The URL can be used to link to this page

Home My WebLink About9672-z· ORM NO. 4 TOWN OF $OUTHOLD BUH,r~IN~ DEPARTRENT Town Clerk's Office Southohl, N. Y. Certificate Of Occupancy Date ....F.e.b!~ .ry...26 .......... ,19...7.9 THIS CERTIFIES that the building located at . .~895. Mar~; s. Roed. ....... ~ Map No .... ~.~. ~ ..... Block No ........... Lot No .... .8.2..+...L.o.t..a..d:}.o.i.n..i.n.g. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ADV,-.1.... 5 ......... , 19.7~ pursuant to which Building Permit No....9.6.7.2;~ dated April 12 19.78, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private One Family Dwellin~ with Addition The certificate is issued to ....R.i.c..b.a?.d....&..M.a..rg..a.r.e..t..M.u.n.c.h. ........................ (owner, of the aforesaid building. Suffolk County Department o! Health Approval N/R UNDERWRITERS CERTIFICATE No. I~909~ HOUSE NUMBER 189.5 Street Mary's Road Mattituck, New York Building Inspector County TaxNumber 1000-1~9-~-2 = Described ~art 1000-10?-g-~h =Lot 82 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9672 Z Permission is hereby granted to: .... Z< ....... ~....~.../.:Z ....... ~:?.~..~. ............. ............................................................... ~.A.~L.z,.~cz~...;. .......................................................... I.~... .~.j.....~.....~... .~ ~ ~ ; £$Cge ~ Wo~ ~ ~ - ~L~ ~07 ~ ~ ~ .............. ......... ...... ................................ ~)".~'~.~'...~(.'~.~.~.~ ....... ~.~.~.7 pursuant to application dated ................................. ~.l.b......~, ]9~,, and approved by the Building Inspector. Fee ......... Building Inspector FOI~M NO, 6 TOWN OF SOUTHOLD , Building Depurtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This appl~cotim~ ~ust be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o certificate of Code complionc~ 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*of property showing all property lines~ streets, buildings and unusual natural er topographic features, 2. Sworn Statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare o 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 Date ............ .~, New B~lilding ................ Addition ..... ~ ....... Old or Pre-existing Building ,, ,~,, .......... Vacant Land .............. Location Of Property .~.~.~......~L~c.%L~.....~.~..~..~....~....~...~.~.~.~.(.~.~..?..~:.w..~.~.~.....L .fi.~.~ O~n~, O~ ~ Of P~op~y .~C~.[~.~...~.... ~d...~.~.C~ ...~, ~.~.~ .................. Subdivision ................................................................ ~t No ............. Bilk No ............. H~se No..J~. No...?~..~]~ ......... Dote Of Permit .~/J~}.].~,,..Applicant ~.~.,....~[~. ......................... Permit Health Dept. Appravol ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .... ~.,,...~.~]~..~['~...~_,,~Plonning B~rd Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate .......................................... Fee ~ubmitted $ ................................... ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant ...... .................................. ~ o 'z- ,~ 4~'$ Sworn to before me this ................ day of ............................................ (stamp or seal) Nota~ Public .................................... Coun~ THE NEW YORK BOARD OF FIRE UNDERWRITERS C~! BUREAU OF ELECTRICITY ~ Ju.t~e 1.~) · ~ ~7~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 · ,,p,.,,c.,,.. o./i,. N390953 THIS CERTIFIES THAT on/y th~ e/~c~t ~r~ca/. m/u/p.me,~t as described b~low and introduced by tl~ applicant named on th~ abot~ application numar in th~ pr~mis~s o/ ~xona~'c ~'~uneh· ~la~ys Ave., North ~fd. ~ F~eeman ~7d.· i~tt:tuok· L.I. in the following location; [] Basemen{. [] 1st FI. [] 2nd FI. Section Block Lot was examined on ~Tt~ne ~J 5 ~ ] 9 7 5.] and found to be in compliance with the requirements of this Board. RANGES S~RVla DISCORNECT I ~NOL~,iO~ S R EXHAUST FANS · ~'r. H.P. DIMMERS OF NEUTRAL Paul Du~n~ Town Ha~bo~ Lane Southold, L.I. 11971 Llg.28P E ~is cedificate mud ~t ~ o~red in any mannerr return to the office of ~e ~ard if incorr~t. Insp~rs may be 11 by COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN I-IF SOUTHOLD OFFICE OF BUILDING ~NSPF~CTOI~ TOWN CLERK'S OFFICE SOUTHOLD, N, Y. ~19~1 TEL. IV~,,q -I'7'ITUC'K, ?4. Y. APPROVED AS NOTED 765-2~60 9AM to 4PM FOR REQU,R. INSPECtiONS: TION OR STYEt r.