HomeMy WebLinkAbout17887-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218205 Date AUGUST 1, 1989
THIS CERTIFIES that the building WOODSTOVE
Location of Property 1620 BAILIE BEACH ROAD MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 099 Block 03 Lot 11.15
Subdivision F11ed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 30, 1984 pursuant to which
Building Permit No. 178872 dated MARCH 6, 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 INSTALL A WOODSTOVE.
The certificate is issued to FRANK RUBINO
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
uildinq Inspector
Rev. 1/81
lOHM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETfON OF TtiE WORK AUTtiOR{ZED)
~ ~ 17 8 8 7 Z Date 4i.A.~r~:.l...... ~ 19.
Permission is hereby granted to:
. ~.~!4.dn.t4.......(~
. r..,~S'.....1~ r~.q.c~o....~...... .
to .~:1:9tS.4S.Q.Q:....ta.a . . ~~T1.?~:~:4Y..~C..............................
/G~o _
ct premises located at .~15.... ~?.....~h~?G~.Ca/7h...^-:5~.. ~..Qc.~c
.til.~...... .
. .
County Tox Map No 1000 Section SJ.`~.`~, , Block Q..3.. Lat No .
n ~ .
pursuant to application dated ~~:G-~')....~-'.. 19~g., and approved by the
Budding i`nspectar.
Fee g. oZJ..:
Building Inspector
Rev 6/30/80
TOWN OF SOUTIIOLD / = ~`-~`-~-aa
BUILDING DL:PART:SCNT
TOWN HALL vJh~keSfa~e~ `v ~
SOUTIIOLD, NEW XOILK [ 1471 ++357
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY --'7711yy
DATE__.Lj.J~,
/ II
NEW CONSTRUCTION .........OLD OR PRE- %ISTING BUILDING......VACANT LAND....__..
Location of Propcrty_.lGj? L-•...~„ L!,>~~~•- ~~_~G/~--~~..-,.~~/,-_'-•
ILOU"rSES~NO~. ../~('`-'r~~'~~-_~~SlTR/E'~ET RAREFY -f'
Owner or Owners of Property.. _ _ ,J. 6.,!-~7vJ"\ U;-'.U ~ ~N~
Couaty Taz Map No. 1000 Section .U~. ~ ~ G~ ~ ~ ~ ~ l ~
Block Loc
Subdivision Filed Map .._,..._Lot..___,___.
JJ //JJY~~ nn ~
Permit No. ~L~.~~.).Da[e of Permit .~.(.6.,~~AppLicant .~:.~NIL.t~VIJl~•
IIealth Dep[. Approval Underwriters ApprovaL...._..__.____
PlaanioE Board Approval
Bequest for Temporary Certificate Final Certificate
Fee Submitted: $_~1,.(~ .~°~.~'-~'~'b'p:7,G~~~v
V_
APPLICANT.
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C o z °S
rem. to/14/ss
r
~~1~rrr~.~ TEL GS•180'_
pS~EF~C'~{~O~ TO~'I`~ Ur SUUTIIULD
,?'l~j~;"`~ ~c OPi'ICI? C1l' GUILDiNG INSI'I:CTOR
o a~~i~ x ['.O BOX 1179
'~;'1'~"~ TO~YN EEALL
;`'O ~ ~ t- SOUTIiOLD,N.Y.1197I
ra0
March 21, ]989
MR. THOMAS HALL
32 MISTY ROAD
ROCKY POINT, NEW YORK 1]778 RE: FRANK RUBINO
To S~1hcm This May Concern,
We arc unable ro complete your Certificate
of Occupancy becauso of the following reasons.
eln application for Certificate of Occupancy
is not nn f1]c.~ (ENCLOSED)
P1o Underwriters Certificate on file.
/ / 't'he clrecF: i:: (~~~~I/nut cn file.) $ ! 0.00
/ / D1o f!ealth Uept. T~pproval on File.
r.o final ~nsF~ec:t.ion has been made.
Please r_ontact our office an this matter. '
Thank you for your cooperation.
13utlc3tr,~] Pcrm~t I; I 7 8 8 7 Z
IIuildinq Dupl.
[1o I'lumbcr 5oldc~ Certificate on file.
( al.l porrtiL~ involv~.ng plumltincl Uciny
issued after ,~pril 1,1964 )
1.::LD i:. _dG ~I:inT ~I ~,~MMENT.°.
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FOUIJDATION (2nd)
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ROUGH FRAME lx
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IIJSULATIOfI PER N. Y. 'j
STATE ENERGY
CODE
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FI;IAL
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ADDITIOIIAL COMMENTS: x `
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765-1802
BUILDING DEPT.
