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Home My WebLink About8651-zl~Mr NO. 4 TOWN OF $OUTHOLD BU~.~ING DEPARTMENT Town Clerk'e O~iee Southold, N. Y. Certificate Of Occupancy No..Z7262 ..... Date ..............5ep~...30 ..... , 19..7.6 THIS CERTIFIES that the buiJding located at ~.. l~,ain. Road ........... Street Map No. ~ia.t.t. Pk. ~rc~lock No ........... Lot No...1.&. p.t2 .... ~at~:~tuck; ........ conforms substantially to the AppUcation for Building Permit heretofore filed in ~hi~ office dated ..............J. une...~519.76, pursuant to which Building Permit No..86~.~.~. dated ............Jure. ~ 6..., 19.7fi, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate.is ~sued is . Bu~lne as. Bu&ld ln~.. ( ras taura~t ). w~th. additians. & .Al~ar. ati~ The certificate is issued to .Chaachien.. Sh~n ..... f~rner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Depar~ent of Health Approval ~ :.~: .................. ~ ............. UNDERWRITERS~iCERTIFICATE No..EoR.o ....................................... HOUSE NUMBER'... ~.96.50 ..... Street .. l~ain. Road,. ~att&tuclc ............... Building Inspector/ FORM NO. 2 TOWN OF $OUTHOLD 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) 8651 Z Date Permission is hereby granted to: Cb~oeh:te~ ~hen Mattltuck N.Y. .B~!ld addition on existing business buildingt also ~oofing ove~ ......... ...................................................................................................... at premises located at ~/~ ]~[~tin ~0~.~ Mattlt~¢k N pursuant to application dated ~TI,~ 16 19. 7~, and approved by the Building Inspector. Fee $ J:.~...~,..~... ........... FORM NO. 6 TOWN OF $OUTHOLD , Building Depa~tment Town Clerks Office Southold, N. Y. I]971 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~0 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 end "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 3. Copy of certificate of occupancy $1.00 ......... ........... New Building ................ Addition .....~.... ..... Old or Pre-existing Building ................ Vacant Land .............. .................................... Owner Or Owners Of Propert ~-~..~.//~'~;~ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicanf Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and perm, i~meets all ap/plicable cocJes and regulations. Sworn to before me this ~ ................ day of ............................................ (stamp or seal Notary Public .................................... County TOWN OF SOuTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. Permit No .................................. Application No ................................ Disapproved a~~~ APPLICATION FOR BUILDING PERMIT [~ Dote .............. .... INSTRUCTIONS 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 public streets or areas, and giving a detailed description of layout of property 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 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. (Signature of applicant, or name, if a corporation) _~..~ .......... ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .................................................................................................................................................... If opplicant is a corporate, signature of duly authorized officer. (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 propo d work w, ill be d e Mo No ' --~ ~ ""lot No Street and Number ...~.....~~.......~.~...~.~.~.~.~;i].ii~~~~.,iZiiiiiiiiiiiiiii Municipality 2. State existing use and occupancy of p.r~mises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~....... .................................................. ~ ................................ b. Intended use and occupancy ...................... ~ ............/...~......~....~-.~..~.-...~ ........................................ property lines. Give street and block nu ~vhether interior or corner Io1'. 3. Nature al work (check which applicable): New BHildlngr, ................. Addition ....... ~t"~....~ .... Alteration ...'..~. ....... Repair .................. Removal .................. Demolitior. ................... Other Work ......................................... : ........ 4.' Estimated ~ost ............................................................Fee ~ ~ ~ (Description) (Io 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, ff any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number 8. Dimensions of entire new construction: Front ................. ~. ...........Rear ........... ~. ........... Depth .~...: ............ Height .................... Number of Stories .................................................................................................................... 9. Size of Io~: Front ........................................................ Rear ..................................... :.... Depth ................................ 10. Date of Purchase ...................................................... ~.~me 9~ Former Owner ........................................................ 11. Zone or use district in which premises are situated ...~ ............................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation: ..... ~...~ ........................................ 13. Will lot be regraded . ........................... Will ex,ss fill be removed fro~i~ )~es ( ) No 14. Name of Owner of ~remises ~4¢~1~ ~ ¢*~Address ~ff~~ No. ...........................................................~.~ ~ .................................. hone~ ~ o,. ............. ......................... Phone No ....................... Name Nome of Contractor .~~......~'..~.~ress ...--~.;. ........ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and ~es and indicate ~CTATE OF NEW~)~.~') IS S /// ....................... ~ ............................................................. being duly sworn, deposes and says that he is the applicanl (Namf/6f individual signing contracf) above named. ~, *x~t ~-q~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized to perform or have performed the said work and to make and file this application; that all state_,n~e~ thor the work wilt be perforrrCd in Sworn to befor~ me this ~x_ ................. ~.... day of .... ~ Notary Pu~' . .............