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Home My WebLink About23504-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25219 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 6500 NEW SUFFOLK AVE. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 15 Lot 01 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1996 pursuant to which Building Permit No. 23504-Z dated JUNE 14, 1996 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 ABOVE GROUND SWIMMING POOL AS APPLIED FOR. The certificate is issued to DONNA L. BREITENBACH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS 'CERTIFICATE NO. N-363091 - SEPTEMBER 8, 1995 PLUMBERS CERTIFICATION DATED N/A Pfiilding Inspector Rev. 1/S1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25220 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 6500 NEW SUFFOLK AVE. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 15 Lot 01 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1996 pursuant to which Building Permit No. 23504-Z dated JUNE 14, 1996 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 ATTACHED ACCESSORY DECK TO ABOVE GROUND SWIMMING POOL. The certificate is issued to DONNA L. BREITENBACH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-363091 - SEPTEMBER 8, 1995 PLUMBERS CERTIFICATION DATED N/A �uil ing Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25221 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 6500 NEW SUFFOLK AVE. MATTITUCR, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 15 Lot 01 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1996 pursuant to which Building Permit No. 23504-Z dated JUNE 14, 1996 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 STORAGE SHED AS APPLIED FOR. The certificate is issued to DONNA L. BREITENBACH (owner) of- the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bidldi Inspector Rev. 1/81 FORM NO. f 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° 23504 Z Date ............... ../..��..�......................, 19. Y Permission is hereby granted to: ,Q .. r . .�9..... /:...i........ �;✓.6........................ ...65 .....�✓�.✓..... ....... : :.. to .4 f, ._ ;..... :✓..... ✓ .... ..f.}...... �T?C ....................... ....... ....... -. �.......� ✓�......... ..... ......... .. ................................................................//..... at premises located at .......fP�?.::"..........'' :.�.......v`r. ...... :.................................... ........................................................................... ..- . ........................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section .. .� .......... Block .....�J..�.......... Lot No. ...®/............ pursuant to application dated .......Oe ... ........11-7.................... 19./.J , and approved by the Building Inspector. �w Fee S. '10. i 3 c o�S ..................................... wilding Inspector Rev. 6/30/80 RR Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT JUL 3 0 TOWN HALL 765-1802 1 r BLDG.DEFT. 'ter.; PLICATION FOR.CERTIFICATE" OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-al form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of l% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '-'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - .25V, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . .n.I�,.1.� . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . .✓. . Old Or Pre-existing Building. . . . . . . . . . . . . AJz- Location of Property. . .°. . . . . . . . .. . j�X-. . . . . . . . . . . . . . . . . . . . . . . Q: . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. RI... L-; L'A- o, & . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . County Tax Map No 1000, Section. . . ./.I.,5 . . . . . .Block. . . 1-5 . . . . . . . . . .Lot. . J. . . . . . . . . . . . . . . . . . . Subdivision.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . .y. . . . . . . . .,. .I. . . . . . Permit No. f'1 �.L . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . .. . . . .�.. .. ' . . . . HealthDept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . .. . . . . . . . . . . .. . .. . . . . . . .. s 3 3?jam APPLI ANT. R M O L5 U T014N OF SOUTHOLD BUILDING DEPARTMENT JUL 0 I�97 TOWN HALL 765-1802 BLDG. DEPT, 411 TQWN OFSOUTHO APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees L. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling S25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy .25'o�. