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Home My WebLink About3170-zTOWN OF SOUTHOLD BUILDXNG DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD, N. Y, I]-rRTIF'II]AT£ QF or. oUI~ANO¥ No..Z... ~63.~... Date ............ J~ll1~I~ .... 3 ..... 19. THIS CERTIFIES that the building located at .$/J~ .... ~ .I~lI~d ............ Street Map No...X~.. ........ Block No .... ~ ...... Lot No..~ ..... 0~:~e~..~f,~ ......... conforms substantially to the Application for Building Permit heretofore fi]ed in this office dated ......... ,~tl~ly.... 2'5 ..... 19~. pm'suant to which Building Permit No...~1~0 .~, dated .......... ~'ll't~ .... 2~..,, 19.~6, was issued, and conforms to all o[ the require- ments of the .applicable provisions of the law. The .occupancy f. or which this certificate is issued is . P-I,~.V~i;e. 'olde 'ff~i'~f · d'~e'];:~t~g .......................................... The certificate is issued to ..... Wa~'~. ~abo~' .......... ~0W~l~l, ......................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ...p.O.0..,....~.~.~...~..~.6..6.....by...~.~. Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Ye BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE ~REM SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3170 Z ~ote · ~..: ....... , ...... ~: ...... : .... 1 ..... Permission is hereby granted to:· . ' .~.~ ~ - ........ : ........... , ...... ~:..~.......::......:.....~:,. ..... to ~' F '' ;"~;~ ..... ...... ~:' .................. pursuant to app caton dated , ~;~.%.'-L:-c?/ c9" .]., , 19 ~c~' .~;' and approved by the Building Inspecto,r ' Fee $ ........................ Building Inspector / FORM NO, (1 Buildiao D~partme~t Town Ha~l Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fii)ed in typewriter OR ink, and submitted in duplicate to the Buildiri§ Inspec- tor with the lollowing; for rmw buildings or new use: 1, Final survey of prope~w with aceurate location of all buildings, property linos, streets, and unn~ai r;atura] or topographic features. 2, Final ~pproval of Health Deph of water supply and sewerage disposal-(S-9 form or equal). 3. Approval o~ electrical in~alistion from Board of Fire Unde~riters. 4. Commercial buildings, ~ndustrial b] dings, Multiple Residences and similar buildings; and h]statla- dons, a certificate o~ Code compliance from the Architec[ or Engineer responsible for the building. 5, Subrni~ Planning Bnard approval of completed site plan requirements where applicable. B. For existin~ buildings (prior to April 1957), Non-conforming us~s, or buildings and "pre-existing" 1. Acrm'ate s~J~ey of peoperty showing ali property lines, streets, buildings and unu~al na'mml or topographic features, 2. ~:;wom statement o[ owner or previous owner as to use, occupancy and condition of buildings. 3. Uato of any housing code or safety inspection of buildi~gs or premises, or other pertinent informa- don ~equirod to prepare a cectificam, Certificat:,· o! occupancy on pre-existing dwelling / laad u~ Certificate of occupancy $5.00 C~y ofbertificate o'J occupancy $1.00 ~ i/accent ].and C.O. 41 5.00 Dale ....................... iq,wv i~mh, mg ............. OM or Pre*existing Building ../~ ...... Vaca_nt Land ..~ ........ Owneror OwnarsofProporty .,~.~.~~(,,.~ ................... Cuumy 7ax Map No. 1000 fi~cdon ....ff.~ ..... Block ...... ~ ...... Lot .............. a b<~ms.on ................................. Filed Map No. P,~rmit No ........... Date of Permit .......... Applicant ........... Health Dept. Approval ........................ Labor Dept, Approval Underwriters Approval ........................ Plcnning Board Approval Request for Temporary Cerl~hcate ..................... Final Certificate Fee Submitted $/.~,~.'.~ .~,. i.. (. ¢. ,'~.. ¢. ~.~ ,~2 ~~- ~ on above described building and perm~ meets a app cab e~es~egula~ns. ~ ~(,' 8/!,: 7'0' Fi ~0' ,5,01 b 0 VAN TUYL & $ 3N S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No, __~/? d ~___ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structu{e located ........ (Give deed locatio~) have been inspected by this department and found to be satisfactory. District Engineer FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ..... ~ .........., 19 . . Approved ....~c' ................................... , 19 ........ Permit No '~'] /O (Building Inspe~or) AFPLICATION FOE BUILDING PERMIT )-, , Date ............ ~' ......................... 1 ,°~.....~.. ..... 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 o detailed 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 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 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, as herein described. The opp icant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signat~'e o applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Nome of owner of premises ........................................................................................................ 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..Mop No.: ........................................Lot No.: ........................ Street and Number ............ ........................................ ........~, .................. 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 ~....~..~--/~" I 3. Nat~,re of work (check which applicable): New Building ~ Addition Alteration Rep~ ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estir~ated Cost .... /...~.....~...~.,,O. ..................................... Fee (to be paid on filing this application) 5. If d, velling, number of dwelling units ........ /. .................. Number of dwelling units on each floor If go, rage, number of cars 6. if ~usiness, commercial or mixed occupancy; specify nature and extent of each type of use 7. Dim msions of existing structures, if any: Front ............................ Rear ................................ Depth Hei,cht ........................ Number of Stories Dim msions of same structure with alterations or additions: Front ....................................Rear Depth ................................ Height ............................ Number of Stories ................................ 8. Dim msions of entire new construction: Front ........ ~...~.. .................... Rear ...,..~....~.-. ............... Depth .....~... ht .,.../..,~....~ ........ Number of Stories / of lot: Front ....'..~.../.~....~../, ...... Rear ...... .~.../.3.:..~..~.. ....... Depth ..... /.,..~...~.-..;...O. ......... of Purchase ......./....~...~/...(~..~, ........................... Name of Former Owner , or use district in which premises are situated ..... proposed construction violate any zoning law, ordinance or regulation? ......~..~ .................... of Owner of premises :~.....~..~...Add ress ......... .~..~ ............... Phone No. ~' ~e of Architect ...................................... .~ ............. Address ....... ...... ............................... Phone No. ~e of Contractor ...~.~.~...~..~_'f'_,~...Address ............ ~~... ............... Phone No. ~ PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nas. Give street and block number or description according to deed, and show street names and indic~ erior or corner lot. Heic, 9. Size 10. Dar 11. Zor ! 2. Doe 13. Nar Nar Nar L.ocat property I whether i'n STATE OF COUNTY of said ow this applic that the w~ Sworn to b, .... NEW' YORK, ~,, )F ....~..-.f.~..~.~. ......... ~ ' ' ~.~....~. ....... ~...~..1~..~..~'./~. ...................................... being duly sw6r~, 'deposes and says that he is the applic iName of individual signing application) above na~ed. He is the ............................... ~...~.~...~...~.~.,C....~..~..~ .......... (Contractor, agent, corporate officer, etc.) ~er or owners, and is duly authorized to perform or have performed the said work and to make and ~tion; that ali statements contained in this application are tree to the best of his knowledge and belief; rk will be performed in the manner set forth in the application flied therewith. ~fore me this ~ ..... day of ............. .~..~...Z..~.. .................. , 19 ~'~ Notary Public, .~,l;D~]jS..C...gj~qGC, O~Ul~tY (Signature of applicant) 'l'erm Expires Mar'ch 30, 196~ I