The URL can be used to link to this page

Home My WebLink About9030-z FOE~ NO. 2 TOWN OF 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 AUTPIORIZED) N9 9030 Permission is hereby granted to: ,lL~har. ~, ..g~.3&eax ............................................. .......... .~....F..a~r~a¥...,~-¢e ............ l~.&.v, erhead.. to ...~,tfELd.. ne~.. ~ne... £a~£1y:..d~e ~],~ug. .................................................................................. at premises located at .......... W~/,,~...A~[d.I'-~h'"L~:FI~ ............................................................................ ......................................................... · La. uFe~. .......... .N.,.Y.., ................................................................... pursuant to application dated ............................. ~Ta-l~ ....... ~ ......... , 19...~.,i/, and approved by the Building Inspector. Fee ........ ~ ~: I ;,THE NEW YORK BOARD OF FIRE UNDERWRITERS, :: .'~ CERTIFIES THAT ~ ' '" ' ~ Richard Milker, W/s~de Alarzch Lane, SounS'Ave. a M~in:'Ra., /] k- ' ~aure~ ~; ~ Fl. ~ S~'ti6~ Block ~t ' DISH WASHER$ EXHAUST FANS FIXTURES RANGES ~5 '57 ~ 4~ 35 DRYERS FURNACE MOTORS FUTU.E A.PUA.C~ F~OE.S Xl~ CLOCKS MULTI-OUTLETsySTE~S OIMME"S Pane!board/s:'I-16~i~. !25amps., ! G.~.C.I. " 2_Smoke Detectors -1-4.51c~ Hot water heater ,'t--5 TonA.C. Unit Dettner Elec. Co., .P.O.Box 482 . Riverhead,.L.I. 11901 1-5cir. , lOOamps ~':-i (,,,,,! :4": Lic ~' 6~ 3E This certificate must not be aJtered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by l~Ol~ NO. S TO~N OF $O~THOL~ , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY 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 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 disposals(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 installations, 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: ]. Accurate survey.of property 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 in- formation required to prepare a certificate. C, Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $$.00 ,3. Copy of certificate of occupancy $1.00 Dote ...... +~../..... ~./...~../,,./,.. .............. New Btlilding .....~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................. .~. .............................................................................. ~;).'.. ~''//Il// ' Owner Or Owners Of Property ..... /..,.[..~'.1':l..C,9./[:~ .......... /..~'.1..~.~.~.~.~.. ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~...~.~..~.. ..... Date Of Permit ./..~./.~...-...~'.Applicunt .,/~.~.fl/..E.~,.~.....ZI~/.~.ZCp.. ................. Health Dept. Approval ...~..~,,~'. ................................ Labor Dept. Approval ................................................ Underwriters Approval ...~..C.,~ .................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ..x~, .................................. Fee Submitted $ .................................... Construction on above described building and .~,~:~t?/~ applicable codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FO~M NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Sou*hold, 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 Inspector with the following; for new build~ngs 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, 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 requirements where applicable. B. For existing buildings (prior to April 1957), Nan-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C. Fees: t. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1.00 ....... IZ....ZL ........ 7.. .............. New Bciilding ..... ~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Pro ert .... ....... ....................................................................... Owner Or Owners Of Property ...... z.,.,..~.~.~.a.~ ...................e...tTZ. ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.....~...~..~.'.'.~... ..... Date Of Permit../..,'~./..~...~...~ffApplicant ../..~.~,~.~..~...~.t...z~/.~Z.~/~.. ................. Health Dept. Approval ..t,~.;.f. ................................ Labor Dept. Approval ................................................ Underwriters Approval ...t.~.,,~ .................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ...~. .................................. Fee Submitted $ .................................... Construction on above described building ~~n}~ets all~jes and regulations. Applicant ......... ~...~. ~..~.~.. ~~~ ............................................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) BUILDING DEPARTMENT~r~ ~ V.~-~ ~.~ u r~ ~ (-~ TOWN CLERK S OFFIC~ ~~ ~ ~ ~UTHOLD, N. Y. /~/~ ~ ~ ~ ~( ~-~~ Examined ~proved ....... ~.....JJ ........ (.~ ....... , 19{..,~.. Permit No....~.~Z ................... ...~ c c~ ~ ~ ~ ~sopproveo ~/c .................... ~ ............................................................. / . / ~ ~ /. ' ~ . ....... : ........ ~~~..~ ~ ~ z r L,1,'; ....................... ........................ / '. )~ ~=~ ..... J .......... APPLICATION FOR gUILDING FERMIT ~ ~ -' ~.~ ~..