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Home My WebLink About9167-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Date ................. :: .~. ~.....'..r~ 19'./., THIS CERTIFIES that the building located ............................ ~ree~ Map No. I ~ 7 ~ Block No. , Lot No, I ~ ~ conforms substantially to the Application for B~lding Permit heretofore filed in this office dated h'P~ ~ 19 ~7 pursuant to which Building Permit No. dated ............ ~.~ ~.. ~'., 19~, was issued, ~d confoms to ~1 of the requ~ ments of the applicable provisions of the law. The occupancy for w~ch this ce~ificate is The certificate is issued to ~ILLI ~ ~ ~ {4 ~ *~ (owner, ~t) of the aforesaid building. Suffolk County Department of Health Approval ~' ~ UNDERWRITERS CERTIFICATE No. ~ 3 '~[ ~ 5 ~ ~ HOUSE NUMBER 3.~/.~{~ ....... Street ~A~ ~ ~-~ ~0 Building Inspector FOl~ NO. ~ TOWN OF SOUTHOLD 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) Ne 9167 Z Building Inspector, ]PO]~M NO. 6 TOWN OF SOUTHOLD Building Del~tment Town Clerks Office $outhold, N. Y. 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 oJ property showing alt 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: I. 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 Date ~7~,-':22.. /.~.?..~.... New Building .. }.~ ..... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...L2.~../..,~.L.~.?i.~.......~.'.,~?.~.~..X.-...~.~.~.(.~../.~....~..~....../~..~¢~,.~.~.~.~..~.~..~.~.~~?/~D Owner Or Owners Of Property ....... ..~/..'.6..J?/...../~.. ......... .Z..:......~_~.....c}...~.....~./...~...~..~. ............................................. Subdivision ~.f.~.~,, ........ ~.;,~'. .................................. Lot No ...... ..~%.. Block No.....Z. ...... House No./..°.~.g.~ · . ...... · .. ..... '..'2... · .... ..... ....... Perm,t No ~./~ Date Of Perm,t ~,~..~/.2. Apphcant ~. /~., ... ~......~ .. Health Dept. Approval ................. .'TZ; ...................... Labor Dept. Approval ................................................ Underwriters Approval ..................... 'Z~...:; .................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......~,.~,~',,,~,,.~,{ ............... Construction on above described building and (p~/~ets all App,,ca.t .......... ......... ................ Sworn to~efore me this // .....~.~....~... day of ..,~.z..:....../...~...~..~.. ........ (stomp or seal) Notary Publ~ ....~-Z,~.~.4,~ ........ County ~. FOBM NOo 6 TO~VH OF $OUTHOLD Building Department Town Clerks Office Southold, H. Y. 11971 APPMGATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--($-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. §. Submit Planning Board approval of campleted site plan requirements where applicable. 5. 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 certificate of occupancy $1.00 $5.00 Date ......... ~.//...-~...J ..~...Z ............. New Building .................... Old or Pre-existing Building ...... ..~.......: .......... Vacant Land ............................ Location Of Property ...~,..~...~.~.~_...~.,~_,~]~,~;~'~_Z~....~.~,~ .......................................................... Owner Or Owners Of Property ...... UW'~,~..../~.~.../~/.,~.-~...~. ..................................................................... Subdivision .....~..~..~,...~.o~.j.~]~...~,.~.~. ................ Lot No..~.~....~... Block No ............. House No.~..~..,~..~ Permit No...~./~.L.~.Z~..~.... Date Of Permit ,...~.J/.~..~,Applicant ..... .~......,~ ........~.. .......................... , .o .. 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 permit meets oil applicob~ codes and regulations, Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County Main Road; Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT ~~'~ TOWN CLERK'S OFFIC~ ~UTHOLD, N. Y. Application ~o..~.~.~..Z ................. Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. 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 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 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 o 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, bi4ilding 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 ~f~: ~4;L4~ '~ . '.~.~.,. ~/~.~ j .