HomeMy WebLinkAbout18562-z FORM NU. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18583 Date NOVEMBER 21, 1989
THIS CERTIFIES that the building ADDITION TO ACCESSORY
Location of Property 105 WESTMILL ROAD & 50 BREAKWATER RD. MATTITUCK,NY
House No. Street Hamlet
County Tax Map No. 1000 Section 113 Block 3 Lot 7.2
Subdivision Filed Map No Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 3, 1989 pursuant to which
Building Permit No.18562-Z dated OCTOBER 5, 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 GARAGE ADDITION TO EXISTING ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to MICHAEL MATTES
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
rosae< xa s
TOWN OF SOUTHOLD
BUILDING DEPARTNtENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 8 5 6 2 2 Date ....,~Q.,
./.~S` . 9.~,~..
Permission is he by granted to. ~ i
ro ..C:..~lrfc~t. r~..Gts......~~al~~~~~.:... ..!`ri..
ti
at premises located at ....lQ~.~/ "`:f... ~
~7
County Tax Map No. 1000 Section .....1/3..... Block ....3 Lot No.....7..1-.......
pursuant to application doted .........,la..~~ 19.~,r.., and approved by the
Buliding Inspector.
Fee $...~O.r..
,G~l,..... . f. ..~etr....... .
'wilding for
Rev b/30!80
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G,~+-^~'~'` ~ ~ 1/9 j~ TONN OF SOUTDOLD D
BUILDING DCPA RT:I CLtT
TOWN IIALL
SOUTIIOLD, NEW YORK 1 197 t 71DW 80V ~p(,Qi
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPAttCY
DATC. ! ~1.~://~ ~ .
HEN CONSTRUCTION V...OLD OR PRE-E%ISTZNG BUILDIHC......VACANT LAND........
Location of Propcrty..~o`r,w~stru/cc 2d +:S-o~2EyifLw~pS,R.t~._!:y],y_?jT/_T~d~......,~_,
HOUSE NO. / ry~ STREET HAMLCT
Ovner or Ovncrs of Property.~lL~4../>.~~.?_2G$
County Taz Map No. ID00 Section .L~3._ Block . 3 Lot .7
Subdivision Filed //MapGG _.......Lot...._..._.
Permit Ho. ~GS6~._.Date of Permit .~~~:rJ.~J..Applicant ~!QF~r!-~~S:r...........
Hea1Ch Dept. Approval Undcrvriters Approval...._._...._._
PlaaninC IIoard Approval
Request for Temporary Certificate Final CertiFicaCC
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APPLZCANT..::~ _
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STATE EIIERGY
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BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
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DATE ~ INSPECTOR ~f"'~
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~ BOARD OF HEALTH
f 3 SETS OF PLANS
FORMN0.1 SURVEY
TOWVOFSOUTHOLD CHECK
BUICDdNG DEPARTMENT SEPTIC FOR,t
TOWN HALL `T~
£OUTHOLD, N Y. 11971 NOTIFY • 13~~
. TEL.: 7G5-1802 CAL - - - • • - • • • .
ff G~ M L TO:..~bNMO~
E:camtned~.!/.~......, 19.4./ ~3Q'`DO'19
Approved .l~ ~ 19~~. Permit Na.~[.Q~~. Z- ~
Disapproved aJc
u~a~
.
(B mg Inspector)
APPL CATI N FOR BUILDING PERMIT /~~~y
Date .:(~!C~". , 19~i
INSTRUCTIONS
a. Tlus 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 ad~ommg premtses or public street
or areas, and giving a detailed description of layout of property must be drawn on the dia~iam which is part 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 permi
shall be kept on the premises available for inspection throughout the work
e. No building shalt be occupied or used to whole or in part for any purpose whatever until a Certificate of Occupant;
shall have been granted by the Building Inspector.
APPLICATIOiv' IS HEREBY IvfADE to the Building Depaztment for the issuance of a Building Permit pursuant to fh.
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appltcab]e Laws, Ordinances o,
Re,ulations, for the constnYCiion'of-buildings, additions or alterations, or for removal or demolition, as herein descnbed
The applicant agrees to comply with all applicable laws, ordinances, buildm~ code, housing code, and regulations, and tc
admit authonzed tnspec{ois` on pret~itses and in building for necessary mspe ins.
~ (Signature o phcant, or name, if a corporation)
(bfailmg address of applicant)
State whether ap~p~licya,~ngt i/s/~owner~les_see~agent, arch~itj~,e",~ct, en/~in~eer, general contractor, electncian, plumber or builder.
