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HomeMy WebLinkAbout17607-zFORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217564 Date DECEMBER 2, 1988 THIS CERTIFIES that the building ACCESSORY Location of Property 4040 DEEP HOLE DRIVE MATTITUCK House No Street Hamlet County Tax Map No. 1000 Section 115 Block 17 Lot 04 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 7, 1988 pursuant to which Building Permit No. 176072 dated NOVEMBER 16, 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 ACCESSORY BUILDING IN REAR YARD. The certificate is issued to WILLIAM & JUDITH MACOMBER (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED .t C/I O-d_. ~-t.v~ Building Inspector Rev. 1/81 s~oaas xa s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfH15 PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_ G17607 Z Date ...N.~-:~:,~-.....1...~ .............. 198.. Permission is hereby granted to• ~~ ~~ ~/J.~/)] t' r, _ . ..3.$.r.4..~.,~.~..f2.t....t~-.. ........... to ... \n~.~~~~°~~\'X Y[~ttY~....dT :I l......~YS~. . .• r... ..i{;y~t/.MR11 •~J..~..~:.T: .IL.`.^. 4K 4.. .4iw.. .. ct premises located at .. ...d.~z:~?..Cy.~1.~L~>Zr.... ..~.`:~-!~SM..Sl4 :................ ................................... ....................... ......... .......................................................................... County Tox Mop No 1000 Section .. ~~~.... Block ......~..7......... Lot No ..0~ .. . pursuant to application doted ..N R:-~/.--4:+v~,~ ~.. .. ......, 19~~.., and opproved by the Building Inspector. Fee S .aS..... wilding Inspector Rev 6/30/80 ~ ' `-ter p ~ :~ v ' FORM NO. 6 ~ `i~ ~ Z ~ ~$ ~ TOWN OF SOUTHOLD Ji~'U, '~(~; I Bualdmg Department Town Hall 6LDG DEPT Southold, N.Y. 11971 TOWN OF SOUTHOLD 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This application must be filled in typewriter OR ink, and submitted ~ ~~~~ 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 Imes, streets, and unusual natural or top ograpfic 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, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Piamm~g Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-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 otherpertment 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 $100.00 3 Copy of certificate of occupancy $ 5 .00, over 5 years $ ] 0.00 4. Vacant Land C.O. $ 20 00 S.Uodated C.O. $ 50.00 Date .~rl~J+;'~~.lC'~.:~~~.~140 NQ,~,rConstruction,,,,,,OldorPre-ex~stingBuildmg VacaniLand Location of Property :~47:~.....~.4°.Gt-1.~.../~;L'I~..l(J~ .. ............. ~.~'.~~.?~44Crt~5'.. House Na. 1I, J~ -~ ~l Sheet Hamlet Owner or Owners of Property WI'~~l ~ C?"r . Jf: ~.r~~.>Lh..,/J~ ~~C~ nJ.~f.'~:- ............... . County Tax Map No. 1000 Section ....1 ~.5? ..... Block .. ~~7......... , Lot ... ?:.......... . Subdivision ............................. Filed Map No. ......... Lot No. ............ . Permii No....... ... Date of Permit ..........Applicant ................................. . Health Dept. Approval ........................Labor Dept Approva{ ........................ Underwriters Approval ...................... .Planning Board Approval ...................... Request for Temporary Certificate .....................Final Certificate ...................... . Fee Submitted $ , f~. ~ ~.......... ...... . Construction on above described building and pe~rm/~it``meets a~ll(app/liyc~able codes an/d_ r,,egu)lations. App hcant ~ ~C E .lY /`l .. ,l +. •. !!J.~.~,C,7.?2:~!-yr.4! ............... . n~,u,oaa~ 3!0 a~f7 ~p J7ba7z co z/7S~y . t y/a./xb -1ELD I;.S: ECTiU;] ~ ~UAiE ~ COPtMEN'f~ »' 1 . ~ ~- FOUtiDATION (1st) - _ _. _ 'OUNDATIO;J (2nd) 2. ROUGH FRAME & PLUMBING 3. Ii1SULATION PER N. Y. STATE ENERGY CODE 4 -•.~ . FIi~AL U.LC/ rto i - ADDITIOPIAL COMMENTS: i i i i \a i 1, f ~ C1 ~ `S ~ ~ "' W 'z ~aua ~ J~ W~ W ~z~~~ uo~o°~Zo '~'O vU' ~~ zOv p~j 22 }- zrnOa~ F~y ~ p- v;Opr-~cnr~ lG. U~ ZLLti wC.w~F- ~16QW~2CCi,~~=~¢ 02 aoc~Q~ ~ ~_a¢zcU Za~xa <zC~za ~~~1t ry~ ~d L:y' cc L'~Z, JJ ~ 0 V./ ~ C l` LL W 1.