HomeMy WebLinkAbout18532-z FORM N0. 4
TOWN OF SOUTHOLD
HUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218638 Date DEC. 12, 1989
THIS CERTIFIES that the building ALTERATION
Location of Property 735 BREAKWATER ROAD MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 106 Block 08 Lot 53.2
Subdivision Filed Plap No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPT. 20, 1989 pursuant to which
Building Permit No. 185322 dated SEPT. 21, 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 ROOF ALTERATIONS TO EXISTING SEASONAL COTTAGE.
The certificate is issued to BARBARA ROESCH
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N103966 NOV. 20, 1989
PLUMBERS CERTIFICATION DATED N/A
Q
Building Inspector
Rev. 1/81
lOB,lt[ N0. !
TOWN OF SOUTHOLD
EUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
('PHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N_ 18532 Z Date /
Permission is hereb granted to:
.rte
~ ~~y.-r~.~... .~a,~..........
at premises located at ...~~..~.r~..~........lLYI,c~F~. .'rl.'.F.......(!4.
..............................................................................................................~~jj................................................
County Tox Map No. 1000 Section .........1 Block ............A........ Lot No.....r,3 . Z.
pursuant to application dated ...............1~~:~~........................, 19..~,Y.., and approved by the
Building Inspector.
Fee $.:=~11....
/ Build g nspector
Rev. b/30/80
a~y~s ~ s Q3 q Q e ~
TONN OF SOUTIIOLD
BUILDING DEPART:lEtiT
TOWN IIALL BLDG. DEPT,
' SOUTIIOLD, NEW YORK ,.1197 TOWN OFSOUTHOLD
j 765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY p
DATE. ~G,-
HEW CONSTRUCTION .-...OLD OR PRE-EBISTItiG IIUILDING......VACAtiT LAND........
Locatioa of Property.~?~~......:_._..f-~~~^!~~~~..../:~~~~~~,-
HOUSE N0.~/Jt STREET IIAHLET
^Ovner or Owners of Property._.'1::~~~~~~.
Lot
County Taz Map No. 1000 Section Black `
Subdivision Filed Map _......_Lot.....__...
Permit No./~`::!4:..Date of Permit _Applicant
Health Dept_ Approval Underwriters Approval.___...._...._
PlaaainE Board Approval
Request for Temporary Cert//i~~f~~i}}cate Final Certificate
Pee Submitted: $..?:~4:V_........
~
APPLICANT.
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iy~iYlCo 2-/~~~~
rev- 10/14/88
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FOUt1DATI0?I (1st}
FOU?IDATI0:1 (2nd }
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ROUGH FRAME &
PLUM3ING -
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II7SULATIOPI PER N. Y. • •
STATE EifERGY `
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THE NEW YORK BOARD OF FIRE UNDERWRITERS 1'Al~~~..~.
1.00(/121 BUREAU OF ELECTRICITY
ds JOHN STREET, NEW YORK, NEW YORK 10038
Date NOYR?fASR 20,1989 APPIlcatlonNo.onfile f'5U66'3fi9f89 N lU:i96fi
THIS CERTIFIES THAT
- only the alectricd pulprwant a dsecribed 6eloto and introduced 6y the applicant named on [he ebooe application number in the promlaee of
7'OAY ALTNAN RORSCA, 239-B BRRARNA'C8R ROAD, POI.R~6, NATTITUCR, N.Y. ~
in theJollo,clnq Inca ' n ~ IAt Fl. ? Ynd F!. OUT .Sertian Bloek Lot -
~II~RNA~t 09';`P~~i9 I-
Rcae examined on ondfound to 6e in compliance with the reyuiremente of thin Buard. I-
NXTUtl ACIEf fW1TCN6 RXTIIRlS RANOK COOKING ORCKS OVENS Sff WAfMBIS UST FANS
OURETS IrKANOetClM nUORlSCEM OTNEP AMT. R. W. AMT. K. W. AMT. R.W. AMT. K. W. AMT. X. P.
3 9 9
DRYERS RIRNACE MOTORS F'JTINE AlNIANCE R1DNt SMK7Al tX1C'Fi 71ME CIOCKS E[ll IRYi NRATMS tNXT40Ui1RT GIRAMlRS
AMT. K. W. ql N. P. GAE X. P. AMT. NO. A. W.O. AMT. AMP. AMT. AMPE. TRANS. AA\T. N. P. ~
~T AMT. WAIn
SfBIVICR OBOaFNMCT NO.Of S ! R V 1 C E
AMr. AM1. Tn+E 1 ~r tW , / Tv t a Tv ] / Aw tq. o~~cecono. aF cc
. No. q Ni.uc of w
~ltad Pa. q N[UTXAlS d },WEUAAI
1 100 CB 1 R 1 2 1 4
oTtRRI AeFARATIIfe
TRAr,R I,IGRTTNC:-4
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PA11L R. AURNS L1t;.~282 R
275 TONN AAR$OR LANK
SOtITAOI.A, NX, 1.19 Tl Oyu MhNhpp
11
Prr
This urKficaM mIM not be alNrod in airy manmr; rHurn fo tM office of fhe Board if ineorrect. Inspectors may be identified by tF»ir credentials.
COPY FOR BUILDING DEPARTMENT. TNIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER.
l ~s~ Tss-isoz
BUILDING DEPT.
INS~PECTIQN
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ )INSULATION
[ ]FRAMING [ FINAL
REMARKS:
DATE ~ D ~ ( INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ (J~INSULATION
[ ]FRAMING ~ ]FINAL /
REMARKS: ~-'~~A.~~,- c9~t-
DATE a! ~ INSPECTOR
19 ~3 ~ 7ss-iso2
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[~RAMING [ ]FINAL
REMARKS: c~
DATE f/' C INSPECTOR ..f/I,~
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^ `R ~ R ~ M ~ BOARD OF HEALTH
U LS 15 IJ n 3 SETS OF PLANS .C:K•...
