HomeMy WebLinkAbout18292-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218192 Date JULY 17, 1989
THIS CERTIFIES that the building ACCESSORY SHED
Location of Property 10120 SOUND AVE. MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 02 Lat 09
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 7, 1989 pursuant to which
Building Permit No. 182922 dated JULY 12, 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.
The certificate is issued to MIIS.ICENT B. DICKERSON
(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
posas xo. s
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)
D Date 19..9.
N- ~.82~2 Z z
Permission is hereby granted to: ,
::~r..,~.~......~-.........:.y.....r.~y.~~........ ,
to ~~cA:... c~...~:c.~R.......o.-~...~.~~-~-~!....~
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .n
. . . . . . 1.1. . .
~
. . . .7.y ; . . . . . . . . . . . . . . . .
of premises located at ~./~:D.....S~U^~A!....~.,......:.'..1..Ck:IA~
County Tax Map No. 1000 Section .......~..~-.Z...... Block ......Q.?c:...... Lot Na.....5~.°1
pursuant to application dated 19..9.., and approved by the
Building Inspector.
r
Fee $..r~~
Bu ding Inspector
Rev. 6/30/80
~rv~%
~ ~ ~ ~
TOWN OF SOUTHOLD ~ ~_y~
BUILDING DEPART?LENT G~'°
TOWN HALL
• SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
DATE...v~~~J•
1~
HEW CONSTRUCTION .......OLD OR PRE-E%ISTING BUILDING. ~..pACAN~T~~JLAND..__._..
Location of Property..~F~~ :,___,_,~~IX_
HOUSE NO. STREET HAMLET
/ y. -
Owner or Owners of Property... l~~C~;7_1/.,__/~. ~~~'/'"~1/al.
County Taa Map No. 1000 Section B1o~ ~
Lot~......._.
Subdivision Filed Map ........Lot..........
Permit No. ..,,......Date of Permit ..........Applicant
Health Dept. Approval Underwriters Approval..._..........
Planning Board Approval
Request for Temporary Certificate Final Certificate
Fee Submi[ted: $
APPLICANT...
a... .
3 7'7 7 d
rem. 10/14/88
:1cLD I:;S:c ~~'J„::, II~ ~U!YMENT~ fie' .
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?OUtJDATZ0;7 (2nd) m
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PLUMBING
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IIJSULATZOPI PER N. Y. y
STATE ENERGY
CODE
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ADDITIOt7AL COMMEPJTS: ~
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BUILDING DEPT.
iNS~EcT~oN
[ ]FOUNDATION 1ST ~ ~ ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] IN ULATION
FRAMING [ FINAL
[ 7 i2~~
REMARKS:
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DATE i I ~ ~ INSPECTOR
- Wt// a inn un K notnin ,
/ecafan p2Enervy ~ ~ ~ .
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ia.o R7. '
SGUND AVENUE
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~~a wm Unauthorizedakerationoreddkiorltethy01~ylsavlola-
- ,D ~ , , '.'A lion of seGbn 7209 of the New Vork Stste Education Law.
~ ~ ~ N ~ y a inked se I oriem weY map not 6esrlnp tM fend surveyor's
~ s• ~edeatshell not beMReitlered to bea
,t ~ e ~~valid copy. t
2 F~ ,r ~ c D(iuaranteeaorq,dq~,yin
- ~ ~ _ , ~ ~ C. !So the person to? d~tlOtlelllNl shall run only
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- s ~ g _ ~gah-ak to Ule qqe su~b~and on his
1' 9 - `tom institutbn Ilstad hereon.
s~
M,w pe„v ana ien-
' ~ ~ ~ \ b , _ ' c. tepoing institutbn. Otteretnase ar tttNg ees of the
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- ~ , ' ~ m ~ ~ stoedfitiotW+pyp„ a t areners
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SURVEY FOR (.-~~c N~ e~S~ ~ REFERENCE ~
MILL%CENT B. TUTH/L ,~t°~ Nej'~'r _
AT MAT T I TU CK ~P~O'a`'pt A"t_
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TOWN OF SOUTHO4D ~ 9UARANTEED T0~
SUFFOLK COUNTY, N. Y. * ~ ~ C CHICAGO TITLE INSURANCE COMPANY
t' S O MILL/CENT B. T(/TH/LL
SCALEt /e= 40~ O ..1 a
APRIL l5, 1974' ~'r'S. /S2B'116
FEB. 4, 1975 Fo LAND ~~"t' `
APR/L 29,/38/ ~ ~ ~ " ~ 'LAND !lURVEYOR
N.1!9. L1C.ND.YQTPQ
RIVERHEAD N. Y.
B0.1RD OF HEALTH , ,
FORM17N0.1 3 SETS OF PLANS
SURVEY
TOWN OF SOUTHOLD CFIECK , ,
BUILDING DEPARTMENT SEPTIC Foarl ~
TOLVN HALL ~ ~ ~
• SOUTHOLD, N.Y. 11D7~ ,
_ NOTIFY ~~~d
TEL.:7GS~1B02 CALL 4
Examined . , /,i 19 ~ PIA I L TO
Approved 1~9. Permit No.~ ~ Z.~ .
Disapproved a/c .
................................:I,ti..~W,. -
Y~~ (Building Inspector)
APPLICATION FOR BUILDING PERMIT
• Date .~.1.... 15 . .
INSTRUCT
IONS
• a. TIris application must be completely riled in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans, accurate plat 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 scree
'or areas, and giving a detailed description of layout of property must be drawn on the diagram which is parz of this appl
=anon.
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 perm:
shall be kept on the premises available for inspection throu;}[out the work.
e. No building shalt be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pezmi[ pursuant to th
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Rc;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described
lire applicant agrees to comply with all applicable laws, ordinances, buildin; code, housin; code, and regulations, and ti
admit authorized inspector on premises and in building for necessary inspections.
