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Home My WebLink About9521-zTO, Frei OF SOUTHO~.t~ BUff.DING DEPARTM~NT To~m Clerk's Office Southold, lq. ¥. Certificate 'Of Occupancy No. ~8089 ...... Date ..............Dee...23 ..... , 19.7.~. THIS CERTIFIES that the building located at . .N/.8...M.a.i.~. B.o.a.d ........... Street Map No...xx .........Block No. XX ....... Lot No.. lac... Laul-e]...I~,X, ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated ..........(lat...27-.., 19.77. pursuant .to which Building Pe~i~-dt No..9.~1~. dated ............. 0at;... ~., 19.77., was issued, and confo~-n~s to all of the req~_~_tre- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to. Amlz'aw. Oaodal~ ........... 0~ne~ .................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval Il,it, ................................ UNDERWRITERS CERTIFICATE No.l~el~tgtl~ ............ .......................... HOUSE NUMBER ..... ~3~ .... Street ...... tlatn .Rea& ...... Lam, el ............ FORM NO. 2 BUILDING DEPARTMENT TOWN CLERK'S ,OFFICE SOUTHOLD, N,. y;" BUILDING pERMIT, (THIS PERMIT MUST BE KEPT ON THE P'REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) · N°. 9521 Z ~Date ...... Permission is hereby g~'anted to: · &n..~.t~..~,~...~ .o..~.~,~.Le. ............. ',..,..,.:..,,.. .................. . .................... Eo....g.uf£o~k ................................. ~o il (der .er) a~ditiop/ oB ~xisting .d. welling... .... at premises located at M~..~.~..~2.o~u~ . . . . . . ................. . ~.~.~.~.~:s.~. · . .... pursuant to application dated ',... . i ...Qd~..2.~..~.....i..;, 19..~.~..., and approved bg the . Building -Inspector. : v, - Fee $ ' FORM NO. 6 TOWN OF SOUTHOLD Building Del~rtment Town Clerks Office SouthoJd, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certifigate of occupancy $1.00 $5.00 Date. 2.e...o..e. New Building .................... Old or Pre-existing Building ..........~ ............... Vacant Land ............................ M~in Eoad, Rte 25, opposite !.~r~y ~ve. Mettituck, N.C. Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....... .}.~..~..~...~.....e.~..~...,A.,D.~.~..e..~.....G...o..o...~.~..~.,e. ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..9~.~[~. ....... Date Of Permit],{)./.~.7..~'Z..~...Appllcant ....O....'t~..,e.,,~. ................................................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ...... .~..,r~,..~.\~.'~.:;..~ ...................... Planning Board Approval ..... ~ ........................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...~.!..0..0.. ....................... Construction on above described building and permit meets al.I ap~)li~cable codes on~ regulations. App,,ean, ........ ................................... Sworn to before me this ~' ...... ~-/~//~//~- ~7 Nota~ Public ............... ~ZO~.... County ~'" /~ ' Examined ......... ............................... , 19. FOlg~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Approved ................ [.! ........ ?....Z....., 19.?...i~.. Permit No.....~......~......~..../...?.~.. Disapproved a/c .i~.....d~~..- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date Oct 2 7 ..7..7. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuildingS'. 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 ir~ buildings for necessary inspections. / New Suffolk N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Owner -re-i~ Andrew Goodale Name of owner of ~ ,,, o~ .................................................................................................................................................... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No, owner Plumber's License No ................................................. Electricion's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No.: ~ XX ........................................ Lot No ......................... Street and Number ..~.~..~.....~..o..~..~ ....... .~.~.e..~. ...................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExisitJng use and occupancy ......... ~..w.,e.,.~.,~.,'.3.,~ ................................................................................................... b. Intended use and occupancy same with dormer addition 3. Nature of work (check which applicable): New Building.. ................. Addition ....~ .........Alteration .~:~. ........... Repair .................. Removall .................. Demolition ......... : ........... Other Work ................................................. .... I .. (Description) 4. Estimated Cost ................ i ................. :.....i' .'.Fee 1 F',00 . ! (to be paid on filing this application) 5. If dwelling, number of dwell?ng units ......... 1 .................. Number of d. welling units on each floor ............................ If garage, number of cars '"'i ........................................................................................................................................ 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 .................... Neight ........................ Number of Stories ................................................................................................................. Dimensions of same structurb with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................... · ............... Rear ............................ Depth ........................ Height .................... Numbe~ of Stories ................. ............................................................................................... . 9. Size of lot: Front ................i ....................................... Rear .......................................... Depth ................................ 10. Date of Purchase ................ ~ ....................................... Name of Former Owner ........................................................ 1 1. Zone or use district in which [premises are situated ..... .~.1 ......................................................................................... 12. Does proposed construction v!olate any zoning law, ordinance or regulation: ...... ZtO ............................................. 13. Will lot be regraded' ......T~O. ................... . Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~,p~zte.l~...~(:}D. cl.a~Le ................. Address ..~].e,l~'...~l.:~f.Q'l~:... Phone No ............ · .......... Name of Architect ..............4 ............................................... Address ................................ Phone No ....................... Nome of Contractor same Address Phone No ....................... ~ PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and Neck number or description according to deed, and show street n~mes and indicate whether interior or corner lot. se~ attached plans STATE OF NEW YDFG<~ ~ ~, COUNTY OF ...... .s...~..z..Y:..°...'k..~. ......... f..S ............................. .~...~.~...e.l¢'....~..9.~.~ ~.~. ................................. being duly sworn, deposes and says that he is the opplicanI (Name of individual signllng contrac0 above named. ~ He is the ....................................... .9.~rkq~.~C..-....b.l~,,J-.~.e.;~ ....................................................................................................... j (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 statementsj contained in this application are true to the best of his knowledge and belief; end that the work will be performed in thee manner set forth in the application filed therewith. Sworn to before me this I .................... day of ........... 0..o.L[ ....................... , &. tS 0, Notary Publ c,. ............... ~.~.l~ ....... County ........ ~J~ ....... ~.....~..u..~¥.~,.~4%~. ........................ (Signature of applicant)