HomeMy WebLinkAbout18366-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18282 Date AUGUST 14, 1989 .
THIS CERTIFIES that the building ADDITION TO ACCESSORY
Location of Property 495 BENNETTS POND LANE MATTITUCK, N.Y._ _ _
House No. Street Hamlet
County Tax Map No. 1000 Section 113 Block 13 Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 28 1989 pursuant to which
Building Permit No. 18366-Z dated AUGUST 10 1989
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 ADDITION AROUND EXISTING ACCESSORY INGROUND SWIMMING
POOL AS APPLIED FOR.
The certificate is issued to~ JAMES H. & LEILA M. McKAY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
lM~ ~l lllJ 1.Q_e~
Building In ector
Rev. 1/81
posas xa 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 ° 1. ~ ~ ~ ~ Z Date .11.~%E? 19A..F..
Permission is hereby nted to:
~~~'~'.~.-..ter.......
w
ro .~~~.~;f .....G.G ....!~'2'1..I........F~i.....~~~~~..~.~7.....
~......t,,s~~~
at premises located at ......J~.._......~.4 ......~'~t......:G
County Tax Map No. 1000 Section Block Lot No....~.°~...
pursuant to application doted 19.~, and approved by the
Building Inspector. ~
Fee 5....
s
a?
Buil g nspecto
Rev. 6/30/80
TOWN OF SOUTHOLD Q ~ v L5 ~ ~ r',
BUILDING DEPART?PENT D
TOWN HALL JUL 2 7 ~
SOUTHOLD, NEW YORK 11971 DLDG.O(:pr
765 - 1802 TO~'/NOFSOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
/ DATE ,~./.~~~J
/
NEW CONSTRUCTION .....r.~/.OLD OR PRE-E%ISTIN,~JG/BUILDING......vACANT LAND....
Location of Property„ T ~S ,~R..c~e_.~~~-. j"d ~C~ - J/IjJQ~~7-fir/< ~ /
HOUSE NO_ STREET ~ Cam! / •./-V~I~Yf L
HAMLET
Ovner or Ovners of Property„ 1 C_~i"x, r
...IGL.(!Me? S. I. .~..~~L..... _
County Taa Map No. 1000 Section
Block Lot
Subdivision..
Filed Map ........Lot...,,,••-.
Permit No. IS3~f¢;~„Date of Permit
....Applicant
Health Dept. Approval
Underwriters Approval......,
Planning Board Approval
Request for Temporacy Certificate
Final Certificate _
Pee Submitted: $.,..7i_5,~~....--.__
APPLICANT. Q:~.~~_~~_..._...•.---..'
rey• 10/14/88
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3 SETS OF PLr1NS
FORM NO. 1 SURVEY •
TOWN OFSOUTHOLD CHEC1:
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY /~~D~,~j
p/~
TEL.:7G5-1802 CALL
MAIL T0:
Examined ~ . ~ ~ 19~ '
.\PProvcd O........, 19~Pennit No. D ~ ~ ~ Q
Disapproved a/c JUL 2 7
......e.....
BLDG. DEPT.
m ~ TOWN OFSOUTHOLD
(Bt in; Inspector
APPLICATI FOR BUILDING PERMIT
Date ..7~ZB........., 35~.
INSTRUCTIONS /
a. Tltis 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 penttit
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
shall leave 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 of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Reculations, for the construction of build;in&s~ additions or alterations, or for removal or demolition, as herein described.
The applicant. agieds~'tb'edinS131yfwotf~~~~p~"tlCable laws, ordinances, building code, housin; code, and regulations, and to
admit authorizeSylnspt3~ors`t~ri%~Yi+s~~s~s~and•dih~building for necessary ins ctions. ,
':.ti t'4:'.7::.ldti'L;~C1K 'F~£.X3{^n ~.q. ~fv.' ~°l ~
Eat° ~3.i.'1t1N.~>''4"d1.t"<D~? tills ,tti~ ".A . .
~ I,C;r}t.:Aklfit; I ss's;•k ~ btwtY tl~li ~A ignature of applicant, or na e tf a corporanon) ~7`y~-
~"t,''•,f'Fi~ ;sty',"t) n
- ~ tt~a.•_y,;,:~'..14•}I~l j', i"'A ...."C .~.S •.~R-ttn ~=-/1 S. !....~~/2.• ~,C
• (Mailing address of applicant)
F.~,,,r, sa =,t~,4~a4i1.€:;
State whether,appliF~gt~(s~o'tvneFg,*1)dssee, agent, architect, engineer, general contractor, electrician, plumber or builder.
c. G
\ame of ownGr:ol; rertlikaS'C:.~1~. • • Lxi •~a• • ~ •
r " I'r• w ~ (as on the tax roll or latest deed)
1(applicanNis-1 `corporation, si~i~[~tre of duly authorized officer. CUPCY
,i~~~~h~ r~ ~~a
t~SE I FL
(Name and title of corporate officer)
Bnilder's License No . ~T T CFTiFiCTF
Plumber's License No . .
