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Home My WebLink About5291-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at t~;~ .~edar-lB~'eh- Rd ...... Street Map No...~ ........ Block No .... ~:~ .....Lot No... ~ .... 0Ft~lat~. If,Y, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .~a~r ..... 11 ~, 19 .Ti. pursuant to which Building Permit No..~29.1Z . dated .......... ~la~...12 .... , 19.71, 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~;.e o~e .fam.~ty- d~el~lag. .................................... The certificate is issued to ~art~ .&. '/4~a. tgilsoil · · · '... 0~ael~8 .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 0et;' · '26" '~'97~' 'byR:' ¥]3.ta ....... ..... Building' i~spector--' FORM NO. 2 TOWN O~ SOUTNOLD 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) 5291 Z Date ....................... JJJl~.; ...... JJJ ............. , 19...~.~. Permission is hereby granted to: Earle & ~e~'a at premises located at ............ W~..~il~Jll~l~,~Jl..JJl~l~eJ..&..J~..~l~J ................................... .......................................................... O~e~t ....... .lt~'Z.~ ....................................................................... pursucm/t to application dated .......................... ~J~. ..........~J ............ , 19...~.~, and approved by the Building Inspector. Fee $.l~,l~J ........... FORM NO. 6 TOWN OF 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 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, Multip{e 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 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. Certificate of occupancy on pre-existin~d~velling or land use 3. Copy of certificate of occupancy (~$1.00 $5.00 Date .......................... New Building .... ~ ....... Old or Pre-existing Building ............ Vacant Land ............. House No. ~ ~ , / ~Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and pe¢;mit meets all applicable codes and regulations. Appucan[ ...... . ....... : ..... ,. ~ ........................... 3/~/~, /&.~ fq7/7 ,St SCHD SUFFOLK COUNTY DEPARTMENT 03 HEALTH Date October 26, 1971 Bldg. Permit No. 5291Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at W/S Cedar Birch Lane, 200' S/o Route 2~, Orient (Give deed location) have been inspected by this department and found to be satisfactory. OCT 2 6 1971 Onlef Of ~eneral Engineering Servlcee Approved .......... !.(. ...... , 19 ........ Pemit No ..................................... TOWN CLERK'S OFFICE ~'/~'~ ~/-/ ~ SOUTHOLD, N.Y. ,/~ ~ Application No...~..~..~ ............... Disapproved a/c ....................................................... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS 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 ofproperty 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 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 code, and regulations. ................... (Signature of applicant, or name, if a corporation) ...... (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.~4~..°/....~..~...~.~...~.~ ................................................................. If applicant is a corporate, signature of duly authorized officer. .................. ......... 1. Location of land on w~proposed work will be done. Map No.: ................ $. ..... Lot No..~ ..... Street and Number /,~_~..~ ..~...~...1~.. ............. .~~, ~..---~//~- ~--/>/~ ~/ / /~ 0 J( ...... ~v~unicipolit~';"' .... ~" ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~.~_.~.....~,~~ ........................................................................... b. Intended use and occupancy .~'~-~--,-~ 3. Nature of work (check which applicable): New Building ..' ..... Addition .................. Alteration .................. Repair .............. ~. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Est mated Cost ..~.~./.~.~..~...~ .............................. 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. Dimensic~ns~of existing structures, if any: Front ;. .......................... Rear ..................... Depth ............ Height.... Number of Star es Dimensions'//of sdr~e structure with alterations or additions: ............................................................................................ Front ....... ~ ...................... i ..... R~'~r ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of eptire new constructiOn Front .... 8. Height ~"/~" .~' Number °f St°ries '''~'~ ................................... 9. Size of lot: Front '"'/3'"'"; .............. Rear .................................... Depth. ,~;~ ...~..~ '0. Date of Purchase .,,,~.,,~..~...~,../.~.~.~.. ............ Name of Former Owner'~ ~ ' -- '''..~..~..~.....~ 1 '). , Zone or use distridt'// .~ tin wr~ich premises are situated .............................................................................//~.... 12. Does proposed construction violate any zoning law, ordinance or regulation;) 13. Name of Owner of premlses ~J~...~,.K~xt~.~ddress ~~.. -~/~~hone No. ~.~.e~.&..'-.~'.,~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ............. .~..~ .....................Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~xack dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW v,~ORl~,~ ~ ~ ! e e OF ..... ..................................... ~..~.~.~...~ .................................... ~ duly ~om, d~s and say~ t~ h~ is th~ applicam (Name of individual signing application) above named. He is the ........................ (~ntmctor, agar, co,rate officer, ~c.) of said owner or ~ners, and is duly authorized to perform or h~e peHo~ed the said work and to ~ke and file this application; that all statements cantoned in this applic~ion am tree ~ the best of his ~owledge and belief; and that the work will be performed in the manner set fo~h Jn the ~plic~i~ filed ther~ith. Swom~.,to ~fore me this~,/- , ......... ........ . ......................... ............................ ELIZABETH A~N NEVILLE g0TARY PUSLI~, State of New Ymk No. 52-8~25~50, Suffolk Term Expires Msrch' ~, ~ _