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Home My WebLink About1040-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-1974t DATE: February 21~ 1991 THIS CERTIFIES that the building NEW DWELLING Location of Property 475 OYSTER POND LANE House No. Street County Tax Map No. 1000 Section 25 Block 1 Subdivision Filed Map No. ORIENT., N.Y. Hamlet Lot 5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18, 1960 pursuant to which Building Permit No. 1040-Z dated APRIL 18, 1960 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 ONE FAMILY DWELLING * Tile certificate is issued to WILLA GODFREY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *NOTE: TEMPORARY CERTIFICATE OF OCCUPAMCY Z-696 WAS ISSUED 7/1/60. · Building Inspector Rev. 1/81 FO,~I~ NO. 4 TOWN OF SOUTHOLD ~U~LDING DEPAH~MENT TOWN GLERK'S OFFICE SO~THOLD, N. Y. CERTIFICATE OF'OCCUPANCY No..~Z_,69~ ......... Date ....................... J~l~.-..1 ................... 19.60- THIS CERTIFIES that the building located a~ ...~/~.,..0~.e..!'.p.Q.%q.d.~...I~¢~. .................... Street _Map No. ~ ..............Block No ............ ~.Lot No... ~ ........ O~fk.~.~..:~...N,.~.* ............... conforms sabstantially to the Application for Building Pormit heretofore filed in this office dated ...... ~ ........ .A.~.i,.%.......1.~ ......... , 19....6...0. pursuant to which Building Permit No....~1.0~.0. ....... ~lated ................ ~.P.~:......~-{~ ........ 19...~.0., ,vas issueS, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ........................................................................................ This eertiheale is issued to ..}.(..O...D.g~.~.....~;~l?.O~ .............. (.o3ari.r~lt~ ............................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector 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? 104o z Date ......................... .t~)r l~ ....].~. .......... 19.6.0... Permission is hereby granted to: ~'or~r l~ort<tun.....~..g.....F, enne.Ch.....e,o~t'rer. ...................... ................. O~:[e~a~4.....t~,,..~.o ................................... to..:B.u~t.. ~e~...one...£~.~r...fl.~e~rt~ .................................................................................... ct premises located at ....']~..~....0~.$.~.9]['~...[~"~...~ ..................................................... ; ............. ........................ ............................... (~te~ ........ ~,.~,. ........................................................................ pur~anf to application dated ............................ ~lal~..~b~......],8 .............. 19.(:~0.., and approved by the Building Inspector Fee $~, {~10.' ........... Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be fille~d in by typewriter OR ink and submitted to the building ~inspector ~:ith the following: for new building o~ new h'se~ 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). ~. Approval of electrical installation from Board of Fire Underwriters. ~ 4. Sworn statement fro/n~plumber certifying that the solder used in system contains less than 2/10 of 1% lead. · 5. commercial building, industrial building, multiple residences and similar buildings znd installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ~ · Fees i. Certificate of Occupancy - New dwelling $25.00, Additio'ns to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $100.00 3.Copy pf Certificate of Occupancy - $5.00 over 5 years - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .... FEB.RUARY 21, 1991 ;ew Construction ........... Old Or Pre-existing Building .............. 475 OYSTER POND LANE ORIENT, N.Y. · ocation of Property .............................. House No. Street Hamlet nwer or Owners of Property WILLA GODFREY ounty Tax Map No 1000 Se ti 25 ! 5 , c on ......... Block ubdivision .............................. Filed Map ........................... .......... Lot 1.0.4.0~-.Z APRIL ]8, 1960 KENNETH C, ODFREY 2rmit No ........... Date Of Permit ................ Applicant ............................. 3alth Dept. Approval .......................... Underwriters Approval ........... [arming Board Approval ....... iques~ for: Temporary Ce mtificate ...........Final Ce rt~~~ Submitted: $ ..... .................... ' - ' ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this location. 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 progress of 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 comp y with all app icable aws, ordinances and regu orions. ............ .............................. (Signatu~ of applicant, or name, if a corporation) (Address o applic, dnt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of prem,ses....~..~..~~.....~.....~-.~...-..~... ................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Nu~bb~r ....~.'..~...-..~...~.......~...~..~.-. ..................... ~~ ...... ...~..~...~..: ......................... ~ Municipality -- State existing use and occupancy of premises and intended use and occupancy of proposed construction: o, Existing use and occupancy ........................................................................................ b. intended use and occupancy ....~~~... ........................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... · /...7, ooo 4. Est,mated Cost ~.... .................................................. Fee ....".Z"D ................................................................................. (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 bu.siness, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions oF existing structures, if any: Front......