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . .�.(:?�?Ial . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . Old Or Pre-existing Building. . . . . . . . . . . . . . Location of Property. A!a . .Na. . . . . . . . . . ._. .�. . . . . . . . . . . . . . . . . . . . .PAar J�: . . . . . . . . . . . . . . . . . . House No. II } Street . .Hamlet Onwer or Owners of Property. �t}�\.. . .. . . . . . . . . ., �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . .{.�. .f.�. . . . . on Permit No. .� 5�.1 . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. 31). ^.`.". . . . ..�(.. . `.L�I!`1'�0� Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . .. X. . . . . . . . . . . . . . . . . . . . . ��ssnn . . . . . . . .U1 �.. . . . . . .. .. . . . . . . . . . . . . . . . APPLI Cd ��o�a l D l5 l5 U L5 TOWN OF SOUTHOLD BUILDING DEPARTMENT i j TON HAL L ,j Q me 0 . 765-1802L ,' BLDG. DEPT. i TOWN OFS UTHOL ' APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50iOO. 2. Certificate of Occupancy on Pre-existing Buildiniz - $100.00 3. Copy of Certificate of Occupancy - .25y,1• 4. Updated Certificate of Occupancy - $50.00 D. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 // Date . . . . .�.I `� . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . .✓ &CIL Old Or Pre-existing Building. . . . . . . . . . .(. . . . Location of Property. . �Ebb . .(.¢<.J ,�t. .��: . . . . . . . . . . . . . . . . . r�R . . . . . . . . . . . . . . . . . . House No. I Street . .Hamlet Onwer or Owners of Property. . .1/.Q(\�\¢: . L . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . -Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . Permit No. .� . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . :. .n . ..`. . ..:. .. :` '.d� Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . 61,QC• .s 333�2 APPLIdQf. . . . . . . . . . . . . . . . . . . . . . ao _ .. THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 2 1001567 BUREAU OF ELECTRICITY F— 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date SEPTEMBER 08,1995 Application No.on file 10027795/95 N 363091 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of DONNE L. BREITERBACH, 6500 NEW eSUFFOIX AVENUE, WITTITUCK, N.Y. in the following location; ❑ Basement ❑ 1st Ft. ❑ 2nd Ft. OUT .Section Block Lot was examined on SEPTEMBER 05,1995 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. I K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1-0 YW 10 3W 3 0 3W 3,B'4W NO.OF CC.COND. A.W.G. NO.OF HIAEG A.W G. NO.OF NEUTRALS A.W.G. EQUIP. PER AY OF CC.COND. OF HIAEG OF NEUTRAL OTHER APPARATUS: THOMAS 14ADONI:A LIC.##1905—E RR1 40 TANAGER LANE WATER MTI�L, NY, 11976 GENERAL MANAGER 11 _ Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT: THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1001567 BUREAU OF ELECTRICITY F_ 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date S ,PTE11BER 08,1995 Application No.on file 10027795/95 N 363091 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of BONNE L. EREITERBACH, 6500 NEW SUFFOLK AVENUE, 14ATTITUCK, N.Y. in thefollowinq location; ❑ Basement ❑ 1st Ff. ❑ 2nd Fl. OUT Section Block Lot was examined on SEPTE11BER 05,1995 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AM/P. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS 1 0 SERVICE DISCONNECT NO.OF S E R V I C E AMT AMP TYPE METER EQUIP 4W 1.B•3W 3 0 3W 3,0'4W NO.OF CC.COND. A.W.G. NO.OF HI•LEG A.W G. NO.OF NEUTRALS A.W.G. EQUIP. PER 0 OF CC.COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: SWfPVING POOL,-1 G.F.C.1.-1 "(SWIP�ZT_NG POOL,) This certificate covers compliance at the cute of inspection only. Because of unusual environments it is advisable to lave frequent test/and or repairs made by a qualified person. p <<< Continued on Page 2 >>> GENERAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MIDST NOT BE ALTERED IN ANY MANNER. �OSpFFO(,�co 0�0 Gyp W 2 Town Hall,53095 Main Road IS • Fax (516)765-1823 P. O. Box 1179 A Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 12, 1997 Donna Breitenbach 6500 New Suffolk Ave. Mattituck, N.Y. 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy -is not on file. (Enclosed) XX No Underwriters Certificate on file. XX The check is (not on file. ) $75.00* No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23504-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. *THREE CO'S REQUIRED - 1 FOR A/G POOL - 1 FOR ATTACHED ACCY DECK & 1 FOR ACCY SHED ui�DiNc u�r. