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Home My WebLink About9694-zFORM NO. 4 TO~VN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency No...~Q0. .... Date ~.e.'p..t.e.m.b. 9~...3.~! ............ ,19. ~.6. 1380 '~tggin Lsne THIS CERTIFIES that the building located at ...... 6'}(~' M~ple. :Lane ..... Street Map No... ~6..5.0 ..... Block No ........... Lot No ....... ,6~ ........................ conforms substantially to the Application for Building Permit heretofore fried in this office dated .. ~:p.r.~..l .... 7.~.6. ....... , 19T..8.. pursuant to which Building Permit No dated .. ~o.v.i'.1 ....2.6. ........ , 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 ..... l?ri.v, ato. 0:~e. F~ily'..I)weltlng ................................... The certificate is issued to .......... ~Iarry~. .~eiJ.~nd .............................. (owner,)le~~ of the aforesaid building. Suffolk County Department of Health Approval ..... B~$0~-2/* ...................... UNDERWRITERS CERTIFICATE No ....... .N399515 ............................. 1~80 Wiggin Lane HOUSE NUMBER ..... 6.10 ..... Street ........ t¢~pte. Lane ...................... .............................................. .qr.e. ........... (THIS PERMIT MUST BE K~P~ ( COMPLETION OF THE WORK AUTHORIZED) N? 969~ Z Permission is hereby granted to: ,.,.; 19.:..:.:. ' ......................................................................... ............ ~" ': ......... '"'+':': '"':~'i' ::'"'""¢-;"--':'-',' pursuant to opplication~dated .~ . ............ ~; ,,19; w;;~and, opprovedby the I~O~ 1~O. 6 TOWN OF $OUTHOLD ~ Building Deportment Town Clerks Office 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 Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, end 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.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 in- 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 New B~ilding ...I .~.-.-. ..... Addffion ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ~'.¢}.~6~..k'-..~. Owner Or ~n~ ~ p~,,~,,, ............. ............. ........ ................................................ Unde~rJters Approval ~...~ ............... B~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ ~ s.b~itted, .~ ......... ~ ............. Construction on above described building and permit meets all applicable codes and regulations. A ~'~ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~' BUREAU OF ELECTRICITY '-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~ohn Wleiand~ ~Tigglns ~ne. Maple Lane, Eas~ Marlo~ L.I. w~ exami~ on A ~ 1~5 ~ 2 ~ ~ ~ ~ 7 ~ and found to be in complia~e with the r~uire~ents of t~ ~rd. RANGES *MT. K.W. iPE~IAL REC'PT R EXHAUST FANS DIMM~:RS A.~T. WATTS rI 1.2 TIME CLOCKS BELL UNIT HEATERS MULTI.OUTU[I A/4T. AMpSI TRANS. .~ N~.Y~o~T.~T V I C 1/0 I~ 9. R1 Box 1Sa Main ~d. ~'/ / ,' ~l ~ is cedi icate mu~ not ~ alter~ in any monnert return to ~e office of the ~ard if incorr~. Insp~ors may be ide~i~ by their crede~ials. ~ ~ ~ ~I~N~ ~~. THIS CO~Y OF (ERTIFI~T~ MU~ NOT B~ ~T~ ~ ~ ~Ni~ TEL. 765-~66G TOWN Of SOUTHOLD OFFICE Of BUILDING INSPEOTOR TOWN P-LERK'S RFFIOE: SOUTHOLD, N, Y. 11~J'7'1 1~0~ NO, 1 TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, ~proved ............~......~.._., ,~ermit No ...................... ....... {Suildin~ Application ...~/. ......................... APPLICATION FOR BUILDING PERMIT Date ....//.....F. ..................... ' 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 scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets m 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 in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........ I,:..... ,~'. ,.~....': .... (A;..'..~. ':. _- ,-,-...,.. _-pJic.....~._nt~r.....~_r)....,..,.,.,.....ddress °f aP a) (~'/' 7 ~© ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ~:~ ...................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. ? Bectricion's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No.: ...,.~... ............................... Lot No ................ Street and Number (~/u />~ n r Mumctpah~ ~ -- ~ . .... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~d~....~[]/~ .......................................................................... ............. .................................................. '"" ........................... / 3. Nature of work (check which applicable): New Building' ....x'~,'.N/ ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. 4. Estimated Cost .............................................................. .~...:....~..'..,L~... ..................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units / .... Number of dwelling units on each floor [f 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 all'erations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ...~..6 ..................... Rear ..... .'/.~..~'~. .............. Depth .....~.....~., .......... Height ....~.. ............ Number of Stones .......... ~ .................................................................................. 9. Size of lot: Front .... Z..~......~......z. ................................ Rear ............ '.,~........~....,~ ............... Depth ..Z'.~.,~...,..(~....~.~.6.. 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: ......... ~., ................................... (~)No 13. Will lot be regraded ,.....~.~ ......... Will excess fill be removed from premises: ( ) Yes 14. Nome of Owner of premises .................................................... Address ................................ PJ.l.l.hpn?~,~N,o..::~ .................. Z ' .- 2- , 37 Name o,- Arch itectr,_'~,,~t~2~.~...~.....¢~..c~-..¢~.'~..~..~...~..4_ ........... Address ........... rnon~ ~1~1o.,,,__ ................. Name of Contractor .(~'~".,'~"~'?'~-/'~'~"'~'~"~'~-- ,,- c-~: ~,__ ............Address~./.~.~.....F~..~..~..~.z.,:~::~p~e,~-No' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate STATE OF NEW YORK, COUNTY OF ................................ ...... ~_~-'/~.~.~...~'~r:~..... ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named.~z~, ~, ~ ( ~'~.~--~ (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 thor the work will be performed in the manner set forth in the application filed therewith. Swor~ to before me this .... .......... d of .......................... , ....... ..-..... Co,n*, ...... .............................. ,~, ' ....... . : '. o~ COP ES O~ THIS SU~V:Y MAP NOT '~ ~N~ SUrVeY) 'S ~,o "AL O~ ~M~SSED SEAL SHALt NOr 8r TO BE A VALID *fl~U~ COPy, :~Y~EM~ FOR THI~ ~[- ,I .t .J -,2 . ~, ~:,.~,, -- _~_-,.;_. _ .~?;~ ~ ....... FOR REqUIR. N.Y. STATE CODE cL .S~ale ~"=1:~" ac,lc ?,+": /:0" 12.