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Home My WebLink About3628-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. DERTIFIP. ATE OF EIP. P. UPANBY No.Z..3074 ...... Date ............ [.lay ..... 21, .... , 19 6.~1. THIS CERTIFIES that the building located at ... Pal~.adtse..$hg~xe~ ....... Street Map No ......... Block No .... ".C~' ...... Lot No. l~ay~r~e~4,..$.Qt~.t,h.~.l..d,..~.e.w...~.o.~.k c~nforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Sel~t:,. ;1,4, .. , 19.67, r)ursuant to which Building Permit No.36.2~.. dated ........ .SepJ:,..18, ..... ,19.67., was issued, and conforms to aH of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr.:L'~a~;e..0~0..~aA~l;[;[~.. d~.~.],l ~g ....................................... The certificate is issued to . .~Ll.l~,am. ~.~. G~el$¥.,..<)~.e.:~ ................... . .... (owner, lessee or teuant) of thc aforesaid building. Suffolk County Department of Health Approval Building Inspector FOE.~I NO. ~ TOWN O~ $OUTHOU~ 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 AUTHOP, lZED) N? 3628 Z Permission is hereby granted to: ............. ~.?..:...~:~.....~../.~.....~..~.,-,~,~ ~ ................. .~.~.~.~.~ ........................................... ,, to .~.. ~.~.~..a..~..~,e~lo~ ..~.. ~.. e~ ~l~ ~e~ ~.~ ........ at premises I~ated at ..~....~.!~.~..~.~:~.,.;~D.~ ............................................................. purs'uan~ to application dated ........................... ~e~,~ .............. .~...., 19.6~..., and approv~ by the Building Inspector. ~F.. S.5~.~ ............. Building Inspecto~ TOWN OF $OUTHOLD PROPERTY RECORD CARD OWNER :STREET 'VJLLAGE ~OP. MER OWN[:R Cld ~LCRo LOT ./ VL FARM TYPE OF BUILDING cOMM. CB. MICS. Mkt. Value L]D TOTAL .DATE R~KS Value Per Value Acre AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FA P~M, Acre ) Tillable FRONTAGE ON WATER j Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD + , TI--ora'~ '~ ~ DOCK COLOR ~..~ ~ ~ M. Bldg. Extension BxtensJon Extension ij ~iF°undoti°B- ~--~ '~ ' / Il Dinette Porch Z~' x' ../ ~o -~ .' '.~ Z ,) ~ 7/.,, .~;~asement ./¢'/ c Porch Breezeway iBath F oars -" c" .? Interior Finish .- _ Heat Rooms 1st Flaor Rooms 2nd Floor ',Ext Walls !Fire Pioce TYPe Roof ~rage Recreation Room r Dorr~Zer,/ ,! Driveway JBR. ,F~N. B FORM NO. 6 TOWN OF $OUTHOLD 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 I ~===m~a 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pz'*operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 $15.00 4.Vacant Land C.O. $5.00 Date ....... c~. ,/...- . .., /....- ~. ..... New Building .../.~, ....... . Old or Pre-ez st ng ~u I~ ng .......... Vacant Land, Location of Property .... ~~..~..~.:...~..Q~~ ....... :' Hou~ No, ~ ~ Street ~ ~/ Ham/et .... ........ Owner or Owners of Prope~y co,,~ ~x ~, No. ,000 s~ctio, ..... ~.~'~ '~ ..... B~o,k .~. ...... Lo, ...... r ......... Subdivision ................. ,/. ............... Filed Map No ........... Lot No ............ ~d~ ~t ~ ........................ ~ ~t ~ ........................ ~m~ ~ ........................ ~ ~ ~ ...................... :~ :~m~ ~. ~ ........................... Construction on above described building anc~ermit meets all applic/]ble r~des and regulations ............... Rev. 10-10 78 FOI~M NO, 1 'T~OWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved lk 1~)..~.~.. Permit No. (Building Inspector) Application No...~.....~...~ ...... APPLICATION FOR BUILDING PERMIT ....... /....'L.. ................ . 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 qf property must 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 availab e for inspection thraubhout 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 Southotd, Suffolk Coqnty, 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 lows, ordinances, bui~ing code and regu~tions. ..... ....... ............ (Signature of a~/plicant, or name, if o corporation) ...... ............... ........... (Address o,f~pplicant) / State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises ..,.~.,,~./J. ......... ~.~,/. ....... ~""~"~'/~'~"i ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ................................. ~ ..... Lot No.: ...~ .......... ber ............. Municipality 2. State existing use and occupancy of premises gnd intended use and occupancy of proposed constr~/ctJon: a, Ex~st~ng use and occupancy ..... ..~.~5'.r.c/.~./.U. Zr.~.A.. ................ : .................................................................... b. Intended useondoccuponcy ...... ~'~..' · .~.~.../~. ·....~.. (.'.~.~. · ......... .~.. ~ ....... x~.~..~-~..~...,...., ............................... ........ ~,,,~n applicable): New Building ..................Addition ~ ......... Alteration ..' ........... Rep,?ir .................. Removal .................. Demolition .................. Other Work (Describe) .................................... ~ (to be paid on filing this application) 5. if dw, eiling, number of dwelling units ............................ Number of dwelling units on each floor If gaFage, number of oars ................................................................................................................................. -. ...... 6. if bqsiness, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7. Dimel~sions of existing structures, if any: Front .......~...~. ................ Rear .....~..~.. ...................... Depth ..~....~. ............ Height ........................ Number of Stories ........ ./. ..................................................................................................... Dimeqsions of same structure with alterations or additions: Front .................................... Rear ........................... Depth~ Height ............................ Number of Stories ~..~.~..~.. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth .................. 10. Dote o! Purchase ...........,/.~...~..~.. ............................... Name of Former Owner ........................................................ 1 1. Zone o~' use district in which premises ore situated ..................................................................................................... 12. Does proposed constructipn violate any zoning law, ordinance or regulation? ..~ ........................................... Name ~f Architect ...................................................... Address ............................................ Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. ,Give street and black number or description according to deed, and show street names and indicate whether interiorlor corner lot, /~ ~ STATE OF NEW ~C)~,~, ~// tS S COUNTY OF~'~"r'?"s~"~,~,~ ~ ~_ ~'M'' (Name of ih~ividual signing applicat~n) above n~med. He is {he .............................. ~~~ ................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ~11 statements contained in this oppllcotion ore tSue to the best of his knowledge and belief; and that the work will be p~rform~d in the manner set forth in the oppllcat~ filed therewith· Sworn to before me this ~ // // ....... ......... day ...... , :9..6. Y . _ .' ........... Notary PuN[c, .~.~.~....~.~C ....... County ~a~ure of applicant) ~o. 52.~233t20 Suffolk County Term ~xpires March 30,