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Home My WebLink About3241-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED Certificate O[ Occupancy No..Z. ! .29.8.8. ......... Date ...N.q v..e.m.~.e.p...1.5. ................. 19.8.~. THIS CERTIFIES that the building . .P..F .z y.a. ~.9..o.n.e...~.a.m. J:..ky..d.w. 9.1.k.~.n.g.. ............. Location of Property ...5 .q. 7. 5.. ~.e.w...8 .u.f.f...o .3_.k.. k..v .e .. ................... ~ a..~ .~.z. ~. u..c .k ....... House No. Street Hamlet County Tax Map No. 1000 Sect,on ...1.1.5. ...... Block ....4 ........... Lot .... .2.9. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Filed in this office dated .... S..e p.t.....2 .8 ........ , 196. 6.. pursuant to which Building Permit No ..... 3. 2. .4 .q.Z. ........... dated . .S.e.p. ~. :..2.8. ................. 196.6.. , 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 ......... .... F, F.i.v,a. ,t,e..qn.e..f.a,m. z .ly..d..we.l.l.% .n.g.. ........................................... The certificate is msued to . . .T.h. fim..a.s..J. :..&..A.n..n..H.a.~..z.e. ?.L. ~ ~.Z.~.~.s ..................... (owner, ~av-z~ ~YK X X of the aforesaid building. Suffolk County Department of Health Approval ....... ~..o y.... ] ,6 .,.. 1. 9. ,6 .6 .................... UNDERWRITERS CERTIFICATE NO ............... ~ ./.a ................................ Building Inspector Rev, 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. r:.ERTIFII::ATE DF nnnUPANCY THIS CERTIFIES that the building located at -~[t[]~. ~i~ .~:[O~]~. &~d~ ..... Street Map No. ~ ........ Block No~iK~ ......... Lot No.. :K~...]~;~'ll~kl~. J[[~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~O])~ ..... 28.., 19~4~. pursuant to which Building Permit No..~.~. 'Z' dated .......... t~])//; ....28 .... 19~., 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 . ~31'~,I~e. O~le. ,/~m~,'~'..d'~t~.3 ~]~g ........................................ The certificate is issued t.o .~oh~ ~r. DOl~J, lt. ])tl~;~01~O~ .... 0~1~8 ............... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval . 1~O~11% 4~1-$. ~t.~...1~ ~t..~& .... FO~M ~0. 2 TOWN ~ SOUTHOLD BUILDING DE?ARTMENT TOWN CLERK'S OFFICE SOUTHOLDo FI. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETIgN,0i: THE W0~RK A,'UTHORIZED) 3241 Z P~rmission is hereby granted to: ...~~.~s..~ ...... 41e...z~..&.~t, ~t~~ to .~ ....... aJv..~..f~...~S ................. : ........................................................... at premises located at ..... ~.~IL....jJ~...~/~.~JlL J~ ....................................................................... ........................................... K~!J~i:kit~..l,X, ................................................................................ pursuant to application dated ...................... JJepj ............ JJ~J ........... , 19.1~.., and approved by the Building Inspector, Bui ding Inspector SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage di~pposal facili~es for a structure (Give~e d location) located have been inspected by this department and found to be satisfactory. District District Engineer FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~,~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted--icc~'~!cctc to the Building Inspec- tor with th~fotlowing; for new buildings or new use: 1, Final sur~ey of property with accurate location of all buildings, property lines, streets, and unusual natural ctr topographic features. 2. Final apl~roval 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. Bo 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 topograph[c featu res. 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 occupancv on pre existing dwelling/ land use --Fre-E×ls t, lng C. 0, $15.00 3. Copy of certificate of occupancy $1.00 Vacant, :l_anc~ C.0. $ 5.00 New Building v'/' Old or Pre-existing Building Vacant Land Location of Property ................... ~ ...................................... House No. Street , , , Hamlet Owner or Owners of Property . .~~ .~.~ .~'....~. ~.~.%..?.~, ~-'z_ ~C~ County Tax Map No. 1000 Section ... ~./.~.-". ....... Block .... .~f. ......... Lot....~..~. ' Subdivision ................................. Filed Map No ........... Lot No .............. Permit ,o, .-~.~' ,~,/..~,.. Date of Permit. Z~?~.~..App,icant. ?.~.~..~...c~.'.~. ?.~E..~... ¢~...'~?...'~.~.../~- Health Dept. Approval . ?.?'..f.~ J2./~.~ .......... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Constructmn on above described building and permit meets all applicable codes and regulations. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... Approved ~'~' 19....]..Permit No. D~sapprov~ ........................................................................~ ~ ~-~'~' ............................. ................................. APPLICATION FOR BUILDING PERMIT Date ................ ................ , INSTRUCTIONS a. This opphcotlon must be completely filled ~n by typewriter or tn ~nk and submitted ~n duplicate to the Build~n~ Inspector. b. Plot plan showing location of lot and of build,ngs on premises, relationship to adjoining premises or public streets o, areas, and gwmg o detaded description of layout of propertymust be drawn on the d~ogrom which is part of thts application c. The work covered by this application may not be commenced before msuance of Budding Permit. d Upon approval of this application, the Budding Inspector will ~ssue o Building Permit to the applicant. Suck permit shall be kept on the premises available for inspection throughout the progress of the work. e. No budding shall be occupied or used in whole or m port For any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of o Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulot,ons, for the construction of buddings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all apphcable laws, ordinances, building code and regulations. 4nSignature of apphcant, or name, if a cori;~rat~on) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .~.~2..~.~........~....~..~...~...~.~. ............. .~...~.~..~--....~..~.~.~"~... .................................................... 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 ............................................ Lot No' . ................... Street and Number ./I..~...~......~.~..F...~.~?.~ ........ ..~..~.,~'. .................... ./~..~-...~../2'~...~:-J..~....: ....................................... Municipality 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy .... ..~t/~(~ ............................ : ...................................................................... b. Intended use and occupancy . ..~.../~./~. ........ · .~4~t~.l...~.7. ....... ...-~.....~...~:....~ ............................................................. 3 Nature of work (check which applicable): New Building .................. Additio .................. Alteration ................ Repair .................. Removal .................... Demohtion .................... Other Work (Describe) .................................... 4. Estimated Cost ...... ~...~..¢~_~.. .................................... Fee ......................................................................................... (to be paid on fihng this application) 5. If dwelhng, number of dwelling units ........... ~.. .............. Number of dwelling units on each floor ........................... If garage, number of cars ........... ~. ............................................................................................................................ 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7. D~mensions of ex~sting structures, if any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stor~es .............................................................................................................. D~rnens~ons of same structure w~th alterations or additions: Front ................................ Rear ............................... Depth .............................. Height ............................. Num.~er of Stories ......................................... 8. D~mens~ons of entire new construction: Front .... ..~...~.....~ ...... Rear ~ ~ ~ Depth ¥. Height ......... .............. Number of Stories ....... ¢..~ ................. 9. S,ze of lot: Front ...... ./...~...~...~ .......... Rear ....... ./..~..~.. ............ Depth ......~....~...~. ................. 10. Date of Purchase ......... ~..~..~.~, .................................. Name of Former Owner ......... ..~,.../....~../~..~ ....................... 11 Zone or use d~stnct m which premises are s~tuated ............................................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation:~ .......... ~...~.. ................................. 13. Name of Owner of prem,ses~..~.~.~.~.~.~.~.~...~rress~...~..~.1~....~ .~.:....,/~i~Phone No.l~/~.....~..~../.] Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor//~/-~..~./~. ...... ~..L~.~......~/~..Address ~!/'/.~../~.~.. ...... /.~../,n..~z.~.~..... Phone No?./~..~..-..?...~..? PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro[ property hnes Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. STATE OF NEW YORK, ~ S.S COUNTY OF ................................ ~.~....~.....~..~,,~..: ......... ~....~/~.~..].be,ng duly sworn, deposes and says that he is the applic~ above named He is the ....... ¥.'~¢~.~.4~r~.,~..,,~./'~::~....~ ............. , ....................................................... ~' (Col~/~ctor, agent, corporate officer, etc.) of said owner or owners, and th~s apphcation; that all statements contained m this apphcation are true to the best of his knowledge and beli and that the work w~ll be performed in the manner set forth in the apphcat~on filed therewith. Sworn to before me this .......................... day of ............................................ , 19 ........ Notary Public, . .......................................................... County (Signature of applicant)