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Home My WebLink About2368-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~ CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....~/~...P~k. wa.~.,&..~.~.n~,..~c~..]~... Street Mop'old..~..~..~...O..O.~ ........ Block No ....................... Lot No ....... [.9 ........ ~Otz~h~ld.,......N,.~. .............. conforms substantially to the Application for Building Permit heretofore filed in this office doted .................................... ~];~.~L. ....... 2.1......, 19~.~.... pursuant to which Building Permit No...~.~,~.. dated ............................... .~Z,~..1......2~..., 1 9...{~}+, was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......... l~i~a~..one...ff, am.i.~.'~ ..d~e.tti.ng· ...................................................................................... The certificote is issued to -.~.G..~.,,..~I~I,~I~ .......................... OWt~I~. ................................... (owner, lessee or tenant) of the aforesaid building. N.D. Approval Aug. 5, 1965 by H?eVilla FORM NO. 2 TOWN' OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~ BUILDING PERMIT (THIS PERMIT MUST B~ KJ~PT ON THE PREMISES UNTIL FULL COMPLI:-T'ION OF THE WORK AUTHORIZED) N? 2368 Z Permission is hereby granted to: ............ ~..2.l.~....,8,,u,a,~ee..l~y, ........................ ............ , ........ .~....: ............................ ~ ............. · to ....tm~:Lct..ne~..~e...~'a,~.:l,~...it',te.l.:l,-~.r,~tl ..................... ~ .................................... ~ ................ ~ ....... at premises located at ~,.....:J~13t~.,~ .......... [JO11~,Jlt~r~)O~ ...... .......... ~ ..................... ~ ........... '~ ................. ~ ..... ......................... ::~t~:. ~.a~ ~.: ~,~_,.w,'. ............ ~, ISo~til~ '~a ~" '~ '~'~--'-". ................................................... pursuantlto~application dated ........................... ~.~ ....... ~:.~0...~.., 19.~l..~;-,'and, approved by the Building Inspector Fee $.~,0,.0 ,~...... ..... ns 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 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 Fines, streets, and unusual natural or topographic featu res. 2. Final approva~ 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 New Building Old or Pre-existing Building ~ Vacant Land LocationofPr~it~'iii'.~.~.~.' ..... .~.~.~'.~..¢~..~. ..... i ii ~ ~ ~ ...... ~~ House No. / Street Hamlet Owner or Owners of Property ....~...~...~..~.~.(~ ~.. ~...~/~ ...... County Tax Map No. 1000Section ..~.'. ~,. Block ./~., ~.~ .... Lot. ~(( .~.~ Subdivision ............ ~~ ............... Filed Map No. ~/ .................... ~/ .Lot No. / Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate,. ....... -~..., ......... Final Certificate ... Fee Submitted $../;..~..~. ................. ~..~..~ Construction on above described building and~~d regulations. Applicant ....~.~..'f~..~. ~... ......................... $-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 8/5/64 Building Permit No.~..~ 2368Z TO ~,~HOM IT MKY CONCERN: The sewage disposal facilities for a structure located at s/w/c Pine Neck Rd & Parkway, ~outhold ' (Give deed loc~tion) ' have been inspected by this Department and found to be satisfactory. District E ngin~r FOKM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................................... , 19 ........ Approved ~k 19...~(..Permi, No. ~)d-~ ~' ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a.. This application must be completely filled in by typewrite, r or in. ij~k 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 deta!led description of layout of property must be drawn on the diagram which is part of this application. 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 pa rt 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, os herein described. The applicant agrees to comply with a!l applicable laws, ordinances an~regulation~s. , ..... .............. (S'gnoture o~pplicant, or na~e, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises Lou.~.a F. ~'e~.n~.l~8~ D,VoMo If applicant is o corporate, signature of duly authorized officer. (Name end title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ....~.]'.~.]'. ............................... Lot No: ..~ ................ Street and Number ~ .~..~..CJ.O~'o Pr. ne ]~eek Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ....]...~.l~,~,~Li~...]~¥~ll[t~g .................................................................................... 3. Nature of work (check which applicable): New Building .....~. ............ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...~..]-..~.x..O..O..O.. ........................................ 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 ....~...~&P....O~l~.g,~>el ............................................................................................................ 6. If business, commercial or mixed occupancy, specify natureond extent of each type of use ................................ 7. Dimensions of existing structures, Jf any: Front .......................... Rear .......................... Depth .............................. Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations 6r additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front....~.(~.~....],.Q~ ............. Rear ......~.~).!...]..~.~ ...... Depth ....~..~..! ................... Height ...~.~.! ................... Number of Stories...~)~.q ......... ~ .............. 9. Size of lot: I~ront ....~1~.! ...................... Pear ............................ Depth ..~.~'.~...I....~.X'.P.~ ............ 10. Date of Purchase ....AgX'.~,.,....~.~..~.~ ......................... Name of Former Owner .~.~.o...O.].~..~.¥.?...~.~....~.....~..~...~..e...~..O.. ..... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .....~'9. ............................................ 13. Name of Owner of premises ..~..o...~..[.~..,,J..e,..n.p...[.p..~[.8. ...... Address ~..O.3;....6..?..~,..~,1~..~...[.~..~.g.¥.~!.., Phone No..~.~....g....-.~..5..~..0 Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~011~g.~J[...C.~S.t;.,.~...~13,~ ...... Address ~.l(~)...5.~/~..J,.~l.{~..~l]~.~r.:. Phone No. ~..~..-..0..~..~.~ Islip, N.Y. PLOT DIAGRAM locate 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 NEW YORK, ) COUNTY OF ............................ ) S.S. ........... ~.~.~.p..~.../~'....~..~,.~.~..~t/~;~..t..' ........................... b~ing duly sworn, deposes and soys that he is the applicant (Nome of individual signing application) above named. He is the ............ ~..~..~.~..~..~ ................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aut~ized to perform or have performed the said work and to make and file this ~plication; that all statements con~]n this application are true to the best of his knowledge and belief; and that the work will be performed ~in~-~er set fo~h in the application filed therewith. Sworn to~fore me this _~ ~;~;;~ _ / 0 NOTE: LOT' v ~