The URL can be used to link to this page

Home My WebLink About9912-zNO. 4, TO~ OF SOUTHOLD BUILnlNG DEPARTM~T Town ~lerk's Office Southold, N. Y. Certificate Of Occupancy No. ..... Z9319....... Date ....No~tsmber...29 .........., 19.7B THIS CERTIFIES that the building located at . 865. Naw. Suffolk Lena.. S~smlxx~x Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in t.h!~ office dated .....A.u. gg.s.t....15. ..... , 19.7..8. pursuant to which Building Permit No .... 9..9.1.2.Z dated ..... A.~gC~.t....2.2. ..... , 19.7.8, 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 . Accessorsr. Barn. w£th. dack. addition .... .* ........................... The certificate is issued to John Peter Hayden (owner,~ of the aforesaid building. Suffolk County Department of Health Approval ............... .N/.R. ................. UNDERWRITERS CERTIFICATE No. N/R HOUSE NUMBER 865 . Street New Suffolk Lane Cutc.h.o. gue, N.e.w York Building Inspector * NON HABITABLE, NO KITCHEN FACILITIES PERMITTED County Tax Number 1000-109-7-3 FORM NO. 2 TOWN OF $OUTHOLD ~ BUILDING DEPARTmEnT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH'E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 991~ Z Permission is hereby granted to: ......... ..V..q.~..~ .............. ~..~...7...~.~..LJ. ......... :.;... pursuant to application d(~ted ' ' ~ Building Inspector. roe ~ ........................ TOWN OF $OUTHOLD ~uilding Deportment Town Clerks Office Southold, N. ¥. 11971 APPUGATION FOR CERTIFICATE OF OCCUPANGY Instructions A. This application must be filled in typewriter OR ink, and submitted in 'W-il~!!ca~ 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 aT property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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 .................................. New Building .................... Old or Pre-existing Buildin~ ...... ,~.~. ...... vw ........ ~acant ~Lond~....; ................. : .... Location Of Property ................. .~..~;~.....7.;':~,.~.;..~...; ...................... Owner Or Owners Of Property ..... ~w~..~ Subdivision "~ .................................................... L.~.t No .......... ~BIo. ck No..... .......... House No ............. Permit No ~'~'i~ Date Of Permt ..~.....~.....~....~..i.~Pl cant .... ii.~ ..~(~.~,~.. ................ Health Dept· Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... · $ O0 . Construction on above described building and perm' t m~/~a~ ,~pp~c~/l~A(~a[~Are~s. Applicant .................... .f~...~'..~.~ .~ .... .i~ ~¢.~..~..,..-~z.. ........... ~. .......... Sworn to before me this ...~.~,n,~.\ ................ day of ............................................ (stamp or seal) Notary Public .................................... County TOWN OF SOUT"OLD TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined ................ .47..6~..,.!.... 4..~.V5..., ~proved / ~ l~.~.. Permit No....;r? ....... ~....~,~ ......... ............... ~..~..~....~..~ ...... ~ _ ~ - ~/ a Disapproved o/c ...................... : ...................................................................... ......................... ............. ~'~ (Build~ng Inspector)- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application N o.~./..7~.~=-. ............... ~ Date ~5 / {' ') 19 ............ ~ a. This application must be completely filled in by typewriter or 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. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port of this application.t. 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 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~r~ 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 neces~ry insoections. /~ (S~a ute of applicont~, or, name, if a corporation) State whether applicant is awner, lessee, agent, architect, engineer, ~en~r~l ~Br~cter, *l~ctrici~,, ~l~mb*r ~r b~ilder. (N~m~ and titl~ oJ ¢o~or~t~ Builder's License No ..................................... Plumbers L~cense No ....................................... Electrician's License No ............. ~ ....................... Other Trode's License No ............. 1. Location of land on which proposed work will be done. Map No.: ..... ,¢o ........ (3. ................... Lot No ......................... Street and Number ............ .,~.....~..~ ........... ..'.~...~.0....~ ~..~....~K/..&..~... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............... ~~- ........................................................................................... ~O b. Intended use and occupancy ~ 3. Nature of work (check which applicable): New Building,. ................. Addition .......~... ........ A rotation ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost 0 Fee J,~...~//..O ........................................................ (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, specify nature and extent of_each type of use .~....~..}.~.~.. 7. Dimensions of ex,sting structures, ~f any: Front ............................ Rear ........... ~.'~. ................ Depth ~ ................ Height ......... ~?. .... Number of Stories ......................................... : ...... i ........................................... :'"'i ............... Dimensions of same structure with alterations or additions: Front ...~...(~.. .......................... Rear ....~..~.. .................. Depth ............. L..'Z¢..! .......... Height ~. ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... . ................ Rear ............................ Depth ........................ Height .................... Number~,,~ ,,et Stories ................................................. ; ................................................................... 9. Size of lot: Front ............ ~.~...:....~.. ........................... Rear ............. .(;....O..~.:....~-...~ ........ Depth ....~..~...O...L.!...~.. ....... 10. Date of Purchase ............~.1~..,..~....~. ................... Name of Former Owner .i.~..~...~..~....~.,..?~.....O.. .......... 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 . ,~,,...4 K.IWill exa;ess fill be removed from pram ses:( ) Yes ( ) .................m ........... ............... e.n3 14. Narne of Owner of premis~ '..~....~....~..~ AddresPhon~ N .7. Name of Architect .............................................................. Address ................................ Phone No Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ar proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or descriptipn according to deed, and show street names and indicate whether interior or corner lot. / Ed o~-~G-,,~ t~_ STATE OF NEW..YOD,44~,, /, ~ S S COUNTY OF ..-,,-.~.-.~.~Lf~..,..'z)....,f'~'~ / ! ....................... (Name of individual signing contract) above named. duly sworn, deposes and says that he is the opplicom 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 c(F'e~rue t/~ the'beat,of his knowledge and belief; and that the work will be performed in the manner set forth in the opplic~tiohkfil~/ Sworn to b~fore me this .......... .............. , No~ P,b,c,. ........... ~.~~ ........ Co..W ....................... ~.~~ .......................... ~ ~ (Signa~ of ~icant)