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HomeMy WebLinkAbout5922-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z..~.7.O. ..... Date ............. ~....1.? ......, 19..7.7. THIS CERTIFIES that the building located at .~.~.~. · .AYe. ~ .~l~f~ .D~treet Map No. ~ .......... Block No.~ ........ Lot No, ~... ~$$~k. · ~*~ ......... conforms substantially to the Application for B~ding Permit heretofore filed in ~s office dated ............J~9 .. $.., 19 .~2. p=suant to which B~ld~g Pemit No..~. dated ............~...2..., 19.7~., was issued, ~d confoms to ~ of ~e ~ ments of the applicable pro~sions of the law. The occup~cy for wMch ~s cemificate ~ issued is .~9..~%~. ~'~$~g w~. a~ ............................... The certificate is issued to ~ .~. CharlR~9.. ~gkgrP.q~ ..... ~ ......... (owner, lessee or ten,t) of ~e Moresaid building. S~olk County Dep~tment of Heal~ Approval . .N ~R.~ ............................. UNDERWRITERS CERTIFICATE No..[$~?~. · · ~er...1.~., ................ HOUSE NUMBER .. ~...~. Street ... ~. ~ ........... ~$~ ...... 1~0 Wo~cl~ff DF ........ Bffilding inspee~ { FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5922 Z Permission is hereby granted to: ... ~ ~.~..~..~,.~..~.o~ ........................................ ............. I~.t,t ~.t~ ............................................. to ...... Jm~d..~u..a~d~t~e~..e~..~t~..d~13~l~ .......................................................... at premises located at ........~/.~..~tl~ll~],..~i.V~.-&..~(~e,l.~.~..~tB. ................................................ ................................................ ~1~t.¢,$*.~1~ ......................................................................................... pursuant to application dated .......................~.l~.tJ......~ ................ , 19....~J~ and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD , Building Deper~ment 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 DUPLICATE 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 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 installations, a certificate of Code compliance fram 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 end 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ............... ...... ....................... New Bc~ilding ................ Addition ......~.. ....... Old or Pre-existing Building ................ V~acorlt l-and .............. Location Of Property '-Z,~ ~' ~A~ .~. ~ c(~ ~. ~'"/~' '~'~' ~"~'~ L f~ ,..~.. ................ Owner Or Owners Of Property ......... .~..~.~,~...!~.~....~.........'.~..~,~.~. ~,......~.~-.~..~-.~..~.~ ................................. Subdivision ................. ............................................ ,at No....: ....... B,o k ........ House Permit No. ~.C~..~...~.....~.... Date Of Permit ....~ ti.~..l..~...'~...Applicant ....... ..~.~ ......~.. ...... ~). ~% ..~..~. ~ Health Dept. Approval .............. -.~..:..~.?. ................... labor Dept. Approval .... .~...' \~' ' ........ Underwriters Approval .......... ~.. ....... .~.....~ ................. Planning Boord Approvol .......... ~ ........ · ..................... Request For Tempora~,~Certificote ........................................ Fin~ Certificate ..... .X .................................. Fee Submitted $ ..... ~.~.~. ....................... Construction on above described building and perr~i~t'~eets a. II al~plic~able codes and regulations. App,icant ................. .............. .. ..................... /// ? ? Sworn to beforemeth~ ~ ~.../../~.1 THE NEW YORK BOARD OF FIRE UNDERWRITERS 85 JOHN STREET, NEW YORK, NEW YORK 10038 /},,,. ~farch 17, 1976 8454]3 .~llen Dickenson, Grand Avenue ~?oodcliff ~rive, ~:actituck, i,.I. ...... ~ ....... ,,.,t .... ~Iarcb. 15, 1.976 .... l~o.ndto~r,,.o.,i~li,,,~ceu,ithth~.retl~i ......... tr~,,~'thi..lt,mrd. FIXTURE FIXTURES RANGES ¢~KING DECKS OVENS DISH ORYE~ ~RNACE MOTORS ] FU~PPUA~E 'PT TiME CLOCKS BELL UNIT U~AT~RS MUL/I-~ILEI I j ~ ' ~ . 6 Recp.. froward Dillingham Box 148 ~?oodcliff Ave. ?dattituck, L.I. 11952 I,I C # ~ 756 GENEIAL MANAGER TOWN OF SOUTHOLD. ~.-_...~--~/'/~'(' ~ /~¢ ~ ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE'S_ ~'"~'~_ / E×om~,,ed ..... ~ ............ , ,gZk ,~ppllcofion No ................................. Approved ,t '~ ? ~ .,_,~....~. ~ ~ ~ '~g"~ ~-'~'~ ........................................ , ........ .mi No ................................... ,so ro ed o/c ......................... ......................... ·: ................ APPLiCATiON FOR BUiLDiNG pERMiT< ~'~/7~C0 '~''~ ~.i~'~ ~ote ................................................ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspact~ith.~ 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 diagram which is part of this c. The work covered IJy this application may not be commenced before issuance of Building Permit.application. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be k on~, the premises available for inspection throughout the work. e. No-buildin~ shall be bccupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have beenl 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, Suffoik 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Graud Ave, Matt~t~ck, NY (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner ~ Name of owner of premises Same . If applicant is a corporate, signature of duly authorized officer. Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. S/W Corner Gramd Ave & Woodcliff Dr., Mattutuck, NY Street and Number Mumcipality[~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: One family residence a. Existing use and occupancy b. Intended use and occupancy ............... QTL.e...,~.~[~L~r...~..e..R~.~.e.~g..e. ................................................................... .~, I~la~t'u~e o~ work (check which applicable): New Building .......................Addition ...... ...Z~. ......... Alteratmn......~ ........ Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... {Description) 4. Estimated Cost ............ ..~. ?..0..O...O..., ..................... Fee ............................ .3:..5. ,., ............................................................... (to be paid on filing this application) uni - One 5. If dwelling, number of dwelling t~ ................. Number of dwelling units on each floor ....... .O.~..e. ........................... 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 structurgs, if any: Front ....... ~.0. .......... Rear .......... ~ ............. Depth ......~ ........................ Height .............. .]:.....S.~,o.~ ............. ' ................ Number of Stories ...........QA9 ............................................................ Dimensions of same structure with alterations or additions: Front ............ 2.©. .......... Rear ......... ~..~. ........................... Depth ..................... .5..0. ................... Height .............. ~....S...tt.°..~ ........... Number of Stories ............. .0.~.e. .................... 8. Dimensions of entire new construction: Front ............... : ......... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ............... ~.0..0. ................. Rear ................. ,Z,,~.Q .................. Depth ........ ~..ZiQ ................................... Height .......................... :. ........................ Number of Stories ...................................................................................... 10. Date of Purchase ............ .3:. .?. .5. ~ ................ Name of Former Owner ...... .[~.~.~.,o..~. ....... ..~..~..,o.a... ....................................... 11. Zone or use district in which premises are situated .............. ,R.?..s...Z..~...e..~.,t...~..a:..1. ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... .~...e. ............................................ 13. Will lot be regraded ............................. Will excess fill be removed from premises: [ ] Yes [~] No 14. Name of Owner of premises Allan & Charlotte Dlcker~on Grand Ave, Matt. 298-~956 (Address) (Phone No.) Name of Architect ~am® (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prop4sed, and indicate all set-back dime property lines. Give street and block number or description according to de~d, and show street names and indi er interior or corner lot. OF NEW Y( SS COUNTY OF ............................... ,sions from ~te wheth- being duly sworn, deposes and says that he is the applicant above named. (Name of indieidual signing contract] He is the ............................. ~ ............................................................................................................................................................... (Contractor, agent, corporate offtcer, 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 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 set forth in the application filed therewith. ...................... ~_~.._da.y/"~f ~'~,.'~' .... 19 ..,.~...~.... ~ ..... ~ ~ no. ~'~~ :, (Signature of applicant}