~.J.~ F~AMING COw~..:~ , ~ O~ ANY KiND FINAL WHeN J~u~ CO~/,PL~TED NOT RESPON~gL~ FC~ ALL CONSTRUCTION t~UST RETIREMENTS G} ~{.Y. STAT~O~E AND TOWN HOUSiNG CODE ~ [ONiNG FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo ..................... d.. ....... ~i~ppro~d ~/~ .................... ~... .............................................................. ................. ....... ............ ...... {Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT 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 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 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 ir~ buildings for necessary inspections. (Address of app icant) //~j~'.~'""-- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...~LC.~.~T.~...~.~.....~.qC~......~.~,.C..~C'~....~,......~¢/.t~.c,:..~ If applicant is a corporate, signature of duly authorized Officer. (Name and title of corporate officer) Builder/s License No ............... / Plumber's License No. Electrician's License No ...... ~.~..9..?...~ ..................... . .__ .~- . .... Other Trade's License No ............................................... . 1. Location of land on which proposed work will be done. Mop No ...J ,..~,.~ .............. Lot No....~r,.~...~.~,~.q!.r.Lo~ Street and Number ...i.?~.cJ..5....J.V..~.B~Hi~....~'~.~.C~ ........ ...~/...l.qtk.{-.i.~Mbg,.~. .................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~F..J...~..0,. ~.....~.t>.~O..~. ............................................................... b. Intended use and occupancy ...... .){.FQ.~.C~).~,~.......~..f~5.r~......O..O.C~.....f~.~.~ ...... .O..~X-~.Q ....................... t.. .... 3. Nature of work (check which applicable): New Building~. ................. Addition ....,..~.. ......... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) (to be paid on filing this opp[ication) 5. If dwelling, number of dwelling units ........... I ................ Number of dwelling units on each floor ........ ./. .................. If garage, number of cars I ....................... 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 L...~...~.2,.~.'.~' Height .....!.~ ............... Number of Stories ....... ~..~..¢ ................................. ~ .............................................. 7 ............... Dimensions of same,stru~,ture with alterotio~ns or additions: Front ..... (~.~. ......................... Rear ..... ~.~ .................. ........ 8. Dimensions of entire new construction: Front ! .......................... Rear ....... ~ .................... Depth ......~...~. .............. 10. Date of Purchase ....LL,J.J.:'LJ..']J .................................. Name of Former Owner ...~.~. ~..~.......!~.r.¢,~ ....................... 1 1. Zone or use district in which premises are situated .~...~..k.C~..~O..~-..~..~..~ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.Q ................................................ 13. W at be rearaded ~R~. W II excess fill be removed from aremises: (~) Yes ( ) No Name of Architect .............................................................. Address '~TCJ¢'f~"Ci(~'¢~:~D;~'"' Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or 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~OI~KI, I ~ IS S COU NT~'~..~ . ,.,-, ~ ~-q-kOF ...,,:¢,.~.,.-'3~....'5......f '; ............. ,.L..~.M~.' ....... ~ ,~, ~-7~',;,,~, ^~^,~l.,.,..¥...~......¥x~.,.~vrx.,.~ .................. being duly sworn, deposes and says tN=t he is the applicon, (Name of individual signing contracf) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 tl',a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ ............. do, of ...... ........................ ' Notar Pub,a .. cou. ................ ......... ~ .................... / (Signeture 6f oppHcont) MERRIE YOUNG NOTARY PUBLIC, Slate of New York No. 52-4655077 Qualified in Suffofk County Commission Expires March 30, 197D