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Home My WebLink About3335-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIERTIFIr. ATIE OF OP. EIUPANI~.Y No. S..~..8~)~ .... Date ............. . .~t~...~ .... 2~.., 19..~7. THIS CERTIFIES that the building located at .~. ~,~t..~.~ ........... Street ~i;l~ I~o~e.SNo ............. Lot No. ~,..~'e~laltwo:~, .I~.~ .......... Map No ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... . .1~..~....8..., 19.~... pursuant to which Building Permit No. dated .......... II~C,...~2 .... ,19blk., 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 ...l?l'l[~;e. I~11®. l'a~ilg .d~,-e23.3x, g ..................................... The certificate is issued to : ; ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .J);1. y...1~..[~7...ll~r. ~ .... Building Inspector ~01~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3335 Z D~e ............................ ~.~.~.~.r.....3,~, ,9.....~.~ Permission is hereby gronted to: ....q.......0.r,~.o~ .s..k..~.. ~.c....~.: ....u.......~ .............. ,o ..................................................................................... ot premises located at ~.t*..~:~...~0.~J.t,J~,J,~...IJJ~.O~..~sI ....................................................................... ................... ~/.~.,.J~;Lue...l~l:l,~lm..Dr. ......... ~z~ee~p~r.t,t..~l,:Z, .................................................... pursuan~ to opplicotion doted .......................... ,J)e~,, ....... ~ .............. , 19.6~.., end opproved by the Building Inspector. :Fee ~.~0.....~ ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da~e Permit No. Bldg. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give de~d ~ocation)~ f have been inspected by this department and found to be satisfactory. Dis%riot ~ngineer District Engineer FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~:~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted,i~=~'F[ic=t= 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 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. 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. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/landuse--Fz-e-Exist,±ng C.0. $15.00 3. Copy of certificate of occupancy $1.00 Vacant, land C.O. $ 5.00 Date . .~P¥. 39, .1~5 ............. New Building ............. Old or Pre-existing Building .. ,X~ ....... Vacant Land ............. Location of Property .. ,i~],u.e..M..ar.l.J.n..D.r ~.v.e. ................... S..o.u. thold House/Vo. Street Hamlet Owner or Owners of Property ....... A.H. FaIR County Tax Map No. 1000 Section ..... 0.~.6. ....... Block .. 7 Lot. 20 Subdivision...M..a[~.o.~..S.o.u.t.h.o}d..S.h.o.r.e.s .......... Filed Map No. 3853 .Lot No. 2 Permit No ........... Date of Permit .......... Applicant . .P.~.u.l..A....~.~.m. [.n.t.t [. ................. 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 permit mee,t.s(~l applicable qo~des and regulat~[ons. R~. 10-10 78 ~,J v FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No '~ .~..? .~. ........ Disapproved a/c.~ ................. i~;ri ........................... APPLICATION FOR BUILDING PERMIT Date ~ ......... ¢ INSTRUCTIONS a This apphcat~on must be completely filled m by typewriter or in ink and submitted in duplicate to the Buildm, Inspector b Plot plan showing location of lot and of buildings on premises, relationship to adloinmg premises or pubhc street or areas, and giwng a detaded description of layout of property must be drawn on the d~agram whmh ~s part of th~s locatior c The work covered by th~s apphcation may not be commenced before issuance of Budding Permit d Upon approval of this apphcot~on, the BuHd,ng Inspector w~ll ~ssue o Building Permit to the applicant Suc 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 in part for any purpose whatever until o Certificate of Occupant shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the msuonce of a Budding Permit pursuant to th BuH&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, os herein describe, The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, ff a corporation) ......... ............................ (A~t:tress of applica/~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ....... /...~.:....~...:../~..(..~ ........................................................................................ If applicant is a corporate, signature of duly authorized officer. .................... ................... 1. Location of land on which proposed work will be done Mop No..~..~...!~... Lot No' ......~.... ..... Street and Number ........................................................... ~e:~,~~../....~.!..~.....k ................................. Municipality jr 2 State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction. a. E×,s. nguseandoceupancy .......... .............................................................................. b. Intended use ond occuponcy ......... .~...~~ ...... ~.. ......................................... 3. Nature of work (check which applicable) New Building ...... ..'%. ........ Addition ......... Alteration .................. Repair ................. Removal .................. Demohtion .................... Other Work (Describe) .............. 4 Estimated Cost ...... /..~.,c ~ .......................... Fee .......... ./'....O....,..~ .................................................... (to be paid on filing this application) ! 5 If dwelhng, number of dwelbng units ........................ Number of dwelhng umts on each floor ......... If garage, number of cars .............................................................................................. 6 If business, commercial er m~xed occupancy, specify nature and extent of each type of use 7 D~mensions of existing structures, ~f any' Front ....................... Rear .......... Depth ................ Height ............................ Number of Stones Dimensions of same structure w,th alterations or oddmons: Front .............. Rear .... Depth .......................... Height .......................Number of Stories ..................... 8 D~mens~ons of entire new construction Front ....... ,~...."~/ ...... Rear i~.. ~ .. Depth i Height ........~-~ ......... Number of Stories . . .&~.....7. ......... 9 Size of lot Front .... .{~.' Rear ..... ./....r.~.. ..... Depth .......~,~...:. 10 Date of Purchase..i~s,ff~.. /.~,..~-'i'. ...................Name of Former Owner ../'~..~..~..~ ... 11 Zone or use al,strict in wh,ch premises are situated ...... R,A.Z~']-.~~......"i. ................ 12. Does proposed construction wolate any zonln_g law, ordnance_ or re. gukat~on?~.,.,~...~ --'. ............... 13 Name of Owner of premlses.../~.[..L...i'li~...'. ..... Address .,~:..,:~0'.,~'". ~',~.., .... Phone NO .................. Name of Architect.~:...'nC~... ~ .................... Address ....~.Z[..-.~..../. ....... .U. .... Phone NO ......... Nome of Contractor.~.~ .~-r'0~....: .......... Address -.e..~~ ¼t/Phone PLOT DIAGRAM Locate clearly and distmctly all buddings, whether ex~shng or proposed, and indicate oli set-back dimensions fron property hnes G~ve street and block numbers or description according to deed, and show street names and mdicot, whether ~ntenor or corner lot f &'" STATE OF NEW YORK, ) S S COUNTY OF, ......................... ~..) ................. ~ ............................. being duly sworn, deposes and says that he is the applica "-('lqame of individual signmg application) above named He is the .................................................... ..'i ............................................................................... (Contractor, agent, corborate officer, etc) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and f this apphcation; that all statements contained m this application are true to the best of his knowledge and beh.- and that the work will be performed m the manner set forth in the application filed t~eret~,ith. Sworn to before me this ,-, -"-- /''' ,- /t~ / i ~ F) ' ......... ...... '~ _ . ' ~,/ /""~'"~.~ _ ,,~__ ~ 'NOTARY PUBLIc. St~'] of I~e'~' York Notary Pubhc, ~.~ ....... :..:.~:...'.'.'.'.'.'.'.':?County ~/ Term Expires M~rch 30, ,!. 9._(~. ")