HomeMy WebLinkAbout18277-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218221 Date JULY 28, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 2540 MARLENE LANE MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 144 Block 02 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 3, 1989 pursuant to which
Building Permit No. 182772 dated JULY 7, 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 AN EXISTING ONE FAMILY DWELLING.
The certificate is issued to MILDRED S. ROSSWORN
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED_ N/A
y~l
Building Inspector
Rev. 1/81
sosai xa s
TOWN OF SOUTNOLD
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 ~ ~ 7 Z Date ...........~t~':""~.....( 19.D..~
Permission is hereby granted to: /
.:~r.~.:.~....5......J~c~-~-~M..
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....1~.s~:...,!!N..::~..:...1..!.9..s. zr...
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of premises located at ...~5.... V......~.5.....1..,~ ~:i........~..w.l?A...-
.........................................................................t..[.....................................................................................
County Tax Map No. 1000 Section ......~..(((~~~~..1......... Block Lot No....~-.1..........
pursuant to application doted .....~.A~.?~.~..c~~,,,,,,,,,,,,,,,,,,,,,,,,,,, 1g.~,~., and approved by the
Building Inspector. I
Fee S.•w~~.:....
...~C.1~'
Building Inspector
Rev. 6/30/80
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TOWN OP SOUTUOLD !rf ~
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BUILDING DEPART:IENT kj'
TOWN BALL 9LDG.OEPT, k~~~
TOWN OF SOUTHOLO ~!t
SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE
NEW CONSTRUCTION ._.....OLD OR PRE-E%ZSTING BUILDING.. „ pACANT LAND.._.....
Location of Property..ZS~a . , , _ ~'1f~~Le-IJE LI~!V~' _ l~~-'jr'k i-UL~.
' _
llOUSE NO. 'STREET ~
/(/J ` . IIAMLET
Ovncr or Owners of Property„/: ~~L'~~~J_S~.~OSSCVORI?
Coun[y Taa Map No. 1000 Section .~~7', Block o2'J.
Lot-....
Subdivision Filed Ma
P ...._...Lot........--
Perni[ :io. ..........Date of Permit
APPlicant
IIcalth Dept. Approval Underwriters Approval..._..........
Planning Board Approval
Requcs[ for Temporary Certificate
Final Certificate
Fcc Submitted: ~~r0 ~
~ APPLICANT.......... . /
R.~.G -~3 ~~3 ~
Co z/~~~~
7/a
rw• 10/14/88 G'~/[--~!
L, Y FORM NO. 6
TOWN OF SOUTNOLD
` ' BIIILDING DEPARTMENT
TOWN HALL
' 765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the follgwing; 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from ',plumber certifying that solder used in system contains less
than 2/10 of 1Z lead:
5. Commercial buildings, industrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board; Approval of completed site plan requirements.
B. For existing buildings GPrior to April 9, 1957] non-conforming uses, or buildings
and "pre-existing" land ;uses:
1. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a Citle company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in ciXiting to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information'irequired to prepare a certificate.
C. For Vacant Land Certificate of Occupancy: '
1. An application for vaunt land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of,the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwe}ling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Updated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy -"$25.00 Residential
$50.00 Commercial
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~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ]INSULATION
[ ~/]/FRAMING ( ]FINAL
REMARKS:
_ C`~~
DATE ~ ( INSPECTOR
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iLLD i::.~.: 1L:: Muni ~ ~'veKMENT~ '
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Ii1SULATION PER N. Y.
STATE EPlERGY
CODE
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ADDITIOt7AL COMMEtiTS: ~
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60.1RD OF HEALTH
FORM NO. 1 3 SETS OF PL.1NS . , , , ~ . •
SURVEY ......./l,
TOWN OF SOUTHOLD C}lECK , ~ ~ ~ •
BUILDING DEPARTMENT SEPTIC Foart
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY c~
' TEL.:7G5~1802 CALL
Examincd...:~,.tctQ;y„]„. 19 g.) MAIL T0: .
Approved ~ 7 , 19 ~ 4 Permit No.I e1;7:7. ~ - _ .
~,~,Jty..... h ~ r ;ggpp
Disapproved a/c U -
a~ ~~9
• ~ w ~
• ~ ~ • ~ ' ' ' ' ' ' ' "TOWN
OF SOUTFi0L0
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 15 .
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 pan 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 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
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Fermi[ pursuant to the
8uitding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described.
