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Home My WebLink About6294-zNO. 4 TOW]q OF SOUTHOLD BUrr.BI]gO DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupency THIS CERTIFIES that the building located at . C~l, d inal. Dz,. &.Bl~mum. Street Map No.l~et~;.,. ][m~;.. Block No ........... Lot No, 3.~- .... ffattituxck.. I~,Yo ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........D. ae...1.~..., 19.7.2. pursuant to which Building Permit No. (~29l+Z.. dated ............. Dec...11~.., 19.7.2., was issued, and conforms to all of the require- ments 02 the applicable provisions of the law. The occupancy for which this certificate is issued is . .Prt.v. ate. ~ne. ~amt~.~ A"relling. w~.th~ an .additiol~ ................. The certificate is issued to . .Cliff. etd. ~ .~leanor..J. ones ..... ~me~s .............. o! the aforesaid building. Suffolk County Department of Health ApProval (owner, lessee or tenant) · .............................. UNDERWRITERS CERTIFICATE No. 1q27870~. .... ApP..t~,...~.~7.~ ................ HOUSE NUMBER.. ~.~ ....... Sff~t ... C~di~l .Dr&~ ................ ~. ..... ~o~ ~ ~tt~ t v - B~d~g Insp~o~ / 1~o~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BI: KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 629~ Z Permission is hereby granted to: ...~;....~. ;~./..~..z~ ......... .~'~.~ ................................ ~....~...~ ....... ~.~..*.-.-..~ .................................. at premises located at ....~,~.~./.~.,~ ............................................................ ~.,9...~.../..~..~...c...:~ ............................................................ ~,...~,..~.~c...~ ....... /~'....5.:z:,,..:~.z-.-......m~..~..z:......~..~:~ ......... ~..~..~....Y./(.~ ........... pursuant to application dated ..................... ~...'~. ........ ~)./.~f--- ...... ,7~.., and approved by the Building Inspector. I~OII~ NO. ~ TOWN OF ~OUTHOLD Building Depo:tment Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 dispcsal--(S-9 form or equal). 3. Approval of electrical installation fmrn Board of Fire Underwriters. 4-Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, 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 os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of eccupancy $1.00 New Building .................... Old or Pre-existing Building .......................... ../~'acant Land ............................ Location Of Property ...,,~.¢..Z~.J.:...(?~.~-.~.-~.....~.......~...~C~r..~.'.~/~...,.~..!~.~i~.~..~~/~C~ ~ner Or ~ners Of Prope~y ....... ~/~-~m4~(...~.~.....~ .......................... Su~ivision ..... ~...~.~/ ................. Lot No..~... Bilk ~L... ......... House No...~.Z~ P~rmit ~o..~2~... ~.te Of P.,~it ~//Y/Z~...App,cont .oa,th .... .......................... Ap, rov. Unde~rite~ Approval ....................... ..~ ........ ~l~.....Planning B~rd ~pr~al ........... ~...~ ................. Request For Tempora~icate ........................................ Final Certificate .......................................... Fee Submitted $ ....~..~ ........................... Construction on above described building and permit meets oil applicqble codes and regulations. Applicant Sworn ,o before me this~' / ............. aayot ...... ~ ~ ~X~ ........................... (,ampor ......... ......... co.. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- *: BUREAU OF ELECTRICITY ~ d ~ BS JOHN STREET, NEW YORK, NEW YORK 10038 N 278704 ~.t~ A~rl I 14, THIS CERTIFIES ·THAT only the ~t~trlcal e~ulpment ~ ~ribed ~low and int~uc~ by the applicant ~med on the abo~ application number in the premises of Clifford ~t. John=s, s/w/cot, Car;Jlnal lit. & t~los~c,m , 0 U t 5 ] d o Section Block Lot in the following lo~ation; ~ Basement wasexan~inedon ~[~r I I I ~ ~ [] lst Fl, [] 2nd FI. and found to be in compfiance with the requirements of this Board. EXHAUST FANS FIXTURES RANGES FIXTURE F[UORESCEhtT OUTLETS DRYERS FURNACE APPLIANCE FEEDERS IME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET 3FHER APPARATUS: OF NEUTRA~ CliffOrd B.Jones s/W/c. Card~&al Drive& Blossom Bend. · Mattltuck Esta'fes, L.I. 17.00 AMOUNT PLEASE REMIT BY CHECK OR MONEY ORDER TO THE ORDER OF THE NEW YORK BOARD OF F RE UNDERWRITERS AS CASH SENT BY MAIL WILL BE A~ ~RISK OF SENDER. 1952 THiS IS YOUR BILL FOR SERVICE RENDERED AND S NOT A CERTIFICATE OF COMPLIANCE TH S B LL PAYABLE AT THE NEW YORK OFFICE, 85 JOHN STREET, NEW YORK, N, Y, 10038 TITLE N0.1270322 Z ut ,34 ~ IVO TE : · = MONUMENT SUBDI VISION MAP FIl ED IN THE OFFICE OF THE Cl £~tq OF SUFFO£1~ ~OUN~Y ON REVISIONS YOUNG & YOUNG 400 OSFRANDER AVENUE, RIVERHEAD. NEW ALDEN W YOUNG HOWARD W, YOUNG SURVEY FOR: CLIFFORD JONES 8~ ELEANOR~,NN JONES LOT :35 "MATTITUCK ESTATES,INC." ~ AT hJl ^ TT ! TI I~ ~ I GUARA.NTEED TO~ TITLE NO. 127¢ ~ot ~5 REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE. RIVERHEAD. ~W YORK ALDEN W. YOUNG I~ti,OV~!~OWARD W. YOUNG SURVEY FOR: CLIFFORD dONES 8~ ELEANOR ~.NN 'JONES LOT :35 "MATTITUCK ESTATES, INC.'" AT [GUARANTEED TO: Examined ......................... .' ............... 19......; '....:' "19....:7.;/ Pemit' No &..~.. ~' Y ~ ~//'? ~' ~T/~ ~ ~pr~ed .......................... ......... , · .................................. /~ ~ ~ppr~ea ale ............................:~ .............................................................. ~.