HomeMy WebLinkAbout17592-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-I-948
Date APRIL 14, 1989
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 1645 ELIJAH LANE MATTITUCK, NEW YORR
House No. Street Hamlet
County Tax Map No. 1000 Section 108 Block 04 Lot 7.9
Subdivision ELIJAH LANE ESTS. Filed Map No. 6065 Lot No. 6
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 28, 1988 pursuant to which
Building Permit No. 17592-Z
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 DECK ADD. & INSTALL SLIDING GLASS DOOR & WINDOW IN EXISTING
GARAGE TO EXISTING ONE FAMILY DWELLIPiG.
The certificate is issued to RICHARD & AUDREY A. MOORE
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
CERTIFICATE NO. N-063567-MARCH 23, 1989
PLUMBERS CERTIFICATION DATED
dated NOVEMBER 7, 1988
uilding Inspector
Rev. 1/81
FORM NO. ~
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)
N o ~ 17 5 9 2 Z Date ..../.~...7 ..........................................., >i 9~g
Permission is here ranted
~Q........~...~~......
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t0 L,.~T.rRw~r~~ekL~~~..~.lF~f............ ~ .~~„7......~{rtk~...~%~t~ie~c~l•••~~f~. ,D'Q*G
ct premises located at ./,~..f.GS.~..~ .....r~-..... ~~ ............................................................
.................................................... ~ i~~ ~ ~ ..........................................................................
..........................................................................yy.rr.........................................
Caunty Tox Map No. 1000 Section ......~J..f.......... Block .......d..~.... ..............................
Lot No........~i... .............
/.........
pursuant to application doted .....~~~Y~ ... ............................ 19... ~.~fand approved by the
Building Inspector.
OD
Fee $.
Rev. 6/30/80
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TOWN OF SOUTIIOLD
BUILDING DEPART2IENT
TOWN HALL
SOUTIIOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
i''Na~ L`
~b~s ~~~~ ~ ~'~
~!a/a ~ .
DATE.. L~... ~ ~~.... ,
NEW CONSTRUCTION .......OLD OR PRE-EBISTING BUILDING.`/...VACANT LA,,.,,NLL,,D........
Location of Property....~~0 5!5 .. _ _ , . _ .~`~~ ~1'_~~_ ....G~.~.~~?`i /~/ ~/C
.......
HOUSE NO. STREET HAMLET
Owner or Owners of Property.. ...~ :`:~'~~..~.... ~1 ~~e E/. _ ~: ~63d'7~._ _
County Taz Map~~No.~j10J00 Section .~. Block ... Lot
Subdivision~`.~^~.`.LQ!?~:~;~5 Filed Ma ~~~ S .., ~'__
p .Lot ___
Permit No. .~.~ ~.~ ~~ ~(~ 7~~ _~C~ PVC f '/~
Date of Permit j. .Applicant ~ „%`:y~~y~
. /~/ad ~-
Health Dept. Approval .................. Underwriters Approval..............
Planning Board Approval ................
Request for Temporary Certificate ....... Final Certificate .~~.
Fee Submitted: $...~~ .............
~,
APPLICANT......~~~~ _"` ~~ ~"" _'C-'~ZL"-....
~~~ 3 ~a3 l
co ~ ~~qyg
rev. 10/14/88
I?~v
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
(FRAMING [ ]FINAL
REMARKS:
,_
DATE a- ' ~ INSPECTOR .(/~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ 7 FRAMING
REMARKS:
[ ]FINAL
DATE ~ 2~ ~~ INSPECTOR
v
~ 7 ~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
DATE /(~ U INSPECTOR ~~
l ... L L l a..~ .~ :. 1. ~ ~ V1~ IlU t1 l u
,. - - ~
FOUtIDATION ( 1st )
=0U;IDATI011 ( 2nd )
2 . /.I G
ROUGH FRAME ~t(
PLUMBING
3.
Ii1SULATI0P1 PER N. Y,
STATE ENERGY
CODE
4. ~
FI;1AL
coa~rMEUr~
N
ADDITIOPIAL COMMENTS
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~~~~«i~~`,~ BOARD
3 SETS OF HEALTH
PLANS
OF
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TOWN OF SOUTHOLD
CHECK •
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........:::
BUILDING DEPARTMENT
SEPTIC
FORM . .