The applicant a;rees to comply with all applicable laws, ordinances, building code, housin; code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections. ~ ~4Q
ignature o[
applicantt,
o~ e, if a corporation)
. 2S~o..,tiy,gcC,~1e_ . L~-mac,, ~'/.¢Tr.~
~ c,~, i
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
b w,vi=/L
:Fame of owner of premises ...~i~~2E~, , S :~o,s5ca?o i~~
(as on the tax roll or latest deed)
If applicant is a corporation, signature o£duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~T~''-!t!~ ~G KO .
...y......n
Plumber's Liccnsc No . .
Electrician's Liccnsc No . .
OtlterTradc's License No .
Location of land on which proposed work will be done. '
..rz. 5^~b sLIG~RC.ENE L/¢!t!E
liouseNumbcr Street.
Hamlet
County Tax Map No. 1000 $eC[IOn , x/:7'.7 Block , , , , , ~ • • • . , , Lot , o~ ~ , , , , • . .
Subdivision Filed t\fap No. Lot . .
..1N:unej'
• State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~Uf~~. =~'~c~' ~ ~~~'f
b.lntended [.IVtl~G;,~?G)C'G Gtlile~~~ ~ C/
use and occupancy • • • :JCC(C;
• 7tt~~' • .
, ."P kt
_ 3. Nature of work (check which lapplicable): New [3uildin . , . '
Repair Removal g Addition Jam..... .Utcration
• • Demolition „ Other 1Vork .
_ 4. Estimated Cost 2j5'aD :Od (Description)
Fee ..`E-.A~
(to be paid on filing this application)
If dwelling, number of dwcllin'
If ~ • . • 6 units • , , , , , , , Number of dwelling units on each Boor
6. If busyness, commercial or mixad occupancy, specify nature and extent of each type of use ,
Hci?ht c lu~rofcars cs,ifany: Front..,,
7. Drmcnsions of exuung strvctu
.NutnbcrofStoncs. ••""'•••Rcar Depth.
Dimensions of sarn'e structur'c ~yith alterations or additions: Front • • ~ ~ ~ ~ •
Depth . I . Iicight . Rear .
' Dimensio • • • .....Number of Stories . • ~ • • • "
~d°(i w construction: Front • 25,E Z" Rcar , 2 ~5-,'.;'y rr ' ' • • • • • • . • • ~
HeiSltt s .Depth . .
,,.:.~`lSinbcr of Stories , ' • "
9. Size of lot:Frant-. !
10. Date of Purchas"c....' tr Rear ....!r$c.~:.7Z Depth 5.~.~i (j .
1 1. Zone or use district in a•hidt premises arc situated , Name~f 1(Q ~~?1~~~ , • , • •
12, Does proposed construction violate any zoning law, ordinanc~ oyr regulation: • ,•Y.Q , , , , , , , , , , • •
l3. Nill lot be re,raded , ,ii/~
' ' ' ' ' • •7 ..Nil! excess III be removed from premises: Ycs No
14. Name of Owner of premises ~<<p(?6,v I~DSSuy~/(,it%~ Address Z~5;4~0 !~/¢!?~X!6,Phonc No. ?`I~^~~a~• ,
Name of Architect
Name of Contractor ~`TN;~!LS' SE/~ KO ' ' ' ' ' • • Address ......Phony, No. ~ •
IS.Is this property located within ••"Address ~aVrt!Zj,~FUG,,,, ,phoneNo.~g~;,Q~~,
300 feet of a tidal wetland? *YES..•.NO.... •
*If yes, Southold Town Trustees Permit may be required,
_ _ _ PLOT DIAGRAh1 -
- Locate clearly and distinctly all'~i buildings, whether existing or proposed, and. indicate aii set-back dimensions fron5
property Lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. i
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:T,ITL• OF XEIV YOR(;,
:OUNTYOF.,S'v~F'ot-I~..... S.S
,AIL
~ovc n mod
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of indi~?ual si nh i?~ • ' • ' ' ' ' ' ' bomg duly sworn, deposes and says that he is the applicant
a contract)
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IhC .....C/LC.1/~~ , ,
(Contractor, agent, corporate officer, etc.) • • • • ~ ~ • ~ ~ ~ ~ ~ ~ ~ • • "
said otvncr 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 arc true to the best of ltis knowledge and belief; and that the
xk wdl be performed in the manner se't forth in the application filed therewith.
'om to before me thesis
.............mod' :el ..day of. . 19~.I.
tart' Public,
' • County •
C~;,.~.
ELIZABETHAN EVILLE • .
NoteryryPubtic,Stete'of Newt (Signature of applicant)
No. SZ-8125860, SMflolk
Term Expires October 91,1