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Home My WebLink About7450-z FORM 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? 7450 Z Permission is hereby granted to: .V. alemt ime...ai~.a~ ..I ~e .......... : .................. ..... 800.. ~i~W~.;tag, ¢t~,a ) .....~ve ...................... ............ Eaat..ZaeeAaW ....... L.I.~..... .................. to ~..~..,~...~..e.~..~.e.~m~,~.~ .(.a~;t.e~:Lt~l..~.~ ................................................. at p~emises located at ..~.J~...O2~JpJ~J~l..~lalJ ........................... i ........................................... J .............. .. ......................................... .~.~.~,~t~.... ,t~.~.~.~ .................... i .......................................................... pursuant to application dated' . ............. ~-],~' .......... .~ ........... '......., 19.~,.., and approved by the Building Inspector. Fee $..1.~'...e.~ ........... t ~ ~ Building"~lnspectorI FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office ~ Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new u~e: 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 Un~derwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan, requ rements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accarate survey of property showing all property lines, ~treets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, dccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land ~se $5.00 3. Copy of certificate of occupancy $1.00 Date May 13¢ 1975 agriculture New Building xx Addition Old or Pre-existing Building ................ Vacant Land Location Of Property N..~..S.~..~..r..e..g..~.~n.~.R..~..a.~.d.z~.M..a.~.t..t.~.i..t.~.u.~t.~ ...................................................... Owner Or Owners Of Property ..~.a..1. e~.n...t..i..n...e.....G..i...r..a..r...d..s..f...I..n_c? .............................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 7450 Z Date Of Permit .J...u..1...Y......3..0..~..A~¢iicont 9alentine Girards, Inc. Heclth Dept. Approval ............................................ Labor Dept. Aipproval ................................................ Underwriters Approval .............................................. Planning Boa~d Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... 5.00 Fee Submitted $ .................................... Construction on above described building and permit meets oil a~plicoble codes and regulations. A~ cant V alenbin~ C~rar~d~, Inc. .................................................. Sworn ,o before me this ...... d,, of .................... 3. Nature of work (check which applicable): New Building' .X ............... Addition .......! .......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work (Description) 4. Estimated Cost .$,~0~0 ............................................... Fee ....$~.$ .............................................................................. (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 of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~L.;f.t,, .................. Rear ..,~.Q..,,~t,, ............ Depth .],;~.~...;~.t,.~ ...... Height ..,%,9.&..£g,,Number of Stories ............ ~ ...................................................................................................... Size of lot: Front ..5.~(!..,.].8 ........................................ Rear ..... ,~.~.,,,,,%.3 ...................... Depth ...4.(l~.a~,,,ll,l~ ............. Date of Purchase ..~..:~.~,~...~.9.'/~ ...................... Name of Former Owner ~,~.O:l~:;~,~&...~;~ll~O~k.~ ............... Zofie or use district in which premises are situated ...-3%gZ':l'~-'%t]'..t:m..~'i.a..]'.. .................... Does proposed construction violate any zoning law, ordinance or regulation: ....... ~ ............................................ Will lot be regraded . ........ ~ .............. Will excess fill be removed from premises: ( ) Yes (/~) No Name of Owner of premises~,%~.~:~,l~kf~l,~l,%"~.l~...:[l)~Address~.~,.....F.~.....~.~......e..~.~hone . Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from to deed, and show street' names and indicate 10. 11. 12. 13. 14. property lines. Give street and block number or description whether interior or corner lot. STATE OF NEW YORK, I c c COUNTY OF ........................ ;, ...... ~'~'~ Richard T. Girards ................................................................................................. being duly sworn, deposes and says that he is the applicanl (Name of individual signing contracf) above named. Sec. Treas. He is the ...............................................,...~.~'~2~tractor, '~,gent,. 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 ali statements contained in this applicetion ore 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..~ Sworn to beJore me this ~ // / /5 ~ ~ ~ / I ./q dayof,.:/. .......... , 1/ /1ti 1 '_ (/ ........... ............................ ' ~7,.~.~' ..... ~ '~" ,~/?~J~. ......... '"~7~' -' (Signature of oppica ) Notary Public in the State of New York No. 52-6806770 Residing in Suffolk County / TOWN OF SOUTHOLD BUILDING DEPAItTM~NT TOWN ~,LERK'S OFFICE ~ ~ SOUTHOLD, N. Y. [xominod ................. ~......, 19. ~proved ..'. ]. ~.....:. ~...., Disapproved a/c .... . .............. INSTRUCTIONS Dote July 30 '9 74 a. This application must be completely filled in by typewriter oX in ink and submitted in triplicate to the BuJlding~ Inspector, with 3 sets of~pl0ns, accurate plot plan to scale. Fee accord ng to schedule. 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 draw~n 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 Building Inspector will issub o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the w~rk. e. No building shall be occupied or used in whole or in part for any pbrpose whatever until a Certificate of Occupancy~] shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for th~ issuance of a Building Perm t pursuant to the ?. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and uther applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, od for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. Valehtine Girards. Inc. (SignatUre of applicant, or name, if a corporation) 800 Newbridge Ave. Easti l~ea(~ow~ N.x. State whethe~ applicant is owner, lessee, agent, architect, eng}neer, gene}al contractor, electrician, plumber or builder. owner Nome of owner of premises .V.~gD.~n~. Gi..r. ar.d. sr Inc. . (Name and ti e of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... ]. LocaHon of land on which proposed work will be done. Mop No,: .I.!!..O....O. .~..,.L.q..O,..~,..~...~.~LotNo Oregon Road ' Matt~tuck ......................... Street and Number .........................................................................~ .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupahcy of proposed construction: Agriculture o. Exisiting use and occuponcy ................................. ,.: .................. 'i .......................................................................... b. Intended use and occupancy Agric..ulture