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Home My WebLink About9702-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...z.9.5. 6.8 .......... Date June 15, 19 79 THIS CERTIFIES that the building ...................... . .......................... Location of Property Private Road NO. 1 (Goose Creek Lane) Southold House No. Street Hamlet County Tax Map No. 1000 Section .... 0.~.7 ..... Block .... 0..3 ......... Lot 16 XXXXX XXX . . . XXX ........ LO[ biO .............. Subdivision ............................... Filed Map No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ M..ay..1.: ...... , 19 .7.9. pursuant to which Building Permit No. 97 0 2 Z dated ................. ?I.a.y..3., ....19..7.9, 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 ......... ............... ?.R.I.V..A.~.~.,. ONE F3d~IILY..D.~..~..~.X.N.G. ................. Robert Waddington The certificate is issued to ..................... [o~,n'o'r, 'l~s'~de'~r't~/~a'~'t) ...................... of the aforesaid building. 8-S~-30 Suffolk County Department of Health Approval .......................................... Pending UNDERWRITERS CERTIFICATE NO .................................................. "~' '"~' Buildifig Inspector- ' Rev 4/79 I70P~ 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) 9702 Z Permission is hereby granted to: /~ /' . · ........ the Building Inspector. Fee $...~.~....~....~.6.... ,/~/"~**" / ~: //~/i Building Inspector 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 features. 2. Final approval of Hea~th Dept. of water supply and sewerage disposa~-(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. 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 featu res. 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., [ ,~. ¢.~..h?-.../.~..~..~' ........ Subdivision ................................. Map No ............... Lot No ............... Permit No. ~..2.1~.~2... ,~. Date of ,Permit ~..¢-~.~.. · ?~..Applicant ....~'~.6.~. ,~.~. ...... ~..~.~., .f~, .~...~! Health Dept. Approval .... /.Z¢...j -- .u:,. ,~., .(¢..~.~1, ..... Labor Dept. Approval ........................ Underwriters Approval... ~/2/2.¢ ........... Planning Board Approval ...................... Request for Temporary Certificate ...................... _... _//~nal Certificate .../~.~ ................. Fee Submitted $. , >?.!..-~-... ......//// Construction on above described building andp~es and regulations. Applicant .................................. FORM NO. 1 TOWN CLERK'S OFFICE ~UTHOLD, N. Y. / a. is opp ication must be completmy tilJeo in Dy 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 o~ ,-,greas, and giving a detail~ 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 budding shall be occupied or used in whole or in part for any purpose whatever until a Ce~ificate of ~cupancy ;~hol have been granted by the Building Inspector. _~ A~PLICATION IS HEREBY MADE to the Building Deportment for the Building Zone Ordinance of the Town of Southold, Suffolk County, Regulations, for the constru~ion of buildings, additions or alterations, The applicant agrees to comply with all applicable laws, ordinances, build admit authorized inspectors on premises and in buildings for n~essa~ issu, a/~fe of.9 Building Permit pursuant to the New Yorj<,,and .e~/~er applicable Laws, Ordinances or ',, .or fo//r~F~nov,~//or demolition, as herein described. buildi~'~',Egde/,~uslng code, and regulations, and to ........ ........... .............. ' '~ (~/ddress bf applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem,ses ..../~,~.zf~f4?.4~.....~;~,~,~'/"~.~ .................................................................................. 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. Other Trade's License No ............................................... I. Location of land on which propos~,4J work will be done. Mop_No.: ....i; ...... .~....-T~... ................... L, ot'No ....................... Street and Number ..~.~,~.,~...(~D~,.'..,..~,/..~,.~.42~..~,,.,/,, ..... / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............... ~'~..4.;Lf~:~.~..~..'~.,...'~... .............. ~ .................................................................... b. Intended useandoccupanc ,./~.O.....&...tg:~O~T~ ..... ,~ff..~.~/./~'~.'././.t',.~/ ................................ 3. Nature of work (check which applicable): New Building' ...~. ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition.... ................ Other Work ................................................... (Description) 4. Estimated Cost ~ ~..~....~.. ...............Fee-Z~..": ............................................... .......... ri' (to be paid on fi ing th s app cat on 5. If dwelling, number of dwelling unitp'../..O~¢~......~....Nurnber 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 existing structures, if any: Front ...... .~..~t...:.~..; .......... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front' .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ,~..~,.~.~,4,~. ............ Rear ...~'...~,':~ ........ Depth. ..~..-~..~... Height .................... Number of Stories ....................................... ~ ............... ~ .................................................... 9. Size of lot: Front ............. ~..~. .......... .O.. ................. Rear ...... I~.~.. ~"~".'z ..... Depth ..... /..~r~ ,er Owner .................... 10. Date of P.,u, rchase .(,,,/~.~'~..~',/'~___________________2~'~ ...... Name of,/F,~ 1 1. Zone or uae district in which premises are situated ................... .~-..¥ ............................................................................. 12. Does proposed construction violate any zoning Ibw, ordinance or regulation: ..... ¢~. ........................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phon~ No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ........... : ................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ell 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 whether interior or corner Io~,~ .o O' I?: , .................... STATE OF NEW YORK, lc S \ COU N~Y,# -- ...~_ , % ,,-.. ,a.__,_"OF ... ,~a:~..~o,1.1¢., 'i ....... 'f .... . ....... ............................... eing ewom, d ,oses and oys that he is the appJicanl (Name of individual signing contract) above named. He is the ........................................... ~,O~t,~'41~.~O~. ............................................................................................................. (Contractor, agent, corporate officer, etc~ of said owner or owners, and is duly authorized to perform or haye perfor~¢'~] thi¢ ~l~id work and to make and file this application; that oil statements contained in this application are true Ilro~he,l~rof his knowledge and belief; end that' the worlc will be performed in the manner set forth in the application,~ ~ th~e~ith. Sworn to before me this ~,~ ............ ~.~.~... day of .......... ',1~1.~, ........................ , 19.7.8_. /~, ~'~N°ta~'~' Public,, ' ............. ' ~i':'//~'s ..... '~'~7" ...... .8~[i~"'~.~ County ............. :' 1'~''~'~'~ ............................... ~aature of opplicont) L/~ BLIZABETH ANN NBVILLFf NOTARY PUBLIC, St,~te of New Y~r~ No. 52-8125850, Sulfolk Ctltg~y , Term Expires M~rch 30. ~ ,. , ~"'> ~ , ~ - ~., - ..... ~ --~ / :' ,, ~ ~ ...... -..~ ~A~O~Sgg SEAL SHAll NOT BE CONSIDERED Jt~J~ ....... ~O'~t,X'VAd~, ~ TRU[ COPY, D~v~S · { LOT'f-E-,et40,~ ~queb~ye , N. ~. I APPROVED DEPARTME~IT AT , '~' 1. :gEFORE BACKFILLING ~ 3. FRAMING INSPECTION , 3, ~FoR~' COVERING PlP~S OF;ANY KIND 4. FINAL WHEN JOB C~PLETED NOT RESPONSIBLE, ~R DESIGN OR COnSTRUCTiON ERRORS ALL CONS~UCTION'.MUST MEET~ , REQGIREME~YS OF N,Y, sTATE ,CQDE AND TOWN HOUSING COD~ ~ZONING ,]