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Home My WebLink About16800-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.7.9.4.5 .......... Date July I, 1988 THIS CERTIFIES that the building A d d i t i o n Location of Property 1350 West Mill Road Mattituck County Tax iVlap No. 1000 Section 106 .Block 10 .Lot 03 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 2, 1988 pursuant to which Building Permit No. 16800g dated............................Ma r ch I I; 1988 was issued, and conforms to all of the requirements of tlte applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... .A.d.cl~.t..ipn t.o..a.n e.x.i.st lng..o.n..e..f.a.m. ?_.l.y..d..w.e.l.l.~..n.g.. ........................ The certificate is issued to ROBERT A. BARIN (owr~er, Xt~ig&~&~X X X X of the aforesaid building. Suffolk County Department of Health Approval Iq/A UNDERWRITERS CERTIFICATE NO ............... ~..0 9.2.3.8..7. ?.y...5.,.. ! .9.8.8 ............. PLUMBERS CERTIFICATION DATED: Iq/A · ........ Building Inspector Rev. 1/81 FO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 16800 Z ...~.~.~.....L~ ..................................................... ...... ...... , at premises I~ated at ...L.~ ....... ~.~ ...... ~.~...~., .......... ~1..~ ................... County Tax Map No. 1000 Section ...... J...~...~ ....... Block ........ L..~. ....... Lot No...,,0....~. ............. Building Inspector. Fee ~i...~. .................. Building 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 This application must be filled in typewriter OR ink. and submitted ~ to the Building Inspec- tor with 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, a certificate 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 p~operty 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.OO POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling.$25.00, Accessory !$I0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 .. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewConstrucBion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... .//.~...~..~. ..... . .~/..~..~C.../~.././;..~:...?.~..,~.. ~. ...... .~.~. ~ .7~'../-~..~7~. Nou.~e No. Street Nam/et Owner or Owners of Property . . ~ ~(~ '7~ . '~/~ //~ County Tax Map No. 1000 Section .../< .~.~. ...... Block ..... /.0 ....... Lot .... ~.~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~.~. ~. ~. ~. Date of Permit ~.).1/~.~..Applicant..~.~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ..... .~. .................................... Planning Board Approval . . Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... ~..'~', ¢ .~.0 .............. Rev. 10.10.78 Construction on above described building and permit meets all applicable codes and regulations. Applicant ..... FOU~DATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME / PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIO~L COMMENTS: TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN ItALL SOUTI]OLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ~of the fol.~owing reasons. //7~ An application for Certificate of Occupancy is not on file. /No Underwriters Certificnte on file. _ The check is(outdated/Do,.on /~/ No Health Dept. Approval on file. /-~/ No final inspection has been made. Please contact our office on Thank you for your cooperation. Building Permit tt _~ ~ ~_ d O Z Building D~pt. this matter. No Plumber solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) :il 765-t802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~rROUGH PLBG, ] F~NDATION 2ND [ ] INSULATION / FRAMING [ ] FINAL .EMARKS: .~~r DATE _'NSPECTOR~~ ~/~/~J 765-1802 BUILDING DEPT. INSPECTION [ ]~ATION 1ST [ ] ROUGH PLBG. [ ] FOUN~ T~ION ZND [ ] INSULATION [ '1 FRAMING FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~- ] ROUGH PLBG. FOUNDATION 2ND [ ~NSULATION [ ] FRAMING [ ] FINAL INSPECTOR .~,~.