Electrician's License No. i8~ CY
Outer Trade's License No . .
1. Location of land on which proposed work will be done . - , ,
. ~~s....l3.eM~.e:~s...
Efouse Number Street. Hamlet /
County Tax \tap No. 1000 Section • • • • • • Block , , • , , , , • • Lot
Subdivision F.ilcd Map No. Lat .
(Name)
Stale existing use and occu ancy of remises and intended use and occupant
p' p proposed construction:
Y of
a. Existing use and occupancy ...~Q c % ~(.6u.t~~. • • o e
b. Intended use . ~~Q SO t;~ ~•1...........7 .
and occupancy
Re air Rempplicable): New lluilding ~ ~ec~
3. Nature of wort, check which a • • • . • • • . , .Other 1Vork
' Q • • • • • • • • Additicn Alteration .
P ( val . . Dcmolitiort
4• Estimated Cost ,~Q,O, , ~ • • • . • . •
(Description)
Fee......
5. ICdn•cllin~ ~ (to be paid on Cling this application)
rn er o welling ti
nits , , , , , , , , , , Number of dwelling units on each Cloor .
If ^ara~c. number of cars l .
6. If business. commercial or mixed occupancy, specify nature a d extent of each t
7. Hctglztsions of extsUng structures, if any: Front ~ YPc of use .
Numtcr of Stories . , , , , • ; Rear ; : , , , Depth .
Dimensions of same~structurc witfi alterations or additions: Front ,
Depth....... ...........Rear
' 8. Dim • • • • • IIcight . Number of Stories . ~ ~ ~ • • • ~ ~ ~ '
~ ~f entire new constnrction: Front S.ZQ• ~~,n. , Rear ,
Iles' t . Number of Stories . • ~ ' ' .Depth • ~ • ~ ~ • ' '
, 9. Size of lot: Front....1
10. Date oCPurchase Rear Depth ?;/,o• .
'•••••••••••....NameofPormer Owner
isesaresituated...
,raded Prey
13. 'i4 11 I P besredis[rict in whirl e any zoning law, ordinance or regulation: • ~ • ' ' ' ' '
14. Name of Owner of prremises V5.',lat' • • • ' ' ' ' ' ' ' • • Nill excess fill be removed from premises: y • • • • •
Name of Architect G~ ~~t"~ ' ' ' ' ' • • ' • • • Address eS Nc
Name of Contractor.~~•••~~• •"""""•••Address...••••••••~"•••..PhoneNo
..Address . ' ' ' ' ' ' ' • • • Phone No. .
15.Is this property located within Phone No. .
*If yes,, Southold Town ~`rustees Pewit may bearequiredetland? *YHS,,,.NO.~:,
I PLOT DIAGRAM
Locate clearly and distinctly all btjildings, whether existing or proposed, and, indicate all set-back dimensions frond
property Lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
'i
i
StlOtl117 NOt1.9fltl1SN09 tl0 NDIS30
' tl0~ QI8NOd8Stl lON 'S300~
' AflM~I 1~ N~fItl1.SN0~ 31b1S
A'N 3NIl »IO S1N3W3tllll1hltl 3H1
.L9dW '1'IYNB NOLL~fltl1SN00 1"1d
! 'O'0 tlOd 319"IdW05 39
1Sf1W NOll~fitl1SN00 - 1dNld 'b
NOtdb'"If1SN1 'E '
ONISW1Y1d 9'JNIWb'Hd ~ H~JfIOtl 'Z
3J3tlON0003tlflOd tlOj
' 03tlIflDHtlONLL NOIJ.f/ON110d 't
~SNO11.93dSNl ONIM01lOd
3N1 llO.i Wd f QL WV 6 ZOBL-99L
ib N bHA~ 0'11118 Ad1.I~A3~
as~ ~ ,
~9 k a'a o~ Lido
,l ~~(~~ra
•
,
ST,1T); OF \E1V Y-ORK, I
COtl\'TYOF.,,,,,,,,
S.S
• • • • • • •(Name of individual sip • . • . ,tract)
m nine con' ~ ' • ' ' ' • • • being duly sworn, deposes and says that he is the applicant
~bovc na ed.
Icisthc
>f said ((Contractor, agent, corporate officer, etc.) • ~ • ~ • ' ' ' • • • • • • • .
owner or owners, and is duly authorized to perform or have performed the said work and to
PPhcation; that all statements contained in this application arc true to the best of ltis knowled c
+orl; wrll be Performed in ttte manner se[ forth in the application filed Ihcrcwitlt. male and file this
wow to before me this S and belief; and that the
• ..day ofy.. ~ y
otary Public. 1~-~-.. !l. , , !t/ 19
' ~ County
.~'!it~c-~l
HELEN K. DE VOE I • • • .
NDT~RY PUDLIC, State of New YorN
Term~Ezpoes~Mirch
30 hun (Si; a ure of applicant)