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Home My WebLink About8495-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall SouthoJd, N.Y. Certificate Of Occupancy No ..... ~gJ.~Q5 ...... Date ................ g:..p.~.5.~., THIS CERTIFIES that the building . 2Xlew. ~welling ................................ Location of Property 1860 North Bayview Road Ex%. Southold t21~tJs'o 'gl'o: ............................. Street Hamlet County Tax Map No. 1000 Section 079 . .Block G .Lot ... 5- 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 43 19 76 8¢95z ..................... , ... pursuant to which Building Permit No ...................... dated ..... ~..~. ~?. ? ................ 197.G.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... A one family dwelling The certificate is issued to . .?~.°9.d. 9 .~9..(:..FI?.~.~..rig.s.s. ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...6..-.sp.-~9. ~ ............................... UNDERWRITERS CERTIFICATE NO ..... ~.. 59.8.55.8 ..................................... Building Inspector Rev. 1/81 ~ · i~0~ NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~[ice Southold, N. Y. Certificate Of Occupancy No..Z7698 ..... Date ............ ~1~e..3 ........ , 19.7.7. THIS CERTIFIES that the building located at . ~S/S...Nor.th. Ba.~rview..Rd. Street Map No.. XX ........ Block No.. Xx ...... Lot No, . .XX .... l~otl2hol[d ..... N.,¥ o ...... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ AP.ri;[.. ,1,3 19.7.6. pursuant to which Building Permit No. dated ............ AI~I~$$...],br, 197..6.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P.~iva.~e. Ol~,e .falaily. d~mlling ...................................... The certificate is issued to .. ~l~eoclor. e .l/~a~a~agaa ...... ~er ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Jta~e .. 2...i97~. · .by'. ~, · V.~.Z.~a .... UNDERWRITERS CERTIFICATE No..lpe~irsg .............. ........... ~j ......... HOUSE NUMBER . .1860. ....... Street .. l~lo~t;h..~ay~/~,ew, road .~.~.~... Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('I'HIS PERMIT MUST BE KEPT ON THE PI{EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8495 Z Date ........................ .~.~.~, ~'.~. ~, .................... , 19...~.~. Permission is hereby granted to: r.~.e...o..:...~.:... !j.~ ~ ~.~,~ ~ ......................................... Mattituck ~.Z. at premises located at ..~D.t..~.'.....Y,~....G/~..}J.QZ:.t~..~n;/3Z~W...,~¢.,,,...~,:~ ................................ ................................................ ~.~,~.~.....~.,.~,, ............................................................................... pursuant to application dated ........................... ,~,g.E,~,......~. ...... , 19..../..~, and approved by the Building Inspector. Fee $..~.....0...0. .......... TOWN OF SOUTHOLD , Building Depmtmont 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 dlsposal--(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 surveyor property showir~g alt 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 promises, or other pertinent in- formation required to prepare a certificate. C. Fees: ], 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 /~/ Dote New B~ild[ng ................ Addition ................ Old or Pre-existing Building ................ ¥ocont Lond .............. Location Of Property ............................................................................................................................ .~. ...... Owner Or O~ners ~ Prape,~ ....~..~.Q~.~..L.;.......~.=.,~..h~.y.~.~.~ .................................. Subdivision .................................~ ............................... Lot No ............. Block No ............. House No ............. Permit No...~.~.~2_' ..~ate Of Permit ..~,,!.~!~.~,~pp~i~ont ....... .~.......~.?.~2..&.!E..~.~.£ ........... ............. .................. Underwriters ~pprovol ............ ~ .............. Planning B~rd Approval Request For Temporo~ Ce~iffcate / Fin~ Ce~ificote Fo~ ~bmittod $ ............ ~ ..................... Construction on ~bove d,scribed building an~r~it ~ ~omlic~o c~ ond r~Oulotlon*. .... ' ' Sworn to before me this ........... ~. day of ..... ~ (~"~ . Nota Pub, ,c .................................... (stamp or seal) FORM NO. 6 TOWN OF SOUTHOLD ~uild~ng Department Town Hail $outhold, N.Y, 1197~ A?PLICAT]ON FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicete to the Building lnspec- tot 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 tooograDhis fe3tures. 2.Final approval of Health Dept. of water suppIy and sewerage dispose --(S-9 form or equal), 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa. tions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5.Submit Planning 8oard approve 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 sur-/ey of peoperty showing ail property lines, streets, buildings and unusual natural or topographic features. 