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Home My WebLink About3541-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE OF IiIBBLIPANDY No... ~, ~913' · ' Date ......... 0ot;ol~ei~- · -. 2,~- ...., 19,. 6~ THIS CERTIFIES that the building located at . . ]~/8.. I/all~lil~ .La~ ..... Street Map No. 8~r!~!~g ~t~No ............. Lot No. 16 ..... ~l'eer~l~O~t~. t~.,.Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~U!~..7... , 1967.. pursuant to which Building Permit No.. 3~..~.Z dated ........... ~ll].~y. · .1~. ·., 19.65, 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 . P~'iva:ge. on~. family, d.~¢t~ 1 lin8 ...................................... The certificate is issued to . .. All,ecl .Tt~ ........ QHt~e~. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~1C2.2~,. 1~.6~'.. bY.R-..~il~... .......... '~3h~ling InspectOr FOEM NO. 2 TOWN OF SOO?HOLD 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? 35~1 Z Permission is hereby gronted to: Building Inspector. .Fee ~OeO0 ............. pursuan¢ to application dated .................. : ....... ,~ :~.,' ....... ~ ......... :,, 171 ~,~ ~., and dpproyed by the ..... ..................... Bu'lding Tnspector ~l FORM NO. ii TOWN OF SOUTHOLO Building Department Town Hall .~outhold, N.Y. 11071 APPLICATIbN FOR CERTIFICATE OF OCCUPANCY Instruction; A. This application must be filled in typewriter OR ink, and submitta~to the Building Inspec- tor with the following; for new buildings or new use: i. Final s,,wey at property with accurate tocation of ali buitdings, property tine% ~traats, and natural or topographic features. 2.Fna approval of Health Dept. of water supply and sewerage disposal-($-9 form or equal). 3.Approval of electrical installer on from Board of Fire Underwriters. 4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings and installa- 6ohs, 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. B. For existing buildings {prior to April 1957), Non-conforming uses, .or buildings and 'pre-exlst'ng" land 1. Accurate survev of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. . 2. Sworn statement of owner or previou~.owner as to use, occupancy and condition of buildings. 3. Data 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. Certilicata of occupancy on pre-existing dw~ling/ landuse--P~,e-Exiat, ing CC.0. $15.00 3. Copyofcer, ificate of occupancy $1.0 . Vacant, land C.O. Date June 17, I986 New Building .... ..~ ...... Old or Pre-existing Building ...~ .......Vacant Land ............. La'n din.g, ~ .a .n.e. Greenport Location of Property .............................................................. .. ,,.~ Hou~ No. Srr~r Estate Owner or Owners of Property ......................................... County Tax Map No. 1000 Section ...0.4..3 ........ .. Block ...0.4..., ....... Lot...0.L.6. .......... Subdivision ................................. ~:iled Map No ........... Lot No .............. Permit No. .. Date of Permit , . ................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ' Planning Board Approval ' Request for Tempora~ Certificate ..................... Final Certificate ....................... Construction on above described building and permit meets al[J~p4~l~able codes and~reguJations. , ...... .... $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da,re Bldg. Permit No. .~.~/ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (G~fve deed location) have been inspected by this department and found to be satisfactory. D ~ ~ ~f0i ~gi~$ grl n e e r FOI%M NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ]9 ........ Permit No .............................. Disapproved ........ ................................. Application No....~.....~..~t.J. ........... APPLICATION FOR BUILDING PERMIT Date ......................................................... , 1 9 ............ INSTRUCTIONS o. This application must be campieteJy 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 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. 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, ordinances, building code and regul~at~ns. .......... ......... ............... ....... State whether applicant is owner, lessee, agent, architect,,,e,,ngineer, general contractor, electrician, plumber or builder. Name of owner of premises ........... ~ ............ ~:~ ............................................................................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed, work will b,e 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 ........................................ ~/771 ................................................................................... b. intended use and occupancy ...................... ..~.J.~..~.-- 3. Nqture of work (check which applicable): New Building ..... ~.... Addition .................. Alteration Relbair .................... Removal .................... Demolition .................... Other Work (Describe) t 00o 4. Es ~mated Cost ............... ~..2,. ....................................... Fee (to be paid on filing this application) 5. If ~welling, number of dwelling units .............. ~ ........... Number of dwelling units on each floor ....... If garage, number of cars 6. If jbusiness, commercial or mixed occupancy, specify nature and extent of each type of use , 7. Dit~ensions of existing structures, if any: Front .......................... Rear .......................... Depth H~ight ............................ Number of Stories gir~ensions/ of same structure with alterations or additions: Front ................................ Rear De~)th .............................. Height .............................. Number of Stories ........................................ 8. D,mens,ons of entire new construction: Front ........ ..~'~',~......~. ....... Rear ........ ..~.....§~:/...?. Depth ........ ..'~.~' ....... H~ight .......... ./.~ .............. Number of Stories ....... /. ................... 9. Si~e of lot: Front ........ .//..~. .............. Rear //o Depth ......... ~ .................. 10. Dc~te of Purchase ........................................................ Name of Former Owner 11. Zdne or use district in which premises are situated .............. ~. 12. DcJes proposed construction, violate any zoning._ Iow, ordinance or regulation? .......... ..~..,~..~. Nc~me of Owner of premises ....~'...~...~.. ...... Phone 13. ..~.....///...~..~,'.~ ~. Ad d r ess ...~...~. ~...~.. Z/~..~.~.. N6me of Architect ...................................................... Address ............................................ Phone No. No, me of Contractor ...~'.....C~...C.~..~...../~J..~.¢.~.~ ............. Address .... ~.-A~ ~/2.~..S........~,~..C,~ .~,...,, Phone No..~'..~....~/...~ j PLOT DIAGRAM Loctite clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property ',lines. Give street and block numbers or description according to deed, and show street names and indi whether i¼terior or corner lot. STATE 4F NEW YORK, ~ S S couNT OF .................. ...... ~.J, ...... ~ .......................................being duly sworn, ..... j(~ame(~f individua s gn ng appl cation) above nc)med. He is the ~ (Contractor, agent, corporate officer, etc.) · ' J ner or owners and is dui' authorized to perform or have performed the said work make et sa a w Y · ' knowledge and this appC~cation that al statements contained in th~s application are true to the best of his and to and thatJ the work wi be performed n the manner set forth n the application filed therewith. Sworn to', be~.~ m~ t~is ........... ~...~.... d y f ..... .~ ........ ~ .............. , 19.~.~.. Notary F~ublic, .~...~--.....~.'..~_C.q~l~b'~ ^. "[~E?]ew yor~ of applicant) ~ ~0TARY pUBLiC State 0~ O/ ~ONToA. I 52-3233120 SuHolk ColJn~ ":~erm Expires Jvl. arcJ~ 30. ~.9,,~ and says that he is the oppl