~. ,~,~/~ ~ .................. , ............................. , w~..x. ..... ~ INSTRUCTIONS a. This application must be completely filled in by ~pewriter o~ in ink and submitted in triplicate to th~ Building Inspector, ~ith 3 sets of plans, accurate plot plan to ~ale. F~e according to schedule. b. Plot plan showing location of lot and of buildings on pr~mises, relationship to adjoining premises or public streets m areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is pa~ of this application. c. The work covered by this application may not be commenced before issuance o{ B~i~ding ~ermi~. d. Upon approval of this application, t~e Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises awilable for inspection throughout the work. e. No building shall be occupied or used in whole or in part Ear any purpose whatever until a Ce~i{icat~ of ~cupanc~ shall have been grante~ 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 o{ the Town of Southold, Suffolk County, New York, and 0tker applicable Laws, Ordinances or Regulations, for the constr~dion of buildings, additions or alterations, or {or r~moval 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 i~ bud ngs for n~ssa~ inspections. ................................... (S~onoture of ~pplicont, or nome, i{ ~ corporoHon) (Address of applicant) (f ~ ~ ff State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ~.~..*.~ ............................................................................................................................................. o* o* ............................................................................................ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Licen;k No .......... ~...~..~..',.....'.~..~. .................. P,umber's License No ........... ................ Electrician's License No ........... ~...~...~....~'......~... ............ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....... ....... ~. ....... ~ ................. Lot No .......................... Street and Number ......... ~..~..~..~../~.~.L~........~..~..~ ................................... ............................ ~...~..~...~..L .... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. £xisiting use and occupancy ....~..~..~.~.~...~......./~.~./~..~.. .................................................................................. b. Intended use and occupancy .... l¢: .............. .~...~..~..~ .......... ~.~....¢ ................................................... V 3. Nature of work (check which applicable): New Building' .....,z~... ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Qther Work .................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........ J.. ................. If garage, number of coJ's .............. Z ..................................................................................................................... 6. If business, commercial ar mixed accupancy, 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 addi*ions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Slories .................................. Height ....~.~.,~ ......... Number of Stories .................... L.Y.~.. .................................................................. , .................... 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 1 l. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~ ........................................ 13. Will lot be regraded . ....... .~..~.. ............. Will excess fill be removed from premises: ( ) Yes ~f No Name of Architect .............................................................. Address ................................Phone. No ....................... PLOT DIAGRAM i ~ocote clearly and distinctly all buildings, whether existing or proposed, and indicate fall set-back d~mens~ns~fl'om property nes Give street and block number or description according to deed, and sho~v street, names and indicate whether interior or corner IoL STATE OF NEW '~ aRK, [ c c COUNTY OF~ ........ ,, ....................... f '~," ...................... .~..~.t.~..~.c~.~d.....~.A.I.Z. Zi~.~.. ....................... being duly sworn, deposes end, s~ys that he is (~e epplican, (N~me of individual signing contract) ' ' t -- He is the .................. ~.~.~ .................................................................................................... ~ ............. ] .................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m~e and file this application; that all statements contained in lhis application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ......... ................................ CHARLES CRUMP (Signature of applicant) ~OTA~Y PUBLIC, State of New York No. 62-4526210 Qualified in Suffolk County Commission ~xpires March 30, 19~ or .formerly 0 now or THE LOCATION OF WELL~ AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS ~'HE WATER SUPPLY AND ~$E~ rE~~B~TJ~SP ' ~ ~ ~FOR THIS RESIDENCE ADDRESS TEL ..... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAl.. OF CONS!2UCTION ONLY DATE_.. ,z~...~ //..~.~ HS REF. HO ...... ~o %~- o%~, APPROVED_ NOT~; · -' MONUMKNT V/A TER SEt~VI¢£ -" PRIV~T£ W£LL A. Miller ¢' or Dominic formerly j. cotolon° YOUNG & 400 OSTEANDER AVENUE, RIV W. YOUNG SURVEY FOR: ~?ICHARD A . MILLER LAUREL GUARANTEED TO: SOU THOLD SUFFOLK CO., N.Y. ~CALE. /" 100' DATE:/VO,~, 15, 1976 NC. 7'~- 9 72 , ! , i1' COD~$ ALL FEDI~RA[,., STATE AND LOCAL CODES, ORDINANCES, REGULATIONS ETC., SHALL BE CONSIDERED AS PART OF SPECIFICATIONS FOR THIS BUILD- iNG AI~D SHALL TAKE PREFERENCE OVER ANY-I'HING SHOWN, DESCRIBED OR IMPLIED WHERE SAME ARE AT VARIANCE. J~OTIFY BUILDING DEPARTMENT AT' '~ ~A/0'ING I'~SP~CTIO/N ' K.!ND ~i ~EFDR~ COVER~NG(PiP;S OF ANY NOTE c~o. To ..ER,~' ^,, DIMENSIONS AND CONDITIONS L [I ~ , / 'l. SA~Y GLASS where required, to be instafled all exlt~doms, fixed glazed panels that look like'doors, patio d~6rs, storm doors, shower doors, t~h enclo- sures, ~11 unframed glass d~ors. GLAZING shall pass,test require- ments of ANSI Z97A; 1972. . H WLL L II / -? 't II ,!