HomeMy WebLinkAbout17347-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217319 Date SEPT. 20, 1988
THIS CERTIFIES that the building ALTERATION
Location of Property 379 RILEY AVE. MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 143 Block 04 Lot 21
Subdivision XX Filed Map No. XX Lot No. XX
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUG. 4, 1988 pursuant to which
Building Permit No. 173472 dated AUG. 24, 1988
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 NEW HEATING SYSTEM INSULATE WALLS CEILING & FLOOR.
The certificate is issued to GEORGE T. WOODHULL-WILLIAM BERLINER, JR.
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL. N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
wilding Ins ector
Rev. 1/81
troaat xo. a
TOWN OF 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)
~ ~f p
01347 Z Date ...~~.1 19.0
Permission is hereby grante to:
~ .
to ...~~,~~.~T:`... .....-.c~...........~~C~~ ............ern-~.:..
ct re~ ate ....~.,7~.....
p
County Tax Map No. 1000 Section ....~~3........ Block Lot No............./G..Z~...
pursuant to application doted ..........~~~f..~ 19:~~ and approved by the
Building Inspector.
~g
Fee
................1.......... K.. .~A!~F
/.{e(ef...............
Builc~t¢¢ Inspector
Rev. 6/30/80
FORM NO. 6
' TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must befitted in typewriter OR ink, and submitted ~ ar~_ to the Building Inspec-
torwith the following; 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 or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
8. For existing buildings (prior to April 1957), Nan-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. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling , $25.00, Accessory $10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ I 0 . 0 0
. 4. Vacant Land C.O. S 20.00
5.Uodated C.O. $ 50.00 Date ~/6~~~..........
New Construction,,,,,,OldorPre-existing Building Vacant Land
Location of Property ~.7
9,, , , , , , , , , , , , , /Q/GaLt ~u/_~ !'2~iJ`iTEte~l
House No. ~ Street ~ ~ ~ ~ Hamlet
Owner or Owners of Property ..ls.~Q~~,,%~,,1t,(pD,!,,/,rrlsLL,.. .,kj~tG/~w-I.,r~~~y~j~„~~9
County Tax Map No. 1000 Section , . , . , /y~, , , , , Block a
Lot.....!?./,.......
Subdivision . ,Filed Map No. , , , , , , , , ,Lot No. '
Permit No.~/.7,3y g~ ~y G9+~PG.L i. u/o~Dh~e~
,7... Date of Permit Y ..Applicant ...w,!<t41,-,-~ , , /,~,/~'.4,tr;.~~~f Y,l, _ ,
Health pept. Approval ........................Labor Dept. Approval , , . , , , ,
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate
.
Fee Submitted $
Construction on above described building and permit meets all app~lica/b/le codes~and~rQgulations.
Applicant a"'- /~+~02+°~~'~!~S-::Y.....
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~5R4tR~gf1}t"~{#fY t~.irdrd,±t~d...i+;>isxtwngn A.... Tram, A `i ,
TO ~ickiazeaa, [di.tdthtsa~a ~ ~res:einr, i".G. AT P.t3. Bow 1~2~a, ?~attTtsac~9 ~7«Y,
At[aa~ Hnlea
SUBJECT
b4i:~E,~I~74's$i{ & 'CdCAtDID~UGi. DATE
.1d7@7~ 2, ~3~2
is
near ~Lk'~.ell:
~1ACileYlTat 1'e> our e:eleQF~orse conexer_sat9o~ of today, _i a"eteaa-Ea &aere~it~t yaex~ c~az~a:~'. ~i~6~
in iiTC areocnai+,: of $IOf4,tJ'd aced t4ae aga}aiicatioTa ~o~ a. ~'re C.O. Pleztse seaad tas a cia~c€~ iaa
't~
;x flan ,,,souibt of $S..U~3 fer a L°oiay o~ t;~ e~-~1431~ stated Sr;Tt. 2f3,b~$3,
a
aaadc T~,
~ SIGNED
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3~
DATE SIGNED
1'3+:JX=~i l"«'»".m3~.'3".~".+#~uSi:S-~+~us'~i9ni.~".b'~+iii 5lap*Yn' .
