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Home My WebLink About5579-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No....Z.1.3. ~ .0.6 ........ Date ....... 0. c..t .o.b.e.r...7 ................19 .8.5. THIS CERTIFIES that the building ...... A..d .d.i.t.i..o.n ................................ . Location of Property ..... 7.0.0. Bay Avenue .Cu~ch.o/~.u,e Hou~ No. Street Hamlet County Tax Map No. 1000 Section .... ~ ? ..... .Block ....... .0.3. ..... Lot .... 1. 0. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .0.c.t. :..2.1 .........,19.7.1. pursuant to which Building Permit No .... 5. .5.7.9.Z. ............ dated .0.c..t} :..2.1 .................... 19 ? .~., was issued, and conforms to all of the requirements of the applicabla provisions of the law. The occupancy for which this certificate is issued is ......... A.~. O. ~.~.~ .~ ~.o.r.~, .t.o..~.t.~u&..qn.e.. story one famil dwelling., The certificate is issued to Cl.ifford B..Jr..& Elizabeth ,G...Tyler. [owner, ~Xg leli~llX of the aforesaid building. N/A Suffolk County Department of Heaith Approval ....................................... UNDERWRITERS CERTIFICATE NO ............. ~ .e P.d./.n./:i ......................... ... Rev. 1181 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.O 5579 z ,:,de ........................ ........ i,././.. Permission is hereby grant~l to: , ~ ...c~.~...[~..a.,~.....s...~ ..... .~ ..... .~.¥.~..~..a to ...~.1D~ ........ A ...... ~i~..Ce~. ....... ~.~.~.~..~ ....... ..~..O ...... £J(~.T..~Ju~ ....... ~M£. ............ ...... **S.~..~..,,,, ......... 0 ~.E:. ........ ~.A t,.-~.t..~.¥. .......... .-~.~.E .L~,.~**~..~. ...................................... ot premises located at ............ ,~. ....... ..'/..~..~. ........ -.-~dl~.~.(. .......~.lr,~. .................................................... .......................................................................... ~t:c.. ~I~.0.. &.u..E~.. .................................................. pursuc~t to application dc~ed ........... : .............................. ~.[...~,, 19~.~..., and approved by the Building Insp~ctc~r. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell 8outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, end submitted i~ ~ to the Building Inspec- tor with the following; for new buildings or new usa: , 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 usas, or buildings and "pre-existing" land usas: 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 usa, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premisas, 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 4.Vacant Land C.O. $5.00 $15.00 Date 1.0. !.'/'.l .F~-" ......... New Building ~ Old or Pre-existing Building Vacant [~and ........... Location of Property ............/'/'DO ..~..~i. ./u..' .~.1/?..~.M. ~. ................................. . ~-- U 7'C/40~.~- .. House No. ~treet H~amlet .... Owner or Owners of Property . .~. ............ .~...'~f'; ...... .( .7'(--~.~-,,~. , .... CounW Tax Map No. 1000 Section .~. ~.-, ....... . .. Block .~. ............ Lot . .l.O ............ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~. ~.'~.9 .'~'~... Date of Permit .'.°./?. C7( .Applicant . ! .~.~...~:.. ~-4.. · .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ................. .. . .... Planning Board Approval ..................... . ~equest for Temporar~ Certificete ..................... Final Certificate ................. Fee Submitted $ ............................. Construction on above described building and permit meets all ap. plicable codes and regulations. ... Applicant .... ~d~-~... : .......................... , FOIgM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ..... O~f,D]a~.....~ ~., ....... , 19..7.~.. Approved .......... ~-.....Z....~...~...~. ....... , 19Z/.. Pemit No. _~ ,~2- ~/~' ~ Disapproved O/C Application No ................................. / (Building Inspector) ~',-~. APPLICATION FOR BUILDING FE~IT Date ~/ ~,T 7/ . ........................................ ; ...... , 19.../ ....... INSTRU~IONS 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 o detailed description of layout ofproperty must be drawn on the diagram which is port 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 Build!ng 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, housing c~e, and regulations. , .... ........ ...................... > ....... i i i ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ..................... Name of owner of premises~-""/' / F.~..~ ?~;j~ ~ --r'~z ~ 7.. dr- . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number"7 0.~... ......................................................... · 7 ............................ ..................................... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. EXisiting use and occupancy b. Intended useand occupancy 3. Nature of work (check which applicable): New Building .................. Addition ....... Alteration .................. Repair .................. Removal .......~ .......Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................. Z....~.~....~...~...~....~.':...Fee ......... ..~....~ ...................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling 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~c~t ex~fing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth .................. : ............. Height ............................ Number of Stories ................................ 8. Dimensions of ~entire new construction: Front .....................~. ............. Rear . . D t Height ...... ,,~.'~.~,~. Number of Stories 9. Size of lot: Front ......... /..~...O...~..... Rear .............. ~ ............ Depth ........ ..o~...~..~ ........ Purchase ..~..~. 10. Date of ........................................ .~......,~um, at former wwner ...............~....7~_~pe.TVd,4 .................. 1 1. Zone or use d str ct n wh ch prem ses are s tuated .~..J;-...~. !./..~.....~.....~....~.~: ........................ .~..~. ................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ ._A/G. ..................................... 13. Name of Owner of premises ...~........7~....z...r.~.l.,......~.....~.....?,~c~e~ss Name of Architect ........................... ~ .................... Address ............................................ Phone No ..................... Name of Contractor .~.?...b.!~....b../..~,.~.~....~..6.![~,...~.. ............ Address ............................................ Phone No..~ .................. PL'OT 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 i~terior or comer lot. ~E C O~,f i~ STATE OF NEW YORK, ~ 1 - - COUNTY OF ............... ~,I_I. FF~7~O .. '-'r~LI,-To'9'- -. .................................................................................... orang duly sworn, deposes and says that he is the applicant (Name of individual signing application) obove homed. He is the ...................... ~.....7.7.7.7.7.7.7.7.~. ................................................................................................................... (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 all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ................ of ........... ........................ Il .......... ...................... No. 52-8~25850, Suffolk Co~ Te~m Expires March 30,