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Home My WebLink About8995-ziro~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTI~.~ Town Clerk'~ Office $outhold, N. Y. Certificate Of Occupancy No. ~.?.6~.9. ...... Date ..............Apl'ti.... ~.., 19..~ THIS CERTIFIES that the building located at . .[[e¥. li~[~olk.. A~e ....... Street Map No. ~r ......... Block No... r,X ..... Lot No, x~r... N~tt~.tuek...1/,~f~ ......... confoms substantially to the Application for Building Permit heretofore filed in this office dated ...........Dee..6 ..... , 19.76 pursuant to which Building Permit No. 899~Z. · · dated .............Dee. · 6 ·., 19~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thin eert'fficate is issued is . P~Lv~te .one..~miZ{t~. dmmllllig, vith...&dd-i-tlor~ ................... The certificate is issued toO&l~r, ii,. Rose ....... .t~n®{~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .N.R. ............................. UNDERWRITERS CERTIFICATE No..Noel. ....................................... HOUSE NUMBER .... 1020 ..... Street .. ll~. ~ag.~olk lye ...... P~ttl~mak ..... Building Inspector -- lt'OB~ NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PEI~IT MUST BE KEPT ON THE PREMISES UNTIl FUll COMPLETION OF THE WORK AUTHORIZED) N? 8995 Z Permission is hereby granted to: ................. ~..~,u~e.f...A~. ........ to ..... ~...~..~.q.~.t..~..?..~...~.,..t.....~....~.~......(..~.,.~). ........................................ at p~ located at ..... .~....~......~..~...~...~.O...~......A...~... ................................... : ..................................... .......................................................... ~...t~t~t ~eil: ................................................................................ pursuant to application dated ........................... ~.t~......~1 .............. , 19.~.;, and approved by the Building Inspector. ~. $~.!~....: ...... Examined TOWN (Hr SOUTHOLD BUILDIN~ DBPARTMB4T 'row~ CLIRK'S OPlqCl SOUTHOLD, N. Y. ,%oproved Dee 6 I9...?..6. P*rmit No. 899~~' Disapproved a/c XX][~]~ 899 ...... Application No ........................... % APPLICATION FOR BUILDING PERMIT Date Dee 6 INSTRUCTIONS a. This application must be completely filled in by typewriter ol?n ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, eccurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, re ationship to adjoin ng premises or public streets oF areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is Part of this application. c. The work covered by this application may nat be commenced bef.ore 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. 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 Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law% 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, buildln. admit authorized inspectors on premises and in buildings for necessary insp~/ (Address of applicant) code, housing c~, and regulatiohs, and to ~ions. / / .k Ave Mattltuck ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises Paary ~Rose If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. E. Horton & Plumber's License No ................................................. Electri¢ion's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....... .~.~ ............................ Lot No ....... ~ ............. Street and Number 8/S N.e.w Suffolk Ave Mattituek Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy dwellin~ b. Intended use and occupancy sam~ with deck additiion 3. Nature of work (check which applicable): New Building.. ................. Addition ........ ~ ..... Alteration .... ~ ....... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) ·. 1000 -+ 1 ~. O0 4. Estimated Cost ......................... ~=' ..... Fee .......................................................................................... (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 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 ...... ..2..8. ................... Re~' ...~.8. .................... Depth ....1..2. ................. Height .................... Number of Stories one ..................................... 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 ....~.....d'l s.'~ ............................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ............................................. 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No ]4. Name of Owner of premises ........ Gar]t...R~3$e. ...................... Address ........ ,Ma...t..t..t. ........... Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor]~.,...~.q~-J~-Q~..~..$.' ............................ Address ....~.e...~.....~...~....~..t ....... 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. see filed plan CTATE OF NEW,,¥QD~K~,_ ~ S S COUNTY OF ................................ ~ Gary ~ose .................................... :'"'.'". .......... : .......................................... being duly sworn, deposes and says that he is the applicant (Name of md~wdual s~gning contracf) above named. He is the .o.',~.e..r. ..................................................................................................................................... ....................................... (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 tobefore methis 6 day of ..D..~.9. ............... , 19....7..~ t /I ^ J~k \¥ ........................ Suffolk x-~-4'llAM 4--~ ~ Nota ,ub,,c.. ........................... ....... , ............. Coun ............... ............................. ~LIZ^BETH ANN NEVILLE/~ NOTABY PUBLIC, State of ~ew Yorl~ No. 52-81255~0, Suffolk Cou~¥ Term Ex~ires Ma~ch 30, ]~ I~OR.M NO. 6 TOWN OF ~OUTHOLD , Building Depodment Town Cledm Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Indrru~ion8 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 Beard approval of completed site plan requirements where opplicable. 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 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 ~.4,~c>~ ~ /~ 3. Copy of certificate of occupancy $1.00 New Building ................ Addl,ge~ ................ Old or Pre-existing Building ................ Vacant Land .............. Health Dept. Approval ............ .~.../..,..~. .................... Labor Dept. Approval ......... ~//./~.. .............................. Underwriters Approval ................ ../~../..~.. ................... Planning Board Approval ..... ..~//.~....i ....................... Request For Temporary Certificate ........................................ FinoJ Certificate .......~ ......... ~ ............. Construction on above described building anld"~rmit meeil, all ~odes and regulations' Sworn *o before me this ~X~ ' Notary Public .........~County