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Home My WebLink About4457-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. zl+2,~ ..... Date ............. lqay ...... 7-.., 19. (Pv ltd THIS CERTIFIES that the building locat~ at E~. ~ar~d~se. ~..R~... Street Map No. ~ .......... Block No. ~ .~ ...... Lot No.. ~ ..... Seuthel~ · .. N-,.Y, ..... confoms subst~ti~ly to ~e Application for Buil~g Permit heretofore filed ~ this office dated ........ ~t...9 ..... , 19 .~9. p~su~t to which B~lding Pemit No..~. dated ......... Gept...10 .... , 19. ~, was issued, ~d co~orms to ~l of the req~e- ments of the applicable provisions of the law. The occup~cy for which t~ ce~ificate is issued ~ .. P~$va~ ·ene .f~ly. d~ell~g. ..................................... The certificate is ~sued to -G~- ~enbeek. .... ~ ........................ (o~er, lessee or ten~t) of the afores~d building. Suffo~ Co~ty Department of He~th Approv~ Eay. "7~' '$97~' ...by. ~ .V~-~la ...... ' ~" >' '~d~g I~pe~or FOB, M NO. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~Yd .~....~x~....~.../.~.....~.~.m.....(.~.a~ ~--~'- - · · ........ ~...~~ ....... ~..'/...., ~? pursuant to application dated ....................... ....y/..--.......,... ............ , ........ and approved by the Building Inspector. Building Inspector a. This application must be completely filled in by t~)ewriter or in ink and submitted in duplicate to the Building~' Inspector. b. Plot plan showing location of lot and of buildings on premise~, relationship to adjoining pm. mises or public streets areas, and giving a detailed description of layout at prag~rty must be drawn on the diagram .``,ich ,s port of this applicatioq,.~ 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 promises available for irt~pectJon throughout the progress of the work. e. No building shall he occupied or used in whole or in part for any purpose whatever until a Certificate of Occupano/ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit poreuant to the Building Zone Ordinance of the Town .o,f Southold, Suffolk County, New York, and other' applicable Laws, Ordinances or Regulations, for the construction of buddings, additions or alterations, ~i~moval or demolition, as herein described. The applicant cgrees to comply with all applicable laws, ordi. iiii:,~e~afld regulations. C.~. · ........ (Address of applicant) State whether applicant is owner, lessee, ~ architect, engineer, general contractor, electrician, plumber or builder. Name of ow er of prem ses ................... : ......................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,. ,_ocat,on o, ,ar, on ,,',,ch ,,mp,,ed work w'" he don*. ','ap No..' ...:. ............. ,...,,.-.,,...~... '--×,.at.,o.:,.,,~.C .......... Street and Number ...................`~"~.~.~.~.~~/.~(~L~`~`~:~/~~~ , /q~/, ~-- ~00 , . Municipality 2. State existing use and occupancy of premises and intended use and occupancy' of proposed construction: "1.,- ~ L~.,u~ .......................................... a. Existing use and ocCUlXlnc_y- ..~ .......... ~.,~...4~.,f...,v:y..! ................... '~"~ ..................................... b. fended use and occupancy ................................................. .~,.! ................. ~. ................................................... 3. Nature of work (check which applicable): New Building , .~...... ........ Addition .................. Alteration .................. Repair .................. R~emoval .................. Dem01ltion .................. Other Work (Describe) ........................................ 4. Estimated Cost .......... ~..O.....0. ....................... ,.,.,.:.~Fee .......................................................................................... (to be p~id on filing this application) . 5. If dwelling, number of ch~elling units .......... ..~.~..~....~-. ...... Number of dwelling, 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. Dimensions of existing structures, if any: Front ....... ~ ..................Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or bdditions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ...~...~t'. ........... ;; ........... Rear ....~ ................ Depth .....'~. ............. Height ..... /...¥. ......... Number of Stories ...... /. .............................................................................................................. 9. Size of lot: Front ...... ~.~.../. .......... Rear ........../..~./. ...............Depth ...,~.~ ................ 10. Date of Purchase ........................................................ ~* of Fo.~er O~er ..... .~....~F..(C~....~... ....................... 1 I. Zone or use dlstnct ~n which premises am situated ........... ~ ................................... ~;'7~ ............................................. 12. Does proposed construction v~olote any zoning law, ordinance or regulation? ....... ..~....~. ............................................ _ 13. N~e of Owner of premises ......~.:.~.d~-4-A'..'~../~t;f~....Address ....z~..~.....~..~.~.~.~....~.~ ............ Phone No ..................... ~--'~L' of Architect Z?.~ ..~...~..~.//'..~.~. Address ~'/.~.~..~.~..~...~.~.'~J'~../~..'..~.. Phone No ~..~r.~..~.~.~. Nam. o, ¢ont.ctor ............................... ......................... .o. ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pmposed~ and indicate all set-back 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 NLCNM~ff~iRK, cou~ oe-,~'.~ s · /[J .... ...~.~.~..~:...~..:: ...................................... ~'~ duly ,om, ~, a~ ,~ ~ ~ is '~ ~licam - _ . (Na~ of individual si~lic~i~)~ .: · a~ve named. He is the .......... ~.~.=.~:~.~ ............................................................................................................................. (~t~r, ~t, co~e officer, ~c.) of ~id ~ner or ~nem, a~ is duly a~ri~d to ~rm or h~ ~o~ ~e ~id ~ a~ to ~ ~ file this a~lication; that all ~atements c~t~n~ in this applic~i~ am tree to ~e ~ of his ~1~ a~ ~lief; and ~at t~ work will ~ peHormed in the manner set fo~ in the ~lic~l~ ~r~i~. - S~m ~fom ~ ~is ~ / J _ ~' ~)Z _ ~ ~~Jt"t* ~ ~g~ ...................... :; ............ ;...~..~...., .............................................. N~ ~~~;~J~n~ (Signore of a~licant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in tvpewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sun/ay of propartV with accurate location of aH buildings, propertV lines, streets, and unusual natu rat or topographic featu re~ 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 bu Idings, ndustrial bu dings, Multip e Resdences and similar buildings and installa- tions, a certificate of Code compliance from the Arch tact or Eng near responsib e for the bu ding. 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 survev of peopertv showing all propertv lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancv and condition of building~ 3. Date of any housing code or safetv inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupaflc¥ $5.00 / 2. Certificate of occupancv on pre-existing dwelling/ land 3. CoPV of certificate of occupancy $1.00 use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ...... ~L?~ ............ CLOSING DATE - OCTOBER COPY X Vacant Land ...... New Building ............. Old or Pre-existing Building ................... N.o ~ Paradise Point .R.oad, ~.o.u.~bp.~g, ~.~ ............. Locati of P party ...... on ro ............................ Hou~ N~ Street H~mler Gilman H. Hallenbeck and Mary Hallenbeck Owner or Owners of Property ............................................................ Coun ax Map No. 1000 Section 81 3 3 tV T ............... Block .............. '. Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Gilman and Mary Hallenbeck Permit No ........... Date of Permit .......... Applicant .................................. Health Dept Approval Labor Dept Approval ......... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... 1.00 F~ Submittal $ ............................. Construction on above described building and perp~Kt-)meets all applicable.codes and regulations. R~. 10-10-78 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. TO WHOM IT MAY CONCERN: ~The sewage di~osal facilities for a (Give deed lor~ation) structure located have been inspected by this del~artment and found to be satisfactory. It 11¸ 4,4 0 ~1 I e'~ .......................................... T ............ ',i ,I -I