HomeMy WebLinkAbout17218-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217110 Date JULY 22, 1988
THIS CERTIFIES that the building ADDITION
Location of Property 460 VILLAGE LANE MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section I14 Block 6 Lot 19
Subdivision VILLAGE MANOR Filed Map No. 3669 Lot No. 22
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 5, 1988 pursuant to which
Building Permit No. 172182 dated JULY 15, 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 CONCRETE PORCH ADDITION TO EXISTING ONE-FAMILY DWELLING
The Certificate is issued to CHARLOTTE DICKERSON
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
~~tAA, ~ ~
Building Inspector
Rev. 1/81
- -
gases xo. s
T01NN 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)
N? 017218 Z Date ...7.~..1.~:r t9
Permission is hereby grant to~ ,
to ~ ~ ~c
~
of premises located of ...7:a~!!.. ®.,.L?...~~.~~~ f.
f~""r".."'.........................................................................
County Tax Map No. 1000 Section ......,/f...r'~......... Block Lpot No........~/..••••••••.
pursuant to application dated ......~~,.1 19~Gd, and approved by the
Building Inspector.
Fee
Oi i . R~~,F~...............
.
~uiidi I ector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department ~ 2 ~9~ ~ f ~
Town Hall
Southold, N.Y. 11971 gLDO. D[P'T.
765 - 1802 TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANC
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ s.~~ to the Building In~ec-
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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of pxuperty 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 otfier 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 $25.0.0, 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 $ 10 . 0q
4. Vacant Land C.0. $ 20.00 "~lYZ4g8'
S.Undated C.O. $ 50.00 Date
NewConstruction,,',r,(,~,OldorPre-existing Buildingg~............ Vacant Land
Location of Property ...~l.~l .....................V.~~~~~~2... ~$............M~?t;l d?R~
House Na. ~ r~ ~ `S~t et G Hamlet
Owner or Owners of Property , . f!„i]/:Y.Q~~O~'e :..~'7.`4•L`./~`/~~5~ .
County Tax Map }N'o. `1000 Section .....I ~ .`k Block V Lot .
Subdivision 1~1~C...4'~ .......Filed Map No. ..........Lot No. vy
I
Permit No. Q[1~t~Date of Permit ~~J~..Applicant I./Y1~~.d~..~.(R.~CSB~:~...
Health Dept. Approval .............Labor Dept. Approval ,`,i~,:...... , .
Underwriters Approval , ....dU..I.~.nn.''..........Planning Board Approval ~......lY. ~ .
Request for Temporary Certificate ....1~1C~
...............Final Certificate . 1~ ~r5 ,
ao
Fee Submitted $ ~ .
Construction on above described building an(d~permit meets all applicable codes and regulations.
Applicant 4. ~ ..,}(~~J:M!p.~....'t.M.
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ROUGH FRAME &Q\
PLUMBING
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IIISULATIOAI PER N. Y.
STATE ENERGY \
CODE
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ADDITIONAL COMMENTS: x
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BOARD OF HEALTH
3 SETS OF PL.1NS
FORM NO. 1 SURVEY
TOWN OFSOUTHOLD CHECK
6UILDINGDEPARTMENT SEPTIC r•oart
TOWN HALL
• EOUTHOLD, N.Y. 11~J71 NOTIFY
.~-r//J y~ TEL.: 765-1802 ° CALL
Examined :5.........., 19~~y~(~ MAIL T0 .
\pproved ..7~,/.~~........, 19U1!Pennit No./~.°r.Z/~~
Disapproved a/c ~ 1~i ~ i~~l°~J '
- . ~ JU- - .61988
~j 4~~~..,~.u..~....,.~,nu___~
A (Btyf~ing Inspector) Bt-dts. JE';"~i.
TOWN OF SOUTF7CLt3
~ PPLICATlON FOR BUILDING PERMIT A ~ ~ ~
a ~
FEE: ~ ! , ~ 15
NOTIFY 8 AT Date .o-:~.~'i'..
788-1802 8 AM ;10 ~ FOR TlIE
FOItAWINCa IN&IsECTION3: INSTRUCTIONS
1. FOUNDATION TiNO REGIRREO
a. pOypEpiap completely filled in by typewriter or in ink and submitted to_ the Building Inspector, with 3
sets QJ' 2i0U6r•CctlKt7i11AN9611~I0 Fee according to schedule.
18. ~118Uowing location of ]ot and of buildings on premises, relationship to adjoining premises or public streets
or ar@~~ttY71d, giving;®fJ.BTNU~n of layout of property must be drawn on the diagram which is part of this appli-
cation. 6E COMPLETE POR C.O.
' cALQ'hRUPtS'El®tll b~NMistali~Htion may not be commenced before issuance of Building Permit.
d[HtUIR&Cell)~fAAEh66tliDfa~jFlCeaNld(t, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall ~T~lFl:pK2ON6~rT#~I@TilS3Ns ~aiENHB~r inspection throughout the work.
e pt9l6SbuildGli'g sAlErflPf4NVSd3Upie~@fi1 used in whole or in part for any purpose whatever until a Certificate of Occupancy
I shall•hFiE~Qi~d~fl3ttl~?I'fllJQfi~JNtE4tf~A~I3tspector. ,
• APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
' The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature ofapplnicant, or nanm~e, Jiff alcorporaiti1on)
2, 2~a' ..~,~~4 ~ ~.1 "lAp?7i.~!inc,~ , IV~i,'~ ~i'L`~d~2
' ( adin~ address of a licant /1
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
............................pp..II.--.~~{!-~-......~.
