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HomeMy WebLinkAbout2337-zTown Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 7, 1998 To Whom It May Concern: Re: Suff. Co. Tax Map #1000-70-9-64 Certificate of Occupancy Z-15048 Please be advised that the correct address for Certificate of Occupancy Z-15048 dated October 28, 1986 is #95 Willow Pond Lane, Southold, N.Y. Very truly yours Southold Town Building Dept. Edward Forrester Director of Code Enforcement EF:gar FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted mm-.--.--- 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 p~operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .......................... NewConstruc f,ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... ¢'.~......~f~...~.~.~.. ~ ........ ~..d.. ............... House No. Street H. ~mlet Owner or Owners of Property ....... .~.,...~..4~..~...~' .~ ....................... County Tax Map No. 1000 Section ..... 7Q. ..... Block ..... .~.. ....... ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit Noo~7...~..ZZ Date of Permit ~//~.~/~".¢.Applicant b~. ~.~ ~..~ Health Dept. Approval....y-~ ............... Labor Dept. Approval ........................ Underwriters Approval ,,.r~-. ~.~ ...... Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate .... ~ ........... Fee Submitted $ ............................. Construction on above described building anc~Fnit, m.~ets all~ppl.icable codes and regulations. App lican tj.~..4~.. ~....~?~.. ........................ FOH, M NO. 4 TOW~4 OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. TEMI ORARY CERTIFICATE OF OCCUPANCY "' .................... ;~1~,~[ 22~ , 1965 No ..... Z...2~,39 ......... ~'~, Date ................................. THIS CERTIFIES that the buiid,~ng located at .~illO~...P.o~lcl.l~e.,...F.~K~..~.e..~...,P...a~rSee~uthOld Map No .......$388 .......Block No...l~i;JQ~ ........ Lot No ......2Q ................................... : ...................... conforms substantially to the Applicati6~ for Building Permit heretofore filed in this office deted ................................... A]/~1~;L1,.,1 ............. , 19.~.4.. pursuant to which Building Permit No ..... .2..~...~..?..~. dated ....................... "...Ap~'J.l...2 ............. , 19...(~.~., 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 ........ .................................... o~e...£am;L%y,..~lling ................................................................................ The certificate is issued to ...A.....Palm~r..~=ha~g ........................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector s-9 SC~D SUFFOLK COUNTY DEPART~NT OF HEALTH Date Oc'~ober 1).1~ 196L Building Permit No. 2337Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at , F~irv~ew ~a~,k~ Sou. t~ol,d (Give deed location) G. Palmer S~hade have been inspected by this Department and found to be satisfactory. Or'7 1. ~ 1964 District Engineer FOEM NO. 1 TO~N OF SO~THOL~ TOWN CLERK'S OFFICE UT.O,D, ,. ,. ......... /~'pllcation INa ............................. Approved N ~ 19.....!..Permil No. Disapproved a/c~ ........ .._._.___--~----~- (Building Inspector)~ APPLICATION FOR BUILDING PERMIT I NSTRUCTI ONS a. This application must be completely filled in by typewriter ar in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot end of buildings on premises, rela¢ionship 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 opplica- tion. 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oll applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .]~.~.~;a.e.~.~ ................................................................................................................................................................... Name of owner of premises ......... ..~..: ........ ] .~...~.:}.v..v..~..?....~.. ........ ~;..[5 ~.<[..~ ................................................................. If applicant is a, corporate, signature of duly authorized officer. ............ ~ (Name and title of corporate officer)~ 1. Location of land on which proposed work will be done. Map No.: '~ ~3 ~' ~ Lot No.: 'z o Street and Number vV~ I ~ ~d ~ ~ ~c ~ ~ ~ ~ ~ ,e ~ "-~ ~ ~ ~'m c/~[~ ~c{ Municipality 2. State existing use and occupancy of premfses and intended use and occupancy of proposed construction. a. Existing use and occupancy ~ o ~ ~ ....... b. Intended use and occupancy ~ ~ o~ ~ ~ 3. Nature of work (check which applicable): New Building ¢"" Addition Alteration Repair .............. ./_]. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ........ ~ ........................................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ........................... I . .... Number of dwelling units on each floor If garage, number of cars .............~ ............................ 6. If bdsiness, commercial or mixed occupa'ncy, 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 ..... ~.~..~Z..&...~ ........ ............... Rear ....~...~....T...~ ............ Depth Height tz-%/ Number of Stories ~z_ 9. Size of lot: Front I q~o ( r .............................. Rear ....... .~q..o ................... Depth f ~ o~ ! 10. Date of Purchase ....~...~..?......~..~,.....l?...~....~. .................... Name oF Former Owner ~,~k~l~ 11. Zone or use district in which premises are situated, r~e S~-{e~ ~L~ 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ....... ?..P... ~3. Name of Owner of premises .~:,~l.~.¢,C...~.C-Address .,~,..~.?.~.,.~m...?...%.~.,......,E,.~ ......... Phone No. Name of Architect .................................................... Address ................................................ Phone No. Name of Contractor ~.¢~,~.~.,~:~:~..~.~.~.~..Cm.~..r.,:~.~.cAddress -~.o~.~m.~....>.~,,~..;~e~..~,.. Phone No. PLOT DIAGRAM Loca.te clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions f~om property I'ines. Give street and block numbers or description according to deed, and show street names and indidate whether interior or corner STATE OF NE~0~, ~ ) COUNTY OF ,~...) S.S. .~.~....~,....~.~ ....................................... being duly sworn, deposes and says that he is the applic~ (Name of individual signing application) above named. He is the ................. C.~.~ ...... ~.~.~:~ ................................. (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and file application; that all statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn toBef~e me this ~ ........... ~...~'.. day of ..................... , 19~. ~ ~ .... ........... Notary Public~j,k~~~. Z~ ~ ..... (Signature of applica.nt)