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Home My WebLink About4496-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT .Town Clerk's Office Southold, N. Y. Certificnte Occupnncy No. Z. ~8(~ ..... Date .............Jt~..y....~.~. .... , 19.70. THIS CERTIFIES that the building located at i/~.]..1. ~reek-Dr~v® ......... Street Map No..~x ......... Block No.. X~ ......Lot No..XX .....~otlthotd. · N,.~o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........Oct - · · 6 ' ' ', 19.69 pursuant to which Building Permit No.. dated ........./)et .... 7 .... , 1969., 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 .... Private 'one' .£am~'l~,. dwetl~ng .................................... The certificate is issued to . ~'1bert '&' I~®' · ~ox*don~am~.th· ..... 0~m®l'~ .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval July.. (~ ~- .~ ~)?0.. by. R,..¥il.l& .... . . .(. . . .': :: . ........... Building Inspec~r ~o~se ~ 260 FOl~l NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER.MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1 196 Z Permission is hereby granted to: Albe~% B. & MAe L. Oord~th ................. .9~,,,69.....~r~let.. zesa ........................ ................. · O~s.t.~Lt/lS ....... I~:E. .............. to .......... ]lmlldt. ~.. sm~.. ~'~tl~.,, ~&3,11z~ .......................................................................... at premises located at ................ Jl~....Jl~Ltl..l~:~etc. J~e:lLim ......... ; ...................... ' ......................... ............................................... -~,a,t~e.3.a .......... ]I...~, ........................................................... .~ .............. pursuan~ to application doted ............................... JJitt~ ......... ~. ......... , 19 ..... ~land approved by the Building Inspector. Fee $...~1..~:,.~. ........ IJ~ORM NO. I IUILDING DEi)A~TMENT ~:)~ TOWN CLEFJC'S OFFICE ~ ,~"~ /~"~ /~'~'~'~,~ SmJTHOLD, N.Y. ,,~ Examined ........... , 19. /-,.- Application No..~.....:...(..?...~... ^m~ved ........................................ , ]~ ........ Perm,t No.....~-.."l..~.~......~.. .... (,' C)isopprav~ o/c .............................................................................................. (Building'lmpector) / 46~ APPLICATION FOR' BUILDING PEP. MI'I' ...... .................... .... 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 adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whiCh is port 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 ir~pection 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 heroin describad. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ~ (Signature of applicant, or name, if a corporation) ~· (Address of applicant) State whether applicant is owner, lessee, agent, architect, er~ineer, general contractor, electrician, plumber or builder. Name of owner of premises ~..~...~r....~..~..~..~..~.~..~..~..~...~.~.~...-....~..~..:..~..~..~.~..~Y.....~...~.~..~..~.~~.~.~d~.~.~ ...... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which prap~ed work will be done. Map No.: ........................................ Lot No.: ........................ - .,.~Go ,~ Street ~na r~um~,,r .................................................... ~ ..................... ~, ........................... ~ .......................................... MunicJpalJh/ 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 ....~...~...'~...~'...'~......~...~...~..~..~..~.......~.~....~..?..~...~........~...~..'W~.~....~.<~..~...~. ............ 3. Nature of work (check which applicable): New Building .... Addition .................. AIterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost : ....4~.../...~...~.q..~.~ .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 ............................................................................................................................................. 6. If bUginess, commercial or mixed occupancy, specify nature and extent of each type of use ...... L...; ................ 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 construct,oh: Front ........ ..d'..~'..~ ................... Rear .......'~....~....: ........... Depth .....?...~-:....~......;... Height .../..~....~..-~...:... Number of Stories ..... ~...~....~..: ..................................................................................................... 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulatio~? .....~...~, .................................................. 13. Name o~ ~wner aT premises ........................................ ~aaress ~..~...~.~.~..r..t~..~.:::~r~,~.~ .X~.//..~.7..,~'. Phone No..~..../...-~'..~...~.~.. Name of Architect .......... ..~..~...~...~.... ............................... Address Phone No ..................... Name of Contractor ............. ~. ................................. .............. =.=~.....y.~...~.-. ......... Phone ..................... PLOT DIAGRAM Locate clearly and distinctly ell buildings, whether exi[ting or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ( ¢ e COUNTY OF ................................ ~'~' /~-]~/~- (~0r~ ~q:)hJ ~ ~ I Tf'~ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above ncmed. He is the .............................................. ;...~. ..................................................................................................... (Contracto~r, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to moke end file this application; that all statements contoined in this application are true to the best of his knowledge end belief; and that the work will be performed in the manner set forth in the application filed therewith. U / NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk CouaLv. Term Expires March 30, I FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existig~,~U~ng or ~. Copy of certificate of occupancy ~ land use $5.00 Date ....... 1/.~./~('. ......... New Building .... ~, ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property..~..~C~ ......... House No. Street Ham/et Owner, or Own.ers of Property .D~).~...~ ..J~CS, .~O-~..V, ~..~t~ .~--x',; .~,(/~ .~.f, zl~,, (V. .... . .... County~ax Map No, 1000 Section ..../.~. ~. ....... Block ... ~7.~. ........ Lot., .~.~. ~ ....... Subdivision ..... 'X~. ........................ Filed Map No..,'~' ....... Lot No..~ .......... Permit No, .~...~. ~. Date of Permit /.ol~/~,~.Applicant .,~//~]P,//T~./~, ,~2'3.-,~'/23,:)~'~.~/~//~ '~' Health Dept. Approval ./7'/~I?~ .~//:/. ,/(~ .... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate...~I.A~ .............. Final Certificate :,~/--~-~2 .'-,..~ .C~. ..... Fee Submitted $ .... l. . . /~. ..... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 S-9 SCHD DEPARTHENT OF HEALTH Date TO %~HOH IT HAY CONCERN: The sewage disposal facilities for a structure (Give deed location') located have beeu ~n~pected by chis department and found to be satisfa~tory. JUL - 6 1970 ])l~tr Ict l~,ng!nr~e ~ District Engineer