HomeMy WebLinkAbout210-zNO. t
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the bu,ld,ng located a~,/~
Map No ...... .~...*:.~.?. ........ Block No ........ ~.*..?.?. ...... Lot No*..*..*...*. ...........................................................
conforms substonholly to the Application for Building Permit heretofore filed in this office dated
.......................... ~i~'~,~_~r..~. .... 19.~.~..., pursuant to which Building Permit No ..~..~.~. .............
dated ........................~T~I~tt~..P,~....., 19....~j~, was issued, and conforms to aH of the requtrements
of the applicable provisions of the Iow. The occupancy for which thts certificate is issued is ..............
.......................................... I:~.~.T~ ..0~ ..~.A~T~Z. Z)~I.~I~.. ~LI~ .. ~~ ~ .................
This certificate is issued to .~IL.~.~'.$...~. ...................................................................
(owner, lessee or tenant)
of the aforesaid building
Ho~a~ ~, ~er~y
FOP~M~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF
APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION
OF THE WORK AUTHORIZED)
Permlss~on ~s hereby granted to
..... ~ ~..:~Za~. .......................
....................... l~w.,l~l~..e.~ ........ ~,~.: ...............
to .... OOnn~t. m0"re~ 1~b].lL~..t~.~l~.et~,],~ .................................................................
at premises located at .... S/8 ~ll~:Ln [~'O0~ ..... )/..~.. -?~l~.t,. ~.$; ........................
............................................... ~sr~. f~..~.~ ....... .~...~ :. .......................................................
'~oYo
pursuant to apphcahon dated ..... ,,Ts~ ~,?. ................................ 19...~.., and approved by the
Budding Inspector
Fee $ .....10,, .............
Budding Inspector /
COUNTY OF SUFFOLK
DEPARTMENT OF PUBLIC WORKS
R. M. KAMMERIrR, COMMISSIONER
YA. PHANK, NEW YORK, 11960
Bate
Dear Six':
Re: Permit No. 2673
County Roa~ "26
(~) County Treasurer has been authorized to
refund you~ security in the amount of
( )
Bond No. to cover
work on this permit is herewith released
and returned to Bonding Company.
This is to advise you that work under the above captioned
permit has been inspected and found to be completed in a manner
satisfactory to this DepartT~ent.
Very truly yours, ~
William S. Matsunaye, Jr.
Chief ~gineev
WSM:E~B:cl
encl ./
cc: F~ment
P~m~i~ No.
IMPORT^NT NOTICE
To avoid se.~=u~'n,~ d~.'~-,~o~.~ ~ to v!tal
] ~ 'i! Long
PERMIT UNDER $EGTION 1~6 0f A~IGLZ VI-of. HI$H~:,~ 7 Company
'.0 before
~ .~ ~ng the work ~,,.u~n~zo~ by ~his
WHEREAS, a certain highway known as the ~ ~ S~.~O~ ~ ~
has been zmproved and zs on the Suffolk County Road System and
WHEREAS,
requests permission to
as per sketch or map attached.
NOW, THEREFORE, permlsswn is hereby granted to said
to do said work upon the following conditions:
CONDITIONS AND RESTRICTIONS
1. When concrete is removed, cut concrete w~th concrete saw t~o feet outside the
limits of the proposed exca~ahon and for the full panel ~idth. When the cut ~s
made ~n pavement w~thm I0 feet of the panel ]oint, the parement shall be removed
for full panel w~dth from the cut on the far ~ide of lhe exc~vatum to the panel joint.
2. Backfill and thoroughly compact fill using power tamper, placing soils so that
various t~pes of soft are in same relative poslt~on as before excavating. Grade to
or~glnal surface
3. Replace pa~emento sidewalk ,r ~urface ,~ame aa existing, if concrete, replace
using 1:1 3/4'3 l/2 m~x stone mix concrete; if bituminous material, replace using
same type as removed.
4. If concrete curb is removed, replace with similar curb 1:1 3~4:3 1/2 mix.
5. Notify the Maintenance Department at Yaphank 4-347{) when work ia to begin
so that an inspection can be made of the operahon.
This permit shall not be assigned or transferred without the written consent of the County Superintendent of
H~ghways.
The work authormed by th~s permit shaIl be performed under the ~upervis~on and to the satisfaction of the County
Superintendent of Highways or hm representative.
Particular attention m called to the necesmty of thoroughly compacting the back fill, which will be requmed by the
County Superintendent
The County Superintendent of H~ghways shall be g~ven one week's not,ce by sa~d apphcant of the date when ~t
tends to heg~n the work authomzed by th~s permtt, and prompt not,ce of ~t~ completion.
The sa~d applicant hereby agrees to hold the State, County and Town harmless on account of damages of any kind
which may arise during the progress of the work authomzed by thru permit or by reason thereof.
Apphcant ce~t,fies all persons concerned with actual work under th~s pemmt are duly covered by Workmen's Com-
pensation Insurance and the State, County and Town shall be held harmless on account thereof.