::::::::::
TOWN HALL
BWfi. DEPT.
T01NN OF SOl7iH0tA SOUTHOLD, N.Y. 11971
TEL.: 765.1802 NOTIFY
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Examined .././/. ~........, 19Q.~
MAIL ..
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Approved ...1~/~7........., 1XJ.~. Permit No.~7.v..C~y
Disapproved a/c ...................................
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(Bui I ector)
APPLICATION FOR BUILDING PERMIT
Date .. ~4 ~ ~..'?.~ ..., 15 ~.'
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
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 iemoval or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housinti code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections. , ~ ~,~/
(Signature of applicant, (name, if a corporation)
,- (bl`ailing address of applicant) ii~S,Z `"~
State whether applicant is'~ow~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................................................................
Name of owner of premises .,?~.~: =!1 R.~. ?~. +~'~t~.y !:~.. ~-~~ ,,t'_ , ,/ ~c, ~rP~/ . • ~.~~. _~0~ r
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
..............................................
(Name and title of corporaQte officer)
Builder's License No. ....~~ f. &~ ~~
Plumber's License No . ....................... .
Electrician's License No . ..................... .
Other Trade's License No . .................... .
1. Location of land on which proposed work will be done . ...............
.... . ...... ..............
House Number Street Hamlet ~~
County Tax ,,\fap No. 1000 Section .. ~ o .~' ~ " ..... Block ... ~. ~°v Lot .. ....... . . . . . .
Subdivision.~:.~.'.,Fr.~...~`':~r.. ~'~.?.~~>:....... FiledDfapNo. .~.~-'~?'.:~...... Lot ...Ce..........
`~ (Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....~ c°.s'..~~,~.~ ::.. ~ ............................................. .
b. Intended use and occupancy ...... 1 ~:.'~ :.`Y .°.-:~.~' : ~ . ~ ........ .
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C~~1p ~1LTH DEPARI'jdEN1~
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facil 11 .,
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er t'~1~ loC r r '= Ply
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to be sat ath~a~ .asnt ande been
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Chief o~Ceneral•EnginBering
Gr~tAe Services
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Uf~AU TNORILED ALTERATION OR •ODI TION TO
THIS SURVEr IS A VIOLATION OF SECTION
7109 OF THE ME1F TORN STArE EDUCATION
LAM .
COPES Of TNIS SURVET YAF NOT 8[ARINY
TNF LANG SURVErON'S IN[[0 SEAL OR
CNSO]SED SCAL SHALL h0T 0E CONSIOEREO
r0 RE A V1U0 TRUE COFL
iuARANTEE$ INDICATED HEREON SMALL RUN
JNLT i0 THE FER30N FOR WNOY THE
WRVET 1! PRE FARED, AND ON MIS OENALF
f0 THE TITLE CONFANT, GOVERNMENTAL
I,ENCY AND LENDING INSTITUr10N LISTED
IC 9EON, ANO TO THE •S SIGNf E] Of THE
.[r:01NG INSniunoN. Gu•uvrE[s ARE
ACT TRANSFERABLE TO AOGTIONAL
vStITUT~DNS OR SUBSEQUENT OMNERl.
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NOTE
o a MONUMENT
SUED/V/S/ON MAP F/LED /N THE OFF/CE
OF THE CLERK OF SUFFOLKCOUNTYON
FEB. /4, /974 AS F/LE NO. 6065
?R>a LOC![770N. ne T^r•IS A1!'D rESSP00~3' _
SHONN F.'£^":.. /t '.. •,,+i t'(-:^ G3.SERY/{770A/S
~IID/08 F@0.,; .;,;, _; ,,,~in'liii:D i@OM 07IIE@$
REVISIONS YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W, YOUNG HOWARD W, YOUNG
PROFESSIONAL ENGINEER AND LAND SURV [YOR
LAND SURVlYO R, N.Y.S. LIC. NO, 12847 N. Y.3, LIC. NO. •~pf17
SURVEY FOR:
R/CHARD A. MOORS ~ AUDREYA. M40RE ~ ~'~
LOT NO. 6
`r 1 `,I
" EL //AH'S LANE ESTATES , S CTlD%V / ," ~ ~ ~
1 j
Ar MATT/TUC/ GUA AN EEO )`J7'TL:ED/V/S/O pF
AME /C N T/TL E'/NSURAN EC .
