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Home My WebLink About3395-zFOR~ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. P. EI~TIFll~AT£ OF OOOUPANEIY No.. ~ .30~.'~... Date ... ~;[~l...4, .................. 19.6~ THIS CERTIFIES that the building loc.ated at . .l~ar~l~l~l. ~0/~t~ ........... Street Map No ............. Block No ............. Lot No. lotl~,~ho~l.~, .]~.., .]~.~'. .......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ...Yial~. L1 ........... 1~?.. pursuant to which Building Permit No..~. dated ...~1~Cb..~i~ ............. 19.~?., 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 ... ]2~'~.~t:~ .Orl~ ~mmt~l,~. d~e,lZi.~.rl~ .................................. The certificate is issued to .... ~e~ .~el~ ........ O~l~e~: ......................... (owner, lessee or tenant) of the aforesaid building. /(f . Suffolk County Department of Health Approval ................................... ...... ....... Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) l~z~b 13 3395 Z Dote ~ ~9...~. Permission is hereby granted to: .............. .~.~.¢.h.o.g~**.t. ............................................ to y~,y~ ~,],~,~;1,~/p,~ ~.**~ b~..]~d ~. add/t/on on an exlBtin~ dvell~n of premises located at ..-.~.....I~&.Z~ii~...P.~:~I~-..]~U], .............................................................. ............................................. Smutl:m~l~...N.o.¥.,. ................................................................................. pursuont to oppiicotion doted .............................. ,~h....].3 ........ , 19...~.., ond opproved by the Building Inspector. Fee $...~...00 ............ FORM NO. 6 TOWN OF SOUTHOLD Building Depa, ~,,ent Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 featu res. 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 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 requ ired 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 4.Vacant Land C.O. $5.00 $15.00 Date ... ~.a~-..2.9:..1.9.8.5.: ......... New Building x Old or Pre-existing Building Vaca Land Paradise Point 'B.a~ V.i.ew: N.ea.r .S.o.u.t.h.o.l.d Location of Property , at HouM No. Street Hamlet Owner or Owners of Property Frederick F. ,& Mar.1 orie Rt~nler 81 .3 Lot .2 County Tax Map No. 1000 Section ............... Block ............................ Subdivision ................................. Filed Map No ........... Lot No ............. p . Previous is~.ta~t~ o(~l~r~l~o~-1960s ~ Builder was Cor~in Grathwohl ermit No ..................... Applicant; ................................ Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .5.00 FOE~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Approved .................. .~..I ................... , 19 ........ Permit Na ................................. Disopp roved o/~Z APPLICATION FOR BUILDING PERMIT Dote ...... ............................ INSTRUCTIONS a. This application must be completely f~lled in by typewriter or in ink and submitted in duplicate to the Buildin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed descnption of layout of propertymust be drawn on the diagram which is part of this application c. The work covered by this apphcat~on 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. SucI 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 m 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 Departrnent for the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable laws, ord,nances, building code and regulations. .'/2~x ~, C~_-.,x~z~Y' ~>~:~-~- (~ignature af apphcant, or name, if a corporation) (Address of ~licant) State whether applicant is owner, lessee, _o~gent, archit,ect, engineer, general contractor, electrician, plumber or builder .............................................................. ........................................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer} I. Location of land on whi, g,,h proposed work will be done. M.qp No' . ........................................... Lot No' /Z, ' ................... Street and ~umber ....... :': .................................. ~,~....~.:.m..~..~.....~.;~..,.~..;..~.;.....C,. ....................................... Mumcipality 2. State existing use and occupancy of premises/gnd intended use and occupancy of proposed construction: a. Existing use and occupancy ...................~.~'.~Z~.~.. ........~Q~..~..~.. ............................................... b ntended use and occupancy ........ ~'...,Y29P...-t6.~ ..... ~.~.~...~ ..... ; ......................................... at In ~on ~ I 3. N ure of work (check wh,ch applicable): New Bu,ld g .................. Add,t' . ................ ~, L~'~Alte-rat'ign/ ............... Repmr .................... R~val .................... Demohtion .................... Other Work (Describe)~.~ 4. Estimated Cost ......... ~....~..~...~.~.....~... ....................... Fee ...................... ..~..:.~.?.. ................................ ~ .................... (to be prod on filing this application) 5. If dwelhng, number of dwelling units ............................ Number of dwelling umts 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 ............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mensions of entire new construction' Front ...... ~..~.. .......... Rear .....~...~. ................ Depth Height ...... .~.., ................ Number of Stones ......... ..~ ............... 9. Size of lot: Front ........... ../...~...../.. ..... Rear ........ /..~ ............ Depth .......~..~....-~. ........... 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zone or use distnct in which premises are situated ............................................... ~ ....................................... 12. Does proposed construction violate any zoni.qg law, ordinanc~,o.r_[egulatio~ ............. ~ .............................. 13. Name of Owner of premises .~..~.~..~~..~r.. ...... Address ~,~.~.',...~.-..~., ..... Phone No Name of Architect .................................................. Address ..... ~ ..................................... Phone No .................. Name of Phone PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK, ~-S.S. COUNTY OF ................................ ..... 7 ................................ being duly sworn, deposes and says that he is the opplica (Name of individual signing application) above named. He is the ....................................................... ~..~-....~ ................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fi th~s apphcation; that all statements contained in this applicahon are true to the best of his knowledge and beli~ and that the work w~ll be performed in the manner set forth in the application filed therewith. Sworn to before me this ................. -_: ,.-- Z5 ..... "_ .... ;_, .. ........... ............................ Notary Public,%~....~ ...... ..~,....~~1 ~rJ:~_~./~: ~,~.~,~, '~ ~,~' (Signature of applicant) (k,) ,'l'er~ [xp,res M. arch