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Home My WebLink About2743-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFIP. ATE OF OQI~.UPANOY No. g. 2~3~ ..... Date .............. 8e.laf,.. 8. ..... , 19.67. THIS CERTIFIES that the building located at . I~$ Jomky. Cazeek. D~' ..... Street Map No.. :xx ... Block No .... XX ...... Lot No.. XX~ ... ;5oll'l;ho~,/t,. I,I,Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Ha.~'. ·. · 3..3 , 196~ · pursuant to which Building Permit No.. 2.7.br3. ~ dated ......... ~4~'....~.3 .... , 19.6.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is PI~iva~c.e. one..fam.%ly, al.wallin§ ....................................... The certificate is issued to ...J.q~gP.h. .l!.a¥.e.~. ............... .0.~e~ ....... . .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 8.ep~;..7., .19.67... bV..R,..V.:illa .... FOI~M NO. 2 ~UILD~NG DEPARTMENT TOWN CLERK'S OFFICE SOuTHOLD, N. Y. BUILDING PEP, MIT (THIS PERMIT MUST BE 'KEPT ON THE PREMISES UNTIL FULL COMPL:ETIOiX OF THE WORK AUTHORIZED) N? 27 3 z Permission is hereby granted to: .... ; ....... ~o:~L~......; .................................. to ..~ul~...new.. en~..~'em.tl~ ..6~e3,~t~ .................... : ................................................. .............. at premises located at ...,~J~....~oi~e~..~eek..~: .............................................................. ..................... ~. ~.~;~.t......~.Z,,. .................................................................. . i .............. pursuant tO,/~ppli¢c~tion dated .............................. ~1~. .........~ ........... 19~.~., ond approved by the Building Inspector Fee $....~,Oe~O.: ...... Building Insp~etorr ' · FORM TOWN OF SOUTHOLD Building Department Town Hal! Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY hqstruotions This application must be filled in typewriter bR 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 features. 2. Final approval of Health Dept. of water supply aqd 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing alt 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. 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.OO Date ....~.~e...4,..],~.8..2 ......... X~ New Building ....... ~ ://.2..L__gld'or Pre-existing Building ............ Vacant Land'. ............ Location of Property ~. ~Tock.e~. C~eek D~±~e~ Sout~old,..~.eN.¥O~¥k ............ House No, Street Hamlet Q ~ ~ MALCOLM A. & DOROTHY Y TUTHILL (acguired title on r L) ners o ~ro erty ...................... · ............................... ~v_r~_§~ ~om ~st~te or G~b~C~ ~/ES) County Tax Map No, 1000 Section ,, 0,7.0, ,00 ...... Block . .0.2...00 ........ Lot...0.],7,: .0.0.0. ..... 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 p~rQ~'lZ(m~s~'apj~c~te c~e~regulations. Applicant ............................. / ' / ~zease ,~ ' ~House~ built in 1964 or 19~ 0 i S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Dage Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. District Engineer NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ ....... ~pproved ........................................ , 19 ........ Perm t No ............................ D~sapproved o/c ............... ' ................... .............. APPLICATION FOR BUILDING PERMIT Date ......................... ...... ............... , 19. ...... INSTRUCTIONS o. 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 propertymust 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 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 Deportment 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 censtruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if o corporation) State whether applicant is owne, r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature o duly au o ' ed ' . (Name and title of corporate officer) 1. Location of land on whict%proposed~ work will be done. Map No: ..... ; ...................................... Lot No: ..................... 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 ............ ...~..~ ......................................... 3. Nature of work (check which applicable): New Building .....~....... .... 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 business, commercial or mixed occupancy, 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 ........................................ B. Dimensions of entire new construction: Front .......... ~ .............. Rear ........~].....~... ............ Depth ..................... ~,..~.../ .... Height ...... ~....~.. ............. Number of Stories ..... .,/. .................... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ · ...~.....~...~....~.~.....~ / ............. Name of Former~Owner ...~......~.;....~...~.~ ............ 10. Date of Purchase 11. Zone or use district/in which premises are situated ....... ~~ ...................... ~ .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~ ........................................... Name of Owner of -rem ses~~ Addre ~-~x~"~/~ ~' ~ .... . ........ ..... ,,one,o ..................... Name of Architect ............ .. ................. ,.....~ .................. Address ....,~ ...................... ..., ............ Phone No ..................... Name of Contractor~..~...~..~..~..Addres~...~... ............. Phone PLOT DIAGRAM Locote clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions from property Fines. Give street ond block numbers or description occording to deed, and show street nomes ond indicote whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ~ S.S. .....~...~..~../../t../......~...-~..~..../.~..~./...~'.~.~.~....'~... ........................ being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ~..,~"/~ ~,..~...~<~ .. (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 ....... ...... dayof ......... .................... Notary Public,-~~....~..,....~...~:~..mrrr~C~ ~- ,:[?,,T, , (Signature of ppplicont) ..................... ~/ NO. 52-3233120 ouiloi',i T~rm Expire~ March 30.