~ ......................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ........ ................................. Builder's License No. ~ Plumber's License No ......... 2.,.~../..../i.'. ..................... Electrician's License No ....... /..~...~/~i ...................... Other Trade's License No ........... Z.::. ............................... 1. Location of land on which proposed work will be done. Map No.: ........ ./....~.'.,~..~x. ................. Lot No ..... /..~..: ............ Street and Number ..... /..~4;...../~L~4~Z~.~/.~..Z:.~:F,.....~.~.~ .............. /Z./.A..Z:~/..~.~L~.k/.~ ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ...¢.rg~.:,,.~t.~,~.~.;~J.~/.~ .................................................................................... Intended use and occupancy ....~.~..4~.C~.2.4~.4~. ...~, .......... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .....~...i.i Repair .................. Removal .................. Demolitior ..................... Other Work ..................................................... (Description) 4. Estimated Cost ........J.,~.?...Z~...~ (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, specifv nature and extent of each type of use ~..-:7 ....................... 7. D mens ons of ex sting structures, ff any. Front ..... ,~,..~., ............... Rear ....(-~ .~. ......... Depth .;~..,5...~ ......... Height b' .......... Number of Stories ....... /. ................................................. ~ ............................................ ; ......... Dimensions of/same/~ structure with o~ additions: Front ..~,.~...?..~. .................... Rear ...~...'e'.....:-~ ............. Depth ....v~.*..~...~.,.~, ............... Height ..:7.~....~ ................ Number of Stories ...... ,~.. ....................... 8. Dimensions of entire new construction: Front ...~,.~.'.':.,~. .................... Rear ....~....~.£..~.. ........... Depth~.~..'.:..4.. .......... Number of Stories ....... f/. .......................................................................................................... Height ....... ~.~ ........ ~ ,/../'.~... / ,~ ~' ~ 9. Size of lot: Front ...... LR..,~.: ........................................ Rear ...... .~....~..~'....~-...~..~ ............... Depth .Z.~.['~,:...~...~.. ........... 10. Date of Purchase ...,J~.~.:../...~.I..~..Z/ ....................... Name of Former Owner ....~.'.,..,~.~..lS,.l~.Z-~.l.~-.,'~,.~...I. ............... 1 1. Zone or use district in which premises are situated .../~,¢;,~.(.l~.~/~/..[lZ~/,- .......... ~ ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~..~ ............................................. 13. Will lot be regraded ...,~.~ ................ Will excess fill be removed from Rre~mises: ( ) Y~s ( ) No 14. Name of Owner of premises .~.I.4-,4.1~..I~,..~I/tZ~.,~..J..'.~. ......... Address ..;¢/~/z.~r.l..17.~./~,.... Phone No ......... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....~.~_1:,~..(,C....~..~.L~..,~./.~.~. .............. Address ~/~'~/'~"'~ ,4~,~:, ' ..,,~..~.r.~'.~..z2 ....... Phone No. ~.~:~:~./...~..~..? PLOT DIAGRAM locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior o~ corner Iol. STATE OF NEW )¢~OP,)~/y~ ¢ ~ S S COUNTY OF ~.....f ' ................................................................................................. b g duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. 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 thru' the work will be performed in the manner set forth in the application filed therewith. Sworn to befor~ me this - ,, 19.'..~.... ............ ........... ' JUDITH T. 'TERRY' Notary p~tblic, Sta~, cf Mow York · ?.;-f' ...:,. : '.. KIDD DHI VE Lot .f Lot ~/. aeooo'~o"w. formerly S Sledzl'~ski I10. 00' NO REVISIONS w = ~ONUI~'IZNT SUBDIVI$10H t,~AP FILED tN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JAN. 1.9,194~ A $/~AP NO, 1672. YOUNG & YOUNG 400 OSTRA.NDER AVENUE, RIVERHEAD, NEW YORK SURVEY FOR: WILLIAM M. HAR~',S & MARIE A. HARRIS LOT [95,BLOCK 15 "CAPTAIN KIDD ESTATES AT MATTt TUCK TOWN OF SOUTHOLD SUFFOLK CO., N.Y. SCALE: I": 30' iOATE: SECURITY TtTLE-A Gu~NTYCC, RIVERHEAO SAVINGS BANK % ApPrOVED/AS NOTED ' '~' A~ F~E: NOToR CONSTRUCTION ER¢oRS /~ ~,~J~RX~,{T~./,'~ "~(D-,~ ,