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Home My WebLink About10116-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Date ...... .8.e~.~ ,rap, .b.e.~.. ~ .............. 19..8.0 THIS CERTIFIES that the building ...................................... ~, ......... Hou~ No. Street H~nlot County T/x Map No. l~)00 Section ....1.2.~. ..... Block ....0.~. ......... Lot ..... .0.2.9 ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .. ?.~.b...l~Aa..~.Ir' .2.6. ..... ,19 .~)pursuant to which Building Permit No ...... 1.0.1..1.6.Z. ......... dated .. :..~.e..b..z~...;~..~.~. .......... 19 .~.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 ......... ............. .,.~..~..~.e...~..a. ~..o.o~ .z~ .i.d.s. ag. ~..~.e ...................... : ......... The certificate is issued to .......... .R.o.b.~..~....~l).d..R..~.~...la.o.t;..d.~y.~.a. .................... of the aforesaid building. Suffolk County Department of Health Approval . ll/R UNDERWRITERS CERTIFICATE NO ............... . .~.O.1.T.~. .......................... ~ ne~ FOI~M 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.° 10116Z Date .......Z..?.. ..... ......... ~,~~.....?~.. ............... ....... ................................ ........................................................ ~.,~ ................... ?, ......... ~: ............................ ,f; .............................. at premises located at ~/'~......~~...~....~.,.r ........ ~~....~..~,e~' ................................... ~_~.~..o.. ................... .(.. ....................... ~.. ........ ..'..... ................ pursuant to application dated .,.~. ............ , 19. . , and approved by the 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 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 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 informa- tion 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 Date ~_. 4/ ~ New Building ... ~ ....... Old or Pre-existing Building ............ Vacant Land ............. ocat~on OT t-roperw ........................... ./ ..................................... House No. ~,eet Hamlet Owner or Owners of Property i~.~4..~'~;4~. ~. ?..~..2Z't~...~..~'~..~..'.~. {./.~ ...................... County Tax Map No. 1000 Section ! ~ °C~ Block ~..~.~. ...... Lot..~. Subdivision ~ Filed Map No ~ Lot No ........ . Permit No. /'.0'.//~' ~ Date of Permit ./ .... ~..Applicant ........... ~ Labor Dept Approval Health Dept. Approval ................................................. Underwriters Approval "~ ~Z'~'O / ~' .Planning Board Approval ~ , Request for Temporary Certificate ..................... Final Certificate / Fee Submitted $ Construction on above described building and permit meets ail41pplicable codes and regulations. Applicant, Roy. ~0-40-78 d~,O, Z- /~X~ 7 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 July 11, 1980 Ernest W. Jones - Applicant Main Road Mattituck, N.Y. Dear Sir: ~his is to notif7 you that Building Permit No.....]01!~Z · ssued Feb. 28,-1)79 to Robt. and Ruth ~og~in will expirg'bn A~gus~ 28 If more time is required to complete the job and obtain Certificate of Occupancy, you may apply, kY le..tter, for six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H. FISHER Sr. Building Inspector TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 1197! TEL. 765-1802 Ernest W. Jones Mattituck, New York Dear Sir: This is to notify you hat Bull.ding Permit No. issued__~4/16/79 . to Wlll~am Grennan " will expire on '10~i6/80 "' 10173z If more time is required to complete the Certificate of Occupancy, you may apply, six (6) month extension. job and obtain a ~y letter, for a If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H. F~SHER Sr. Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS , ,-' BUREAU OF: ELECTRICITY ~ 8S JOHN STREET, NEW YORK, NEW YORK 1003S THIS CEI~I'IFIES THAT only the electrical ~qu~prnent as described b~low and i~troduc~ by th~ a~/icant nomad on the abov~ appllc~ion ~umher in the premises o~ in the following location; [] B~ernent [] 1st FI. [] 2nd Fl. Section Block ~as examined on ]~;~Pl~ 12, 1~79 =ndfoundtobelncompliancewiththerequirementsofthizBoard. DRYERS FURNACE MOTORS FUTURE APFUANCE FEEDERS RANGES S E R NO. OF CC, COND. PER ~' Lot COOKING DECKS OVENS DISH WASHERS AMT. K.W. AMT. K.W. ,*~T. K.W. V I C: E EXHAUST FANS AMT. H, P. DIMMERS LA a o ;~ !.t 2 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by th~{ credentials. coPy F?R ~IUILOIN~G D~ARTMENT. THIS. COPy OF CERTIFICATE MUST NOT BI ALTERED IN AHY MANNER. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y, Approved .~,~'.~......~:.~. ....... , 19.~.~... Permit No....~..,,~,...~.Z~.'..~... ...... isopproYed o/c ................................................................................ (Building Inspector) Application No..Z..~)..'..~..(..~.. ............ APPLICATION FOR BUILDING PERMIT Date ............. y. ............................... 19..~.. ..... 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 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) ........................... .............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.~...~..~..<~.~....~.~..~........~..~...~....~...~....,L...~/.. ......................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. f~// Plumber's License No ................................................. Electrician's License No ............ .~. ............................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .~f...~ £~/../ i .c. ~..,~..~../.~. ZC. ......... .~...~..~..~....0.. ................................. ~/.~ ~/ ......... Municipality State existing use and occupancy of premises and infended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~/....~?..;~..~...~....,~..,.../;~....?. ... b. Intended use ond occupancy ............ -- .......... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . " ...~.,.~..'.7 ...~...~.Z (Description) 4. Estimated Cost ....~..7.,...~'.~ ........................................ 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 ~.Y...~,.~.~:..f,.A.~..~..Z...~.~.. Rear ~.~..~'.~..../,../.~...+..~z~-~ Depth ......~,,..~. ..................... Height ......: ..................... Number of Stories ./...,z~_. ........................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone,or use district in which premises are situated ........................ ~..~ ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~'....~. ................................................ 13. Will lot be regraded ......./~..o. ................ Will excess fill be removed from premises: ( ) Yes (~')~ No y~ ~A ~'1 ~V, re .......... ]4, Name of Owner of premises ..~)~:.,...~ ....... .~.,,.......~.. · ........... Add ss ~...rF~,.,/..~..../. ............... Phone No..~..~.;?..~....~..~. Name of Architect .............................................................. Address .............................. Phone No ....................... Name of Contractor ..~..~...'~.Z....~...'...qt2~..¢.~. ........................ Address /. ..... Phone No. 2rt?....r. ....... '.~.... 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. STATE OF NEW ~OP~I~.~/ ISS COUNTY OF .~..~... ........ · . be n duly sworn, deposes and soys that he is the applicam (Name of individual signing contracf) 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 application; that all statements contained in this applicction are true to the'best of his knowledge and belief; and that' the work will be performed Jn the manner set fo~h in the application filed therewith. Sworn to ~fore me this ~ day of , ~~.~ , 19~ ...... .. ...................................... ~ .... ~ (S~ure of applicant) JI1~T~ T. ........ ~T ~',.~w York commtsston ~P~ APPROVED }AS I~OTED ~(,bO CAM fo 4~M FC~ REQUIR. ~SP~CT~ONS: :]~ORE BACKFiLUN~ ~OUNDA- "SN O~ STAqT ~],~ ~O¢::~,,o P~P;S OF ANY KIND ::)T 2ES~ONS~BLE FOR D~GN CONSTAUCTiON :'i