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Home My WebLink About8834-z I~ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE $OUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8834 Z Date ........................... .~e.p'~ .......... 2 ....... 19.76.. Permission is hereby granted to: A~u~...F. oat e~ ................................................. ................ lfa~.~;t.~.ugk .......................................... · "-'~-'~ ~ "f~4'--b~~-. aC e~o~--.s ~l~.-~he~, ........................ premises l~Qted at ............ ~.~,..~. ..................... ......... ...................... ~ ............................. ~ ......... ~ ...... pu~uant to a~hcat,ondat~-. ....... :..:.; ....... :.::..;~.~.....~ ,. ,~ ,, , 19~ and~o~rov~, b,, the --~(. - Building I~p~t~r. Building inspectqr { FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 Underwr)ters. 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 Planmng Board approval of completed site plan requirements where applicable. Bo 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 unusum 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. Fees: 1[. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... ~QO. ~.l~.e~s.a...D.r.i.M .e, .................. .~.a.~..~.l~.u;.o.~. ~ rY." ...... House No. Street Hamlet Owner or Owners of Property ..... .A.r.~.~,~..~, ,~.o.s. ~.e.~. ....................................... CountyTax Map No. 1000Section . .1.1~. ......... Block ....... 1.~. ......Lot ........ ']..~ ...... . .Ck~ t. Subdivision.. ]D.e.e. LQ. ~lpj,~. ~ ................. Filed Map No ........... Lot No .............. Permit No..,.8,8~Z... Date of Permit ,~./.2/.7.~,,..Applicant.....,.,,..................,,.,...Mr' Stephen F. Grilling, Jr. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. 1, C.O.~.:~7;?.!L~. 9/~2/76 Con struction on above described bu ,Id lng and per~~c~/od~u~tions. [.~,~ Appl,cant. :/¢.~~ .~~~.. < ~ ............ ~. ~ ' //// January 20, ~981 Mr.~Stephgn F. G~iffing, Jr. '!L0 Court~treet, .Riverhead, New York 15901 ~D ar Mr~. G I Arthur Foster ~00 Theresa Drive, Mattituck, New York In reference to the above, please be advised that we have received yot~r signed Application, check ~92 in tlhe -mount of $1.00 for a copy of the aboves Certificate of Occupancy. We are enclosing herewith receipts 1806~ and duplicate cody of ApPlication for 3-our files. Encs. 2 Yours truly, / Georg6 H. ?isher Senior ~ilding Inspector INSTRUCTIONS a. This opphcation must be completely filled ~n by typewriter o¢ in ink and submitted in triplicate to the BuildiJ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which ~s part of th~s applicaho 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 wdl issue a Budding Permit to the applicant Such pern shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan. 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 ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construchon of buildings, additions or alterations, or for removal or demohtion, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit aulhorized inspectors on premises and in, buildings for necessary inspections. ........ .......................... (Signature of applicant, or name, if o corporation) .¢,. ...... ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build.- Name of owner of premises ......... .~,. ....... ~~.~'~....~,-~.... If apphcont ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's L,cense No ..................................................... Plumber's License No ................................................. Electrician's License No..~..:.....~.~..~!..~..J~..)....~.. ......... Other Trode's License No...'~....~..~.......~..~..~.~.~.~ ....... ~,~ Location of land on which proposed work will be done. Mop No ~.~'..~....~../,~ ...... .~ ...... Lot No St, eat and Number ........ ~i1~........~..~....~...~ ......... ~...~.~..4~:.1~......~...~(..i.' ............... Municipality State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Exis,ting use and occupancy ~.:.¢~.. .¢.~..~:.... ~.(~ .-~...¢~.~'.~'...~j ........ /-~D/....~.~.:~.~.~,~......~....~..¢..~... ....... b. Intended use and occupancy ............ /~ .................... :~ ................................................................ 3. Nature of work (check which apphcable). New Budding ~ ~ P--~'') Addition Alteration ............. Repair ................. Removal .................. Demoht,or. ................. O. th~ Work .~...~.!~.~.....~. ....... ..~..~'..~...../~.. ........ ~ / ~,-o-~ (Description) 4. Estimated Cost ...............-- --..~..~...~...(~..!~.. .......................... Fee ........'~L_...~...,~..~:...6....Q.. ......................................................... (to be paid on filing this applicat,on) 5. If dwelling, number of dwelhng umts ............................ Number of dwelhng units on each floor ......................... If garage, number of cars ........................................................................................................................................ 6. If business, commercial or m~xed occupancy, spec,fy nature and extent of each type of use .......................... 7. D~mens~ons of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Storms .......................................................................................................... Dm~ensions of same structure with alterahons or addmons: Front .................................... Rear ....................... Depth ................................ Height ........................ Number of Stories ................................ 8 D,mens~ons of enhre new construction: Front ................... , ................ Rear ............................ Depth ..................... Height .................. Number of Stories ............................................................................................................ 9 S~ze of lot Front ...................................................... Rear .......................................... Depth ............................. '1'0: Date of Purchase ....~.;....;....~. ....................................... Name of Former Owner ..................................................... 11. Zone or use d~stnct in which premises are situated .............................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: ...................................................... 13 Wdl lot be regraded ............................ Will excess fill be removed from prermses: ( ) Y~s. ( ) No 14 Narne of Owner of prem,ses .:...:.:..:.~!.?.- ....... ......'-'..~..:..'.. ........ Address ...~z.;....'";.;;];.'.;;.;.... Phone No .................... ; Name of Architect ....................................................... Address ................................ Phone No ..................... Name of Contractor ......................................................... Address ................................ Phone No ..................... PLOT DIAGRAM Lacate clearly and distinctly all buddings, whether exzstmg or proposed, and red,cate all set-back dimensions flor property lines G~ve street and block number or descnphon according to deed, and show street names and indicat whether interior or corner lot t STATE OF NEW YORK, COUN~T-Y~OF ...$.~£ f~o t~.: ............ f S.S ..................... ~.~h~...¢ ..... ~.],~ ..........~ ....... ~ .............. bem~uly.sworn~ depos~ and says that he is the apphcar (Name of individual s~gning contrac~ above named He ~s the .............................................. ~lLe~ ............................................................................................................... ~ ~ , x ~ , ~ (Con~ector, agent, comorat~ ~fhcbr., etc ) of sa~d owner or owners, an~s duly authorized to perform or have performed the sa~d work and to make and fil this application; that all statement~ta~d m ~his appiicahoh a~e true to the best of his knowledge and behef; an that the work will be performed m the manner set fo~h in the apphcahon filed therewith. Sworn to before me this ....... ~ .......... day of .......... Nora~ Publ,c, / ........... ,,% ...... ' .......................... ...................... [LI~ABEIH RNN NEV1LL[ No 57.SJ2585D, Suffolk County~ Term l:xplres March 30,