(( ~ Q h V !.. G OC+ 9 ~~GG G.o ~''~,~~,~ o ~%`~~~~' F G ~ ~f C 3-~, a' .~ I~ ~ ~ ~~ i ~~ ~~ ~~~~ ~ ~~. a a iZl .~--~ ~~- THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE. 1 t067)37>4 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEWYORK 10038. Date r'"7'''P^RUARY p9.191?4 APPltcationNo.onfile 594P,66R8/RA N 05lk(lA THIS CERTIFIES THAT only the electrted equipment m docrt6ed 6elore and 7nerodYACed hY the applicant named on the chose epplicottan number in the premises of 1:6t,1AF7 A,MAC08NP:R, 3R1t1 r)F;h;Y Ngl,w: N)Rr:VF: r:/S, POJ,F,~GIt,Ct) `l.2; k1A'!"1'1Tt11aC- N,Y. in tkeJdbrainR locotion; ©Bssement ^ /st FI. ^ End Pl. Section Bloek Lot 1 989 :7ANIJA RY 2,~ , . and found to 6e in complianrn with the requirements of thu Board. waa examined on NXTUEE RXTUElS RANOfS COOKIN60lCKS OVlNS DISH WAElNlf EXHAUST FANS OUTLETS ACtES SYYITCIIK INCANOESCEM FlUg1ESCEM OTNER AMT. K. W. Anti. K. W. AMT. K.W. MIT. K. W. AMT. N. P. 1 7 9 DRYMS RlRNACE MOTORS NTIME ANUANCE IEEDERf SFlUkI f3C'FT TIME CLOCKS E!U UNIT MEAflEf MULIFCUIIlf gMMlRS AMT. N. W. Oll N. P. OAS N. P. NAT. NO. A. W. G. AMT. AMT. MIT. M115. TERNS. AMT. M. P. ~ ~ ~T AMT. WATTS 9lVICE DIECONNECT NO.OF S E R V I C E MIT. AMP. TYPE ~ I,e't'M 1/Te 3I TV S/IW NO. ;COND. OF CC. COND. NO. Oi N4lEG Oi~~IEOC. NO. OF NFUTKAlS OF NFUTGWM 1 ] 5tt (IB 1 X 1 l ltd 1 1 Oi11EE kFMRATUS: snlr~r; n~;~ecTf)R:-7 ~~ ~% s'rxvr-,Ys xr.w,.lsR~ts. ar,H>•.ar, r,7C./3x94-r. G Y.CI, RItX 12bA 4QtrrHQrd), NY, 1.1.9`•'7. ORIrRAL RR i1 Per - This nrtificaN must not be altered in any manner; return to iM oNice of 1M Boord if iYlcorrect. Inspectors may bs identified by Nair credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER. ~~ a~~~ ~~ ryry ~~~~ BLDG DEPT TOWN OF SOUTHOLD FORM NO. 1 70WN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N Y. 11971 TEL.: 765 1802 BOARD OF HEALTH ......,, 3 SETS OF PLANS ......., SURVEY ................. .... CHECK ............. SEPTIC FORM ............ NOTIFY ~QQ Q X~~G CALL !. . / .... , , MAIL T0: Examined .lV ... .~ ~.., 19$ Approved -~.Q^t4?^~~: ~ (? .., 19~~ Penntt No I'](oU 7 Z; . ~ Disapproved aJc .... ..u. _ . -. r . . ... .. .................. .. ... 1.~ ~o'a:. ... ~....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~ e'v :. ? ......., . INSTRUCTIONS a. Tlus apphcatton must be completely filled m by typewnter or in ink and submitted to the Butldmg Inspector, sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locauon of lot and of buildings on premtses, relationship to ad~ommg premtses or public • or areas, and giving a detailed descnptron of layout of property must be drawn on the diagram which is gait of ttus catron. c. The work covered by t}us apphcatton may not be commenced before issuance of Buildm~ Permit. d. Upon approval of this apphcatton, the Building Inspector will issued a Butldmg Permit to the applicant. Such b shall be kept on the premtses available for inspection througltout the work. e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occu shall have been granted by the Butldmg Inspector. APPLICATION IS HEREBY MADE to the Butldmg Department for the issuance of a Building Permit pursuant Butldtn; Zone Ordinance of the Town of Southold. Suffolk County, New Yozk, and ot}ier applicable Laws, Ordtnan Re_ulatrons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein desc The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, a admit authonzed inspectors on premtses and m building for necessary mspecnon~. .`fl~lSx4'., Lt~,~.Let a%,,~~.. 4'j1Q.~C-1`ic.F.L'h.~.. (Signature of apphcanY, or name, tf a corporation, (Matting address of apphcant) Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu .........~ ~:V:??:~~ ............... .................. ............ ..................... 1{~ ........ Name of owner of premtses W..LL~.C.Cxr7.7.1.. IYt . ~?rfx.. ./J _ .