The URL can be used to link to this page

Home My WebLink About17593-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bulldlng Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17901 Date MARCH 29r 1989 THIS CERTIFIES that the bulldzn~ ACCESSORY Locatmon of Propert~ 2035 THERESA DRIVE MATTITUCK House No County Tax Map No. 1000 Section Subdmvmslon DEEP HOLE CRK EST. Street 115 Block 16 FILE~ MAP NO. 4256 Lot 15 Lot No. 59 Hamlet conforms substantially to the Application for Bulldlng Permit heretofore fmled in this office dated OCT. 26~ 1988 pursuant to which Buzldlng Permit No. 17593Z dated NOV. 7~ 1988 was issued, and conforms to all of the requirements of the applicable provmslons of the law. The occupancy for whmch thms certificate zs issued is ACCESSORY STORAGE SHED. The certificate is issued to RICHARD & LYNNIS BAKER (owner, X~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/a Rev. 1/81 FOR~[ ~0. · 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) N9 b17593 Z County Tox Mop No 1000 Sect,on ... ///. .~.. ... . pursuant to opphcat~on dated ............... Budding Inspector. ............ , 19 . ., and approved by the Rev 6/30/80 APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 765- 1802 Instructions A. Th~s applicatmn must be filled m typewmter OR ~nk, and submitted .- ~ to the Building Inspec- tor w~th the following, for new buddings or new use: 1. F.nal survey of property w~th accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.F~nal approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal}. 3.Approval of electrical ~nstallat~on from Board of Fire Underwmters. 4. Commercml buddings, Industrml buddings, Multiple Residences and mmilar buildings and installa- tions, a certifmate of Coda compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed rote plan requirements where apphcable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" [and uses: 1. Accurate survey of p~operty showing all property hnes, 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 certffmate. C. Fees. Add~tzons $25.00 POOLS 825.00ALTERATION $25.00 1. Certifmate of occupancy New Dwellzng $25.Q0, Accessory ,$10.00 Bus,ness $50.00 2. Certificate of occupancy on pre-existing dwelhng $ IOO.OO 3 Copy of certiflcate of occupancy $ 5 00, over 5 years $10.00 4oVacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewC°nstruction ...... Old or Pre-existing Budding ............ Vacant Land ............. Location of Property 2.63. House No. Street Hamlet Owner or Owners of Property .)L~C~/~IE'.(~....~J-L ....... ~'/~fJVJ~. ~?~L:..~..~./~ .......... .......... County Tax Map No. 1000 Sect,on .././. ~.- ........ Block .../. ~. ........ Lot .... /.~. ........ Subd,ws~on ............................. Fded Map No ........... Lot No ............. Permit No .......... Date of Permit . .% . ~cant ................ Health Dept. Approval ....................... Labor Dept. Approval ............... . ..... . .o Underwmters Approval ....................... . Planning Board Approval Request for Temporary Certificate .................. Final Certificate ....................... Fee Submitted $ ......................... Construction on above descmbed bu tiding and perm!t meets all applicable)codes and ragu lations. Apphcant ............................... Rev 10 10-78 :. ~'...(. FOUNDATION =OUNDATION 2. -- (1st) (2nd) ,, PER N. Y. t' ' ROUGH FRAME & PLUMBING 3. INSULATION STATE ENERGY CODE FINAL ADDITIONAL COMME~;TS: O'C~UPANCY OR USE IS UNLAWFUL ~tl HOLi,]- CF. RTi~'iCATE Examined Approved . ., 19OC~Permit No.. ~. . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL 765-1802 BOARD OF HEALTH ........... 3 SETS OF PLANS SURVEY CHECK SEPTIC FORM NOTIFY ..._...~CALL MAIL Disapproved a/c ................................. APPLICATION FOR BUILDING PERMIT TO: INSTRUCTIONS a. Tlus application must be completely filled in by Wpewriter or in mk and submitted to the Bmldmg Inspector, witl 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 adjoming premises or pubhc sire or areas, and giving a detmled description of layout of properW must be drawn on the diagram which is part of tkis ap, cation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl issued a Building Permit to the apphcant. Such pen shall be kept on the premises available for inspection throughout the work. e. No bmldmg shall be occupIed or used in whole or m part for any purpose whatever until a Certificate of Occupu, shall have been granted by the Bmldmg Inspector. APPLICATION IS HEREBY MADE to the Bufldmg Department for the issuance of a Bmlding Permit pursuant to, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances Regulations, for the construction of buddings, a,d. dltlons or alterations, or for removal or demolition, as hereto descnb The apphcant agrees,~jh~n~Sh~t .t)T tll apphcable laws, ordinances, budding code, housln; code, and regulations, arid admit authorized msp~at'O~ on premises an__d m bmldmg for necessary inspect~aps. ,., c~ .... '-*-' _.," .... ......... ~~t}f~~~. ~.