HomeMy WebLinkAbout18038-z •
FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hail
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18245 Date AUGUST 4, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 65 FREEMAN ROAD MATTITIICK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 139 Block 03 Lot 35
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed i.n this office dated APRIL 13, 1989 pursuant to which
Building Permit No. I8038Z dated APRIL 14, 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 TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to RICHARD E. & MARIE A. DRAKE JR.
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
roaas 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 O ~ 8 ~ ~ $ Z Date ~ 19...1
Permission is hereby granted to: U
N:.y.:..... !.cq~ z.
..................................................e................................. .
at premises located of ..L..~
..Q.A.GR~rtAr»..~ ............~.Y..)..,C.(G,,
.
County Tox Map No. 1000 Section^..~ ~9......... Block ....Q...~......\.'..ppLot No ...~5
pursuant to application dated 19A...1.., and approved by the
Building Inspector.
Fee ;.>n~..:. ~
1 ~ '"a...
. .
uilding Inspector
Rev 6{30{80
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~ y,~_
FORM NO. 6 _
TOWN OF SOUTHOLD jj''~~ ~ ('c?'~"~}~ 3
Budding Department U C~; i~l~%7~~
Town Hall ~I
Sout765 ~
N 8021971 ~ ~ 3~
APPLICATION FOR CERTIFICATE OF OCCUPANCY ....~,,,~,jL
Instructions 7O1N SO~U7FI'OLp
A. This appl~cat~on 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.
a Gommerc~al bu~4dmgs, tndusts~ai bu~ldmgs, Muit~ple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Piamm~g 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 pivperty showing all property lines, streets, bu~idings 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-
t~on required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $SD.OD
2. Certificate of occupancy on pre-existing dwelling $100.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
9.Vacant Land C.O. $ 20.00 ~ CC,,
S.Updated C.O. $ 50.00 Date ~.~1
NewConstruction,,,.„Old or Pre-existin Budd,n Vacant Land
9 9
Location of Property ~,r'c~:-4'?~: z~? ~ . ~C~~~..4'~?`~
J . .
House No. ~ Streety~ j~""/ Ham/et
Owner or Owners ofPraperty ./.1:4C?i-"~:~~G.....GC:Y~..~.•./.y~:~C..L:r.!..~-,~f~`C:-5:~..
~ ~ i
:row,w ~ax,JapNu. iuuDSecvon .l.l../.: Block Lot................
Subdivision ..Filed Map No. S. 1 ~ ....Lot No. 2nk ~ ~ ? :
Permit No........... Date of Permit ..........Applicant
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Piamm~g Board Approval
Request far Temporary Certificate /
...................Final Certificate .
Fee Submitted $ ..°?~~..~~~7 ~ g
Construction on above described building and permit m~ee~ts eft applica!b~~j~ codes and regulations
Applicant.1,~.C.~'~.~'~./~~r?~f.
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BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
( ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS:
O
DATE ~ -3 IN5PECTOR
~~3 ~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ~ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU TION
[ ]FRAMING [ INAL
REMARKS: ~
_ ~r~.~~,
DATE ~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
/ TION 1ST [ 7 ROUGH PLBG.
~(~65~ ] UNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: , ~
DATE INSPE ~
BOARD OF HEALTH
3 SETS OF PLANS
FORM N0. 1 SURVEY ~ ,
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD, N Y. 11971 NOCALL ~~:.l. ~ .
TEL.. 765-1802 ,
• \ 1.l ' 191q LG~~_ MATL T0:
Examined `~~~'{{C~~ b ~
APProved ``S . , 19~~ Pennit No ~ ~4.~~~.~ / ~ n '
Disapproved a/c . ~J ~ 1
~i3~ ~I!,
`t~tl~'. •9'i':?.. TOWN~~SQU~t'FIOID
(Building Inspector) •
APPLICATION FOR BUILDING PERMIT
Date . 15 .
