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HomeMy WebLinkAbout17139-z FORM N0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town HaII Southold, N.Y. Certificate Of Occupancy No. „Z17046.,,..... Date July 1, 1988 THIS CERTIFIES that the buildin A c c e s s o r y g Location of Property ....,3905 Ole Jule Lane Mattituck House No. ~ Street ~~~~~~~~Hamlet County Tax Map No. 1000 Section ~ ??.......Block S ............Lot ? 5 . Subdivision ...............................Filed Map No. ........Lot No. . conforms substantially to the Application for Buildinb Permit heretofore filed in this office dated June , 15 , 1988 pursuant to which Building Permit No. ~ 7,1.39Z dated .June 2 I , : 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 shed as applied for. Tlie certificate is issued to ......ROBERT 6 JEANNE DIETZ (owner, ~elvl of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO N/A, , , , , . , , , , , , . , . PLUMBERS CERTIFICATION DATED: N/A Building Inspector nov. 1/81 aosat< xo. s 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) Nfl 017139 Z Date .......~.,~ss~L4.:..~1 19~.g Permission is hereby granted to(~ . , ~ N:.y... /~Y. at premises located at ...a~.9.....~.......D...~ .............~:+,d.. ~I 1....r. Caunty Tox Map No. 1000 Section z.~-..... Block ......0..~....\~ ~Lpot No.. a:.~............ pursuant to application doted .......~.,,(.frX.1.Q...~..~~ 19..P..4., and approved by the Building Inspector. Fee wilding Inspector Rev. 6/30/80 ~~-~~.A._ FORM NO. 6 q 5 I~,~ TOWN OF SOUTHOLD Building Department Town Hall ei-DG. DEPT. Southold, N.Y. 11971 TOtNN OF SOUTHOLO 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~e~~ 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 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 instaila- 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 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 other 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, $25.00, Accessory-$ 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 $10.00 4. Vacant Land C.O. $ 20.00 5. Undated C.O. $ 50.00 Date...~d.~-~:N:~-.~:~t.1.1~.~.3~ NewConstruction,,,,,,OldorPre-existingBuifding Vacant Land t Location of Property ~ ~.05.-. , . _ .1v l.- E ~.Q TJ~....... ~ {i:. k .l ~ ~ C- ~ House No. Street ~ ~ Hamlet Owner or Owners of Property ~.1. ~ L-. ~ ~ County Tax Map No. 1000 Section Block Lot ...yL.:~ . Subdivision .................................Filed Map No. ..........Lot No. . Permit No. Date of Permit ..........Applicant . Health Dept. Approval ........................Labor Dept. Approval . , , , , , . Underwriters Approval ........................Planning Board Approval Request for Temporary Certificate .....................Final Certificate . Fee Submitted $ ..1.4. •.p4 . Construction on above described building and p r i meets applic kal code and regulations. Applicant. Rev. 70-10-78 n ~3S C7/lo 7/~/~~ C_ O z/~o y6 "OhfME T° c'1ELD iGSYEC:ib~:i IIUnTr. I ~ N ~n ,J m 1 . ~ H _ y FOUt1DATI0N (1st) C~ N FOUNDATI011 (2nd) m 2. o P,OUGH FRAME & v~ PLUMBING F_. N H 3. m ra H I1ISULATIOt! PER N. Y. ' STATE ENERGY CODE x~ A ® ~U' 1 y 4 . --1 FIi1AL o` ADDITIOPJAL COMMENTS: x ' X .o ' H XJ 9 H H F' o ~ z oU _ ~ 1 y M A r . ~ c7 m ^c H ~ ~ ~ 7GS-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. 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Z 5 ~~I= ~ _ ~ J j / , • ~ ~ 1° f1, J SURVEY FOR A/VGELO ACCARDO AT hILI TT/TUCK DATE TowN of sourHOLO SCAL SUFFOLK COUNTY, NEW YORK No. N uwurHOnIZED ALTERATION OR ADDIiION'TO TNIS GUARANTEED 70~ SVRVEY 15 A VIOL ATIOH OF 3E CTION 7204 OF THE CH/CAGO T/T( NEW YONK 5TATC EDUCATION LAW N COPT ES 0+ THIS 5URVFY MOi bEARWG THC LANG A/VERN SUn VE YC1n~S IHNtO SEAL ON ENpOSSEO SEAL SHALL HOi CE COHSIOE RED TO RE A WUD TRUE COPY ~..ff V NGUwN AH TEES INUICA TEO HEREON SHALL NUH LWIY N v,P E ALTM DEPARTMENT-DATA FOR APPROVAL TU CQJSTRUCT THE PEn SDN rOn wHDN THE su RVEr a Pnc PAR EO ~ ~O wND ON n15 bFHALF TO THE TITLE fOMPANV~GOVE1tN- HtARESI WATER ¦AIN _NI _ ,N 30 UHCE Of wATER PRI w+TE _PUbuC _ MENTAL AGE NCV AND LEN OiNG wSTIiUTI OH LISTED %Rr CO iAK MAP OIfT ~_L5EC 710N ire YLOCn LOi HENS d~, AND TO THE ASSION EES OF THE LENDING TMFhY ARE I1C1 DW EL LINOS NITNIN 100 Ft ET OF THIS PNOPFn TY INS TITUTiON GUwHANTf FS AwF NO? n..... (1 c,? ('~(~J'JI~u-~ BOARD OF HEALTH U L 1•/I°,~'9y 3 SETS OF PLANS FORM N0. 