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Home My WebLink About9359-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at ][/.~; ~5.0.t~¥;l, QV. &~, ...... Street Mattituek Map No.XX. ........ Block No...]~. . .. Lot No .... .X~ ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .~ .~'.Y.. ].~.* ..... , 19 .Tr/. pursuant to which Building Permit No..~ dated . Jill .~r..~2.~ .......... , 19.~., was issued, and eonforrns to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~..c~.~.~..al~. ~.~t.o..l~.g~..b.~,~g ................................ The certificate is issued to B.O..I~A~.~ ..J~ .I~'OW~ ............. , ..................... of the aforesaid building. (owner, - ~ Suffolk County Department of Health Approval .. lg/R .................... UNDERWRITERS CERTIFICATE No ........ ~[ ............................... HOUSE NUMBER . .1~..~ .... Street .8. q~,J, QW. Avo,.~ .1~ a~1~ttuek,. N, .Y,... Bmld, ng Inspector I~OEH NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL -COMPLETIO~ OF THE WORK AUTHORIZED) No. 9359 Z . ~: :~'~ pursu~ht fo application dotod ................. .~.~.. ................ , 19...~.t and opproved by the f ~: Bu:ld,n~ Inspector. LAW OFFICES WILLIAM WlCKHAM, MATTITUCK~ LONG ISLAND NEW YORK II952 July 11, 1977 Southold Town Building Dept. Main Road Southold, New York 11971 Re: Donald J. ~rc~n Gentlemen: Enclosed is Application for Certificate of Occupancy, in du )licate, together with prints of survey. Enclosed, also, is check to your order in the sum of $5.00, to cover your fee. Thank you for your cooperation in this matter. Very cordially yours, William Wickham lw FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office $outhold, FI. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fflled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings ar 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: l. 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. ~ Fees: 1. Certihcate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .'....~...u~..~...]:.3:. z.. ~.9..7.?. .................. New Building .................... Old or Pre-existing Building ...........~ .............. ~vacant Land ............................ Location Of Property ~/~S~V~:~e~V~e~u~L~u~q~k~N~e~r~ ................................................ Owner Or Owners Of Property ..... ..l~,.~.d...,J.:....B.~ .................................................................................... Subdivision ................................................................ Lot No ............. Block ~o ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................. , ............................................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........... ~ ............................ Fee Submitted $ ...~.:.OJ;). .........................~/~~ Construction on above described building and p mi me s I pi' I ! and regulations. pp ca t ............................................... Sworn to before me this ]:.]:..'.~.. ......... day of ...... .J...u~.. ~.~,, ~.9..7..7. .................. Notary Pubhc .................. ~ ................. County ~ ~DorRoTHY H'ENDERSO~ I~OTARY PUBLIC, State cf 'No 30-$848100 (~)uahfied ,n Nassau ,o ~ommiss~on Expires MarcOr J6, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~xo~,~ ...... ~,.....~ ......... . ~.~...:. ,^~,,~o,o~ ~o....:..~:~ ......... ~o~ .~/~...:z ......... . ,~.~..~ ~,~ ~o..~.3:~ ............... . ...... : ...... =. ................... ............. ....................... APPLICATION FOR BUILDING PERMIT I NSTP, UCTIONS a This application must be completely filled in by lypewriter or in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b PIo'~ plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c areas, and giving a detailed description of layout of property must be drawn on the d~agrom which is part of th~s applicatiot c The work covered by this application may not be commenced before issuance:of Building Pertain d. Upon approval of this application, the Building Inspector will ~ssue o Building Permit to the apphcant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe< The opphcant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and t admit authorized inspectors on premises and in, buildings for necess~~~~ i(g'n~l:ire O~a~n~c~rn~, if a corporat,on) Main Road, Mattituck, N.Y. (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, Name of owner of prem,ses ............................. ..K~....z~...];.d;..~:...~..z:..°0~... ................................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's bcense No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. Map No ................... ~ .................. Lot No ...................... Street and Number N/S Sound View Avenue, Mattituck, N.Y. :~"~':: ............................................................................ j ........................... '~;~'~;~i~; ...... 2 State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction' a Ex,s,ting use and occupancy ................................. ~..~.~..a...t~......C~...e....~.~.l..~.i.~.~.?-.'.z~...g. .................................. b. Intended use and occupancy ................................. Same with_ aclclitio: of 3. Nature of work (check which applicable). New Buddmg ....Ag...c~... ..... Adder,on .................. Alteration .............. Repair .................. Removal .................. Demolit~or. ................... Other Work ................................................. (Description) 4 Estimated Cost ............$..2..0..0..:.0..0. ................................. Fee ...... .$..1..0..: .0..0. ................................................................. (to be prod on filing th~s apphcahon) 5 It dwelling, number of dwelhng units ............................ Number of dwelhng umts on each floor ......................... If garage, number of cars ....................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature end extent of each type of use .......................... 7 Dimensions of existing structures, if any: Front ........................... Rear ................................ Depth ................. Height ........................ Number of Stories ............................................................................................................ D~rnens~ons of same structure with alterations or addmons: Front .................................... Rear ........................ Depth ................................ Height ......................... Number of Stories ............................. 8 D~mensions of entire new construction. Front ........ .8. .......................... Rear .8. .......................... Depth ....1.0. ............... Height ....7. .............. Number of Stories ........ .1.. ..................................................................................................... 9. S~ze of lot' Front ................~..J$.g~'. ...................Rear .......................................... Depth .............................. 10. Date of Purchase ....................................................... Name of Former Owner ...................................................... 11. Zone or use district ~n which premises are s~tuated ......... .A...~.~..s..i...de~.,-..t!.'...a~.. .......................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: .......... Nc;). ....................................... 13. Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises .................................................... Address ................................ Phone No ..................... Name of Architect ................................................. Address ................................ Phone No ..................... Name of Contractor ................................................ Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buddmgs, whether existing or proposed, and mdlcate all set-back dimensions fra, property hnes Gwe street and block number or description accordmg to deed, and show street names and ind~ca whether mtenor or corner lot see Attached Survey STATE OF NEW '(-~I~L~,.,.~. COUNTY OF ...... ~.~.'k~...'~:.. ............ fS S , ......................................... ..W..i..1..1.~....a~.....W..i..c.~..a~.. ...................... being duly sworn, deposes and says that he is the apphca (Name of ind,vldual signing contract) j above named Agent I }He ~s the .................................................................................................................... : ...................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duty outhorized to perform or hove performed the sa~d work and to n%ake and this application; that ali statements contained in this application ore true to the best of his knowledge and belief; that the work will be performed in the manner set forth ~n the application Ol~J' ther~ewith. Sworn to before me this l// Noto~ Public, . ............ .,.r .$.~ ..................... Coun~ ............ ~/.~~/~_~ .......................... ., ~/ , , ~ ~(~i~e ~ a~cdnt) Ne~ 52-6905650 ~ehfled in Su~k Ce~ Term E.p,res ~e~h ~, i~