The County Superintendent of H~ghways reserves the r:ght to at any t~me revoke or annul th;s permit should the
sa:d apphcant fail to comply w~th the terms and conditions upon which ~t m granted
The applicant agrees to pay all necessary expenses incident to supervmwn and mspectmn by reason of the granting
of such perm;t as certffmd by the County Supemntendent of H~ghways, such payment to be made w~thm ten days from the
rendemng of the certified account
Work under thru permit to be commenced within thirty days from the date of permit and continued ~n an expedi-
tlous manner
The apphcant shall submit ~ detailed plan of structure to be built, with a descmption of proposed method of con-
structlon
It is understood that should future changes in the alignment or grade of the h~ghway reqmre changes in the work
covered by thru applicatmn and permit, the applicant shall on reasonable notme from the County Superintendent make such
necessary changes at his own expense within the time so specified in notice
Trafhc shall be maintained by the apphcant on this section of the h~ghway while the work is in progress and until
~t~ final completmn.
Certified Oheck payable to the County Treasurer of Suffolk County is
A ~n the sum orS ~0~
d~q~ security that the highway will be restored to its original condition where dmturbed at the expense of the
applicant, as soon as the work has been completed, and the said County Superintendent of H~ghways m hereby authorized
to expend all or as much of such deposit as may be necessary for that purpose, should the said applicant neglect or refuse
to perform the work.
In consideration of granting this permit the undersigned accepts it subject to conditions descmbed.
//./Applicant ~
County Superintendent of Highways, Suffolk County
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOI. D, N. Y.
Examined..~ .........................
Approved ............................... 19 ...... Permit No .................................
............. ..................
(Building Inspector)
Apphcahon No .~. ..............
APPLICATION FOR BUILDING PERMIT 6t..~l ~...~ /C~ ~ ~
INSTRUCTIONS
a. Th~s application must be completely filled ~n by typewriter or in mk and submitted m duplicate to the Buildin,
Inspector.
b. Plot plan show~ng location of lot and of buildings on premises, relationship to adjmning premises or public street
or areas, and giving a detailed description of layout of property must be drawn on the d~agram which is part of this location
c The work covered by th,s application may not be commenced before issuance of Buil~ting Permit
d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant Sucl
permit shall be kept on the premises available for .nspection throughout the.progress of the work
e No braiding shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupant
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 th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances;
Regulations, for the construction of buildings, addmons or alterahons, or for removal or demohtion, as hereto describe,
The applicant agrees to comply with all applicable laws, ordinances and regulations
(Signature of a[~phcant, or name, if a corporation)
................ .....................
State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, eJectncan, plumber or buildc
Name of owner of premises ......... : ........... : ......................................................................................................
If applicant is a corporate, s~gnature of duly authorized officer.
(Name and title of corporate officer)
1 Location of land on which proposed work will be done Map Nc) ............. 7'.. ........... Block ..............................
Street and Number ............~./.~....~~ ................................... ~ ~..~..~..~ /~ ~J~( ................ ~/~~' .................. ~ .....................
2 State existing use and occupancy of premieses and intended use and occupancy of proposed construchon
a. Existng use and occupancy.....~.,.....~....~~.~ ~.: ...............................
3. Nature of work (check which aDplicable) New Building ................ Addihon ................Alteration.
Repair ................... R~emovaJ .............. Demolition .................... Other ?,/~ork (Describe) .....~.~...~.f~.( S S t 'L-~'
4 Estimated Cost .~..=~.....' ......................................... Fee
(to be paid on filing th~s application)
FEES
5 If dwelling, number of dwelling units ........................ Number of dwelhng umts on each floor ........................
If garage, number of cars ..........................................................................................................
6 If business, commerical or mixed occupancy, specify nature and extent of each type of use../~.'~....U~.(...~..~.~...~.. .....
7 Dimensions of existing structures, if any Front ......... ~...~ ........Rear ...'~q .......... Depth ~ ~
Height ........................... Number of Stories .... ~ .....................................................................................
Dimensions of some structure w~th alterohons or addmons' Front ....... .~. ~ .... Rear .... ~.~. .............
Depth ............ ~..~. ....... Height ......~ ...... Number of Stories .. ~ .........
8 Dimensions of entire new construction Front ........ ~.~ ....... Rear .... ~.~ .......... Depth ..~.~ ...............
Height ....................... Number of Stones .... ~ ......
9 Size of lot: Front .......~..~ .... Rear .. ~..~ ......... Depth J ~ O
10 Zone or use district ~n which premises are s~tuated .............................................................................................
11. Does proposed constructio~ violate any zoning law, ordinance or regulahon~ ...... ~ ............................
12. Name of Owner of premises..~.t...~~ ...Address .... ~.~..~~ ..... Phone NO ................
Name of Architect ................................................ Address ........................................... Phone NO ...............
Name of Contractor ....... ~. ....................................... Address .......................................... Phone NO .................
PLOT DIAGRAM
Locate clearly and d~stinctly all buildings, whether exishng or proposed, and red,cate aH set-back dimensions fro~
property lines Give street and block numbers or description according to deed, and show street names and ind~cat
whether interior or corner
s s.,
COU~
..~~~' ' ........................... being' duly sworn, deposes and says that he Js the applJca,
(Name o~n~dual signing a~icahon)
above named. He is the .................. ~ ..................................................................................