. ~~F~M, 4$ 469 _ SEND PARTS 1 AND 3 INTACT Cdr60q/~5
POLY PAK (50 SFTS)-4P 469 PART 3 WILL BE ~RETURNED',WItH, JtEPIK.
DETACH ANp FILE FOR FOLLOW-UP
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~WALLACE 6 RUTH FIELD N/O/F EILEEN
BERGEN
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~ SURVEY OF
° :~'/O LOT 7
o MAP OF PROPERTY OF
Z / G.H. , W. T... & D. T. R/LEY
{ ~ FLED 1\IOY. 27, 78'18 FLE Nb 188
AT MATTITUCK
\ TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
f000 - 143 - 04 - 21
Scale 1" = 30'
d May 13, 1988
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CERTIFIED TO'
AOUEBOGUE ABSTRACT, CORPORATION
TITL F_ NO. 632 S 1390 -
WILLIAM BERLINER
GEORGE T. WOODHULL
6~ LAND SG
~~yy~p~+ n -INC
~9~F
o y .c
~ 0 0
s
s
a N.Y.S. LIC. N0. 49668
. Preparad M occordence wllh the minimum y ~
standards for l/l/a surveys e+ ssfeb/lshsd yQ VEYORS, P. C.
by the L.LA. L. S. and approved and edepled RJN 5020
lar ouch use by The Nsw York Stale Land P X 909
Tll/e Asaaclal/on. MAIN ROAD ~ - -
•'I~ BOARD OF HEALTH
11 ~~I 4v~~,.•;{k 3 SETS OF PLANS
U r ~ ~ FORM NO. t SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
BLDG. DEPT. ' f,OUTHOLD, N.Y. 11971
TOWN OFSOUTHOLD TEL.: 765-1802 CALL • • • • • • • • • • • • • • • -
MAIL T0:
Examined ..~~,1
191..
Approved • • • • • I ~.l~ Permit No~ .~I.~.p. ~ ~ ~
Disapproved a/c ~
C
~~S ~t
' (Bui ng Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 .
INSTRUCTIONS 5~}IC,~yl;;s~atC~tfli9~4'#9'Y~~
, s d'r 4- `sEi. ~~d~r°uit' ~ ilf
a. This application must be completely filled in by typewriter or in ink and,submit;<t~dg~tlk~~,uiir~~pegtor, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule. ,sE .,1rti,hr ~+~r. ~,Ifa 9, PE.
b. Plot plan showing location of lot and of buildings on premises, relationshipitq_a¢ljoi%taj~g lpa~ai~esyel~rpEblic streets
• or areas, and giving a detailed description of layout of property must be drawn on ,the.. digg~a~ntwt~ich is part of this appli-
• cation. =:S~e~x;,£,L.e,?ry~srr;
c. The work covered by this application may not be commenced before ,issuance pfc+BuIlding Permit.
d. Upon approval of this application, the Building Inspector will issued a Bu~ildj lgsPer~nar?a0~tjiehN~licarl~t.:~uch permit
shall be kept on the premises available for inspection throughout the work. f <x+:~si4 ~~~I=s
e. No building shall be occupied or used in whole or in part for any purpose °what0ve'nAUnti] tt~CFE:r6ifibdi~.f Occupancy
shall have been granted by the Building Inspector. ~ ~
APPLICATION IS HEREBY MADE to the Building Department for the. issy~nce, of-,a,,~uildigH,4~,er~aij,pu;guant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and'otfierappl~cable I:aW's~ Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or,demalitign„as,hezein described.
The applicant agrees to comply with all applicable laws, ordinances, b lding code, housing c~d"z,"and regulations, and to
admit authorized inspectors on premises and in buildin fork a specrions. ~jr
.~r<.
1,'!"
(LS/ig_n9ature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
L W ~.f ...............................................r...~ .......................11........ .