I'UIf 'FORM NO. i SURVEY z' .
SFP P O 19~ TOWN OF SOUTHOLD CHECK • • ~!`}G~~
' BUILDING DEPARTMENT SEPTIC FORPI
t'i:DG. DEPT. c TOWN HALL NOTIFY
L..~tn,~rd OF 30UTHOLD ..OUTHOLD, N.Y. 11971 CALL • • • • - ~~O-~• `/f
.n°f-`~•°--° TEL.: 765.1802
MAIL T0:
Examined 9f°~/~ 19
`2-
Approved , • 19(f1`. Permit No..~.~.ti?
Disapproved a/c
c=' i~~. .'eC.~ .
(B~Lildin~ 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
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 stre=
or areas, and giving a detailed description of layout of property must be drawn on the diagrsm which is part of this app
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 perry
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 Occupan~
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tI
Building Zone Or ,g~~r n of Southold, Suffolk County, New York, and other apglicable Latvs, Ordinances
Regulations, foz~~8f buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant a r es~tq~o,~,,,mg~,~vj~„a~Tlicable laws, ordinances, building code, usrng code, and regulations, and
admit au`Chonze mspe Yours on premises a}~¢lin building for necessa ins ctions.
'tA
fiA:?.gnr;';pgg1"S #TM!t1JilP~ ,~r
.
;111 RCI} RY; b $ C("? nature of applicant, or name, if a corporation)
t7T-'SL1L13'! 45 ~.T Ni'n4c7~!
t{?° .
(hlaiIing address of applicant)
~7N1°1`"~ilq y ~.:kk.s.'i7. ~~ry,C:! '
State whether applicant is ow'H~rt, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
Pl ~ fj~~``r~~''~r1.'...,',
~f~Lt..Z'{! . , .
Td~IJ~ ,!tar;? " Yi
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Name ofm~hteittbiFp}6tnf$es ? 4'vta~ ~3...~t.9.~.SG.tf......
Y~•~R?!k~~ K NCB'. ~ (as on the tax roll or latest deed)
as ~ ia+,~~.1'?nE?'*:• ~~,~s s
If applicar~h~s~ppr~pgration, signature bf duly authorized officer.
.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License Iv'o . .
Plumber's License No . .
Electrician's License No . .
O[ltcr Trade's License No . .
1. Locatio~~~and on which proposed work will be done . .
House Number Street Hamlet
County Tax hiap No. 1000 Section "
4 Block Lot ....:5.`3!,Z,•
Subdivision Filed \lap No. Lot..............
(Name)
State existing use and occupancy of premises and intended use and ccupancy of proposed construction:
a. Existing use and occupancy ~ . .
b. Intended use and occupancy • • ~r~~P?~-!..'~, , ~~'~C......... .
3. Nature of ork check which applicable): New BuIlding Addition Altesation V... -
Repair ..t~4'A~....... Removal Demolition Other ~l'ork •
UVVUUU ~1 C (Description)
~
A. Estimated Cosi ....+~c':~1.~.Q Fee .
' (to be paid on filing this application)
5. If dwelling, number of dwelling units ~ Number of dwelling units on each floor ~ .
If garace, number of cars f~....................................... .
6. If business, commercial or mixed occupancy, specif nature and extent of each type of usa .
7. Dimensions of existing structures, if any: Front ~S.U........ Rear ~.U......... Depth ~i(1, .
Height ~ .......Number of Stories ...l .
Dimensions of same structure with altcrafions or additions: Front Rear .
Depth Height Number of Stories .
8. Dimensions of entire nets construction: Front Rear Depth .
Height ...............NumberofStories........................................................
9. Size of lot: Front Rear...................... Depth
] 0. Date of Purchase .............................Name of Former Owner .
I I. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. \Vill lot be regraded ............................Will excess fill be removed from premises: Yes N~
14. Name of Owner of,pzemises ....................Address ...................Phone No.............. .
Name of Architect ...........................Address ...................Phone No...............
Name of Contractor ..........................Address ....:..............Phone No............. • .
15. Is this property located within 30D feetyyof a ti9idal wetland? *Yes No
*If yes, Southold Town Trustees PermitPLOT D1AGftAM ed.
Locate cleazly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fror,
properly lines. Give street and block number or description according to deed, and show street names and indicate whethei
:ntezior or comer lot.
a4TE:g zi ap x ~ 3
HarlFV ullo~o ~PAIarM~~
785-tIt02 g AM 7t) 4 PM FOR THl:
FOLLOWING INSPECTIONS:
t. FOUNDATION TWO REQURIED
FOR POURED CONCRETE
2. ROUGH - FRAMING b PLUMBING
3. INSULATION
A, FFNAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION 8 ENERGY
CnDES. NOT FtESPONSIBt~ FOR
Lrc"SIGN OR CONSTRUCTION ERRORS
TATE OF NE«' YORSC, S.S
~OIi1TY OF ....i.1..~..~........
• d~`~^'J• • • • • • • • • • • • • • • • • • • • - • • • • • • • • being duly sworn, deposes and says that he is the applicant
(\ahnc of indi~•idual signing contract)
hove named.
ie is the ~`-1!S~J":^•" ~ .
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
~plication: that all statements contained in this application are true to the best of leis knowledge and belief; and that the
ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
..............°.rU......day of...............,19~~
otary Public, , . kJ,.~•4!~:..... County
rl/,l/'
HELEN R DE 4llf .
spy 08878 ~ffolk~u~r (Signature of applicant)
terra Eepires Mtroh 30,1