1 SURVEY 51~~ TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM BLDG. DEP'T', c TOWN HALL TOWNUfSOUTHOLD .,OUTHOLD,N.Y.11971 NOTIFY TEL.: 765-1802 CALL MAIL T0: Examined • ~~arksA • 1J • • 19 Approved ..~.!'~!!a'>•Q . ~'.1..., 19~~. Permit No. ~ ~ L :$9.~. . Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . ~ v!''. ~...L~..~~., 19 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 fo removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu' code, housing code and regulations, and to admit authorized inspectors on premises and in building for necessary in ct' ns. Sigtlature ofj applicant, o~~``r nom oranon) (Mailing address of applicant) L (9~"Z_ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~~E•.L,1~-:•~•~V~9.,.I~-••"•t.~:~•~•••••••••••••••••••••••••••• (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. • • • Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed(work will ble done . . ~ °YO s O L-; ,a-~-? .1..~.6,.9:~ tYy P.`~ b.) : k tSG.I%; U House Number Street Hamlet County Tax Map No. 1000 Section f 2 Z........... Block 5 Lot ~ , Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .........lL~c b. Intended use and occupancy • ~ / . 3. Nature of work (check which applicable): New Building , . Addition Alteration , . , . Repair oval Demolition Othe~r~!~l 4 , o~a 4.4 ~ . Rem' ( escription) 4. Pstimated Cost ~ "1 S'`". e:d Fee ......~L.~~ . g g (to be paid on filing this application) 5. If dwellin number of dwellin units 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. ~I~mhYsions of existing stru Nures, if any: Front , . Rear . De th , . p „ rpberofStories Dimensions of same structure wjth alterations or additions: Front Rear , , . Depth , .Height Number of Stories . p 9. Size of lot SF onttire l ~ ~ nstruction: Front . Rear De th Height Number of Stories . . ~'~....q.~ Rear ...!:~?o;ao.......... Depth 1.1.`~:Gz.`a.,lo~::-1~... ~ t~.~. 101. 7,one or usecdistrict in which premises are sit • ' ' ' • Name of Former Owner ..~~.4 . uated ..f-2,ES t. ~~.~!`C ti 1,+L . p 13. Will lot be'i•egraded . , , ate any zoning law, ordinance or regulation: ..9..9© . 12. Does pro osed construction viol Will excess fill be removed From premises: Yes No 14. Name of Owner of premises . ...............Address ...................Phone No............... . Name of Architect ................Address ...................Phone No............... . Name of Contractor . . . ......Address .Phone No..... . IS.Is this property located within 100 feet of a tidal wetland? *YES....NO.... *]:f yes, Southold Town Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly ally' 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 ]ot. A ° ~"~l i , STATE: OF NEW YORK, ~ S COUNTY OF . being duty sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the......... ~ (Contractor, agent;eoppl~r~teoffider,ate.)~-•~••~~~~•~•••~~,••~~•~•~••~ of said owner' or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in .khis application are true to the best of Iris knowledge and belief; and that the work will be performed in the manner,set fortft in the application flied therewith: Sworn to before me this ' ~Sr ..,,day of , 19 Notary Public, . , , , , , , , h~?~x! , ° , , ,UU~,Q,.,(/D?-, , County E NOTARY PURL C~Sta a of New York No.4707878,SuflolkCounq ignature of applicant) Tenn Expires March 30,19~~ i