HomeMy WebLinkAbout18206-z FORM NO. 4
TO'riN vF SOUTHOLD
BUlLD1NCi DEPARTMENT
Office of the Building inspector
Town Ha11
Southold, N.Y.
CERTIFICATE vF OCCUPANCY
No 218698 Date JANUARY 8, 1990
THIS CERTIFIES that the building ACCESSORF
Location of Property 13380 COUNii RD. e48 MATTITUCK
House No. Street Hamlet
County Tax 'riap No. 1000 Section 101 Block 002 Lot 03.2
Subdivision Filed Map tdo. Lvt No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 16, 1989 pursuant to which
Building Permit No. 182062 dated JUNE 20, 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 ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to YOiv`G CHAUL FAK
(owner, ~
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT ^vr^ HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATIOYd DATED N/A
Building Inspector
Rev. 1/81
Boss: xo. A
TOWN OP 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 ° 8 ~ ~ ~ Z Date G~~ 19.. 6.y
Permission is hereby granted to:
~.e...~~.~
to .~r6..~1....~./~a'l.?......~~
of premises located at X33 ffoC'~~°~~~'f' YG4'.
County Tox Map No. 1000 Section ../~d.~......... Block ....2 Lot No....3.~..L-...
pursuant to application dated .........ro.~/..~? 19.I1.J~.., and approved by the
Building In~s{pector.
Fee
r
.lf~:ft`.:.
uildi I r
Rev. 6/30/80
--1
TOWN OF SOUTIIOLD
BUILDING DEPART?PENT
_ TOWN IIALL
SOUTIIOLD, NEW YOF2K 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY Q y- f
DATE.WQi~v'..~j..~~l
NEW CONSTRUCTION ._.....O2LDQ OR PRE-E%ISTING BUILDING.„ pACANT LAND........
Location of Property.,~.3.yJ g.~- - ~ ~'y`?j .1`1.q-~~F~.~'v~k..
~ HOUSE NO. ~ l
Y . • yS~TREET • ' • ' . • HAMLET
.Owner or Owners of Property.,YoN~. L~nu~ i-
• ..............AK...............------..
County Taa Map No. 1000 Section .~®j., Block a- oC
Lot
Subdivision Fi//l''ed Mappp........Lot.v..+.'.....
Permit No. .~.0.?~.K~„4Date of Permit .1p.~.?~~$J-Applicant ./.0.1Y~..C•„}~,~t,~...
i
Health DepC. Approval Underwriters Approval..............
Planning Board Approval
Request for Temporary Certificate
Pinal Certificate
Fee Submitted: $.~25;q~?
APPLICANT..rt~___"r"'.'G~
~ 3~~YZ~
~~~~q~
Co Z /d'd%~'
rev. 10/14/88
=1ELD I;:S: SS. iU;i ~~JniC, ;;CMMGNT° ~
7 . m l~y
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~OUI7DATZON , (1st) o
C
zOUNDATI07J ( 2nd ) _ _ ~i~~°~
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BOUGH FRAME &
PLUMBING
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3. ~
m
IIJSULATIOP7 PER N. Y. y
STATE ENERGY \p°~ \
COpE v
x~
5
J.
4 . ~ ~ ~ ,~J ~ ~ A
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FIIJAL
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ADDITIONAL COMMENTS: ~
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765-1802
BUILDING DEPT.
r"
[ ] F UNDATION i5T [ ) OUG ~ PLBG.
[ ] FO TION 2ND [ ] 1 ULATION
[ M G ] FI N~L
REIYIARKS: ~ ~ C L`1,2 ~~B t~~il~-~u 1 i 'hl ~
cs0~ ~~T~,~~~i
DATEINSPECTOR Urn ~t~,
~ZD ~ '765-1802
BUILDING DEPT.
~r~sPECT~®~
[ ]FOUNDATION 1ST ( ] !ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ULATION
FRAMING [ FINAL
[7
REMARKS:
DATE INSPECTOR ~
CCUpANCY OR
USE ,S UNI'P'FUL ~E
ITHOUT c~,R11~ICA
~j - ~ OCCUPANCY
aaa ,
1
~.a._,.~~ ~
~~X.
4
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BO.1RD OF HE.ILTH
FORM N0.1 3 SETS OF PL.\NS~,•
SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORPI
TOWN HALL
EOUTHOLD, N.Y. 11071 NOTIFY
~~}}..~~~~^j TEL.:7G5~1II02 CALL
Examined ~D~Ll.Y........., 191. Q 11A I L T 0 : ' •
Approved .~0./.;~........, 19~Pctmit No.~Q ~ 6
Disapproved/a/c • . • - . • • ~
~1~~
~ `IUN ~ 619&9
• •(Buil g nspector) • • ~ • ~ TOlrirtIIyL
jp~'• OEpp }
APPLICATIO FOR BUILDING PERMIT
Date 6.. ~.~D..........., 15 g~.
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-
.:ation.
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 kept an the premises avai]able for inspection tlirou;}tout 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 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
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appticable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal ~ein described.
Tite applicant agrees to comply with all applicable laws, ordinances, building code, hou tn~ code, and regulati nd [o
admit authorized inspectors on premises and in building for necessary in~ectians....rwrwM.rr~*,~.»•r•~•••«» ~
• •(Si^ a(~ ture of NM~~.ttiit~ •t":i:s::1... .
gtp'Aar~°fI34~aI~4n)
. „(3 3B D • • C :8N L"~j°~'r('e,; reHo~p~
• (M • • WCr1Ylx43'r! t : 3• • ~
- ~~5~?~i~i~F!~~l tti}
State whether applicant is owner, lessee, agent, architect, engineer, general co °`~'~'~~'~3 "t`~
t~;l~electiictan, plumber.or builder.
