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Home My WebLink About9857-zFOIlM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z 9157 ..... Date ........... August. THIS CERTIFIES that the building located at 470..T.here~a .Dr.i.ve ....... Map No.. 4.256 ...... Block No .... ~X. · .Lot No .... 15 ............................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... July..20 .......... , 19.78. pursuant to which Building Permit No..9857Z · dated .... July..24, .......... , 1978.., 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 ... ACCESSORY. ~UILDING ............................................... The certificate is issued to .Gary..V.. and..V, irginia. N... ~ttlemyer ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..N/A .............................. UNDERWRITERS CERTIFICATE No ........... N./A .............................. HOUSE NUMBER .~ .670 ........ Street .. ?.h.9 .rg.s.a..D..r.i.v.e. ~..M.a.t..t.i.t.u.c..k/..N.e..w ..... .......... %'ork ............................................................... Building Inspector FOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING prERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9857 Z Permission is hereby granted to: ...~..e~...y.,...~'l;~.e~..e.~ .................................... to ...... bu.Ll, d...a...ac.c e.,s s.o~...~.~[~,c!.,f.x~ A ................................................................ : ...................... at premises located at ................. ~O..r~l~e:~q~g~:..]~$ve .................................................................. ?i!';'' ;' pur~Subnt to application dated '"~Ttl~'"-'~ ............................. :.,., 19.~8,., and approved by the., Building ~ hSPector TOWN OF $OUTHOLD Building Delm~tment Town Clerk~ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR. ink, and submitted in trlpllcate 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), Nan-conforming uses, or buildings and "pre-ex'st'ng ' 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 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 ~ ~u .~f.. ~/,y ~'/~i.¢C~&£C:~r~ ~.d~ Date .................... ~ ..................... New Building ..... ~ ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~..?..~?.......~...J~..?.?.~..~....i./.~..~../'~.~... ' ...~"K~'t?"~'/~ Owner Or Owners Of Property .,.~...,.~'~..~......~.:..,,~,..,.~..,.~ ...................................... '~ ............................. Subdivision ~..RIg....~...D...~.......~...~...~......~.~-~.~..~.~...~.~-.''''~'''~:L°t No...J~ .~.,.,. Block No......~.: ..... House No.......~ ..... Permit No. ~,......,.~..... ~- .... Date Of Permit .....-...-....~/...............-..........-.......'"'"'"'.'.... Health Dept. Approval ................ ~...:~ ....................... Labor Dept. Approval ................................................ Underwriters Approval ..................~:~ ......................... Planning Board Approval ....... .~'~'~ ......................... Request For Temporary Certificate ........................... Final Certif cate ..... ~ ....................... Fee Submitted $ .....~[~.:.~ .................... Construction on above described building and pe~it)meets all apphc/ab~ codes and regulahons. Applicant .................. ../~.-'~..:.::~ ................ ~ ................................ Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County ~:~'~(~'"' -/ ~ £°40 '~O'E. HO~ O0 * ' ' rom Lot 15 a = 20020 sq. fl. ~14. 41 ' D~IVE O~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Yo ~:xomJr~ed ....... ,~.., ,~,, ,~,.,.....~. ,~., .............. 19...,,.~., ~proved ~ 2~ 78 ...................................... , ]9 ........ Permit No .............. ~ ........... Disapproved a/c ......................................... ~ .................................................. (Buildino Inspector) Application No ..........9 8.~'~'. ............. APPLICATION FOR BUILDING PERMIT Dote .......... _7.~/~....0. ......................... , 19.Z.~. ..... INSTRUCTIONS o. 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 or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port 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 o 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 hove 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, buildjJ3 I code, housing code, and ragu at ons, and to admit authorized inspectors on premises and in buildings for necessar~ns~ actions. / j. ~, i~Addfess of qpplicont) 5tree whether applicant is owner, lessee, a~ent, architect, engineer, general contractor, electrician, plumber or builder. ... If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... License No. Plumber's, ' ............................................... ~ ~z-- .:~3'~0C~ , ~- ~'~ 5' Electricians License No ............................................. ~-15'- /-~/~ , 1- /.~- ,, ~ ~ .. C.~t ~" Other Trade's License No ............................................... -~. Locot on of ond on wh ch proposed work wU be.done ~cp No' .~...~.. 5 ~' Lot No Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended and occupancy ........ .-~.,, ....... ..................................................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. AJt:~ratio,, .............. Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ ..., ,, . / (Description) 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 ............................ Nu~nlber of Stories ............... z ................ 8. Dimensions of,entire new construction: Front .............. ;....,. ............... Rear ............................ Depth ........................ Height ...... '.' ............. Numbeh of-_~ Stories ....... /. ........................................................................................................... 10. Date of Purchase ........ ./..~...~...~. .................................. Name of, F/ormer gwner ........................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ; ...................................... 13. Will lot be regraded . ...... ~ .......... Will excess fill be removed from premises: ( ) Yes Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~c c COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and soys 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 stetements contained in this application are true to the best of his knowledge and belief; and ti.ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ...................................... ......, 19 ......... Notary Public, . ................................................... County ............. ~...;.'...r.~,...' ~ ,----x f~ ,\,, f (Signature of applicant) C om~,*s~,en Jx,,*es March 30