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Home My WebLink About10262-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clark's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building... ~ .~. .................. ....................... Location of Property ...~.~. ~ ........... .~.LLb.~ )~....~..~.,.V..~.' ...............~'~A~......... -' -~ ('¢ ,~. Hou~ No. Stree~ Harnle~ County Tax Map No. 1000 Section .... ~ ~ ~ . .Block .. t I .Lot ... ~. Subdivision .~:!1.(.-.~ !'.(.~....~.E.~.~ }.C ?..(~.k~ .U~....~ed Map No..'7.7..~...Lot No.L~.. ·w ,..~ ?~,. ~ .~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... '.l.c!l?..~...~.~ 19~. pursuant to which Building Permit No. lC .~..~.~...'~..... dated ........ ... ...~ ............f~ . , was issued, and conforms to all of the ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ........... .~. e~r- ~.~, ~ ~ ~.', Th, ce~ficate is issued to ...~..E 9. ~'..F-. ~ .... ~. .... I~ .~. ?J.?.~: ...... ~ .~..~..~., ~ .......... of the aforv,~aid building. Suffolk County Del~'~mont of Health Approval /V A UNDERWRITER5 CERTIFICATE NO .................................................. Building Inspector n~ 4~s FOR~I 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? 10262 Z Permission is hereby granted to: ........... ................. ....~.~,1 ....... (_J~.~.:c.ZPze~..~ ..................... ..... ~.5~z.&.,....~,..~.: ........................ to ...C~.~.~....:~.~.~....~2~Z~...~/~...~5/~.~.~..~:~' ~.~.....~~.~ ...................................................................................... ~, ~,~,~, ,o~,~d ~, ...~g:c:....62~.~zc..~.:.~ .......... ~~,~,..~.:.~. ....... pursuant to application dated ......... J(,.,,~,.....L/ ...................... 19~..,~.., and approved by the Building Inspector. TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Yo 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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: 1. 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 electrica~ installation from Board of Fire Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Cade 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 propert? lines, streets, bu~t~lings 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 3, Copy of certificate of occupancy $1.00 $5.00 ,o,, ........ ................. New Building~l, ,~,,.l~.r.~,,~.~.. Old or Pre-existing Building ............ ................ Vacant Land ............................ Location Of Property .~1~'~...~.~...~."~..~...~.:.....~..~...~./...'~.~.~/~.'..~..:..~-'. ............... ~.t~.~.....~..~.,~. ......... Owner Or ~ners Of Property ~~. ~.~ ........................ ~'7[.~'6':;'~ "' Subdivision ....................... ~.~.~..~ .......... ~L.Lot N~ff.'~.t~Block No ............. House No.~.. Permit No.Z.~.~.~.. Date Of Permit ..~./~Z~.Applicant ~.~.~..~.~.~.~ ................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporo~ Ce~ificote ........................................ Final Certificate .......~ .......................... Fee Submitted $ ..~ ........................... Construction on above described building and permit meets ali applicable c~es and regulations. Applicant ..~.~ ...................................................... Sworn to before me this ................ day of ............................................ (stamp or seaD Nota~ Public .................................... County ~ ~/~ ~ ~ Examined...~..~.~.(~ f-~...~.., I9 ?.? Approved ~/o ~c~ iZ' ................ ,19... ennitNo../~ .... ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No./.¢~ o~.6/~-. ....... Disapproved a/c ........ ~ 7 ....... .-7 ......... ~. ........ / (Buildin~nspector) APPLICATION FOR BUILDING PERMIT Date ................... ]9... 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 Pemlit 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,-.r~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, anal regulations, and to.~ admit authorized inspectors on premises and in buildings for necessary inapgctions, x / '~ ,~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~- Name of owner of premises .......................................................................... [,,j (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. t~..{~.. 7)..~./~. ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...( · .. .................... . ·;: ............ : ........ House Number Street Hamlet County Tax Map No. 1000 Section)~7~-V~¢~} j.//~. ;,... Block ......... · .... ..... Lot ................... ~ubdivismn ........ .~'AZ...'7.... ~ ............ mtea ~viap c~o .... ~ ...................... (Name) ~ 2. State existing use and occupancy of premises and intended use and occt~pancy of proposed construction: a. Existing use and occupancy .-~.~&/.--i _..Od.~'...~..~/.~.~..~_,d~///../~d~' .......................... b. Intended use and occupancy ~..~.,~-F~. '..../~//. ~:2,~:2...~.~X~/v//~./O....7.~.'....,~. 1~.~.-(..r/./(/~,Y~ ........ 3. ' Nature of work (check which applicable): New Building .......... Addition ....... ~'... Alteration .......... Repair .............. Removal .............. Demolition .............. Dther Work ............... (Description) 4. Estimated Cost ........................................ Fee ...................................... (to be paid on filing 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, 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 ..... .. ~ ....... Rear ............... Depth ...., ........... lteight ............... Number of Stories... :'.' ................................................... 9. Size of lot: Front ...................... Rear ...................... Depth ......... . .. ............ 10. Date of Purchase ...~ ............................ Name of Former Owner ......... 11. Zone or use districlri~ which premise~'d~e situated .................. . ............. :'. i': ' ' ' '/'': "'~'j' / ':: ..... 12. Does proposed construction violate any zoning law, ordiflance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be remb~ed' from premises: Yes No 14. Name of Owner of premises ..................... Address ............ . .... ;... Phone No ................ ~lame of Architect ......... ~. ........... 2. ;~: .'. Address ~. ~ ....i . .~'..~.: ... Phone No. '. ,.: . ' . . Name of Contractor .......................... Address ................... Phone 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 whether interior or corner lot. STA~OF NEWARK - S .~¢;~~ .... ~~ ........ be,ng duly sworn, deposes and says that he ts the apphcant /' , ~ .~e o~&Mdual signing d~tract) a~ove named. He is the ................... <1~4-~-..~ ,.,~-~. ........................................................ (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 application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ ./.'~...~.~. ........ day of ......r'7(/'.'~"' -¢.--~-. ...... 19~7. , A.~ ~V,L,.t . (~gnature of applicant) I~TARY P1JBLIC, Stete elf New No. ~t2-812§85e, Suffolk County f~fff J~gire$ March ~. NOTE: al= MONUMENT SUBDIVISION MAP OF "MATTITUCK DEVELOPMENT CO., FILED IN THE 0FFICEOF THE CLERK OF SUFFOLK COUNTY ON MAY I ~ 192.~ AS FILE NO. 776. YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK ALDEN W, YOUNG HOWARD W, YOUNG . ~., G/GRGE,:PAP/~$8~EOUISE PAPAS