(Contractor, agent, cor~rate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fi
this application, that all statements contained in this application are true to the best of his knowledge and beli~
and that the work will be performed in the manner set forth in the application flied therewith.
Sworn to before me this
. .........
Notary Publ lc,.....~.'] .."~,~~ .'~.. ..... C°un[~ls[
~ ~bhc, State ol New Yo~
Residing m Suffolk Coun~
No 52 C36;'8~8
~ ~mmms, on E,~;~'~s f,',crch 30, 19
(Singature of apphcant)
I~OP-lYI NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........ ~ ................... 19.~..~.~..
Disapproved a/c ............~., ............. ~, ......................................................
Application No .... .~,,~ .[ .O.....
(Budding Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................. '.'~
.................. 9 :.'e...1 .....
INSTRUCTIONS
a. This apphcation must be completely filled ~n by typewriter or in ink and su~)mitted ,n duphcate to the Budding
Inspector.
b Plot plan showing location of lot and of buildings on premises, relationship to adloining premises or public streets
or areas, and g,ving a detaded description of layout of property must be drawn on the diagram which is part of th,s location
c The work covered by this opphcation may not be commenced before issuance of Building Permit
d Upon approval of th~s application, the Budding Inspector will issue a Building Permit to the applicant Such
permit shall be kept on the premises available for ~nspection throughout the progress of the work.
e No building shall be occupied or used in whole or in part for any pumose 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
Regulahons, for the construction of buildings, additions or alterations, or for removal or demohtion, as herein described.
The apphcant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or name, ~f a corporation)
.......... ...... .........................
(Address of applicant)
State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... ....
Name of owner of premises ...... --
If applicant ~s a corporate, signature of duly authorized officer.
(Name and titJe of corporate officer)
1. Location of land on which proposed work wdl be done. Map No ~ Lot No' . ..................
Street and Number :.~...~..."~../..~.'.~..~...'.:...,.../~,...~.,~.,.,../,~../.:.....'.'~..'.: ......... ~....~4..~..Z...,f...~,~ .~.'. ..................
Municipality . /
2 State exishng use and occupancy of pr, em~ses and intended use and occupancy of propg..s~J cc~str.gct~n:
a. Existing use and occupancy ......... ~: ..~(......~. ~..~./..~. :.'..~...'(....~.~..:..'~..: ff...'~....~1......~.. ~r~. f.2 ~...ce..r'.~ .. :~ ......
b Intended use and occ_~an.. ....... ~ ' ~
3. Nature of work (check which applicable) New Building ................. Add~t~n . · .;.... ~ .. Alteration .......... .~ .......
Repair .................. Removal . Demo ton , .. OtherWork (Describe) .~.~ ~ ~4TT'z+~t~
.... '.2.2.. .................................................................
4 Estimated Cost .... ~..5..j.O....O .~.. .................................. Fee ! u,c o j ~., ~t
(to be paid on filing th~s application)
5 If dwelling, number of dwelHng units ......................... Number of dwelhng umts on each floor .....................
If garage, number of: cars .....................................................................................
6. If bus~ness, commercial ar m~xed occupancy, specify nature and extent of each type af use ....
7 D~mensions of existing structures, if any Front ............ ~v)~. ~ ....... Rear ..... ~.}.-. ~ ..... Depth .. ~i 13...~
Height ....................... Number of Stories ~
Dimensions of same structure w~th alterations or additions' Front ...... ~-I '3 b2' Rear ~ ', ' G'
Depth ./.~/.!.~...t:~..Z/.. ~..¢ ..... Height ............................. Number of Stories . ..~.."~ ...........
8 Dimensions of entire new construchon' Front .... :.~.....o. ............... Rear ..... ~ .O.. .........Depth .~.~..~. ..........
Height ........................... Number of Stories ..... ~ ......
9 Size of lot. Front ..... 2...~. ........ Rear....?....~.. ............... Depth ...../r..~..'.~..i .............
10 Date of Purchase ................................................. Name of Former Owner ........................................
11. Zone or use d,stnct ,n which premises are situated .......... "'"/.~:.".....~..~'----- .........................................
12 Does proposed construction violate~any,,~ zoning law, ordinance or regulat~on~ .....................................
13 Name of Owner of prem,ses....~....~ .2¢.:~ .............. Address ........................................... Phone NO ...................
Name of Architect ...................... :f ............................... Address .................................... Phone NO ................
Name of Contractor ................:.'. ............................... Address ......................................... Phone NO ...................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro~
property lines. G~ve street and block numbers or description according to deed, and show street names and mdicat
whether interior or corner lot. ~
STATE OF NEW ~.OR~I ,~/~ ) S S
................................ ...... eing
(Name of indiwduol signing application)
sworn, deposes and says that he is the opplk
above named. He is the ................................ ~,~~ ...........................................................................................
(Contractor, agent, corl~orate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and
this apphcation; that all statements contained in this application are true to the best of his knowledge and be
and that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this d~,r,'~&-Z'~f~., ~ ..