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]�INULATION ( ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: wc Z�L � c DATE INSPECTO �^'� 765-1802 -� BUILDING DEPT. SPECTION [ FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE k7l INSPECTOR ~ ` � / �---_-_-'--_____----__' - --' -�-�-'--�---__ -- U ----_--'--_ - -_-_-_- [j MP ADDITIONAL COMIRIM" I .............. -� -__-�_-'-----'- -_ -' '. . ''... -' .. ......... - -- '--'--�-----''- ' - � - ' ��'---'-'------' �] . �--_-- ' -�'-- � o 1 9nd --- //�. s • SE1' ®7 1995 t t ` JiV4 ti L/A/G — k'sl OD y 0 -� -T Yh I! q el d y N ,, Lrl C�- NSA • b 55" U -tt �" �� , I I I A I • I I , t i j I�T-i i I i Ii - : I ' i I : I : i I : I I • I I I I L I ! I I 1 , I I , I � ,• I : I i I : ! ' I ' I i � i I I � ! • 1 Pj--- II� --------------- - I , - I : J .1 Sin! IT-V L 6 wo 9A—4 s4- ----------------- L. --J LC- 41 ' 0 7"cr �1 beck Q n - . V cr— ON -- F - '!`4(/ i _ r� - _ nv,Q,,,,�,��..•_�...-.4-�^--�x`� .. �.....a�yc. .-.., s,.- -�.......�..�,rt�...s.-,-..�.'«..,,�...:m-� '"mow — y . o�oS�FFo�,�eo y. G cc Z Town Hall, 53095 Main Road ro • Fax (516)765-1823 P. 0. Box 1179 44 o Telephone (516)765-1802 Southold, New York 11971 �j �►� OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 29, 1996 Ms . Donna Breitenbach 6500 New Suffolk. Ave. ,, ' Mattituck, N.Y. Re: Building Permit Applications for Accessory Shed, Above Ground Swimming Pool & Deck around pool Suff. Co. Tax Map #1000-115-15-1 Dear Ms . Breitenbach: As .per, our telephone conservation today, I am returning your original building permit application and checks so that you can include the construction of a deck around the pool . Please resubmit the application with 3 sets of construction plans for the shed & for the deck. 'We will need new checks - $50 .00 for the pool, $35 .00 for accessory shed, and the 'fee for the deck is $35 . 00 for up to 500 square feet, and $ .20 for each additional sq. foot. ,(See attached copy of fee schedule) If you have any questions, please do not hesitate to call me. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Georgia Rudder, Secretary encls . - Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT AUG 1 TOWN HALL O Lqq 765-1802 APPLICATION FOR CERTIFICATE OF, OCCUPANCY - - -•• A. This application must be filled in by typewriter OR ink and submitted to the building inspector with' the- following: for new build'ng 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. Appraval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of :electrical installation from Board of Fire Underwriters.. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1•7. lead.. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate -of Code Compliance from architect or engineer. responsible .for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings- (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines-, streets, building and- unusual natural or, topographic features. 2. A properly completed application and a consent to .inspect signed by;; the applicant.If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in'writing to the applicant.. C. Fees 1 . Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate. of Occupancy - $50.00 5. Temporary Certificate of Occupancy- Residential $15.00., Commercial $15.00 Date 1$1*s. . . . . ... . . . . . .. . . . . . . . . . . . . . . 'few Construction. ... , .. ... . . . Old.'Or Pre-existing Building. Location of Property. . . . . . . �.. . . . . � 'NL�It. . . .. . ... . . . . . . ... . . . . . . . . . . . . .. House No. • . ff Street Hamlet )nwer or Owners of Property. :. �Dn�1Gt. . ."' . &,u+e1.b&A . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . r No 000, section,ounty Tax Map . . . . . . 1 . . . . . .Lot. . �. . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . .Fi.l.ed Map. . . . . . . . . . . .Lot. . . . . . . . .Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . .Appli errnit No. . . . . . . . . . . . :Date Of Permit cant .. . . . f.. . . L��`�f"� � l lealth Dept_ Approval_.. . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. , . . . . . . . . . . . . . . . . . . . 'lanning Board Approval. . . . . . . . . . �' tP tequest for: Temporary-Certificate. . . . . . . . . . . Final Certicate. . . . . . . ...... SEP _ .7 ee Submitted: $ v:,D.� . . . . . . . . . . . . . ' '' - 71995 . . . . . . . . . . . . . . . . . . . . . . . . . . . .-.. -__-_.. ...i,. . . . . BOARD OF HEALTH . . FORM NO. 1 / 3 SETS OF PLANS . • . . • . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT ;/SEPTI /cttect: . . . . . . _ _ . . . . . , . , _ ( TOWN HALL C FORK _ SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:OT I Fl` o r.. CALL Examined,— . / r/ . . . Approved . . . .� 19/f/Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Bu' ins, nspec APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . ., 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.' Upori 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,liuilding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have lieen'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'cbnstru,ction,of buildings, additions'or alterations, or for removal or demolition, as herein described. The=,ant.agrees to.comply.withall applicable laws, ordinances, building code, housing code, and regulations, and to admrized irispectors;on premises and in building for necessary insOe t . '° 0+ (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. V WxLr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . ... . . . . . . . . . . . . . . . . . . . .'. ... . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . `. . . —`{-zs bn the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer.' (Name and title of corporate officer) gad Builder's License No. iMAY`1795 Plumber's License No. . . • . . . • . , BLDG. P-FPT.-_- Electrician's License No. . . . . . . . . . . . . . . . TOWN OF SOUTHOLD� _ Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . l, Location of land on which proposed work will be done. . • : . . . . . . . . . . . . . . . . S 'D 0 . . . . . .0 . . . .5. .� . . . -. . . . . . . . . . . .M A -. . : . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section Block . . �./ . . . . . . . . : . . . 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 S`nt��t , • ,� 1✓�! . , , , , , • . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . .�l,R . . •�tol , , W� DD�1� . ��c� bD� -3. Nature of work (check which applicable): New Building . . . . . . . . . ; Addition . .Paa I . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition Other Work . . . . . . . . . . . . . . . G D (Description) 4. Estimated Cost . . . . . . . !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, 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 type of use 7. Dimensions of existing structures, if any: Front . . . . . ; . . . . . . . Rear Depth Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Rear Depth . . . . Height . . . . . . . . . . : Number of Stories . . . . . . . . .. 8.' Dimensions of entire new construction: Front . . . . . . Rear Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories 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 regulation: 13.' Will lot be regraded _ �• . . . " " "•removed-from'" " " ' ' " " " ` " " " • Will excess fill be premises: Yes No 14. Name of Owner of premises �,vcv.a• �4 Address �451�-•,:tJL &44 :1'}ione No. . ��:`Ea�U. Name of Architect . . - - --- -- Address r:•..;.` ' ; ..::. . Phone No. Name of Contractor Address ?y �' �i '::phone No. 15. Is this property within 300 feet of a tidal wetland? � No *yes. . . . . . . . *If yes,- Southold Town Trustees Permit maybe required. ' 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. APPROVED AS(NOTED DATE: B.P.# f � FEE:y �i BY: / NOTIFY BUILDING DEPARTMEN AT 766-1802 9 AM TO 4 PM .FOR THE FOLLOWING.INSPECTIONS: 1. FOUNDATION - TWO REQU RED FOR POURED CONCRETE 2. -ROUGH - FRAMING & PLUM ING 3. INSULATION 4. FINAL - CONSTRUCTION M ST ., BE COMPLETE FOR C.O. ALL CONSTRUCTION. SHALL M ET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENE GY CODES. NOT RESPONSIBLE qOR DESIGN OR CONSTRUCTION ERR RS Adz- 193fbto TATE OP NEW YE�Rk,. S.S 'OUNTY OF C.". b • • • • • • • . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) Jove named. eisthe . ... . ... .. . . . . . . . . . . . . . . . . . . . . . . . . ... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this +plication; that all statements contained in this'application are true to. the best of his knowledge and belief;and that the irk will be performed in the manner set forth in the application filed therewith. =vorn to before me this _ . . . . . . . . .7. . . . .day of. . .U.U.u's. . . . . . .. 19q.5 � �:v"l . .S .Tr. =otar$� Public, . . . . u ° County �nffony t: LaNtagria. � . . . . . . . . . . Notary Public, State of New York ' No. 54- 4617184, Suffolk County (Signature of applicant) Commission Expires _ 8 3 9 5 i/�^w ' 3 O I, ry � D C 1 T V ; r e c� g 5 t ru/I C,0 r j __ �1 ��. VIF.h ► �� iJ� 1�1�W - le