,r~ II-- .......................t;
Vame of owner of premises ...rQIC~.. •L~, vIG u ~ ~:1te+S .~.;r,~:s° ~ ` • .
h (as on the tax roll or la ~u`~`~• • ~~~1~~'~~`~~~ ~
[C applicant is a corporation, signature of duly authorized officer. ~{°t~ 9.bNt ~tt'3+t<
(Name and title of corporate officer)
Builder's Licansc No. .
Plumber's License No. ~ . .
Electrician's License No. .
Outer Trade's License No .
Location of land on which proposed work will be done.
13.3 ~ o ~~~r.~:~ ~c
1louseNumber Street.
Hamlet
County Tax Alap No. 1000 $eCtlOn ~ Block , , , , ~ • • • • • • • • • , , Lot ;3; 01-•
Subdivision Filed Atop No. Lot . • • .
..IN:uttc)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ../1ir2~j~4-... ~!"1?! ~.i/..//.. ~ USA .
b. Intended use and occupancy . ,5,1.7q 1 ~...~alYli.L~. •CLQQ;SQ •G j~~ •
v
3. A`aturc of work (check which applicable): New
Repair , Building , , , • Addition .
• • . Rj:moval • • • • • • • • • ~Vtcration •
• • • • • • Demolition .Other Rork . • •
4. Estimated Cost ,~~b~, . • . (Description;
.!L. Fee.~ol~
5• IC dwelling, number of dwelling units • ito be paid on filing this application)
eara,c, number of cars " • • • • • Number of dwcllin6 units on each floor .
6. if business, commercial or miffed occupancy, specify pature and extent of each type oC use . • • •
7. Dintcnsions of existing structures, if any: Front • • • • ~ • • •
Hciaht . Number of Stories , ~ Rear Depth .
Dimensions of same structurcliwith alterations or additions, Pront • • • • • •
Depth: .Height. Rear................
' 8. Dimensions oFf entire, new construction: Front , ~ • ' ' ' ' ' ' ' • • • Number of Stories . • • • • • • • ~ • • ' '
Height . 4~. ' N mbcr o Rear Depth ,
9. Size of lot: Front ~ fStorics....,,,,,„•,,;,..,.,
10. Date of Purchase ........i............ Rear...... Depth
11. Zone or use district in which ' ~ • • " " • • • Namc of Pormcr Owner • • • , , , • • ~ • • •
p p remises arc situated . , " " • • • • • • • • • • • ,
12. Does ro ~
osed construction viplate any. zoning law, ordinance or regulation: . .
13. Nilllotberegraded
14. Name of Owner of premises . ' ~ ~ ~ ~ ~ • • • • ~ • ' • • • 1Vill excess ill be removed from premises: Yes • N,
Name of Architect • • .Address ...................Phone No. .
Name of Contractor • . Adclress Pltonr, No.. • .
IS.Is this property looted with in~•~"Address.. .Phone No.......•••.•.•.
*If yes, Southold Tow~ri Trustees P ormit:emayQtiea requir~detland? *YES..,.Np, • •
PLOT DIAGRAhf
Locate clearly and distinctly al+ buildings, wh'ethcr. e ` ' ~
property fines. Give street and block' number or flescri , Eio.
~acTCOr 9r-po poasded'.;~d' Indicate all set-back dimensions fro"m
interior or comerlot. I = ;dz.I!~..a ..~ndshow street names and indicate whethc:
f C':
• ~ '1y~-.''e 'A ~
.
yo
~ G
DATE. .,y ~ _
FEE: ~L`
NOTIFY
~efi-,eas ~ AM ~.r rM ~~A
FOU-OWING tNS~:. l~ /e?~
1. FOUNOATNjN T~
FOR ieQUREC CONCRlTt
2. ROUt3H -FRAMING 6 PUNN~lMrfA
3. INSUL.ATIOI(1
Q. FINAL - I ONSTRUCTION MUBT
BE COMPLETE FOR C.O. ,
ALT, CONSTRUCTION SHALT, MEET
THE REQUIREMENTS OF THE I N.Y.
STATE CONSTRUCTION & ENERGY
COQES NOT RESPONSIBC~ ',FOR
Ri"SOL;N OR CONSTRUCTION EpWOA8
.
TATL OF \E1l' YORK,
OUNTY OF .
,
• ~ • • ' ' ' ' • • • • • • • being duly sworn, deposes and says that he is the a
(lame of individual si^nim' • ~ • ~ • ~ • •
rove named. ~ ;contract) pplicant
is tltc
• I, .(Contractor, agent, corporate officer, etc.) ~ ~ ~ ~ ~ • ~ • • • " •
said owner or owners, and is duly authorized to perform or have performed the said work and to make and lile•tltis
lieation: that all statements contained in this application arc true to the best of his knowledge and belief; and that the
rk will be perCortncd in the manner set forth in the application Gled therewith.
om to before me this
...............~'P.....day of..'' t
ari Public, ...~[,;Q2'KJ..~•.!!iL County i
RELENK.OEYOE ~ ' ' • • ~ • .
NdfARY PUSLIG State of New YorM ,
T
m~EK~~7Mieeh301~9.,~~ 1 \ (Signature of applicant)
'I