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Home My WebLink About9937-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ADDITION Location of Propertv 245 BARTLEY ROAD MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 166 ·Block 3 .Lot 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ·,, ..... ,19.7.8. pursuant to which Building Permit No. 9937Z dated . . .~ .0 y.E.~ B..E ~..1.3. ............ 197. .8., 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 ......... FOR AN ADDITION TO AN EXISTING ONE FAMILY DWELLING The certificate is issued to EDITH G. RAFFORD ' (owner, .............. of the aforesaid building. Suffolk County Department of Health Approval Iq/A UNDERWRITERS CERTIFICATE NO. Iq / A Rev. 1/81 Building Inspector FOI~ NO. ~ TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN GLERK's OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISE~ UNTIL FULL COMPLETION OF THE WORK' AUTHORIZED) N? 9937 Z Permission is hereby granted to: ....... .~*....~ ............ , ................................. ~...~ ............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 features. 2. Final approval of Health Dept. of water supply a6d 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 from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. Bo For existing buildings (prior to April 1957), Nomconforming 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 $5.00 Date ... ~,u.~.~ ,2.7.,. ~.9J3~ ........ New Building ............. Old or Pre~existing Building ............ Vacant Land ............. Location of Property ... ~Na .~.). D~t~ey. ~d,. ~4~t:$~g~]¢ ................................... House No, Street Hamlet Owner or Owners of Property . .PAt%l. ~.e~k.i=..a~...~¥.e.cg.~o. ~..o.f..~..d~..Y~..G..., .~,a..~.~o.~.~. .............. County Tax Map No. 1000 Section ...~.4.4 .......... Block . .0.3, ........... Lot.. 024 Subdivision.. ~p. O¢. PrQ];~;~;~..q~..L~i..c~..~..a_,~,..1.ay. F lied Map No.. 7.70. '. .....Lot No..~.[. ,&..1.2 ...... Permit No. ~.3.7.~ ..... Date of Permit .......... Applicant .... " ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ' ....Final Certificate ....................... Construction on above described building and per 'rr~t ~e~/~/c~'s~ OWN OF $OUTHOLD //~-~ BUILDING DEPARTMENT~ -- TOWN CLERK'S OFFICE ~- Exami~e~ .................... ~ ............. .. .... ................. ~proved ..................... ~ ............. , P~'~u? lY ........ Fermir mo ....................................... D,sopproved OIL ............................... ~..,.,~ ............................... ~~ .................................................................................. ~; .................... ~ ....... ~ (~ h ........................ .................... APPLICATION FOR BUILDING PERMIT Date ................................................. INSTRUCTIONS 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 ~ale. 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 ofproper~ must be drawn on the diagram which is pa~ 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 Ce~ificate of ~cupancy shall have been granted by the Building Inspector. B ~PLI~ATI~ .IS HERE~Y MADE to the Building Department ~or the issuance of a Bud ng Permit pursuant to the u,aing ~one urainance at the Town of Southold, Suffolk County, New York, and other annlicable Laws Ordinances or Regulations, for the constru~ion of buildings, additions or alterations, ? for removal' or de~ t on, as h;rein described. The applicant agrees to comply with all applicable laws, ordinances, budding c~e, housing code, and regulations, and to admit authorized inspectors on premises and i~ buildings fo~ ~essa~ i~ectlons. ......... ~'~;;;;';;";F;~;~E';;'~;';';;'- /';";;';~;;;~;~'~ (Address of applicant) S~o~e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ ........................................................................ ~...~A .................... , ............................................................ · L ~ ~ ~ ~*'¢':a ~ ................ Nome of owner of premises ............ L- ................ ~ ................ .~..~ ......................................................................... If applicant is a corporate, signature of duly authorized officer. .... .~ . .L . .~. .~ ~. . .~.~. . . . ~'.~ . , % .......... .~ . .& . ..~. , .C c~ ........... (Nome and title of corporate officer) Builder's License No..~..m..~.. .................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... 1. Location of land on which proposed work will be done, Mop No.: ........................................Lot No ......... : .............. Street and Number ..~..~ ..1~ b.~. L......~,~:...~,~.~........~...~,..~..~...t..'X.,~.....~,..I,~ .................... Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~'~ ~ ~ b, Intended use and occupancy .........................~.,.~.,~.....~.~..~.9.¢:?c~ ........................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition ......,~ ........ Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 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 ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each typo of use ............................ 7. Dimensions of existing structures, if any: Front ........:~: f~ ........Rear ............... ~...[ ........... Depth .-.7~..~ ....... Height .....!....{ ............. Number of Stories ( .................................................................... Dimensions of same structure with'alterations or additions: Front ............. ~.4 ................. Rear ..... .2..:,..~...~ ............... Depth ...... ~..¢'.~..: ........ i ...... Height .......... ~,f;~ ............ Number of Stories ..[ ............................ 8. Dimensions of entire new construction: Front .................................... Rear ........... ~. ............... Depth ..../..;.~ ............... Height ...... ,,' ............. Number of Stories i ........................................ 9. Size of lot: Front ....................................... .~..k ........... Rear .............. :i ........... Depth ........ ~...~'...Y ........... 10. Date of Purchase ........................................................ Name of Former 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 ........... ,,u.l~ .......... Will excess fill be removed from premises: (*--~r Yes ( ) No 14. Name of Owner of prem ses ..~...~J...~ZL¢.~, ....... J.1,,~,'~..~.,.;..£..~,¥...).,.. Address ..~..]~V;',~...".x. ZT..'.k...~....'Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .,.,... ~,.,,~,.... ~..~ ........ ~ ....... /..~.~ .......... Address .;~.~,...~...2J.~.:.:J;..:.: Phohe No......~.,..~*cs ;, ~...~?,..., PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and bloc/< number or description according to deed, and show street names and indicate whether interior or corner lot. COLJNTY OF ..~.....~".t~./..O..~....k~t.. ....... ,f ~'~/ / ...... :: .......... ~L~.~.E~...~:....~..~.~..' ............. being duly sworn, deposes and says that he is the applicam (Name of individual signing contact) 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~totements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be Ee~ormed in the manner set fo~h in the application filed~erew~.~ Sworn to b~fo~me (Si~noturo~f o~pHcant)