7owN of SOU OL$,SA,V/NGS BANK
SDUTHOL D R/CN B:A!/OREJ',9/M . RE
SUFFOLK CO., N. Y. aY •,r . _ -
rw ;i
SCALE: „ , DATE: NO.
/ = 50 APR. 2B, ~ 976 I 76-306
rt RE 17 ]i]] 9-0• A09U•
~='`~~'~~~ y i S/ i n s
3. Nature of work (check which applicable): New Building '~ ~'~~ e~,~ ~-~
Repair • • • • Addition .......... Alterati/ctn
.............. Removal....... ..........
• • • • ... Demolition .............. Other 1Vork,.............. .
~ ~ " `' (Description)
4. Estimated Cost ..... ~a:~. =~r-E~ • ~ ,
................ Fee ........ ?::-;..~,-~•.•,• •...:t ~.•
....
5. If dwelling (to be,paid on~;f~i'izjg;'tfiis."~ l~tiorv
„ number of dwelling units ........... "`+'" "'•' "~"'° """'~
~ .... Number of dwelling units on each floor ............... .
If garage, number of cars
.................................................................
6• If business, commercial or mixed occupancy, specify nature and extent of each t ~ • ~ •
7. Dimensions of existing structures, if any: Front .....~:. _ , YI?e of use ................... .
~:. r!/; .Rear ..? . '.~:!`...... Depth . a ~?, i~
Height .. /, : ;,';", • • • , , , Number of Stories ... . l . ' ' • • • • • -
Dimensions of same structure with alterations or additions: Front `~J `~ • • ~ • ~ • • ' ' ' ' ' ' ' ' '
Depth ..........U~ ,~, .Height . / ~ ...::.. ......... Rear .: ~../ .......... .
•~"" "•••• ••••• Number ofStorics...
8. Dimensions of entire new construction: Front ......~:. '~' ' ' ' ' ' ' ' ' ' • • • •
Height .. . /. ~-.... ...... Rear .... 3 :'........Depth ...-? .C: .
.... Number of Stories . , 1, , • • • • • • • .
9. Size of lot: Front......l..r.4-...... .... ....... ........................................
10. Date of Purchase ~- i _. - • • • • • Rear ......... ! ,5,:~ , , , , , , Depth -2 ~ v
..........:.:.?.~ ............Name of Former Owner ~-, e /ti-:~• ~ !~ ~; ::.~. .
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 ........ :.;-~ ..Will excess fill be removed from premises: yeS • . `~,Na
14. Name of Archite~t P~mr?-)L;>-C• "q <7 ~r-}~~~ny,l~~: t`?Address . ! ti ~? ~(•~;Z/;, ~°i ...Phone No.~;~: ~?r-sa~ ~
:~~,• ~;-,/~'.' .Address ... ~:: ~,~-~c~ di '
Name of Contractor a~f'u ~ ~, , ~r.3~~ ~ `F~ e ~ .Address . , `-' ~, X-1 u % d ' ' ' • Phone No ............... .
15.Is this property located within 300 "~'~" """ • • • • • Phone No.
*If yes, Southold Town Trustees Permitemay bearequiredetland? *YES....NO...."
.. PLOT DIAGRAM
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.
STATE OF NEtiV YORK,
COUNTY O/F ..... %~ , , , AA „ • • • S.S
' ' ' ' ' ' ' ' ' ' ' • • • • • • • • • • • ... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
E~eisthe .......................
.....~Co t ...............................................
n ractor, 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 this
aPplica[ion; that all statements contained in this application are true to the best of ttis knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
...........~ ~ ....day of.....Q G
Notary Public. ... ~. ~!:..~-e•G~z'~-......
HELEN K DE VOE
NOTIUtY PUBLIC, State of New York
No. 4707878, Su%olk Coin
Term Expires hkrch 30,19~'.`~
......, 19e"~
County
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/` ~~ j ~ ~•
• v (Signature of applicant)
070H1009 d0 NMOl y -
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