~~~~:'f/. (as on t ta~c roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......... ...... ...... ..... ........ ....... (Name and title of corporate officer) Builder's License No ............. ...... . Pluinbcr's License No ....... .. ...... Electrician's License No Other Trade's License No I. Locatton of land on which proposed work will be done .. ... ..... .. ............. ..~ 4~a .. ........ ~.-e.z¢.l .~ ~e,.,,~ ........... Y17 l,~c.~~~~c c.k.~.......... . House Number Street ^~ Hamlet (~ County T~tv Alap No f 000 Section .... j ~. ~ ....... Block .... ~ . f .. .. Lot .. !:.......... . Sobd[~ision ............. ... ........ ... Filed \lap N'o ... ..... Lot ............ (Naive) . . 2 State evsung use and occupancy of premises and intended use and occupant y of proposed construction a E~is[m~~ u d r-- • - sc. an occupancy ... .. ..... .. ...... ... .... ....... b ]n[ended use and occupancy • - .cwt-'~ a-~•~ • ~i"'~`~ ... ........... 3. Nature of work (check which appftcable) New Building • . ~ • • • • Additwn .......y terauon ... . Repair ...... • ....... Removal .. ........... Demohuon .... .... ¢,;; . the rk ... . • ~ .... (Descnpt 4. Esumatcd Cost .... ~ ~.b O ......................... Fee ............. .. . (to be paid on filing this apphcauon 5. If dwe]Itng, numbcr of dwelling units .. ..... .... Number of dwelling unit> on each floor .......... . If garage, numbcr of cars ....... ......... ...... ...... . .............................. 6. If business, commerceal or mixed occupancy, speedy nature and extent of each t pe of use ... , ..... .. . ... 7. Dimensions of existing structures, if any Front ...::: $~ ...... Rear . , ... ~.... .. Depth .. ,/, ~ ~, , , , Hciglit ............... Number of Stones .. ........ ...................................... . Dimensions of same structure wdh alterations or additions Front ...... .......... Rear ............. Depth ...................... IIcight ... ... ......... Number of Stones .... ........~ , , . 8. Dtmensions of entire new construction Front .... ~. ~ ........ Rear .... ~. ~ ........ Depth .. fat, , , , , Height ..... .........NumberofStones.................................... .. ......... 9. Size of lot Front ...................... Rear...................... Depth ... ............ 10. Date of Purchase ..... ................ . . .Name of Former Owner ........ . ......... .... 11. Zone or use district in which premises are situated .................. ...... ..................... . 12. Does proposed construction violate any zoning law, ordinance or regulahon• ............... . . ....... . 13. 1Vil11ot be regraded .... ................... • . Hill excess 611 be removed from premises Yes 14. Name of Owner of premises ....................Address ...... ............ Phone No.... , ...... . Name of Architect ...........................Address ....... ...........Phone No............ Name of Contractor ..........................Address ...................Phone No. 15.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.mdicate all set-back dunenstons property lines. Give street and block number or description according to deed, and show street names and indicate wh~ interior or corner lot. STATE OF NE~V YORK, S S COUNTY OF ...... ......... •••--•••••••• •.• .•••--••••-•.••.. .. .. ..... bmngdulysworn,deposesandsaysthatheistheappli (Name of individual signing contract) above named. fie is the ... . (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 application, that al! statements contained m this apphcauon are true to the best of lus knowledge and hehef;and tha work wdi be performed in the manner set forth m the apphcauon filed therewith. Sworn to before me this ..... ......... C ..... day of ...}~4.T?:..... ..., 19 . d~ `J~ ~~}} // 1 Notary Public, ...F.K~'iLr.. ~....`:: ~: U~ ... County ~j // /~ ../;b..~./7; ,~~:.,~~.. . liDTARYPU6~ ~fhat~tdawTurk /1 (Signature of appli~ Tu n fxgres Mi~h30 1~~