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Home My WebLink About4749-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z!~17.1 ....... Date ............. l/al'eh.. 16 .... , 19..71 THIS CERTIFIES that the building located at . .~//~ .Cedar.. B~r. eh. Read.. Street Map No.. X~ ........ Block Ncg, XX ........ Lot No...XX .... 0l'~.ellt,. lq.¥, ........... confoms substantially to the Application for Building Permit heretofore filed in this office dated ............ 14a~....1~,, 19.70 pursuant to which Building Permit No. dated ........... Pla),... ~1~.., 1970., 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.~va~ · en® .fa~.ly. dv®ll~.ns ....................................... The certificate is issued to .l/~.~lSa~ &. Je4~0n&.. T&yl®l, · · · Ovner& .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. D~e.. 28 ~..1.~O.. ~oy. R,..V~.l~a.. lt.u,, # ~00 . ../.~... ?,..~.. ~.._.~f~..,.~..f ............ Building Inspectgr FOILM NO. 2 TOWN OF SOUTHOLD 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? 4749 Z at premises located at ............................... ~..~.~...~...,~...~ .......... ...~.../...7~'....~,..,,H. ............ ..~...~....fJ....,~,. ............... pursu~ tO application dated .................................. .~.~...~..~.., 19...Z~and appr~ by the Building Inspector. Fee $ ............ : ........... Building Inspector FORM NO, 6 TOWN'iF 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 properW 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 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 safeW 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-existing dwelling or land use $5.00 .,~/_//,j/~//~ 3. Copy of certificate of occupancy $1.00 Date .......................... New Building .......... O~d or Pre-existing Building ............ Vacant Land ............. Location of Property , ~ Street~_ Hamlet j ................. .................... Owner or Ownersof Property .................. ')~'~q ~(.~ /~'J ~ CounW Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. ?.? Permit No. . Date of Permit . .Applicant ....... .O.../".~. .................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~l ......................... Construction on above described building and p_ermit meets all apczljcabJe codes and regulations. Applicant ~'( ~-'"'z ~/ .',~,~:~.~/~" ~.. ' · .. ................... ...... ................ S-9 SCHD SUFFOLK COUNTY DEPAHTHENT Date Bldg. at OF HEALTH Permit No. The sewage disposal facilities for a structure located (GiVe deed location) have been inspected by this department and found to be satisfactory. BEC 2 8 1970 ~'~tef of General Engineering Servises Disapproved ale ................. ~ ....... ~..~ .................. .............. .. (Building Inspect:or) 6 : 1/Ic.° 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 bud ngs on premises, relationship to adjo n ng prem ses or pub c streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of thi~ 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 app cant. Such permit shol! be kept on the premises available for inspection throughout the progress of the worl~ 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 Perm t 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 build!pgs, additions or alterations, or for remova or demo t on, as herein described. The'applicant agrees to comply with all .~pplicbble laws, ordinances, building code, housing code, and regulations. -' (S'g oture of applicon ,f~or name, if a corporation)' ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. Name :of owner of premises .~.i.~..~.~.~.~C~...~..*......~.......~..O....~.....~...~.,.~...~...~..~...~..~..0.~ ....... :i ........................ If applicant is a corporate, signatL~re of duly authorized' officer. ' (Name and title of corporate officer) 1. Location of land on which propose~ work will be.dane. Map No.: ............................... ; ........ Lot No.: ........................ Street and NumberC..~..~...~..~....~...~...~.....~....~..i...~...~...~ ..~...,~...Z[...~.. ~~ ....... 2. State ext~ing u~ a~ ~cu~ of premiss and intended use and ~cu~ncy of pr~ co~tJ~: a. ~i~ing me and ~c~n~ (check which applicable): New Building V Addition Alteration Nature of work Repair .................. Removal .................. Demolition .................. Other Work (Describe) ............................... 4. Estimated Cost .....~..!..~.T/..~...°..?.. .................................. Fee .'~.~/...0..:. (t'~"i;'e' ~i'~,"~,;,'"f[ii;,'~'"~'i~'~';."~,'~'~ii';:';='ti'~';,) .................. 5. If dwelling, number of dwelling units ....... l. ........... ~ ...... 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, jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimens~on.s of entire new construction Front ..O. Rear .....~.. Height J...~.: ............... Number of Stories ........].~ ............................................. · /.5~ s I~'~ ~ 9. Size of lot: Front ...... :. Rear .......... Depth ..../..~..0. .................. 10. Date of Purchase ..... ~.....~s ......... .r]..O.. ......................... Name of Former Owner .~...~....c:~... ~ ..~..~.:....~..)..~...~ ............... 11. Zone or use district in which premises ore situated ................................................................... 12: Does proposed construction vioJate ~nY zonina law-ordJno~ce or reaulation Name of Owner of nrem ses .~..?'J(~j'¢% ,L~ .~t, "~'-Pf~I/,L,I)~I~. ,~.L ~_~ j~)~ , ~/~';t~-~',~"~7--T~'I ........ '-';'~'~'"~ 13. ~ .............................: .......... ~aaress~v. .................. .~..).~'..~.%~....~..~.1 Phone No...../~..~.:.K..~.. .... Name of Architect ..... ..~...~..~..k.~...~....l~....~.~ ............. Address ............................................ Phone No ..................... Name of Contractor ..~. ,~.?'L~C I'~1~ ~ - Address .............................................................................................. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, 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 corner lot. STATE OF NEW YORK ..... J ~ ~ COUNTY OF .............. ~..~&./:?.f.!~.~ ~'~' .~.~ /~.. T~ Y ~. ~ ~. ..................................................................................... oemg d. uly sworn, d~s and says t~t he is the applicant (Name of individual signing application) , -' - above n.med. He is the ............................. ~ ~: ~ · .' ~ - (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~.ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the maqner set fo~h in the application, fil~ ther~ith. Swam to Before ~; this ................ o, ........................... .... ~o~.~ ,.u~ . z ............................ ~..~z:f:.¢~ Cou.~ ~s~a.~;~re o~'~pi/;~i ............................. ~ ~ BETH ANN N~ ' g ~ ~ ~ARY PU EVILLE BLIC. 8tate No, 52.8125850 guf of New York · Term ~pires U~r folk County ch 30, 19~ . i I T I \po'm J