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Home My WebLink About8959-zTOWN OF S~UTHOLD BUILDING DEPARTMENT Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy No. Z76~3 Date .ff~..~...1.~. ...., lg. 7.7. ............ . (lta~at.ers aoad THIS CERTIFIES that the building located at .. ~.~ .~.~. ~... Street Map No. FiSh~ ~o ........... Lot No, ~ ~ .... ~guo ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~V. ~ 2 ..... , 19.~6. pursuant to which Building Permit No.89.~gZ... dated ............ ~gY...~..., 19. ~., was issued, and conforms to all of the req~e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr. ivata .one..fami~ .dwelling.. ~gVe~..$9. ~. !~q~ .......... The certificate is issued to ...~l..ti~..~O~t~O~ ..... ~l ....................... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval ~. ,~X!~ ........ '...: ........ UNDERWRITERS CERTIFICATE No. ~r. ~lS~!~g ............................. }lOUSE NUMBER ..... l l~ .... Street .. Pi. Sh~. ~oh..~oad. .............. TOWN OF SGUTHOLD BUILDING DEPARTMENT TOWN CLERK's OFFICE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8959 Z Date November 12 19 '"/6 Permission is hereby granted to: Mattituck Move existi~[: at premises located at ..... ~.~...~.....~.~.~.~.~...~.~g~ ~. .............. , isherma s Be ..a~ R~ Cutcho~ pursuant to opplicotion doted .~.e..~.~....~.r~....t..~..~....~...~..O..~....~..~. ....... , 19....~..6., ond opproved by the Building Inspector. NO~J~I to ti. sE ~X:~st:1.Ftg po0'ls & water ......... Building InspeCt0( ~ TOWN OF $OUTHOLD , Building Department Town Clerks Office 5outhold, 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, 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: 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 as to use, occupancy and c~ndition 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 $1.00 /! Rte ................................. New Building ................ Addition ................ OIc[or Pre-existing BUilding ................ ¥ocont Land .............. Location Of Property .................................................................................................................................. Owner Or Owners Of Property ¢~/, ~-o l¢$.'/~e~J ~ ' Subdivision ................................................................ Lot No..!..?. ...... Block No ............. House No ............. Permit No. b~ ~,~,~ Date Of Permit #/d.~. ~./~..,Applicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate Fee Submitted $ ...~. ................................ Construction on above described budding and permit meets aU applicable Codes and regulations. Applicant ff. ·..r../X'..~.. ~..~-.:., .. ~....'...~.., .~.....~.. ...................................................... Sworn to before me this ......... ..f/!.... day of ...~......(...~..~.~.. ........... (stomp ~ 't ~¢[ ~' Notary Public~ .......... County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. Examined NO¥ 1 2 19..~,.~... Approved ............. ii ............. '.'. .......... , 19..~..6.. Permit No....8..~.~.~...~. ...................... ..... ........ ................... INSTRUCTIONS / Application No. 8959 Z a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildingr~ 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 ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this gpplication 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. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy~ e. 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 necessary inspections. Ernest Jones (Signature of applicant, or name, if a corporation) ...... 15a.t.t i.~.u.¢k ..................................................... -. (Address of applicant) ~3 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, c~ builder \ Nome of owner of premises William & Alysse Johnston If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) / Builder's License No ........................ [//( C ........................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ...~,?..?..o.~.J:?.....~.?:..~....?.?'...o.? Lot No ....... Street and Number ~.~?].J:~.S~.~..e.~.~.?.:~s~.~.~.e.~..~.~.~.c?~.(.~.~..~..?~.~z~!~.~~ ....................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...~.~,.?.e..~.~..~.~ .......................................................................................................... b. Intended use and occupancy ........... ............................................. 3. Nature of work (check which applicable): New BuihJ~ng.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work .................. move ex±$tin§........... ....... dweZ llng... ...... (Description) 4. Estimated Cost ...................................... Fee 2~o00 (to be paid on filing this application) 5. If dwelling, number oF dwelling units ......... .O.~ ............ Number of dwelling units on each floor ............................ If garage, number of c~rs ................................................................................................................................... 6. If business, commercial or mixed eccapa~cy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ............................................................................................................... Dimensions of same structure with allerations or additions: Front ................................... Rear ............................ Depth ................................Height ............................Number of Slories ................................ 8. Dimensions of entire new construction: Front .................. , ............... Rear ............................ Depth ........................ Height .................... Numbe~ of Stories ........................................................................................................ 9. Size of lot: Front ....................................................... Peor~ ........................................ Depth ................................ 10. Date of Purchase ........................................................Nome of Former Owner ........................................................ 1 ~. Zone or use district in which premises ore situated ...... ~.....~.$.~ .............................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .......... .~...O....(..~.~0.~.O...~..e..~..~.~....~.~... I3. Will lot be regraded ....... ~..e...s. .............. Will excess fill be removed from premises: ( ) Yes ( :~ea].s~-- '~ 14. Name of Owner of premises .~..m.. ....... .o.~';~,.'~.q~..fk..~.~,$.e. ......Address ..... .O.l~t.0.~og.g. fl .....Phone No ....................... Name of Architect ......................................................... Address ................................Phone No ....................... PLO~f DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil 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 See filed plan 5TA'FE OF NEW YORK } ,-~ COUNTY OF ...S...~.~..~.Q~.~; ............. f~'~ ............................. ..~.?...D:.e...s.,~....,]].o...~..e...s. ................................... beiny daly sworn, deposes and says thot he is the applicom (Name of individual signing contract) above named. Pie is the Built.er (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 oil statements contained in this application are true to bhe best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... .1...2..... day of .......... ~. ........ ~¢.xfmb.e.= ..... , 19_2.6. '~;;o ry Public,. ................. .S_~..~.~,o, .~. ................. County .,.~.-., ~ ,~...~. ~:...,~ ................................... (Signeturff applicant) L NOTA~"~PIJRIIC, Stat~ o~ F~ew o Term Expires Nlarcll 30,