~.?~ ~ ~o ~ ~ Date ................................... ;..., ........ , 19....~.. ,. This ,ppli.tion ~~ filled in by ty~writer or in ink ,.d submi.ed in tripli.te tO the Building 3 ~ts of plans, ~urate plot plnn to scale. Fee n~ording to ~hedule. b. Pict plan showing lo.rich of lot and of buildings on premises, relationship to adjoining premiss or public stF~ ~r eraS, ~ giving a detailed desoription of I~yout of pro~rty must ~ drawn on diagram which is Pa~ of this appli~tion. e. T~ wo~ ~vered by this application may not ~ commen~d before issunn~ of Building Permit. d. U~n 8pprowl of this n~pli~tion, the Building Ins~otor will issue a Building Permit to the appli~nt. ~uch ~rmit.shall be k~ o the premi~s.~v~ilnble for ins~ction throughout the work. e. No building shnll ~ ooeupied or u~d in whole or in p~rt for nny pur~ whatever until a ~ificate of ~oupan~ sh. II h~v~n grnn~ by the Building Ins~ctor. APPLICATION IS HEREBY MADE to the Building Department for the issuan~ of a Building Permit pursuant to the Building Zone Ordinnn~ of th~ Town of ~uthold, ~uffo~k Oounty, New York, and other applicable Laws, Ordinnn~s or Hegulntions, for t~ ~nstru~ion of building, edditions or alterations, or for removal or demolition, ns herein descried. The nppli~nt agrees to ~mply with ,11 ,ppli~ble ordinnn~i, building ~ode, housing code, nnd regulations, and to admit authorized inspe~ors on premiss 8nd in buildings for ne~8~ ins~ions. TOWN OF SOUTHOLD ' , ~'/'~'~ - ~ ~ BUILDING DEPARTMEN'I~¢~'c"/-~~.'~'?-'~ X ~ TOWN CLERK'S OFFICE ~///.~-~ ~ ~ ~7~ ~ ~UTHOLD, N. Y. ~ ~ . ~ ~/ ~ ~ . ~pli¢~hon ~o ................................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ,. ' ' ,' l ' ! / ' * /" ^'' , · :,' . ',/'- If applicant is a corporate, 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 be done. Map No .............. ./..:...;..:~ .................... Lot No...;.:.....~. ............. ~ /~ t~ / / /v /, .' ~ , ~ ' ' i ,', ,, \ Street and Number ....................................................................................................................... , ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex st ng use and occupancy ................. ;.; .......................... .................................. ~...., ............................................. b. Intended use and ' occupancy ....................................................................................................... · 3~n N~"bre of work (check which applicable): New Building ....................... Addmon ..................... Alterat on ............... Repair .................. Removal .............. Demolition ........................ Other Work .................................... .................. (Description) ,/ ~ ~r~ /§- 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 occuoancy, 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 ......................................... ~' Height Number of Storii]s Depth ' · ................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of ct Front ............... ; .......... ?i..~ ..... Rear .................................. ;..;....~epth ......... ~....~..: .............................. 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: ............................................................ Yes ['~ No 13. Will lot be regraded .......... .~.....~.....~... Will ..%e~cess'fill~be remove~d fer,om premises: [.;! ~ ;. 14. Name of Owner of premises ....................................................................................................................................... .~ (Address) (Phone No.) Name of Architect .......................................................................................................................................... (Address) . (Phon,e No.) Name of Contractor .......................................... , ............................................................................................ (Address) (Phone 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 wheth- er interior or corner lot. STATE OF NEW YORK, ~'L ' ~ ~ ~-' COUNTY OF .................................................. .................. ;. ......... ~ ............................................................................ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ................... : ......... :.f.?...!}....ir...:.:..../;'..C...i~../,..,..~ ..................................................................................................................................... {Contractor, 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 application; that ell 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 set forth in the application filed therewith. TERRI LEE ELAK ~ ' tlOTAi~Ya,P.U~lC, State of New ~., ' 19 ..'. .......... ................ ~ ..................... Yl~. 5~6'~69Z9~ ................................... Qualified in Su o k County Notar Pu h Cmnmisson Expires March 30, 1~"/ , x , % y b 'c, . ................................................. ;' ................. County ........................................................................................................... (Signature of applicant}