signature of duly authorized officer. · (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~ z'.~ t/'Ia '~ /~ ~/~ t'o o a d o w idh propo~e~ work v(Jll~e done.//'/...tf~.~..r..~., y.."t,L~_,~I,~..(?~."(.~. 'i ....... -"" :" "'~" .......... .................... ./. ...... House Number Street Hamlet County Tax Map No. 1000 Section .... l,~. ~ ......... Block...~?. ............. Lot../.~. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (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 .... ~.:...1~..~.. :-.., ,, ; .... . ................ Repair .............. RemOval ........... . .2. Demolition .............. Othe~J~/ork.. ~-',:[t~' I .... 4. Estimated Cost...~/./~5 ¢.d'TZr'~/,e..~ ............... Fee ..................... <..... -.,, ."7~:.. '!" · { ' ' (to be paid o~,filihg-this,~app'lf~'ffti~m~l / , 5. If dwelling, number of dwelling units .............. Number of dwelling units o~ each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature arid extent of each tYl~e of use . ....... ' 7. Dimensions of existing structurei, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Numlber of Stories ........................................................ 9. Size of lot: Front ..~..~..~Rear ...................... Depth ...................... 10. Date of Purchase ...... T ........ ~ ............. Name of Former Owner ............................ 11. Zone cruse dmtnct m which pr~m~ses are s~tuated ........................ i ~-~ i i ii ................. 12. Does proposed construction violate any zoning law ordinance or regulation: .................... 13. Will lot be regraded ......... ! ................... Will excess fill be removed from premises: Yes No 14.' Name of Owner of premises 7{a~. ~. Address .. ~ ...... Phone No.,,~-.~a~. · ~. ~7../'~... Name of Architect ...... ?,..~. · ~ · · ..a-t · · ._.o ..... Address ........................... Name of Contractor . ./g~///~ ~.t~,'.. ~t,t,~.~Address :i: ' ~'~'.' i...: .... Phone NON~,Z. tt~' ~ ~'/ Phone . . . .~ .... PLOT DIAGRAM Locate clearly and distinctly all'bufldmgs, whether existing or proposed, and, indicate all set-baak dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I STATE OF NEW YORK, COUNTY OF ................. ' ............................. i .................... being duly sworn, deposes and says that he is the applicant (Name of individual sign}ng contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized to perform 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 filed therewith. Sworn to before me this .............. ,..~ .[ ....... day oi ..... ~ ............ 19 fo. ....... .rT. ........... HELEN IL DE;VOl NOTARY PUBLIC, State of New Yod~ (Signature of applicant) lerm ~plres M~rcn