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Home My WebLink About3887-zFORM NO· 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~.1.1.99~ .......... Date ......... 0~.t, Ql~Or..1.~ ........... ,19 .8.3. THIS CERTIFIES that the building ................................................ Location of Pronertv 1325 Gull Pond Lane .~¥.e.e. rlpp?.t... - - ....................... ......... County Tax Map No. 1000 S~ction 035 ·Block .04 .Lot 010 .... Subdivision..F.q.r'.d.h.a.m...A.c?.e.s.;.Sec. 1 .Ffled Map No. 351.9. LotNo. 14 .P conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...M.a.:t..1.5 ........... ,19.6.8. pursuant to which Building Permit No...3..8.8.7. Z dated .... .M.a. y..1.6. ................ 19 .6.8., 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 ......... ~ private on.e-family dwelling. The certificate is issued to ............ TORDIS WALLIN (owner, of the aforesaid building. Suffolk County Department of Health Approval 9/.13/68 #$0-427, $-9 N 88029.2 UNDERWRITERS CERTIFICATE NO ................................................. Rev. 1/81 Building Inspector FORi~ NO, 2 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? 3887 Z Permission is hereby granted to: ............ ~L~.~..~....~.~...~;~.e. ....... pursuan¢ to application dated J~' ~.. 19.,.,.~..,, and approved by the Building Inspector. , ~ee ,.t~.~. ........... Building inspector' L FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF ICCUPANCY 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: I. Final survey of property with accurate location of all buildir~gs, 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 Underw~iiters, 4. Commercial buildings, Industrial buildings, Multiple Resided, ces and similar buildings and installa- tions, a certificate of Code compliance from the Architect ot Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conformin~ uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and co, ndition of buildings. 3. Date of any housing code or safety inspection of buildings o? premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling landuse ~-?re-Ex±sting C.0. $15.00 / 3. Copy of certificate of occupancy $1.00 Vacant land C.0. $ 5.00 ;Pate...0. ?.:/. 2 ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Proper!?...~'. ....... ,j~? .u/...L: .Z,..../.~.A.~ ?.... ~;,/?./~.E. .... L~'~-~' (~-/~4' ~L~'~ (~ House No. Stree~ ' ............. Owner or Owners of Property ~ L) / .S ~- D / ~ County Tax Map No. 1000 Section ...... ?.T? ..... Block .... i.~. ........ Lot.../.(U.~.. .-~ o _ .Y~/~v 1 . ./.~ Subdivision ............. ,/-?.~, ?.t.-I,l.~ !~J../.~F~ ~5, .Filed Map No. :: 'D~ ] c~ .Lot No. PermitNo. ~/.~ateofPermit ,~'ll,~/~' '~ .............. .............. L. .... App icant ..... ~ ........... ~)~ Health Dept. Approval ..... ~ .................. Labor Dept. APproval ........................ Unde~riters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final C~rtificate ....................... ...... Fee Submitted $ ....................... Construction on above described budding and peters all agp~able codes and regulahons. ~...~.., $OUTHOLD, N. Y.~¢ c~¢-c~L~/ cf~'- ~' .om,ned /¢ ,9 ...................................... . ....... Application No .................... .~. ...... 19 ........ Permit No. i / '- ........................................ ' ........... ,~,~ ,~,~-,u~u ¢,~,~'. ~' Disapproveda/c ............... ~ ............................. . ~4,,~_~, ~_/_~o/ ~.,~/.., ~ ...................................................................... ";'"7"~( ........... G'~- L a =-~,~, L.. -tlc ~, ~- .................... ~.'~, ........... .~..., APPLICATION FOR BUILDIN MIT Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining promises or public streets or areas, and giving 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 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. INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building ~' 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, ordijarjces, building code and ~ulcjfJo~s. ~'Synature of applicar~,,~r name, ifa corporation) ..... ........................ State whe~r applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ................................. i .......................................................................................................... Name of owner of priem ses ........ ..~.. ~"~J ...~.. ~..~.. .......................... ~.O.~O ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of co~orate officer) ~ 1. L~otion o{ land on which pr~o~*d ~k will b* done. Mop ~o: .: .......................................... L~ ~o: .~ ........... ~/- /~ Stre~ and Numar ..~.~.~ ..............~ ~~.l ~ ~ 0~. .................... ........... ........................................ 2. State existing use and ~cupancy of promises and intended use and ~cupancy of pr~osed construction: Existing use and occupancy ....,,,,~...~ ........................... Intended use and occupancy .....,~,,.,.~,',.J,.t,~,.iJJ~J~....J~....,.,~,,.,,~.--,.,,,~,.,.;,.~,..,~,,.~.~ 3. Nature of work (check which applicable): Ne~ B'uild~ng .................. Addition .................. Alteration ............... ~.~ Repair .................... Removal .................... Demolition ............ , ...... Other Work (Describe) ...................................... 4, Estimated Cost ..... .~..~t.l~.J~¢~., ........................... Fee .......... ~ ................................................................... (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 .................... .O. ........ t ......................... .. , . 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 construction: Front ....... ..(~...~. ............. Rear .....~...~ ................ Depth ......~?....~. ............... Height .....J..~. .................. Number of Stories ....~ ....................... 9. Size of lot: Front ..... .~.J~.~ .............. Rear ........ j.l~..~. .......... Depth .....J...~J...~,~..." .......... 10. Date of Purchase ........................................................ Name of Former Owner ..... ~.~.....i~. ........................... 11. Zone or use district in which premises are situated .~..~...~..{..l~..~..[~'~t:~..~..~ .................. 12. Does proposed construction violate anv,,,.zoning law, ordinanc~,,or r~j~J/i/t~jgJ~ ...l~:~J./~ ...................................... 13. .Name of Owner of premises .~.~..!..k~...l~ ...... .l~..l~..~......Address ..(~J(~"II, J~.~I~G.~. ................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~...~...~..,...~..(~....O..~..L~. ........... Address .......~..J~.?.: ................... i ....... Phone No.~....~....'~...O..J~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW YORK, / S.S. COUNTY OF ................................ ......................................................................... being duly sworn, deposes and says that he is the applicant ................ i~l'~'r~'~ of individual signing application) above named. He is the ................................................................................................................................... (Contractor, agent, corporate officer, etc.) of seid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith.~ ~~~ ._~...~ (S,gna~'~r~ of a~pl,c~t) ...... ................ .. . Notary Public,