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Home My WebLink About8675-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPAHTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ?J 2.1 ..... Date ............. July .... 12. · ·., 19..7.6 THIS CERTIFIES that the building located at P.V.~. RD.-..Hyatt. Road. ,.N.. Street Map No. Hyal;t. 0D.A. Block No..xx ....... Lot No, mx... B.outhold.. N.,Yo .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ June .2.3., 19.76. pursuant to which Building Permit No..8.6.?~.. dated ........... ff.uD..e..23 .... , 1976.., 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 . Private..one. £amily..dwelling. with. addition...(.deck) ............. The certificate is issued to .R. 9~.a.l.d...L.o.w. ell ..... . .0w~el' ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N..H, ................................ UNDERWRITERS CERTIFICATE No..l~. :.R: ....................................... HOUSE NUMBER .... 12.)+.~ .....Street. PF~..Itcl. ~..8. ~y.a~;t. R~d. 1~.. ............ Building Insp~/q~or FOI~M NO. 2 TOWN OF SOU?HOLD 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) N? 8675 Z Date ........ ~.ll~e...~t ............................. Permission is hereby granted to: R~ehter Home Zmprovement go. .............. .4_/g...~..o..n. ~:.z..a.....~..o..w.e..l~ ......................... .............. .~,.....O..,...W.,....o..~.~...~'.a .%~....a~.~ .......... .............. ~...~...~b.o...%~.,... ~....~.. ................................ to ..~,.d~...~.e.~}Lt t~...~ ~ ~.t !rig...QZke... f.v~¢il~...dw.e Lting ............................................................ pursuant to application dated ....... .~....~...e.....~.~....1.~.~..6.. ................. , 1c) ........ , and approved by the Building Inspector. Building Inspector TOWN OF SOUTHOLD , Building Department Tostn C~egks 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 fallowing; 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: 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 Dote ..... ........ New Bu. ilding ................ Addition ..~..~_~...w~..~.. Old or Pre-existing Buildings, .............. Vacant La.nd ............... /, / Owner Or Owners Of Property ~..~..77..~..L;~ L~/~'~;~./'.~L'-~ Subdivision ............................................................. Lot No ........... ~BIo~k No ............. House No ............. Permit No....,,,?.,~,..:'~,,,,~,,, Date Of Permit .:,/,,,~,~,.~',^pplioant .,..~:.~_.~'...L.~..~...~.,.~.,'..~../.x..~.......~....~........:~.-,'.¢?..~. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempora,~ Certificate ........................................ FinoJ Certificate ~'" Fee Submitted $ ......: ............................. Construction on above described building and permit~r~ii~ts all ~ c~J~s a~tions. Applicant ................ ~~:_...~...~..:.~..~. .;.. .................... Sworn to before m~-h'~ ) ~//>~ ....... ~Tu~e 23, 19. ?~ Examined ......... ~ ....... ~,. ................. , ..... FOB,M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No.....~...~.~.~. ................... ~' Approved ........................................ , 19 ........ Permit No ...... .~...~.~.~..~. ................... Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is pa~ 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 Ce~ificate of ~cupancy 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 n~essa~ inspections. ..... ....... ......................... (Signature of applicant, or ~me, if a corporation) ................................ .............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~.. ~...~..~':. u..,L~ ...... (:.z..x~.~. J..z.~,.~..ZL~.~ .............................................................................................................. of owne ........ ........................................................................................... If applicant is o corlPorate, signature o,f d~ly 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 ............................................... ~" ~)- ~ 7- ~/ 1. Location of land on which proposed work will be done. Map No.: ....................................... Lot No. R. O. W. N~S tlyatt Road~ Southo~.d~ Street and Number ...................................................................................................................... .~ ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ~/~..~.< e ~,r ~ ~e f~il[ b. Intended use end occupuocy .-~.~ ................ ~. ........................................................................ 3. NQture of work (check whlch applicable): New Building .................. Addition .................. Alteration .............. Repot ., Remora .......... Demo t or ..............Other Work ~....~.! /..'¢~ ¢~/ · ................... ......... 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, 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 /~ C~) Depth 10. Date of Purchase ........................................................Nam? of F~,~mer O~vner .............................. ~ .......................... ~o . .... /~..,-, ~-.,,/,.,Z 1 1. Zone or uo~ d~stnct ~n which premises are s~tuated .......................... : ........................................................................ 12 Docs proposed constructi,o,g violate any zoning law, ordinance or regulation: ..../~../.~.. .............................................. 13. XWill lot be regroded ...,../.' ..................... Will excess fill be removed from premises: ( ) Yes ( ) N~o ]4. J%ame of Owner aT premises .................................. ! ................. ~ddress ....................... ./~...... Phon, Nu ......... .............. Name of Architect ............ , .................................................. Address ................................ Phone No ....................... of Contractor ........... Address .......... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from proparty lines. GiYe street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ........ ~i.~.l~g.'l.~. ...... f ............................... JJ]~lil~.'~..~.,,..~l.~e,,J'l,'~. ....................... being duly sworn, deposes and says theft he is the pplicant (Name of individual signing contract) above named. He is the ........................................................ e,~lt,~il.¢t4:~ .............................................................................................. (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 ~he best of his knowledge and be ief; ~har the work will be performed in the manner set forth in the applicati,.o~ filed therewith. Sworn to before me this ,~,) ~-- - ........ ...... .................. ................ £,,, Notary Public,. ............................ .~:~,.'~ ..... County .......... .~.....~..~...~...'.........~/..~~~ ............ -- ~Dignature aT applicant) NOTARY PUBLIC, State of New York No 52.8125850, Suffl~lk Gnunty Term Expires Marcll 30,