~.? ................ Rear...../'Z~ ................ 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 ~/0 ~ Rear ..... .~/.~...: ............. Depth Height 2-0 t Number of Stories.....'~.....~.. .................. 9. Size of lot: Front ...?..~'.~...O...?...~ ........ Rear .....~..~:..0...; ............ Depth .../..~...~'.'...~.~...'. ..... 10. Date of Purchase ........ ...(~..F~........./..~.~.Z ................. Name of Former Owner ..,~,~,~..~~ .......... 1 1. Zone or use district in which premises are situated..........'~4~.,, .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...'..'~.A .............................................. 13. Name of Owner of premises./~'.:...~..~ ......... Address ~../~....~..~..~...0..~..~.,...~.~ Phone NO~'./I~....: .................... Name of Architect .~....~ ............ Address ~~.....--' Phone NO ..................... Name of Contractor ..... ~..~.~ ........ Address ...... ..~...~ ................ Phone NO.O../'~...Z..L/..~...~.../.. PLOT DIAGRAM I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from . property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~-%YOI~ ,~ ()) S S COUNTY OF_ ///~//~";;;ie~4cCg-¢%~") ¢ ' ' ' .......... i ....... .~.~~..~,~.~ ................................. being duly sworn, deposes and soys that he is the applicant (Nome (~f individual signing ~oppiic~:J/~:LL_,,~~-~ - z r~ above named. He is the ..................'.~......~...~....~....~f/;~ ............................................................................................. (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.....~. ,~ ..... 19.~.. ..... Z .~....~.~... ..... day of .~ .... (~gnature of applicant) FOI~M NO. I TOWM OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... .~.~. .......... 19..~.¢~ Approved .........~,_.~.~.....~.......~..~?...,z 19...~?..(.Permit No ....... ..~../~'.2..~...~.. ........ Disapproved a/c ................. ~_~~ ........................ ..... (Building Inspector) Application No ..........//...~...../.'~..~ ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 ava,ilable for inspection throughout the progress of 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 and regulations. ..... ...... ......................................... (Sig~6ture of applicant, or name, if e corporation) (Address of apC~ticant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... K ......................................................................................... tf applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate, officer) Location of land PO which proposed work will be done. Map No: ............................................Lot No: .................... Street and N~-/~r ....~..~.,~,...'~....~.~.'..~..~ .................. ..6~..~.~..~.?...~......~.~..,..¢.~...,: ................................ Municipality State existing use and occupancy of premises and intende/¢2 use and 'occ'upancy of proposed construction: a. Existing use and occupancy ......... '.~.//--~......¢¢~¢....~..~..~..~ ............................................................................. b. Intended use and occupancy .. ~..~..~¢~..~...~... ........................................................................................... 3. Nature of work (check which applicable): New Building .......l~.. ........... Addition .................... Alteration .................... Repair ..................... Removal .................... Demolition ..................... Other Work (Describe) .................... 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 bu,siness, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing struct~ures, if any: Front ......~ ............... Rear~i~.~..~ .............. Depth ~cz~? 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 ...,~..?....'. .............. Height ......~;,..~.[ ............... Number of Stories...-../....~,,~r .................. 9. Size of lot: Front ......~..?..*.~.~..I ...... Rear ...~....~.,,...~....~ .......... Depth ..../..~..~.X..?.~..i... 10. Date of Purchase ........-- -~ -~--~-.(.?.~....../..~..~..?.. .................. Name of Former Owner" ~ '~ ..~......'~....~ ' 11. Zone or use district in which premises are si~ua~ed.,..~'~.~ .................................................................................... 12. Does proposed construction violate any/~ ~z°ning law, ordinance_or regulation? ...?~..~. ............................................... 13. Name of Owner of premises.~..~.....~.'~ ......... Address ~./...C..'.~..~..~...~..~,,, .~.r Phone NO,~..~.~...?.:..~...~..?./ Name of Architect ..~....~..~'~ ~ "~~/' -(/ ............. Address ~.~~-~.. ....... Phone NO..~Z: ....... Name of Contractor..~..~...C./~'~,~ .......... Address ....... ...~..~ ............... Phone NO.~../~..2.:.~'..~.~i .~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s~reet and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. L STATE OF NEW Y~I~I~.Z~ ) S S above nome& He is the ........ ~ ............ ~.~'.'. ................................................................................................................... (Cantroctor, ogent~ corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to 'n~ake 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 ~~ ...... ...... Notary Public, .......... aunty (Sign~re of applicant)