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Home My WebLink About3858-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z..3.281....~ ......... THIS CERTIFIES that the building located at .Lon~j~:Lew...[ane ..................................... Street Map No..~.e..~...z.~. ........ Block No ....................... Lot No..6...2.~....S...o..u....t~...o...~..d..t....~...~..~.....~...o..~..~.. ................ w&te~8 conforn~ substantially to the Application for Building Permit heretofore filed in this office dated ..................... ..~.[~..~..1.......2..5.., ..................... , 19~...~..... pursuant to which Building Permit No....3...~..5..8.....~. dated ........... .~.~..~..~...]:......2..6..r. ................... , 19..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 ........ ..._or.~,y.~.~a..~e...~a~l,l~r...~.e~,g. .......................................................................................... The certificate is issued to ........ ~,,1,f,f~.i=..~A...~jr~;J,:I;~ ........................................................................ (owner, lessee or tenant) of the aforesaid building. Health Dept. ApprOVal, September 25, 1968, Robezt Vllla -~JC~-~ ~ ~v~ - Building Inspector{ FORM NO. ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENTi' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FER/~IT (THIS PERMIT MU.ST BE KEPT ON THE PREMISE ~ UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? 3858 Z Permission Is hereby granted to: ................ .~:[~. ......................... ,i ................. 19...,~, and approved by the pursuant to application dated ................................ : .........~ · Building Inspector. Building Inspector FORM NO. 6 ~ TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF QCCUPANCy Instructions A. This application must be filled in typewriter OR 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage d!sposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Resident, es and similar buildings and installa- tions, a certificate of Code compliance from the Architect or', Eng neer responsible for the building. 5. Submit Planning Board approval of completed site plan requirffments where applicable. B. For existing buildings (prior to April 1957), Non-conformingiuses, 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 prewous owner as to use, occupa~ncy and condition of buildings. 3. Date of any housing code or safety inspection of buildings tion requ ired to prepare a certificate. C. Fees; 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 premises, or other pertinent informa- $5.00 New Building ............. Old or Pre-existing Building ....v~..; ..... Vacant Land ............. Location of Property. J.~/.-.~.-.~.....~,..~. ,,~.d,~.~/..~...¢~4,.. ~. R.I.I~..~.. .......... .~'..~..c.t..~. ~/J. ...... House No. Street ' Ham/et Owner or Owners of Property . ..~.~ .~. ',T~.~'.~ .... .~.t..~.~.'*./?../.T'..j~, ............................. County Tax Map No. 1000 Section ,...~..~. ........ Block ..... ~i.Z'J/ ........ Lot .... ~...'~.. ........ Subdivision'.-[-,~..~¢y..~'. ~.¢~5 .~..7~./l~(2.1¢~ .... Filed Map No. ~.~. ?.~....Lot No, . .~...~ ........ Permit No ........... Date of Permit .......... Applicant .... '. .............................. Health Dept. Approval ........................ Labor Dept, ApProval ........................ Underwriters Approval ........................ Planning Board ~pproval ..................... Request for Temporary Certificate ..................... Final C!rtificate ..................... Fee Submitted $ ..... ~',¥¢. [?;4-~2'. [? .'~ ,~ (-~% ':;~; ~: Construction on above described I c ~ 'e ' I t on building and permit meets all app i able coo s eno regu a i s. Applicant · . ............... SCHD SUFFOLK COUNTY DEPARTMENT OF~ HEALTH Date September 25~ 1968 Bldg. Permit No. 38[18Z TO WHOM IT MAY CONCERN: The sewage disposal facilitie~ for a structure located at L onr, view Lane (Give deed location) S o[~thold~ Sou thold have been inspected by this department and found to be satisfactory. Ommer ~alter~,. '~ Smith Builder (eor~e W Sm~ th and Sons Distrigt 'Eggineer BUILDING DEPARTMENT TOW'H CLERK'S OFFICE ,~ ,..------, Exomined ....~....c~......~...., 19....~....~ ,~pplicGtion No....~......~,-,~..~ .... Approved ........................................ , 19 ........ Permit No ............................. Disapproved o/c ........................................ APPLICATION FOR BUILDING PERMIT /- INSTRUCTIONS a. This application must be ComPletely fill'ed in by typewriter Or in ink and submitted iD duplicate to the Building Insp~6r. b.~, Plot elan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas,~nd g'iving a detailed description of layout of property must be drawn on the diagram which is Ix~rt of this application. c. ~'he work covered by this application may not be commenced before issuance of Building Permit. d. t~pon 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 applicant agrees to comply with all applicable laws, ordina~nces, building code, ho~ing code,~d regulations. ($i~lfiat~e of applicon, or name, ifa corporation) (Address of applicant)~ State whether applicant is owner', lessee agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If appli~~a~eze.~of~thorized officer. (Name and title of corporate office~' 1. Location of landonw~edwork~w'II bed ne .J~AapNo.~"~....,.~..~.L~No.i~.~ ............. MuniCipality State existing use ~ond occupancy of pre[p, ises and intende~d~u~l~ ~nd ~ccupancy of proposed construction: a. Existing use and occupancy ...... ~,Z'..~.~-- ........................................................... , .............................. b. Intended use and Occuponcy .....~.~' ~'~ .............................................................................................................. ' 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..................s~..a~..~.~..~ .......... Fee ...~'.~2....~ .................................................................... (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 .............. ~..~r:~.... ...................................................... ; .................................................... 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 ................................ 8. Dimensions of entire new cons~ction: Front ......... ..~..~- .................. Rear ~.~......'~... .............. Depth ~ ............. Height .~..~.../.. ....... Number of Stories ..~w~,.~ ...................................................................................................... 9. Size of lot: Front ...... .~..~..~. ......... Rear ....... ~.....~....~.~ .............. ~.D~ptb ....~..~...'~...~... ................. 10. Date of Purchase ................................................. .:?...NOme of Fc~rr~er Owner ........................................................ 11, Zone or use district in which premise~ are situated .i....~i:...?.~...~.. ....................................................................... 12. Does propOsed construction viOlate any zon'~g law,,~ordinance or regulgtion? ....'~. ................................................. Name of Owner of premises ~.~~(z......Addres~...~..-~.... Phone No ........... .~.....-.~-~. 13. NameName olaf Cant ract,~,~,.¢,~,~..~.,,,.~.,.,.,~ ~Architect,, .~ ~/'~-~,~J~' z~,~-~'~ ........................ ........ AddressAddress ~~[iii~iiiiiI PhonePh°ne No.N° ..................... PLOT' DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, u~arrfe of individual §igning applicat~Lo~) ._.a.__ ..._~_~ above named. He is the ......................................................................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said ewner or owners, and is duly. author~ed-to perform or- have performed the said-.wo~k .~ to rnake and file this application; that all statements contained in this ap~!!cation are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in tel 615plicatiOn. filed therewith. Sworn to before me this __ Notary Public,~i~R~ Coun~~ (Signat~;;;'~ .................... Co NO. 52'0618 / 00- ('~ u f f°lk -~'ou'n~"