Name of owner ofptciriises !.`.'-GF~. f.!C~!:~f . .
' ~ 7 ~ (as on the tar roll or latest dead)
i., ~ +
(f applicant is a corporaTi'osi; signature of duty authorized officer.
.
(Name and title of corporate officer)
ALL CONTRACTOR'S MU$$,,~~ BE SUFFOLK COUNTY LICENSED
Builder's License No Y~~~ h.`:?', , . , , , , , ,
Plumber's License No . .
Electrician's License No . .
Otlicr Ttade's License No . j G '7 ~,>~1 ~ n~ z Q ~ 7` ct~
I. Location of Land on which proposed work will be done, . ~~E:. ~.~'L./~~. :~A~~~~...~~...~~~~rTT~,ie./
House Number > Street Hamlet
County TaY hiap No 100() Section ,1 :3 , , , , , , , . , Block Lot , . ,7,.~, • , • • , ; • ,
Subdivision Filed \iap No Lot .
(Name)
Slate existing use and occupancy oC premtses and emended use and occupancy of proposed construction:
a. Existing use and occupancy .
b. Intended use and occupancy • • • ~~r t° •'-.a+~ .`t iC~'~
14:Ei:it Jbt'...............
+teLntt»I~SiW~`
r
3. Natuze of work (check which apphcable)• New Br ldmg . ~ Additton Alterazion ~ .
Repair Removal Demolition Other 11'ork .
(Descnption)
4. Estimated Cost C-~-!7 Fee .
` (to be paid on filing this application)
5. If dwelling, number of dwellrng ur~ts Number of dwc]ling units on each floor .
if garage, number of cars .
6. IC business, commercial or-•mixed occupancy, specify nature and extent of each type of use
7. Drmensrons of a s~jino trc>xtures, rf any Front Rear ....:3°?...... Depth :~?,S! .
Hcrght , .~r N~uijtber of Stones .
Duncnsrons'of sa~~turei y~~rth altcrahons or additrons Front Rear .
Depth .:-l.~e..f~ ~ Herght ................Number of Stones .
8. Dunensrons of entrr c~CUis~ ruction• Front Rear ...............Depth .
Height ...:..Nil»iberofStones
9. Size of lot. Front Rear Depth
.
0. Date of Purchase ........Name of Former Owner . .
1. Zone or use district in which premises are situated . .
2. Does proposed construction violate any zoning law•, ordinance or regulation• .
3. Will lot be regraded \Vili excess fill be removed from premrses: Yes No
4. Name of Oivner of premrses ........Address P}ionc No............... .
Name of Architect Address ...................Phone No......... .
Name of Contractor .........Address ...................Phone No................
5. Is this property located within 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit may be re aired.
PLOfi DIAGRAM
Locate cleazly and distinctly all buildings, whether existing or proposed, and indreate all set-back dunensions from
roperty lines. Give street and block number or description according to deed, and show street names and indicate whether
itenor or corner lot. f~
I~PP 0 11S NO(ED _ ~
DATE:
FEE.~BY:
NOTIFY B IL,DING DEPARTME AT
765• t 802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECiITO~NSRE~iRED
1 FOUNDATION
FOR POURED CONCRETE
2 ROUGH - FRAMING ~ PLUMBING
3 INSULATION
q FINAL CONSTRUCTION MUST
tiE COMPLETE FOR C.O._
T4tE REQUIREMEINTS OF THE N.Y.
STATE CONSTRUCTION 6 1~1ERGY
CCiRES NOT RESPONSIBt'1E FOR
L ~ SIGN OR CONSTRUCTION ERRORS
iA?L- OF V YORK, S S
~L\'fY • .
l~z~ . bang duty sworn, deposes and says that he rs the applicant
(tiamc dn•iduaI signing contract)
ovc named. ~ / Fj
e is the . ~...G~1?~-..
Contractor, agent, corporate officer, etc.)
said owner or owner, and rs duly authonzed to perform or have performed the said work and to make and file this
olication, that all statements contained in this application are true to the best of ]iis knowledge and belief, and that the
irk a•Al be performed m the manner set forth m the apphcatton filed therewith.
•orn to bctorc m~ this ~~-77--
3 .day of ~-•~`=chr......., 19
itar>• Pu~bli/c . County
HELfNED.NflllrlH rgnature of applicant:
~ 4661 ~4Nwn 1~MWCt~ /
~1rd~irsMa 7i.1s.LL