Name of owner of premises ......~.!V1 ~r l~ "`E lt-~Q1~~r'~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
OCCUPAGYO
(Name and title of corporate officer) ~
Builder's License No. ...d.2t? yt:2!Ll UE'V UIY®i~U~
Plumber's License No . ~DrM®U 1 C~R~R~~GAT~
Electrician's License No . • • • • OF OCCUPANCY
Other Trade's License No . .
Location of land on which proposed work will be done.
~.~~o . ~~~tA
House Number S`f'rce \ Hamlet
County Tax Map No. 1000 Sectionn......~:~.7......... Block ........~b........ Lot .
Subdivision ~ ~'.~Q 1~~°%............ F.il'ed t,lap No. Lot .
(Name)
State existing use and occu anc of remises and intended use and occu
P' Y P panty of proposed construction:
a. Existing use and occupancy ~'r~NA~%• • C\:~S~4te~lce , , , .
b. Intended use and occupancy •
' it3ttitsvt9 .
,..C. x~s3~ta#s~r=eau;!
G
3. Nature of work (check which applicable): New Uuilding '
Repair • • • • • • • • • Addition ..~.k Alterat'on
• • • • • • Removal , , , , , , , , , , , , , , Demolition ,Other Nork .~~~,QrV,LFPatncE
4. EstimatcdCost~`.~,d~ {Description)
Fee
5. If dwelling, nwnber of dwelli {to be paid on filing this application)
r~g units , . , , ,kyle, , , , , , Number of dwelling units on each floor , ~[!l Q
If garage, number of cars • • • • • • • . .
6. Tf business, commercial or miffed occupancy, specify nature and extent of each~y e of use •
7. Dimensions of existing stntctures, if any: Front , ; , • • ~ ~ • ' ' '
Height ,I;Z;~ , , , ; Number of Stories , , Q'l.t ~ • ' ' ' ' • Rear Depth . , ~ , , , , . • • • .
Dimensions o same structure with.altcrations or additions: Front . , ~ ~ • • • ~ ' ' ' ' • ' ' '
Depth . . ~ '.'Height . Rear ...~P 2 .
' 8. Dimensions of c ' ' ' • • • • • • • • • • • • Number of Stories D,'t1;Q., , ,
pe new construction: Front , Rear . • • • ' ' ' •
Height . ' F'~ r~R,.,.. . Nu4nber of Stories , • Depth .
9. Size of lot: Front .~~!20. Rear , .....,l 2.~? ' . • " " •
10. Date of Purchase , , , , , , ' ' ' ' ' .
~"•••~(O•••••••••...,Na ofF rnt rO ner ,.Y2 .
1 I. Zone or use district in which p'
p p ~ Yemises are situated ~?S.t ~Q,v,,~ 1 ' ' ' '
12. Does ro osed construction violate any zoning law, ordinance or regulation i9Y • • • •
13. 'Hill lot be regraded tfll;~, •y~h{apt.... .
14. :Name of Owner of re t es . i LI Nill excess fill be( v r ~t~t ~ pit No
P ~1 ~ ~2 1~4c~c2y[~'1Address`Y'Y%~S r;AU4 2
Name of Architect ...5-~•4y~Q ,t;t,~.-f!M • ,Address Z'?~. ,~9r ~pna N ;J?p, , • •
iVame of Contractor ..C?.k~r:~ o ~c, 2,(SOy~ • , ,Address ~?~~,C~^r, , , , , ~-1~ ~ ' '
15.:Cs this property loczted with in~00 feet of a tida~~~]~rµ~d~Tq~.{~tll,+p;'~a;~.~"
*If yes, Southold Towin Trustees Permit may be required. y}{11la_1s,~;t; i;
'I PLOTDIAGRAM t~F3Mt~,~i`P~1:is-rY;.+`?'r ,..t`..;
,Locate clearly and distinctly all buildings, whether existing or proposed, and,Kndicate;~l';~e~=}iaq `?d~; signs from
property lines. Give street and block number or description according to deed, anfl ~1't'o ~ ~~A
interior or corner lot. ~ ~ ~ ~!!S{re~tl n~ ande~dicate,w~tether
p 11 .r~~~~ t^tYt.
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STATE OP NEw ~ a ' .f ~ " ~ xx
COUNICY OF . ~~f~~ff{: r'~ t „8' ~ ~ e .
, • , • . • . • • , , • • ~1~/~,~f o~e , '1'~".4~ ~~r~~:,,,~:' : ; , • ' being duly sworn, deposes and says that he is the applicant
(Name of individual sighi~tg contract)
above named, f..,
[ie is the (~?tiQ!L .I' ...Cu.':~f1.CJ~ e~i;o(....:.............. , .
(Contractor, agent, corporate officer, etc.)
of said owrtcr or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; [hat oll statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the mannersc[ forth in the application filed therewith.
Sworn to before me this
~~.......day of .i , 19~.
tiotary E'ublic, , , , , , r, , ,S.CI , .1, .County
NOTANM (Signature of applicant)
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