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Home My WebLink About6719-zTOWN OF SOUTHOLD Blrn.r~n~IC DI~PART~k~IT Town Clerk's Of[ice Southold, N. Y. Certificate Of Occu ncy Z6639 Au{ ~9 No. Date ....... THIS CERTIFIES that the bu~dl,g located at West Creek Ave Street MapNo. xx BlockNo. xx .LotNo. xxx Cutchogue .N.Y. conforms substantially to the Application for Building Permit heretofore filed in th~ office dated ............ .J..ul..y...~..0, 19.7.~.. pursuant to which Build~-g Permit No. $?19Z dated July 10 .,' 19.7.~. was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which th~, certificate is ~sued is Private one family dwelling with an additio.n. The certificate is issued to Edw & Betty Jean Hassildine ~ers (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... pending UNDERWRITERS CERTIFICATE No ............................... :. HOUSE NUMBER .............. S~ree~ ~est reek Ave FOP, Mr 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) Permission is hereby granted to: at premises located at .......................... ,~,,,~.,~......~,/.¥ ......... ,/,,~,,,,,~,.,,cL-- ........................................ pursuant to application dated ................................... ./...~......~..?.../.~..., 19..7~, and approved by the Building Inspector. Fee $...../.,.~,..~... Building Inspector FOE~ NO. $ TOWN OF $OUTHOLD , Building Depo~ment Town C~lerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFICATE OF OCGUPAN¢¥ Instruction8 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 disposol--(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 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: I. 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 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 New BL(ilding ................ Addition ................ Old or Pre-existing Buildin~ .............. · Vacant I~r~l~,,~.. ..... Locaton Of Property ..... ~..~.~ ~{~._~, .~...~.'.,~....?....~..~Of~ ~.~,.~ Subdiv,s,on .......... .............................................. Lot B,ock ....... Health Dept. Approval ......... .~........./r~... ..................... Labor Dept. Approval ................ /...V....~...!..%....~ ............... Underwriters Approval .............................................. Planning Board Approval ..... ....~..~..: Request For Temporary Certificate ........................................ Fined Certificate ....... .r ................................ Fee Submitted $ *~ ~) O Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me ~ ~' (stamp or seal) ~.~/-~ ~ TOWN OF SOUTHOLD ~/'~ '*'/~'~ /'~ ~e ~'~ ~-,.~-- /----~. BUILDI~O DEPA~I:MENT~ ~_~ TOWN CUtK'S omc Approved .......................... i ...... ~ ...... , 19 ........ Permit No ..................................... Disapproved o/c ..................... :..; .................................................. ~ ~___. ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................................................ , 19..;..... ..... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocatl0n of lot and of bui~ingS on premises, relations~.ip t,o. adjoinin, g p. remises or. .public st..reets os areas, and giving a detailed description of layout otproperty must be drawn on the aiagram which is'part aT mis application. 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 issue a Building Permit to the applicaat. 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 buildings for inspections. ............ ;.:....~ ...... , ................... ~.~.~ ............... ~.../. ......... .~..~. ......... · ~ ~'~ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of ' ' premises ....................................................... , ............................................................................................ If applicant is a corporate, signature of duly authorized offtCer. (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 ....................... Street and Number ........................................ ~ .............................. ~. ........................................................ : ........... /~~ Municipahty 2. 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 v/ Repair .................. Removal .................. Demolition .................... Other Work ...................................................... /~;/ 0OO /-~ ~ (Description) 4. Estimated Cost ............................ .,~ ............................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwel units /f Number of dwelling units on each floor If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, sp~/t n~t~'e and extent of ~chstype 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 .~.~-,.~.3...'~. ............. Depth ......... .//...L...~.. ......... Height ........ ~...~.~. ........... Number of Stories ............~ ............. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...~ ......................................................................................... ~4~c.....~. ......... Size of lot: Front ............................... ~....,....~... .......... Rear .......................................... Depth ....~....12.......~. ............ Date of Purchase .......... ' ........................ ~. ..................... Name of Former Owner ................................................. Zone or use district in which premises are situated ...................... ./~----~..~. ................ ~ ............................................... Does proposed construction violate any zoning law, ordinance or regulation: .......... ~ ................................. Will lot be regraded ............. ~ ....... Will excess fill_be re.rn~oved from pre.~ises:,( ) Yes Name of Owner of premises ........ .~. ......................................... Address ................................ Phone No ............... , ....... 10. 11. 12. 14. Name of Architect .............................................................. Address ................................ Phone 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 whether interior or corner lot. STATE OF NEW YORK,'"' ~ COUNT~ Of ................................ ~'~'~ H~"--ff r /'J /q.~ l L ~ I ~L ~ .... ben ....................................................................................... g duly sworn, d~oses ond says t~t he is the opplicom (~ome of individuol signing contrec~ above ...................... ............................................................................................................ He is the (Contractor, agent, co~orote officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all statements-contained in this application are tree to ~e best of his knowledge and belief; and that the work will be performed in the manner set fo~h in t~e application filed therewith. Swam to bef~e me this ~L ................ L.~. ~ay of ................................ ........ ............ co. .... ................................... (Signature of applicant) TERRI LEE ~OTARY PUBLIC, Stata of New No. 52-6~68295 ~ualifm~ in Suffotk County ~m~s[oB Expires March 30, [9 THIS D~A'G .......T TO F;~CTS AI'iD DATA SHOWN BY REAL SURVEY, _L ARCHITECT MATTITUCK. N.Y. 298 - 4883 - RIVERHEAD, N.Y. 727 - 8245 PLAN NO:. ~/~ ,,~¢ t:. ',' ' :-~ ;-, ~ 5 OF SCALE: ~"-- ILo" DATE ~Tuu~- I1 STRUCTURE ONLY. USE OF THESE PLANS FOR ANY ADDI- TIONAL STRUCTURE WITHOUT THE WRITTEN APPROVAL OF THE ARCHITECT, WILL THEREBY TRANSFER ALL RESPONS- IBILITY FOR THEIR USE TO THE USER AND THE AUTHORITY ACCEPTING THEM.*' ARCHITECT MATTITUCK, N.Y. 298 - 4883 ' RIVERHEAD, N,Y. 727 - 8245 Pl..AN ~0. ~'~- 4~,~C, ~ " ¢~ OF T $CALE:~ ~ .,I ~- DATE ~u~J~ "THESE PLANS ARE FOR THE CONSTRUCTION OF A SINGLE STRUCTURE ONLY. USE OF THESE PLANS FOR ANY ADDI- TIONAL STRUCTURE WITHOUT THE WRITTEN APPROVAL OF THE ARCHITECT, WILL THEREBY TRANSFER ALL RESPONS- IBILITY FOR THEIR USE TO THE USER AND THE AUTHORITY ACCEPTING THEM." ARCHITECT MATTITUCK, N.Y. 298 - 4883 - RIVERHEACi, N.Y. 727 - 8245 "THESE PLANS ARE FOR THE CONSTRUCTION OF A SINGLE STRUCTURE ONLY. USE OF THESE PLANS FOR ANY AODl~ TIONAL STRUCTURE WITHOUT THE WRITTEN APPROVAL OF THE ARCHITECT, WILL THEREBY TRANSFER ALL RESPONS- IBILITY FOR THEIR USE TO THE USER AND THE AUTHORITY ACCEPTING THEM." , ' '~1 /.~ , ' '~- l[ ' "u ~ ~ ~ ~ ' ~ Ill ~11/ ~ I ~" ~"~' ~ J ~' ~ : ~ "~' T i , , :. , L~jO-b _ , ~L~ ~ ~.~. ,, .. . .. , ,, ,~,,,,~. , ,,,,~ ....~ ~ -,, ~ ,~.~,~? ,~~l~ .... ,-~: r- ' - - t- ~ ~ .... ~ .... T' ' ' 'v: itL,'- , ' ,o~ ARCHITECT ~ i~ ~ -- , ........ I , I I ~ ~ { ~~~. ~ I . I ~.ucru~ o.~v. use oF rH~s~ .~A~s FO~ ~Y ~..i- I