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Home My WebLink About8717-zI~OB,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy .... ....... conforms substa~i~ally to the Appli?tion for Building Permit heretofore filed in this office dated ....... .(~/...'I ..... ~. ...., 197.~., was issued, and conforms to all of the require- ments of th~.,applicable provisions of the law. Th~ occupancy for whic~this certificate is The certificate is issued to . .~ T. ~ .fi ~ ........................... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval . .if. ............................... UNDERWRITERS CERTIFICATE No ~ r [~ ....... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THiE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8717 Z Permission is hereby granted to: ................ ~..a..~..t.~.u...,.~ .......................................... to ...~:z...z.~....~.n.....a.,~..x.~.t...o..n. ...... (.~.e...~.~...4...f:.a..~.t..~..~.......~..n.....e.~.t..~.~.t..n..g...¢~.e...~..z...t.n~ ..................... at premises located at ..,~..o.,.~...,.9......,.]~..~....~.t.,o..~..,e.~ .................................................................................... .................................................... ~.,e.~..z..t...e...~.o.~.~ ...... ,.q~..q~.,o.g:.~.e. ..................................................... pursuant to application dated ............................. ~T~.~. ....... .9 ........ , 19...~.6., and approved by the Building InSpector. Fee $.1.~..,...0~).. ............ Building Inspector FORM 1~0, 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY 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 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 o 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 Da,e ........ .......... New Building Addition ,~OId or Pre existin Building Vacant Land oco,,o o, ...... ...... ZiZ ....................... Owner Or Owners Of Property ..(~..~ .C~.....~ .............................................................................. Subdivision ...~......~.....[~ ........................... Lot No.....~. ...... Block No ............. House No ............. Permit No...~...?../2....~... Dote Of Permit...~...t~..~'..Z~.Applicant .....~.'..~.......~.'~" '~f-r:¢,~ ................................. ,ealth Dept. Appro,,a~ ....... ~..~ ........................... Labor ~pt. Appro,,o, .............." ,/.~.:...K... ...................... Underwriters Approvo, ........ ~.:.i~ ........................ P, onn~ng Bo~rd Approval ....... ~..f~. ....................... Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ c~ Construction on above described building ondpermit meets all applicable cedes o, nd regulations. NOi'ary Public ...... .~... Coun~ Examined ................................. , Approved .......... , TOWN OF $OUTHOLD BUILDING DEPARTMENT · ow. ~UTHOLD, N. Y. ........................... Disapproved a/c .................. ................ ............. APPLICATION FOR BUILDING PER~IT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ir~k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t9 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 application may not be commenced befbre issuance o~ 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 wf~rkc 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 Renu at OhS for the construct on of buildinns additions or alterations, or for removal or demolition, as herein described. The app icant agrees to comp y w th a app cable laws, ordinances, bud ng code, housmg code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. George Taylor (Signature of applicant, or name, if a corporation) Mattituak (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. o ontraotor Name of owner of premises ........ .qb~?..~...e.§...~.e..~..q.~.. ................................ ......................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... p.e..n..d..i.]~.~ ............................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ...~..~..~....[~..o..~...e.~ ................. Lot No...~. ..................... Street and Number ...... .J,.~..~..0.......~...e.~..1..J;..e....~...o..8;.~ ....... .O..~...t..o,~.o..g..':$..~. ....................................................................... Municipality 2. State existing use and occupancy of premises and intended use and'occupancy of proposed construction: a. Exisiting use and occupancy ...~.~[..e..];..].:~ ......................................................................................................... " With addition b. Intended use and occupancy ............................................................................................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition ...... ~ ........Alteration ....:f~... ......... Repair .................. Removal .................. Demolitior, .................... Other Work ................................................... (Description) ? F 1;~o00 ................... 4. Estimated Cost ............................................................ ee ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .o.b.e. .............. Number of dwelling units on each floor ............................ If garage, number o~ 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 ...~.br ............................. Rear.~.Ll'.. ...................... Depth ...'[.8../....1.~ ....... Height .................... Number of Stories ...... o~e ........................................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..... !!&U...&Z,~.'[; ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. DO. ...................................... 13. Will lot be regraded .....~.fl~ ................ Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ...~,.8......~f~.~.~.~ .................... Address ......C.~q~..o..~...o.~.e..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .....G..e...o....?..&.~.~..o...z: ................................ Address Mattit~ck Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn and indicate property lines. Give street and block number or description according to deed, and show street naPnes whether interior or corner lot. STATE OF NEW Y4::)RI¢. ~ - ~ c c CO NTY OF ~ttZZ'O.LL¢ ~'~.~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. agent of contractor He is the ................................................................................................................................................................................. (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 that 'the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................... of .................. ................ ' Notary Public, . ....................... ~.,~.q~ ........... County ....... ,z.~.'r~'~/~,....a~ ........ ~c~z~.~,-'~rr ~~...,~...-. ............................ ~,lSignoture of o~51icont)