1 NSPECTIGIN
[ ]FOUNDATION 1ST ~ ] ROUGH PLBG.
[ }FOUNDATION 2ND [ }INS TION
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REMARKS:
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BOARII OF HEALTH
3 SETS OF PLANS
FORM NO. t SURVEY .
TOWN OFSOUTHOLD CHECF:
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
. SOUTHOLD, N Y 11971 NOTIFY aC~~i Gi~~t.~.
TEL.: 765-1802 CALL J G i''(~n......
7 i98~ MAIL T0: I•-AA7n~.o Rurcc
Examined tR -q~q 3~ta7~~,, y~~~leQ •
Approved 1~ . t?.. , l9~ i. Permtt No. ~ ~1.~ $ v,~ ~-+~~i
1 !1 7Q^
Disapproved a/c
r~q-S•~. `".-:rte .
(Bwldmg Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~~/.c<...~ ~ 15
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, wi
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 str
or areas, and giving a detazled description of layout of property must be drawn on the diagram which is part of this a;
catron.
c. The work covered by this application may not be commenced before issuance of Building Pennit.
d. Upon approval of this apphcatron, the Building Inspector wdl issued a Building Permit to the apphcant Such pe<
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 Occupy
shall have been granted by the Building Inspector
APPLICATION IS HEREBY h1ADE 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
Regulatrons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnl
The apphcant agrees to comply with all applicable laws, ordinances, build g code, house ~ code, and regulations, anc
admit authorized inspectors on premises and in building for necessary inspe ions.
(Sign/'ature of""~`oa-pphcaUn~t, or name, if a corporation)
• (Mailing address of apphcant)
State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull
. At?.b.Y.e
t / nn
Name of owner of premises . !:!GV/T !Cu l t~f.d .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
. .
(Name and title of corporate officer)
Builder's License No . .
Plumber's License No
Electrician's License No. .
Other Trade's License No .
1. Location of land on winch proposed work will be done . !`7++'. ~?.~vc.~,~ .
House Number Street Hamlet
9.R /
County Tax heap No 1000 Section Block Lot ..~~:1•Q........
Subdivision Filed heap No Lot .
(Name)
2. State exuLng use and occupancy of preen/ ices and intended use and occupancy of proposed construction
a. Existing use and occupancy . ~r.n
f,/,r .F~arKr.~f /~C5 ~ l1'.r~e4 r' .
b Intended use and occupancy .~<+si••C • • 1'?.r•~~ • • t~?4' ` • -~fQ``~C • .
3. Nature of work (check which applicable) New Building Addition . Alteration .
Repazr Removal Demolition Other fVork a? :d .?,7ov,{' .
(Desenption
4. Estimated Cost ~p~/.: Fee .
(to be paid on fling this application)
5. If dwelling, number of dwelling units Number of dwellm~ units on each floor .
If gara,e, number of cars at .
6. If business, commercial or mixed occupancy, speedy nature and extent of catch type of~use .
7. Dimensions of existing structures, if any: Front , i . ~ Rear ! ......:'"Depth .
Height Number of Stones .
Dunensions of same structure with alterations or additions Front Rear . .
Depth Height Number of Stones .
8. Dimensions of entire new construction: Front . Rear Depth .
Height ...............Number of Stones . , .
9. Size of lot Front Rear Depth
10. Date of Purchase Name of Former Owner .
1 1. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation• .
13. WIll lot be regraded ~ \Vill excess fill be removed from premises. Yes
14. Name of Owner of premises .I:!CK~I. ~u~~r~<~..... Address [.3>: 6G~~( f. ~e~,t~r~dPhone No.~f/.~..9.x:5: y
Name of Architect .....Address ...................Phone No. .
Name of Contractor ..........................Address ...................Phone No............. .
IS.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 clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dunensions fry
property fines. Give street and block number or descnption according to deed, and show street names and indicate when
intenor or corner lot.
STATE OF NEW YQ~~K, S S
COUNTY OF .=11t~ij~1(~....
. • ~'~'IAM~.. {~f11~~1M. • • • • . being duly sworn, deposes and says that he is the applic:
(Name of individual signing contract)
above named.
He is the ...~rlGt!/jx`.!t
(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 t
application, [hat all statements contained in this application are true to the best of tus knowledge and belief; and that '
work will be performed m the manner set forth in the application filed therewith
Sworn to before me this y y
7r~. ~ ..day of ~rx~M Rte....... , 19 R`
Notary Public, County f„
,fin, ~ (Signature of apphca