-.--~"~ ,~; ,' (Sigrmture of apphcant, or name, if a corporation) ~ ~ ,~ ~ ~ ,,, e '~",~ .'2.~ ~.C.T,~.~,~ ?.~,*...P/~.. ),~.~..c.~. ,~? ~'~' ,,,, .,, . ~TA~UOa ! (Mailing address of applicant) State whether apphcant~J~qe~, ~rchitect, engineer, general contractor, electrician, plumber or build, ........_.__~ ~e,~..~. ................................................ ..... . Name of owner ~1~~ ~¢f. f .~T')~/.~ . ~'o.t~, ......................... ~1~ ,8a~1S ~ ~II~AI ~t~ (as on the tax roll or latest deed) If apphcant is a ~ y zed officer (Name'~na title of corporate officer) Builder's License No... ~.~ ....... Plumber's License No . . , Z~.~. ............... Electrician's License No ./~//f. ............. Other Trade's License No ~.~. ............... 1. Location of land on wlnch proposed work wdl be done ............................. House Number Street Hamlet County Tax Map No I000Sectlon . /./. 55. .q .o. ..... mock ./~..9.o. ...... Lot..Q/.F. c~o o Subd,~,SlO~ ./)..~/at.e C.~..*.~.~ . .Z-7.;~/.?.~ .... riled Map No.. S2.5.'7..C3. .... Lot... $'~.... (Nalne) State existing use and occupancy of premls[2s and intended use aud occupancy of proposed construction a. Existing use and occupancy.........- ....................................................... b- Intended use and occupancy ...J"/K_~,~, ~.l~;~g. fX~ ~ 3 Nature of work (check wh:ch applicable) Ne~v Buddmg ~ ' Addition Alteration Repair ........... Removal ......... Demolition .......... Other Workt 4-. Estimated Cost . ./ ..................... Fee .............. · ,~t.~ .... , '',', .... .w..~., '~- (to be pa~id on~l!ng th:s apphcaI4ton) $. If dwelhng, hum her of dxvelhng umts ........ Number o f dwclhng umts on each fioor ........ If garage, number of cars .......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. 7. Dimensions of existm~ structures, lf any Front ............. Rear ........... Depth ............ Height .............. Number of Stones ............................................. Dunenmons of same structure with alterations or additions Front ............... Rear ............. Depth ..................... }Iciest ..................... Number of Stones .................. Dimensmns of entire new construction: Front . . <9.'. ........ Rear ...g.' ......... Depth . 7.21 f ...... Height . ./?.' .......... Number of Stones .... /. ............................................. 9. Size of lot Front ././.,,qT..~ Rear .//,J... 2 .............. Depth 10. Date of Purchase .......................... Name of Former Owner ........................ 1 1. Zone or use district in whmtx premises are situated ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation..AZ ¢.2 ....................... 13. Will lot be regraded .~35'..o ...................... Will excess fill be removed from premises. Yes ( 14. Name of Owner of premises .~., . .~,~ ~ ....... Address 2.°. ]42,~r~eq°eJ.~.g.g .. Phone No..Z.?. ?.. ~.~g..2. Name of Architect . ~. ~.r,< ~ ................. Address ................... Phone No ............ Name of Contractor /Yd. ~ F-/'.~. ................. Address .................. Phone No ............. IS.Is this property located within 300 feet of a tidal wetland? *YES .... NO.~.. mil yes, $outhold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distmctly all buddmgs, whether ¢xmtmg or proposed, and~indicate all set-back dimensions fr~ property tees. Give street and block number or description accordmg to deed, and show street names and mdzcate whetl interior or comer lot. f8. STATE OF NEW YORK, COUNTY OF ...... S.S ........ (Name of mdwidual stgmng contract) above named. being dui>, swam, deposes and says that he is the applier He is the ~_;2LOA'.~../q. .................................... (Contractor, agent, corporate officer, e't~.') ......................... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file apphcation; that all statements contained in tbm appbcatlon are true to tim best of Ins knowledge and belief; and that work will be perforated in tt~e manner set forth in the application filed therewith. Swam to berate me this ............ /.... ..dayof..'~.~ .*'*~,. ............ , I9 .~. ota ub,l ..... ounty HEL~ K. DE VOE NOTARY PUBL C, State of New N~. 4707878, Suffolk Couflt~ .c' Term Expires M&rch ~0, (Signature of applica: 1, 'oo - 115',0~-/6,, Oo - Ol~",