The URL can be used to link to this page

Home My WebLink About3341-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy No...~.1. .4 .3 9.6. ........ Date ...... ~..a.r.c.h...2.4 .................. 19.8 .6 THIS CERTIFIES that the building ........ ~.c..c9.~.~.°..rY. ............................ Location of Property .2..8 7.7.q ..............~.a.%n. . .~.. .............. .c.u.t.c. ~. p~u.e. ....... House No. Street Hamlet County Tax Map No. 1000 Section .. ~..0 .2 ...... Block ... 0..6 .......... Lot ..0..2.0...q 0..1 ....... X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Apphcation for Buildlng Permit heretofore filed in this office dated ..... D.e. 9.e..r~.e..r...1. 7..., 19.6. 6. pursuant to which Building Permit No. 5. .6.2.2.Z...w.a.~.. 3. .3.4.1. Z.... dated ....... D..e.c.~..mt~.e.r ..... 3.5. .... 19.6.6., was issued, and conforms to all of the requirements renewed 8/18/76 of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ........... A.c..c.e.s.~.9.~y. X .a.r.m..BV.%Z.4~..n~. 3. ~. ...................................... The certificate is issued to .............. ¥.~.C.K.H..32yl..,..J..O..H.N., !W. ?..c,k.h..a.m.'.s...F.r.u.J:.t...'.'.F.a.r.m. !.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........... .N./..R ........................... UNDERWRITERS CERTIFICATE NO ................... .I'{./..13 ........................... Building Inspector Rev. 1/81 FOEM NO. 2 TOWN OF $OUTHOLD 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? 3341 Z Permission is hereby granted to: to F, zect.. &.. £az~ .~u:Ll~t~g...Cg~.eem'~ou s e:~ ........................................................................ at premises [ocoted at ..~/.~...~,~.1~..~<}~1,~[ ........................................................................................... ................................... ~tcl~og~et....~l.~o ...................................................................................... pursuan¢ to application dated ............................ ...]~...c..?..~...b..e..z'........~......, 19.6...6...., and approved by the Building Inspector. Fee $...],.Q, ~ ......... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Ac This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- torw~th the following; for new buddings 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 Underwmters. 4. Commermal 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 property 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. .ees: Certificate of occupancv $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O, $5.00 5. Updated C.O. $15.00 Date .. ,,%. [~.' Lek. ~../..~'.~. ....... New Building .... ~ ...... Old or Pre-existing BuHdmg ............ Vacant Land ............. House No. Street Owner or Owners of Property .. ~a).,.iO¢~.,.-'.~;. ~?..~/¢¢~¢4-~.. ~..'-:..t-'~T. ? ...................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No Date of Permit//~./.¢? ./..Applicant..L~,.c/g~,,~¢4'o ~,~Z~.~..' Permit No. Nealtb De~t A~rov~; '. ....................... labor De~t AD~rova~ ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... .~ .~. ................. & .~_~ef¢-c ,~:¢~--~_ ;z~--/ C~1~¢_~z~o¢~ o/~t_ Construction on above described building and permit meets all applicable codes and regulations. - _ C_J6_a¢= 2~qC[ Applicant 'Q~r' ................................................ FOI~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE C~~' /,,4'~' ~....~. SOUTHOLD, N. Y. Examined ......................................... 1 ... ,, , Approved ........................................ , ]9 ........ Permit No ................................. D~sopproved a/¢ .~,.~ .... Application No....?.?...~.[..[ ............. APPLICATION FOR BUILDING PERMIT Date ........... nc. ........... (. ................................ , 19..~. ~.... INSTRUCTIONS a. 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 adlmmng premises or public streets or areas, and g~ving 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 ~ssuonce of Budding Permit. d. Upon approval of this application, the Building Inspector w~ll ~ssue 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 m part i~or any purpose whatever until a Cerhficate of Occupancy shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance 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, addmons t)r alterahons, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. t~Sj[~nature of applicant, or name, if a corporation) .......... ................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............... ~:1:....~...:;.:.~. If applicant is a corporate, s~gnature of' duly authorized officer (Name and t,tle of corporate officer) 1. Location of land on which proposed work will be done. Map No ............................................ Lot No' . ................... Street and Number ..::.~..; .......... ~..; .................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Existing use and occupancy ................. ~.....' ....................................................................................... b. Intended use and occupancy .......... ~.~,...~ ....................................................................... 3. Nature of work (check which applicable): New Budding ..... ~ ....... Addition .................. Alteration ................ Repair .................... Removal .................... Demohtion .................... Other Work (Describe) ................................... 4. Est,mated Cost ........... 7. ............................................... rea .................................................................................... (to be paid on filing this apphcation) 5. if dwell,ng, number of dwelling units ............................ Number of dwefl,ng 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 D~mens~ons of ex~sting structures, if any: Front .......................... Rear .......................... Depth ......................... Hmght ~ Number of Stories ........~ ................................................................................................. D~mens~ons of same structure w~th alterations or additions: Front ................................ Rear ............................. Depth .............................. Height .............................. Number of Stories ........................................ ' , 8. D~mensions of entire new construction: Front ....... .6:T..R...~/..~... ...... Rear ............. ~ ..... Depth Height .....Z..~'.....: ............ 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 ~n which premises are s~tuated .................. ~ ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... ~ .............................. Name of Owner of premises .... Z~_~ress ..C~ff.<---~--~ ............. Phone No.~,~...z..6'../~. Name of Architect ...................................................... Address ............................................ Phone No .................. Name of Controctor .................................................... Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ~ndicate all set-back dimensions ftc property hnes. G~ve street and block numbers or description according to deed, and show street names and ind~ca chether interior or corner lot. /~'. STATE OF N~ ~YO~ COUN~ OF~ ..... ~ S.S. ........... ~-~.~c~,~m ................................... being duly sworn, deposes and says that he is the appli, " ~ame of indiwdual signing app ~cat~on) above named. He is the ............................................................................. ~.¢...~ .............................................. (Contractor, agent, co,orate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s apphcation; that all statements contained in this application are true to the best of h~s knowledge and bc and that the work wdl be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this ........ ......... ........... ...... ......... ................ Notary Pubhc, .~~ .... County ~[ (Signature of applicant) V