2.Stvorn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housJn9 code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. · ,', C. Fees: 1. Certificate of occupancy $5.00 ~ ,~ 2. Certificate of occupancy on pre-existing dwelling dr land use ~i;/ 5.00 3. Copy of certificate of occupancy $1.00 ~ Date . · New Building ............. Old or P re-existing Building(X} ......... ~ /Vaca~L~and - Owner or Owners of Property ~/ ¢¢ ~ ~*~ ' County Tax Map No.,lO00 Secdon . . . ~ Block ............... Lot ............... Permit No, Da'eof permit App cant ~ UndennzritersApproval ~¢~([;~-'-,....,.,,., ....PlanningBoardApproval Request for Temporary Certificate ..................... Final Certificate' Construction on above de,crib~d b~iJding and THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~'[~D THI~ CERTIFIES THAT only the electrical equipment ~ ~scribed be~w and int~duced by t~ appBcant ~med on the a~e application nfl.~ber in the premises of ~n the/ollowlng location; '~ Basement ~ 1st Fl. ~ 2nd FI. Section Block Lot was examined on ~'~'~. ~ ~ ~ ~0~ a~td found to ~e in compliance w~th the r~qulrements of this Board. ~ FIXTURE FIXTURES RANGES~cooKINGDECK$ OVENS DISH WASHERS EXHAUST FAN~ / SERVICE DISCONNECT NO. OF S E R V I C ~ ! Per , t~ ? ~[~eir cred~nfiols. COPY FOR BUILDING DEPARTMENT. SU~FO]~ OOL~TY HEALTH DEPARTMENT Sewage disposal ~nd ~ter supply ~cfllties for this ~ocation ~ve been ~spected b~ this d~rtment and found Services ~DUCATION LAW, TOWN OF SOUTHOLDXJ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. p ....._~......... _.....~..:~***..., APPLICATION FOR BUILDING PERMIT Date .. =..X..b.. ................. . 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 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 punic 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 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. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove 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, Ord nonces or Regulations, for the construction of buildings, additions or alterations or fo~ removal or demolition, as here n descr bed The applicant agrees to comply with all applicable laws, ordinances,/b~ilf~hg code, h0usinn code and renu at OhS and t~ admit authorized inspectors on prem,ses and ,n buildings for nece/~a~f~ns~p"ectio/e~'. /? /) = ..... , (S~gnatKre of applicon/, or name,'~'Z~';~"o';~,ii'~;~'i ........ ~///.. , i . . x..~.~ ~ ~ ............................... i~;~;-;~'~'~:~'~,~i~'~:i ........ x' ................... State whether applicant is owner, lessee, agent, orchite~tI engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ................... 1. Locat on of and on wh ch proposed work w be_done Map~'N ....................................... ..~Lot No Street / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building.......~ .......... tion .................. Alteration ................ Repair .................. Removal .................. DemoHtioc .................... Other Work ................................................... (Description) 4. Estimated Cost ............... Z..'~...~....,-~... ........................... 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, spe,9,jify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ./...~..~...'~..~ '--~- Depth '~ , . Rear ................................ Height ......... :..-z;.. ......... 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 c:~ Depth ....... ,..~T.....'¢~..~. Height .................... Number of Stories ....................... ?. ............................................................................................ 9. Size of lot: Front ........... ./...&...~.,./..z....~.,...~..-- ..................... Rear .................... .~...&....~.~ ......... Depth ........... '/----.~.....Z~...~.. 10. Date of Purchase .......... ../..°~'..../..~.,~...Z~,.'Z~...-- ~" ............... Name of Former Owner ....... '~" '~ ' ' -/-../.~./~.-.....~.~....~.../...~(~.~.~../.d.47.... 11. ZoZ or use district in which4'/pr~mises are situated ................................ ../..~...~..~ .................. ~.~ .............................. 12. Doe~ proposed construction vis[ate any zoning law, ordinance or regulation: ...................... ~.. ............................ 13. Will lot be regroded ....... ./.Z~.. ........ Will excess fill be removed from premise, s: ( ) Yes ~ ~~- 14. hJame of Owner of premises .......... /....../.'/...'~...../..~....~r~,../~../',~...,~... Address ...~'...~.(.z:-..K...~.*... Phone No.~..~..~...:...c~......~-~ Name of Architect .............................................................. Address ................................ Phone No ....................... r' fr Nome 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 Y.0~K,, [ c c ................ ~ee~:.:~...~.~~ ............................... being duly sworn, deposes and says that he is the applicam J (Name of individual sigmng contract) above named. (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.}o the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application ~ed there~th. Sworn to before me this ,, /, / ~, / ~SJgnature of ,~pplicant) Al BERT T, FICKEISSEN No. 62-~4602498 ,,~hfied m Suffolk Coun~ ~.~m~,,t ~an Expires March 30,