The URL can be used to link to this page

Home My WebLink About9884-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... Z97.7.5 ........ Date .. ~e..O.e.~}e.?..6. .................. 19.79. THIS CERTIFIES that the building ................................................ Location of Property 2760 Ruth Road Mattituck, N.Y. [4~Js'e ~Jo; ....................... 'S't;~i ....................... County Tax Map No. 1000 Section '106 .Block 'l .Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A.I/t. g~...~.~...'l ........ , 197..1~.. pursuant to which Building Permit No. dated . g.~gl,t~.~..~. ................. 197..~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ................... .Garage .Ao~.e.~Ory: .l~..i.l.d..i~a~ .............................. The certificate is issued to .... .I'[.~.1..OTI..~.]'. 9.~-~O..~.k~-~n~)~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .............. .~./.R. ................... UNDERWRITERS CERTIFICATE NO ................. ~/.R. .................. · Building Inspector Rev 4/79 TOWN OF SOUT~D BUILDING DEpAR'r~NT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT · (THIS PERMiT~MUST BE KEPT ON ~HE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 988~t Z Dat~ ................ : ...... ~....7...? Permission is hereby granted to: ~ / //~ ~ ~..7~,.o.'''~'''' '~- , . ............. ~ -....~.,~.~ ~, . ". l~ts~uant, to apphcahon ated '' "Building In~pector~ at premises located 4¸` FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 featu res. 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 installa- tions~'a~certificate of Code compliance fr~om the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. 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 ~. ,% .~. Z/.~. ~. ~. ....... New Building ............. Old or Pre-existing Building .. ~ ..... Vacant Land ............. Location of Property .~7~.~.....~.... - ....... : .J.J. ,~..~.. · .~.. ........ House No. Street Hamlet Owner or Owners of Property ...................................... /,0..~. County Tax Map No. 1000 Section .I.T./.,.,~,... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, ~' Date of Permi /,/~ .~,Applicant 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 all applicable codes and regulations. Rev. 10-10-7S Applicant ./~, ~. ~ ¢)' ~7~ ~? ~/~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N, ¥o Examined ... / ~ ' '~' No. ......... . .. App,eat,o..qZ./. ................ , proved ,9.?Z.. ...... 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 Inspecto'r, 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 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 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 t 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 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. Name of owner of premises ....~..(~l,e~,~lGit~;J, ........................................................................................................... If applicant is a corporate, signature of duly authorized officer. Plumber's License No ........... v _~.-.~ ................ Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be.done. Map No.: ........................................Lot No....: .................... Street and Number ~.~..~t~''~.~{~.~`~/.~.?...~.J.~..~`..~.~j~``~..`;~y.~j.~ ........................................ Municipality 2. State existing use and occupancy~ ,~ ~../ ~--~,/ ' ~ ~ ~°f premises an~ intended use and occupaoCy o~ proposed ¢onstructi~on: a. Exisiting use and occupancy~~'-(-,~:~~--~ / / 3. Nature of ~prk (~heck which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ..................................................... (Description) l, 00. 4. Estimated Cost ..... ....................................................... Fee .......................................................................................... (to be paid on filing this application) 5, If dwelling, number, of dwelling units ............................ Number of dwelling units on'each floor ..... , ...................... · ~0 0~'~ . If garage, number aT cars ............................................................................................................................................ 6, If business, commercial or mixed occupancy, spegify nature and extent of each type of use ............................ 7~ Dimensions of existing structures~ if any: Front ............................ Rear ................................Depth Height ........................ Number of Stories Dimensions of some structure with alterations or addition~: Front .................................... ~eot Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................... . ............... Rear ............................ Depth ........................ Height .................... Number of Stories .............................................................' ........................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10, Date of Purchase .................. ...................................... Nome of Fo~mer Owner ............................... , ......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ....................................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( J~Nt~- 14. Name of Owner of premises I-[elea 8).ed~leek::[ Address asae Phone No.--'- Name of Architect ............ ; .......... ' ....................................... Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone~No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing er proposed, and indicate all set-back dimensions frore 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 ~ORK, ~c ~ ..... ~...~'.,./T...E..~.. ....... .~..,.k.,~.,I~...~...E...3...K..I ............................ be ng 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 Car have performed the said work and to make end file this application; that all statements contained in this oppJi~a, tion are true ,o the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this / /~ ~ovof ~...~'~.y.~..?...~ , 19 ~ , ~/ _ >,9(~¢- ~ignorure o~ applicant)