(Signa[ure of appl~ant, or name, if a corpornon)~
,
, ~ (1• ai' daii ss of applicant)
State whether applica'nt'iS'owner, less~ee,aagent, architect, engineer, ^eneral ~s.~~! I
o..... o coniii'a~fOrc el'e~t [ ~3"n umbe
L~~ i.., G , $ ~b ~ P r or builder.
' r.e>..'t ,4~, 4d':.
'
y . l _
tiame of owner of premises ,~r . , , , , ~ , c
(as on the tax roll or latest deed) ~ ~ ~ " ~ " " ~ "
iC applicant is a corgo{anon=, signature of duly' authorized ofrcer.
.t..
(Name and, title of corp`drate ofrcer) "
Builder's License No . . _
Plumber's Liccnsc No .
Electrician's License No . .
Ot1~cr Trade's Liccnsc No . .
Location of land on which proposed work will be done. , , , , , , , ~CS /a d ~7
,.~9 4t• It FK. t .
HouseNumbcr ~ ~"/.~d-.:1./.1~,2,t/1.~.,l~fY
Street. Hamlet
County Tax ,,\lap No. 1000 Section . ~ Biock
Lot..........
Subdivision Filed lfap No. .
(Name)
ot
State existing use and occupancy of premises and intended use and occup~nc
'~C y of proposed construction:
a. Existing use and occupancy ~/..~.4:~'
2..:.~~t ~
i~ .....`,l..X./.v.........
b. Intended use and occupancy c/
t ~
3. Nature of work (check which applicable
"Repair 1Jcw Building
~tcmova! . • • .Addition ,Vtcrauon
+~,~1 S•/ Demolition Othcrll'ork.
4. Estimated Cost t~ d>•~. (D :cr•,...
• Fee ptte
5. If dwcllin„ number of dwc~ling units , , , , (to be paid on filing this a
)fgaragc,numbcrofcars Pphcation)
• Number of dwelling units on each (lour....... , , , • •
6. if business, commercial or mixed occupancy, s ecif ~ ~ • • • ~ • ' ' ' '
7, Dimensions of existing strudtures, if any: nt , y nayire and uxtcnt of cadt type of use . • • • • • • ~ • • • • • •
Heialtt Pro „~~~0/
• • • • . • . Number of Stories , .Rear Depth . ~ • •
Dimensions of same structur;c with alterations or additions: Front • • • • • • • •
Depth. ...............Rear:........
' 8. Dimensio IIcigh[ , •
ns of entire new construction: Front , • ' ' ' ' ' • • Number of Stoties . ' ' '
Height ........IVumberof ...~,~,/'Q... Rear . .Depth
9. Sizcoflot:,Front , Stotics.........
10. Date of Purchase • Rear , .....:.~..........:.Dcprh
11, Zone or use district in whichlprcmiscs ~ ' Namc of Fot•mcr Owner ~ • • • • '
1~. Docsproposedc are situated,,,,,.,
onstruction F•iolatc any zoning law ordinance or regulation:
13. 11'illlotberegraded
14. NamcofOwner .1Villcxcess~llbcrcmovcdfro..••~•~••~••••~•""
of premises . m premises: Ycs •
Name of Architect • • ~ ~ ~ • " " " • • Address . , i
Name of Contractor • • Pltonc No........ , , •
.Address. •Phonr,No.. _
IS.Is this property lopated vitltin "'Address.., ••••..phoneNo..•.•••~~~•••
*If yes, Southold Town Trustees P Ormit ma ° b a ,tidal •x+etland? *YES...,Hr~-
-~I PLOTDLIGRADI a required.
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all setback dimensions frrr
property lines. Give street and block number or description according to deed, and show street names and '
interior or comer lot.
I indicate whcth;
•
APPRDVEp AS N01ED
DATE: ~3/~ s,P a, /L~~L~
FEE: EiY ..y. C.
NOTIFY 8111LDING DEPARTMENT 7`,7'
,`<(i, 7SS• 1802 8 AM TO A PM FQR THE
~Cs G~ FOLLDWING INSPECTIONS,
~G~~Q
~~``Q~~~~~~ r. FOUNDATION TWO REQUIRED
fOq POURED CONCRETE
5~~~ ~~Qj ~ 3. INSUt,~1T1ON~MING & PLUMBING
V ~ ~C? i 4, FINAL - CONSTRUCTION MUST
,y~'t ~ BE COMPLETE FOR C.Q.
~c° ALL CONSTRUCTION SHALL MEET
S ATE ONSTRUCTION & TENERGY
I CODES, NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORg .
TATL• OF XGI~' YORK,
~U\TY OF , S
~.S
(\..mc of indieidua! signit%o contract)
~ • ~ ' • • • • • • • • • . being duly sworn, deposes and says that he is the applicant
:ove named.
:isthc ~ .
said . . • . -~COnlfaCtOr, ascot, corporate officer, ctc.)~ • - ~ ~ ~ ~ • ~ • • • " • • • • -
owner or owners, and is duly authorized to perform or have per(ormcd the said work and to make and file this
iltcation; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
rk will be pcrfomtcd in the manner set forth in the application filed thcrcwitlt.
~m to baiorc me [his
............•^7~•....dayof..' ~J........... ,19~~
a;, Public. C/lfJ'~•-r~4~'.µ
:../a1f ~l/
County
HELEN It DE VOE - • .
NOTARY PUBLIC, State of New York ' ' ' • • .
No. 4707878, Suffolk Countypp (Si ^na tore o f a
Term Expires March 30,19.._b pplicanU
t'