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)