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Home My WebLink About7606-zFOILM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z6.~.2.~. ...... Date Feb ~ 19.7.? THIS CERTIFIES that the building located at ...... S~.l~llby. RO&5 ......... Street Ma~ ~,~ ~ · Pk. p ~- ............. ~r~ No ........... Lot No.. ..... ~.gtlt~*.k.. ~,... confoms subst~tially to the Application for B~ld~g Permit heretofore ffl~ ~ ~ office dated ........... ~t.. 28.., 19~.~. p~su~t to w~ch Buil~g Permit No. dated .......... ~.~.. 2~ .... , 19.2~., was issued, ~d conforms to ~ of the req~ ments of ~e applicable pro~sio~ of the law. The occup~cy for which ~s ce~fficate is issued is ~r~e. o~,. f~y. ~we~g .v~h .~..~dd$.~o~ ................... The ee~ificate is ~su~ to . ~sr~ .~ ...... ~er ............................. (owner, lessee or ten~t) of ~e afores~d b~ld~g. S~olk Co~ty Dep~ment of He~th Approval ...N.R, ............................ HOUSE NUMBER ..... ~0~ ~ .... Street .~gg~. ~ ............................ lei)BM NO. ~' TOWN OF Sou'rHOLD BUILDING DBPARTMBNT TOWN ~L.ERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT .......... FI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COAAPLETION OF: THE WORK AUTHORIZED) 7606 Z Permission is hereby granted to: ........ ~........~..:..C...u..~.~.-- ............................. .. to ...A.....P.. ........ ~. ................ ......~ ......... ~P....~ ......... £ .~....~.././,., .......... /)J~.~Z.~/..i~ ........... at premises located at ............................... ~.{.~..5..~.~.~. ......~.~....~... ........................................... .............................................. ~ .............................. ~e..~/..z.~.~.,.(. ........ ./...x~.u.~:~....~....~.:.~ %,._ pursuant, to application d~ted .............................. ..~....~........~...~....~...., 1~'...~..., and approved by the Building InspeCtor. F. $?.~. .................. PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSI~)OL CONS[RUCTION CELLAR CONSTRUCTION ~ J OTHER I Building Inspector 0 Approved .................. ~~,,-........IQ7C/' Permit No .................................... Disapproved a/c .............~...~.!~ .......................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT(/' ,-~/.~/~ ~ TOWN CLERK'S OFFICE ~U~OLD, N. Y. (Building Insl:~tor) APPLICATION FOR BUILDING PERMIT Date .......... : ..................................... , ~9 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plo.ns, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on prem ses, re ationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this 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 applicant. Such permit shall be kept on the premises available for inspection throughout the work. shalle' haveN° buildingbeen grantedShall bybe the°CCupiedBuilding°r usedlnspector.in whole or in part for any purpose whatever until a Certificate of Occupancy Builder's License No. ~, ................................ Plumber's License No ........ Electrician's License No. ~...7..~.....~'... ........... 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 necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ Name of owner of premises .......... ' .............................. ~ .... if applicant is a corporate, signature of duly authorized officer. ~ Other Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: ~'~- ~'o~7/ Lot No.......~...r.~.....~...~...~.. Street and Number ..................... ~~,~~...~...~...~....~ ................. ~ ~nunicipa ity State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ~ ......... ~ ...... b. Intended use and oCcupancy ......... ~ ........ ,i~~ ~. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior ..................... Other Work ..................................................... )~ ..~..l.~.... (Description) 4. Estimated Cost .... Y~....~...~...:...~... ............................... 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 ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ............... ~ .................................. 13. Will lot be regraded .....~? ............... Will excess fill be removed fronm.pre, mise~s: (l~Yes ( ) No . r/[~r~...~ Phone 14. Name of Owner of premises ..~.~.~...~.~..-m. ........ Add ess~ ..... Name of Architect ...... .~ .................................... Address ................................ Phone No ....................... Name of Contractor ........=..-.....~...'.~ ....... Add es ......... 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, ~ ¢ ¢ COUNTY OF ............................... ...... ~~.....~..~ ............................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above no'med. He is the ........................................... ~ .................................................................................................. (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 all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn t~efore me this ,- ~ Notary Pub lc,. ........ ~ .......... County ............ .~.~.~,.~.......~'~'~ .............. /~ ~ , "~' ............ ~ ..... (Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 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: ]. 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 Date ....~...~..~Z..../~ :.~......~......../.. ~. ,/.- New Building ................ Addition...Z'~ ............. Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~~..~.....~:~ "'~""~~"~7 Owner Or Owners Of ap rty ........... ?'~'"~f"~"r~ ................................................. Subdivision ................................................................ Lot No..~....~.... Block No ............. House No ............. Pe Fruit No. Zf~ ~..'~.... Date Of Permit Z(.~..~./~ .~..Applicont Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempo~'~ry~,.~,Certificate ........................................ Final Certificate ...~ Fee Submitted $ .....--~,:...~....:..(...L~.. .............. Sworn t~efore me this (-~-~,~,_~_ / < ...... ~ ........ day of .[~.~.~..~ .......... Nt ~ o a~ Public ..~.~ ........ County Construction on above described building and permit meets all applicable codes and regulations. Applicant ~./. ~,..~.¥,~... .¢ .............................. (stamp or seal) : -,,II f :oo CNr'J ~ot 86 Lo~ 05 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7~09 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND 8URV£YOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COP~ GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED~ AND ON HiS BEHALF TO TH£ TITLE COMPANy, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LrSTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL REVISIONS ~OTE~ o .~ PIPE- SUBDIVISION MAPPILE-D IN TNE- OFFICE OF THE' CI EBK OFEU~O ~K COUNT Y ON dAN. I~ 1926 AS FIL~N~ ~01. YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG LAND SURVEYOR SURVEY FOR: JEROME GUTH LO T NOS. B 4 ~ 85 ," MA TTITUCK P,~RK PROPERTIES, INC." ^ T MA TTITUCK TOWN O~ $OUTHOLD SUFFOLK CO., N.Y. GUARANTEED TO: la' ~-AsT ~" PC F'Lo°[ NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM TO 4PM FOP,, REQUIR. ~D INSPECT ONS: i BEFORE BACKFILLING FOUNDA. ?ION OR START FRAMING .:- BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMFL[-TED ,OT RESPONSIBLE FOR DESIGN OR CON- ~ouTH