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Home My WebLink About9661-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at 2255 Grand Ave Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 5 1978 pursuant to which Building Permit No. 9661Z dated April 7 78, ....................... , 19 .... 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 a Accessory Building The certificate is issued to Allan C. & Charlotte T. Dlckerson (owner, of the aforesaid building. Suffolk County Department of Health Approval ........... N../.R ...................... UNDERWRITERS CERTIFICATE No ................. HOUSE NUMBER 2255 Street Grand Ave Mattituck, New York Building Inspector (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9661 Z ........ 3~to~r ..~e~e ..~'~,k ......................... to ........... _~ 1 d...a. ~.~ ~.~ ~oz~.. ~i:L~Lng. ................................................................................. at premises leo~l~cl at ......~'.~.v..~Oz'~e~..~z',~'~..~.~e..~..~0~_..~.:~f...~'.~ ............................... ......................................... ~vb~,~ie~.,¥oe,k ............................................... ;.~ ...................... pursuant to app{}cat{on dated ........ d~]t-~-~i- .......... ~ ...................... , ]9..~., and ~ by h~sm Building Ir~:~or, TOWti OF $OUTHOLD Building Deportment Town Clerks Office $outhold, ti, Y. 11971 APPLICATION FOR CERTIFICATE OF OCGUPANGY Instructions This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: I. 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam 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 3. Copy of certificate of occupancy $1.00 $5.o0 . .. Date ............. h"q .......................... New Building ...:.~.~. .......... Old or Preexisting Building .-..v..~......,'",'"-', Vacant~ ~a~ ............................ Location Of Property .................... &.~,/~.....~,.~...,.......~..~lj~..J~.~.~.~ ........ ~,..~.~. ................... :......r;... Owner Or Owners Of Property ... .,~..! t~..,I ..................... ~., .?...~.~ .......... Subdivision ........................................ Lot No ............. Block No ............. House No ............. o, ................... ................................ Underwriters Approval ................... ..~...t.A.. .................. Planning Board Approval ........................................ Request For Tempo~g~ Certificate ........................................ Final Certificate ~,.,,~. .............................. Fee Submitted $ .,., .~. ............................. Construction on above described building and p/~,meets all 9ppljcable codes and regulations. App,icon, ............. ...................................... (stamp or seal) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. ¥. Examined ..... Ai~A,[ ........... ~ ............. ] 9.~J.. Approved ..... Ap~'i'~ ......... :ie ........... , 19..~a.. Permit No....~.~ .................... Disapproved a/c ............................ <~ ~, /.~A,~,(, , , , . , ,', .~, ~ ............ ',, ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ........., ...... .: .......... :.. 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 plot plan to ~ale. Fee according to schedule. to ad m b. Plot plan showing location of lot and of buildings on premises, relationship jo' lng premises or public streets areas, and giving a detailed description of layout of property 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 Ce~ificate of Occupanc~ 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 afferations, or for remova or demolition, as here n described.~ The app icant agrees to comply with all applicable laws, ordinances, building c~e, housing code, and regulations, and to~ admit authorized inspectors on premises and i~ buildings for n~esse~ i~ections. (Signature of applicant, or name, if a corporation) ........................... ~:~:;;; ;f a~plic;:;f ........ : ................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ Name of owner of fetuses ~ ': ............................................................................................................................. [~'~X~' ,c[c~vS~ 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 willbe done. Map No.: ........................................Lo~ No ......................... ................................................................... ....... State existing use and occupancy of premises and intended use,~qnd occupancy of proposed construction: a. Exisiting use and occupancy ....................... i~/.~..~.0..,~..~.¢ ....... !..~...~..~...~.c~.~..~(~..~ ......................................................... b. Intended use and occupancy .............................................................................................................................. ¥ 3. Nature of work (check which applicable): New Building' .......b,. ........ Addition .................. AlteraHon ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost ............. .g...O0.. ....................................... Fee .......................................................................................... (to be paid on fiting 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 type of use ............................ 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Rear ....... l.~ ................. Depth ........................ 8. Dimensions of entire new construction: Front ........... J.~ .................... (~'~ Height ....... ~ ........... Number of Stories ......... ~..~.?/.. ................................................................................................ 9. Size of lot: Front ........................... !.t~.0. ....................... Rent. ........... .~.5.~..O. .................... Depth .....~.~...~ ................... 10. Date of Purchase ....................... I.~.~..~ .............. ............. Nome of Former Owner ............ i~.~,$.q~ :~)~.~' 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...V~ ................. dl ............................... 13. Will lot be regraded ....... ~P'~'n,~ ~ .'xtWill excess fill be removed from..~ ~ ~ upremises: ( ) Yes N/~ ( ) No 14. Name of Owner of premises ...~.~,,~/k..~.'.~.Lg~¢.¢.C~...¢~%. ........... Address ~(.4Y~..~C~..p~.4,'~.., Phone No. ~.~.~...L}.~..~.'~ .... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~ (~0 ds' S'I'AT£ OF NEWfYOPFIf:,[~ ~c¢ COUNTY OF, ..,..~d..'~/~L~ ........... f'*'~' .................... l~.\~.j~....~....~..L.q~.~c~oT~ ................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) 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 opplication; that oil statements contained in this appJicaHon are true fo the best of his knowledge and belief; and that the work will be performed in the manner set foRh in the application filed therewith. Sworn to__~ore me this -- f.- ~ ........................... ..... co.. ............. .............................. ~~~~ ~/~ ~,g n a~u re o t a pp,,can~) ~NOTAIK~ ,'g~LIC, s~,to o~ New Yor~ Ou~iiTh I in Suffolk Counf~ ~