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Home My WebLink About10970-zFORi'vl NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Cerfificate Of Occupancy No........Z 10261 ......... . Date ..... .Ng.v.~m..b.e?.. !7 ............. ., 19 ...8.0 THIS CERTIFIES that the building ................................................ Location of Property 3/~5 Breakwaters Ro~d~ Mattituck, .l}J~)(, ...... h~s'~ ~o: ...................... 'S'tr'o;i ................. Hamlet 11 ~ B 03 ......... .qCt5 ......... County Tax Map No. 1000 Section ............ lock .......... Lot Subdivision ........... .-. .................. Filed Map No .... .- .... Lot No ...... .' ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated 10969 Z .... N. 9¥.e.~.b..e..z'..9. ..... ,19 .~0pursuant to which Building Permit No....10970..Z .......... dated ...N.o.~..e.~l.b.e.l?...1~. ............ 19.80, 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 . .P.O?.C..h.. · ..~d.~..~?.o.n...~9...E~..~.s~.n.g. pa..r.ag.e...~.¢..Ac..c.e.~.s.o, ry..S.~..or.a.g.e..~.u.~¢~g, ........ The certificate is issued to . . . .R.t-.o.h.a..I~.d. '.~.17. O~.a.l~O~.lqt,. ~..1~t~, .......................... (owner, I~iU~X of the aforesaid building· Suffolk County Department of Health Approval ...N../.R. ................................... UNDERWRITERS CERTIFICATE NO.. i~I/1~ ............................................ ector Rev 4/79 TOW BUILDING DEP,~RTMI~IT TOWN HALL _SOUTH'OLD, (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) ~ Permission is hereby granted to~.~ at premises located at .~..~. ~ ........ ~./~~ .................................... pursUont ~o ~ppl~cat[on d*t*d ~....~ ....... ~ .................. ~..... ...... 19. ~nd opprov~ by the ~uil~n~ Inspoctor. / Rev. ~ 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:* Examined .ff..w..~.. ~:7~. ..... , 19~... Approved .~. r? ?./..< 77 ...... 1~. Pe=it No../~ .7. ZO~, APPLICATION FOR BUILDING PER~IT Date . .~e~ .... .~/.. INSTRUCTIONS Application No...~. ,~. f.~. 6q' ........ 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 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, additi6ns 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 auth°rized inspect°rs °n premises and in buildings f°r necessaT, i.~sT~~... (Signature of applicant, or n m~/if a corporation) 2. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ...................................................................... ......,,.. ... (. .e-e. .j .-.q. ? .............................. Name of owner of premises (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 ..... ~. q~J. :M :g-. ~.%<. ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... coz s.' o-i 1. Location ofland on which proposed work will be done.,o-~./--~,,_--"':.':;"'-'"' ................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... /~.~. ....... Block ....... ~ ......... Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /:~9~.,%. ,' d,,~.~./f-2~' b. Intended use and occupancy ......... ~.. c..C. ~> ...... ~ o ..... ...4-~'.-~-~.. ........................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Removal .............. Demolition .............. Other Work .......... t ' 0 4. Estimated Cost .............. Fe ............................ (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. r)imensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth. ................... '.. Height ......... .,~ ........... Number of Stories ............... ,, ...... 8. l[ ~menslons of entire new construction: Front '~T Rear ~. Depth . Height ..... 2 ........ Numbgr-of Stories ........... 4~..,'.~ ............................ ,,..~ .......... 9. Size of lot: Front ....... / 2~.. ........ Rear ........ ,~. ~.~. .......... Depth ...... ~..~. ....,..., .... 10. Date of Purchase ......... ./.~. ~..~. ....... Name of Forrr~r Owne~; ...'Do ~,g .~.'q.~. · · ./?.~ .'f.'P.K · .'~'~-~. 11.. Zone 9r use &strict in winch pr0m~ses are situated ...... ~ t~.~. ,...~... ~-~r..4-.. ?..C:....~.~-., ................... 12. r)oes proposed construction violate any zoning law, ordinance or regulation: ....... ,4~.<:>. .................... 13. Will lot be regraded ~ ~ D . . Will excess fill be removed from premises: Yes 14. Name 0fOwnerofpremises/~2~.~..,~,. O..~.~?~'.~e..or~..~:.i .................. . . ...... ~/" .' . ..,~...~w......~.~/g Address ...92-.. ?.., .... l .... ,P,~one No. Name of Architect .......... Address /:~ ~..~.."~-~. hone No. Name Of Contractor ..... ~.~..-q.,~...~m~.. ......... Address .... Z~f',~.~.-. ./.': &..w.. Phone No. PLOT DIAGRAM Locate clearly and distinctly alll 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 NEWj~.OP,,~ ,,1/., ~ ~ COUNTY , .......... ~,~~. · . · .~..~~ .... being duly sworn, deposes and says that he is the applicant (Name of individual siring contract) above named. ' He is the .. ......... (~).cj~....xq ~ ............................................................ (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 ~ ........... ./.0. ~'~ .day of ~.//..ef77. ~. 19 ~ / ~OTAR¥ PUBLI$ atate of /~ew Yori · · ]U NO. 62.1000esll Su~fo k O0ant¥ ,k ~ (Signature of applicant) ' Commission Expires March SO, 19' ~l-J ~FO* NO. 6 TOW SOUT.OLD 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: 1. 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. B. 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 3. Copy of certificate of occupancy $1.00 $5.00 Date. ~.0. ,7~,,, .[. 7. / ~>0 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ,~', .'~. ........... ,~_/~.."~,~.~-, .C~..~?. ,~,',~.'.~'., /~..~.~., ~ ...... / /~/.../1 ~ ........ House No, ~t~t Ham/et Owner or Owners of Property . ~' ~.~...~/~ ~.~.'...~: .~ ~ ........... County Tax Map No. 1000 Section . .L~ ........... Block .. ~, ~, ........ Lot,, ~,~ ........ Subd~ws~on ........................... ~...Filed Map .......... Lot No .............. 1, 7M; - . . o " r it ........ Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $... ~ ....................... Construction on above described building~a, nd permit meets al, I applic~le c~odes and regulations. ,,v.,o.,o-,e ,,/'