~ 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND []~ISULATION / FRAMING If] FINAL REMARKS: DATE THE NEW YORK BOARD OF FIRE UNDERWRITERS PAOE 1 ~'"' BUREAU OF ELECTRICITY ~e ~pplica~i~ ~o. on file THiS GE~IFIES THAT o~y t~ ~t~ ~u~m~nt ~ ~ ~ ~ int~u~ ~y t~ ap~t ~ on the a~ ~t~ numar ~ t~ p~m~ o~ DAR~N, 1150 W. MIL~ RD., "ATTI~CK, N.Y. ~ examin~ on and found to be in compliunce with th~ ~qui~ments of th~ ~. fiXTURE BXTURES RANGIS OVENS DISH WASHES EXHAUST FANS OUT.TS SWITCHES I 3 1 DIYE~S FUENACE MOTORS TIMICU~CI(S UNITMATEIS MU~T~OOTi~T MMMER$ SYST~AS NO. Of F~IT SIRVIC~ DISCONNECT S E R V ! C ROBERT DARIN 11350 VEST HILL RD. MATTITUCK, I{Y, 11952 This certificate must not be altered in any manner; return to the office of~the__Board if incorrect, inspectors may b~ identifi~cI by~ their credentials. (Building Inspector) BOARD OF HEALTH FORM NO. 1 SURVEY .... ... TOWN OF SOUTHOLD CHECK '~ ......... ' BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 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 insp,~ (Signature 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. .... ............................................................................... Name of owner of premises . . . .~.~. t~t~-.. F.. ~ ................................................ (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 COUNTY LICENSED Builder's License No .... ~.~_~1.-}~ ............... 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.~. O.. ~.)s.~J.~..L.. ~..~. ..................... ... ! no ........................ Tr.. .w,J ..... ............. House Number Street Hamlet County Tax Map No. 1000 Section .... ).l~.& .......... Block ..... ~..O ........... Lot .... .O.. ~ ......... Subdivision ..................................... Flied Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ...~/~./~..~. ........................................................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~,,., ~i (Descriplion) 4. Estimated ....... lu. ..................... Fee ...................................... Cost · (to be paid on filing this application) If dwelhng, number of dwelhng umts .............. Number of dwelling units on each floor .... [ ........... If garage, number of cars ..... i .................................................................. 6. If business, commercial or mixed! occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front .... .~ .~k.,D. !... Rear . ,.~.7%. [CP. ! .... Depth . . ~.d~..~ ...... Height .... I.~ .' ........... Numb?r of Stories ..... ~./~. ~_~ ............................................. Dimensions'or sam .~[~iC~e~ alterations or additions: Front .... ~..~r.,.O.' ...... Rear...~..Oc.,.O .' ......... Depth ... ~ O.~.0.' .......... i. Height ..... ~]~, C} ! ........... Number of Stories .. ~6,ti~' .............. Dimensions df entire new construction: Front ..... [~.,.O.' .... Rear ... l .~-.,. O. [ .... Depth ...~-..~, O. ! ..... Height ...... 1.(~ ~O ......Number of Stones .... O...-~- .............................................. 9. Size oflot: Front [~.t,..cl,~ .. Rear...~]~'~.~.-/~. ........ Depth ...,,~.~..~.~.c/.{ ......... 10. Date of Purchase ........... ~. ................ Name of Forme_r Owner' .'TH&ZB~...5.~.U/-~/]. ........ 11. Zone or use district in which premises are situated .... ~.l~ ./.t~7.~.~ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...AJ.O ...................... 13. Will lot be regraded ....... ~0. .................. Will excess fill be removed from pr.~mises: Yes 14. Name of Owner of premises /12'P/~. t~-~iC./~....~)~c~dt0 Address ~>(9. ~..~( ~.~ .~..~tt~j-/'~/~e No.. ~-~t~ ."~. 7~.'~.. Name of Architect .......... i ................ Address ................... Phone No ................. Nmne of Contractor ......... i ................ Address .... : .............. Phone No ................ 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No .~.. *If yes, Southold Town Trustees Permit maybe required. i 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 interior or corner lot. umber or description according to deed, and show street names and indicate whether STATE OF NEW YORK, Si S COUNTY OF ................. .... .~.O. ~'~..~T-...~.:. ~..'--~t~/i.ttfl. ................ being duly sworn, deposes and says that he is the applicant (Name of individual signigg contract) above named. He is the ................... ~ .................................................................. i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyiauthor/zed to perform or have perfonned the said 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 ~et forth in the application filed therewith. Sworn to before me this ........................ day of .............. , .. Notary Public ....... [.~.~-.. ~&~--~ .... Count. y ~ H£tm lC ~)£ rOE HOTARY PI, J~ C, ~q~te of New Yo~k Term ~pires Uareh 3Q (Signature of applicant) TON /