Name of owner of premises ...~~.~..~^..~.~.®~•-~d • ~ • • • I•`ll Gu-x ~~Cr.~t•h eJ~
(as on the tax roll or latest deed)
IF applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COi/NTY LICENSED
Builder's License No . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
<
3 ~.9 l... ~ -............~'1~..t~~~-~-..............:.......
House Number /Strtee/t Hamlet
County Tax Map No. 1000 Section L ..7. Block ~ .T............ Lot d,.. .
Subdivision - Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises a~npd intended uselI and occupancy of groposed construction:
a. Existing use and occupancy ~ t~, S.C~: • ~U,VYt l '~Q.S r deh ~,P,~,,~
y......
b. Intended use and occupancy ..........5.~~'1pr',1. .
=h~-
3. Nature of work (check which applicable): New Building i! Alterat' n ,
Repair .Removal . Demolition ~ Addition : + Other Work ,~CG1rih . ,
. ~ (Desc lion)
4. Estimated Cost ~ ~ ; O'l7... .Fee .
Number of dwelling uni paid on filing this application)
5. If dwelling, number of dwelling}~nits ~ is on each floor .
If garage, number of cars / . .
6. If business, commercial or mixed occupancy, specify nature and extent of eagh~pe~f use
p~ qq~i //~-77``
7. Dimensions of existing structures, if any: Front . .F , . ,Rear j , : , : ; Depth ; . , , ,
Height ,S.'t'Q.~!, Number of Stories ....2 . j , . ,
y....
Hunensions'of same structure with alterations or additions: Front ~m Depth .
De th Hei ht ~C)~.C'......... Number of Rear , .
p g Stories
9. Size of lot SF onttire n~e`w~con~chon: Front •Rear 7 , ~ ar . . . . • , . • , . , . .
erght Number of Stones .
Depth O. U.. F7~'•......... .
10. Date of Purchase ame Qf Fo}?~e Owner
1 1. Zone or use district in which premises are situated ...~s i .4~1./.+??.~. ,C!t~.Yi ~ ~??t , , , , , , , , , , , , , , , , , ,
12. Does proposed construction violate any zoning law, ordinance or regulation: O, ,
~ ~~r, .
13. Will lot be regraded ...1~`~ . . . . W~j'11 exc ss fll be r~~ u 'd from premises: Yes o
14. Name of Owner of premises' •.T ,GJpp~;h.~1/-WL~ev/rr~r~diess ~Dx...7./Yi~ reC-. Phone No4?.~~:B~S-3 ".mil
Name of Architect ..Address ..Phone No............ .
Name of Contractorb~l~4eR~~!~~'%~CS , , , . , , , Address/~!~~~n.~.
.i ,phone No~os,3.':~'~~P~.. .
15. Is this property located within 300 feet of a tigidal wetlandY *Yes
*If yes, Southold Town Trustees PermitpLO~ DIAGKAM ed.
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. I
I
AP VED AS NOTED
DATE:~~ a e.a ~,~,~7~
~~~~~~r~~~Y p~ NOTIF 8~~, ~ INCi pEpA TAT
UN j (~t~ 786-f802'i 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNgAT10N TWO REQUIRED
1 FOR PQURED CONCNETE
~~~~t~ 4. ~NA~t10N ONSTRUCTION MSUST
®C~~A'CY 6E GOMFLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE RE(1 IREMENTS OF THE N.Y.
STATE C N$TRUCTION 8 ~Rl3Y
CODES. NOT RESPON$t9Lff FOR
DESIGN OY~ CONSTRUCTION ERRORS
STATE OF NEW YORK, S S
COUNT OF !
~ .........~~i~~9' T7,".i:
Yi? being duly sworn, deposes and says that he is the applicant
(Name of individual signin contract)
above named.
,
He is the ~ l,,(!~! ~6,~..S
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this
application; that all statements contained in this application are true to the best of his~knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before methis I
................da~y9/of~. L,C~44 :C..-......, I9 / ~ .
Not~~ary public, ' . JG~4 ~T7"sr~~ County l~ ~t~~~" - l/
a ~ ~ , LINDAJ. COOPER (Signature o applicant)
i n~91.is~