INSTRUCTIONS
a Tlus apphcatron must be completely filled m by typewriter or m ink and submitted to the Building Inspector, wit
sets of plans, accurate plot plan to scale Fee according to schedule
b Plot plan showing iocatron of lot and of bwidings on premises, relationship to adloming premises or public str•
• or areas, and giving a detazled description of layout of property must be drawn on the diagram which is part of this ap
cation.
c. The work covered by this apphcatron 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 Pei
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupa;
shall ltave been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnb
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary inspections
(Signature ot""applicant, or name, if a corporation)
. . . .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build
.G.I~:fNC..K
Name of owner of premises ~Tf/L^f71.~. - ! .?'-l----- „
(as on the tai roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
. . . . .
(Name and title of corporate officer)
- Builder's License No G~'-c,`3~i r
Plwnber's License No -
Electrician's License No -
Ot}ier Trade's License No
1 Location of Land on which proposed work will be done ~ //j~~' , ; t~<~•. ~~'j:' , , ~~C~/E, , ,
.~y'........
House Number Street Hamlet
7
County Tai C,fap No 1000 Section ,3 t7 • - Block , , , , , , , , Lot
.
Subdivision - . - Filed slap No .Lot . .
(Name)
2. State e~istmg use and occupancy of premises and intended use and o~cupanc y of proposed construction
n
a. Eeisnng use and occupancy ~~~i - ~c1~Tt.0, ~ ~ ~?S/¢~~y'C~ . .
b. Intended use and occupancy n NL . 1` ~ n1:t.~..y _ - , , , , , , , . ,
- E~1~
3. Nature of work (check which applicable) New Building Adddio ~ Alteration .
Repazr Removal . Demolition Other Work .
(Descnptio
4 Estunated Cost ~'~"•,r"°•~ Fee
(to be paid on filing this apphcaUOn)
5. If dwelling, number of dwelling units ~'t~nl/ ,L.`j. Number of dwelling units on each floor .
If garage, number of cars
6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dunensron,,t:_gf exrsUn~ structures, ~f any Front ~ Rear Depth .
HeighY•'. C:. .R 1, • Number of Stones J. .
.
Dunens~ons oi~same styntcture wrth alterations or addrtronr Front Rear . .
Dept .I.:...... Height . Number of Stones .
8. Dimes
o~e a ne• coonstruction. Front ..~:2.-'' . .Rear Depth .
Hei~hp„t ......~~'.'Numberof Stones
9: Sizeyto lo'#.'-~~ ~aH.-1{ Rear Depth .
10. Date-~ Pm•c . . Name of Former Owner
1 1. Zone or use drstnct in which premises are situated . . . .
12. Does proposed construction violate any zonrng law, ordnance or regulation : .
13. Will lot be regraded . Will excess fill be removed from premises• Yes
14. Name of Owner of premises ....Address ..........Phone No . , .
Name of Architect ..Address ..Phone No .
Name of Contractor ...................Address , ...............Phone No .
15.Is this property located within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and drstmctly all buildings, whether existing or proposed, and, mdreate all set-back dunensrons f~
property Imes. Grve street and block number or description according to deed, and show street names and mdreate whet
rntenor or comet lot.
STATE OF NEW YORK, S S
COUNTY OF . .
• • • • • • • • • • • • • • • . • • beme duly sworn, deposes and says that he is the appl~c
(Name of individual signing contzact)
above named
Hersthe
. . .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
apphcaUOn, that all statements contained m this apphcaLOn are true to the best of lus knowledge and beltef, and that
work will be performed m the manner set forth m the application filed therewith
Sworn to before me this
~ day ofd/. 19
Notary Public, ..~:tY~~-..!! County
~
NElEN K DE YOE ~
NOTARYPUBtIC•SbteofNewYak (Signature of apphca
No 4707818, Suffolk CauMy
Term Expres MaieN 36,19 ~