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Home My WebLink About9733-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate ~0[ 'Occupancy No... ZgJQ1.8 .... Date ..... M.~.Y .....!7 ............ , 19..?~ THIS CERTIFIES that the building located at .. 1.}}D....BOy..A.v.e. .......... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... MaY .... ~'Z. ........ , 19.7.8. pursuant to which Building Permit No .... 9:7.~Z dated .... M.ay .....l:f. ........., 19. :/.8, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... p[I~A~ .E. QNE. F.AMILY..D~LIN. Q. I~I~H. ADD. ITIQN. (D~.~I{) ........... The certificate is issued to ........ ~.e.o. I399 .$~l~..d.e.l? ................................ (owner, ~) of the aforesaid building. Suffolk County Department of Health Approval ........... N/R ...................... UNDERWRITERS CERTIFICATE No .................... N/.R. ..................... HOUSE NUMBER . .. 1. ~.0. ...... Street ........ .B.a.y. :~.v.e. ......................... .............................................. ~.~.~.~.~u.c.k,..~.e..w..¥o. rk .......... ./. '/. , . . Building Inspector FO~ NO. S TOWN OF $OUTHOLD , Building Department 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. Fina~ 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 dispasal--(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 formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ........ .~.~ .y.....~..6...~... ~.?..7...8. ........... New Building ................ Addition ..... .~.. ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... .~.~..~...A...~..e...~_.t~.. .......... ...~....1,.~..~.~.~..9..~' ................................................................... Owner Or Owners Of Property ........... ,.C~....o.~.e....~.,~.~..d..e...~. ............................................................................ Subdivision ................................................................ Lo~No ............. Block No ............. House No ............. Permit No.....~...7..~..~,~,~.~ate Of Perm t ~. !~..!..~,'.7,~pplioant .~..~..~...e..~..?,.....~..~o~....~....S...o..~...s...~..~.,c,... ....... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .......... : ................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ ...~......0..0. ......................... Construction on above described building a~mlt meets~ a{~,l~i~o~:l~es and regulations. Applicant .~~ .......... h..~ .Y...~..", ...'~=~... ................................... Sworn to before me this ................ day of ............................................ Notary Public ................................. County (star~p o,r seal) Co. Z qo FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. r? ..................................... proved ............................ ........ , Appficotion No. Disapproved o/c .................. ~~::l': .................... ............................................................................. .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ........ ~. ....... · ............................ , 19....7.,8. ..... INSTRUCTIONS a. 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 plat plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is part of this application. c. Thf'work covered by this application may not be commenced before issuance of Bt~ilding 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 o 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 oil applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. Eugene Herren & Sous Inc. (Signature of applicant, or name, if a corporation) New Suffolk, N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. general contractor Name of owner of premises Geo.r.~e Snide. r. ................................................. 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 ............................................... Location of land on which proposed work will be done. Mop No.: ...................... : ................. Lot No ......................... Street and Number Bay Avenue Mattituck Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: one family dwelling a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy same ............... 3 Nature of work (check which applicable): New Building .................. Addition..... ............. X Alteration .............. Repair .................. Removal .................. Demolif/or: .................... Other Work ................................................... (Description) 4. Estimated Cost ........ .$. .~. . .~. .0. . .0. :. .0. . .0. ................................. Fee .......................................................................................... (to be paid or) filing this application) 5. If dwelling, number of dwelling unit's ............................ 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 existing structures, if any: Front ............................ 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 '14 t ].4' ].4 t .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 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: ......... .~...o. .......................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 1/.. Name of Owner of premises ...G..e...o..~.g..e...~p..~..~_~..?. ................... Address ..~...~.~.~.. .......... Phone No....2.?...8..-.~.~..~.0.. Name of Architect .............................................................. Address ................................Phone No ....................... ~',!,~me of Contractor ~o Hoz'to~ & Sons Address Ne~ Suffo1.tc Phone No. 754-691.0 PLOT DIAGRAM Locate dearly 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 aad indicate whether interior or corner Id ET/\T? OF NEW YORK, COUNTY OF ................................ S.S ~er~y Lo Horton ................................................................................................ being duly sworn, deposes and soys that he is the applican~ (Name of individual signing contract') above named. corporate officer 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 oppliccHon are true to the best of his knowledge and belieC tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....................... ................ g