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Home My WebLink About10963-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Halt Southold, N.Y. Certificate Of Occupancy No. Zq 1624 Date April ..................................... , ............ 19 .~.3. THIS CERTIFIES th at the building ................................................ Location of Property . .q.5.9..0., ~.e.s.t...F[.i.l. 1., .~.d... ............... .~.a.~..t.i.t.u..c.k .............. House No. Street Hamlet County Tax Map No. 1000 Section f106 .Block fl 0 .Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 2q 1¢~.0.. pursuant to which Building Permit No. . .'1.0.9..65,Z. dated......OPt°bet... 2fl ..... .. ...... . 19.8.0., 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 ......... Accessary Storage Buildin~ The certificate is issned to Howard & l~atrica Wolbert of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ............ .~l./..k ................................... Rev. 1/81 FORM NO, ~ TOWN .OFsoUTHoLi,: BUILDING DEp~RTMEI ~1'~ TOWN HALL SOUTHOLD, N~ Y. BUILDING P, ERA~iT!~ (THIS PERMIT MUST BE KEPT ON THEPRE/V ISES COMPLETION OF THE WORK AUTHORIZED) N°. 1'0963 Z UNTIL RULL Date ...~.;. a...;.. :......-. ....... ? ............ ; ............ . ....... Permissiori is hereby granted to: Mat~;i~uck, ,N~ Yor, ~19~2 : Bu:l. ld an Aooe~o~ (StOr~)e Butld~ ' Ma~tt~uck, New York 00~.~ 2~, ~ ~ 1~...~. ond opprovod by the BU ding ,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 subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sur~,ey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohic features. 2. Final approval of Heaith Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of e~ectrical 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 Beard 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 sunzey 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 ar 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 land use }¢/ 5.00 . Date ..... , . . New Building ............. Old or Pre-existing Su~]ding(X) ......... = ¢Vacant Land ............ z¢ff¢ ...... .... Hou~ No. Hamlet ... Owner or Owners of Property ....... ~ · .-, ,. ~Z .... . co~ T~ M~ No .~000 S~o~io, .... Z~ ...... ~o~ ..... Xd ....... Lo~... ~Z ....... Subdiw~ion ...... ~ ........... ~ .............. Filed MagNo. ~...Lot No..~ ..... // P~ tm it No / Health Dept. Approval ...... ............. ............ , Request for Temporary Certificate ..................... Final Certificate .... * ......... Fee Submitted S ............................. Construcuononabovede,cr~bgd 5uddmgandp m~tmeetsalla [cable . ' ~ ' ' ' an~ p~ ' ' app[~cable~od~s and regulations. . -- ''"' ' ' -'".. ' " 7 ~, ~ '.,'; .. " ... - ~C~L~ C~ N F~AIV'~,F_-. (/% / /. L lC' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 ~ /:5,19~'7-) Disapproved a/c ....... ~ ....................... Application No /~)~'-'~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..................Z/. '.~.~....~? 1~.~. ~ 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 buildiffgs on premises, i'elationship 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 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 constructi6n 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 nece~ary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. zC.,e .x 5'. i.. ......................................... Name of owner of premises/g~(.4~_,,~.....~..~ .... .,~,~t.f.Z¢... ~.,~/..~r'../.~.,,,..,,~. :.. ~.~ ...... (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 .......................... 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 .... ~...~..'~.' ....... Block ....~..~. .......... Lot....~. :../' .......... Subdivision - ' Filed Map No ............... Lot~......-77. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... fi_'../..,~..~..,/~..~ .... · .,~--.~../'~..../4.~..... ~--..,g'~/~...,ftC..~ .............. b. Intended use and occupancy ..... ~"'Z~7/~'~ .................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removai .............. Demolition .............. Other Work ............... 4. Estimated Cost ...--.' . ................... Fee ........ .off. ....................... ! ~ (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 mixe~ occupancy, specify nature and extent of each type of use .... ~ ........... 7. Dimensions of existing structures, if any: Front....~.%~.. ,r~T~..... Rear . .~.~..',~fiT. ..... Depth. ~,~..~..7'7. ..... lteight ~..~7.(/ ..... Number of Stories ...... .,:~....' ............................................. l)imensions of same structure With alterations or additions: Front ......--:-7:Z... ........ Rear Depth ...... · .--::::: ........ ,.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new const[uction: Front ...x(~. ~. .... Rear ....z/~...-~..~~. .... Depth .. ,~.~. f. ....... tteight /~ '~// Number of Stories . 9. Size or lot: Front ..... ,f.~. ~ .:~..' ...... , Rear .... J~.. ~. .......... ,,Depth .,~2, :~..~.,. ~.. ..... 10. Date of Purchase . ,Z'~'~'~'~'~'~'~'~ .~.. ~..~.~../~..f~'. ........ Name of Former Owner~..~.: 1 1. Zone or use district in which premises are situated...: .................................................. 12. Does proposed construction vioiat~ any zoning law, ordinance or regulation: . .~..O. ............................ 13. Will lot be regraded ...... ,4-(,.///51...,~ ........ ,...,._.Will exce~s fili be re~a,,oved from premises'~O,g]~s 14. Name of Owner of premise~/'~...~/~..~.. ~..,q~[ddress zff-~f~¢. ~'~/,~(~,,f','/Z~.~ Phone No..~<.~.,~r:Sf,~.~/... Name of Architect ......... i ................. Address ................... Phone No ................ Name 'of Contractor ... ~.~-~.. ............... Address Phone No ................ i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, ~md. 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:: ~rner lot. STATE OF NEW YO~ -- COUNTY OF. ~.~... 'S'S .../~h~.~.. ~,. ~¢~ .............. being duly sworn, dePoses and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... . ................................................................... (Contractor, agent, corporate officer, etc.) of s~d owner or owners, ~d is duly author~ed to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements cont~ned h this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~nor set for~ h the application filed therewith. Sworn to before me this ........ ....... ...... Q~a[if~ed ia ~0ff01k O00n~ ~ (Signature of applicant) ~ Commission Expires M~t~h