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Home My WebLink About7881-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .................. Date .............................. 19... ~T' THIS CERTIFIES that the bt~ilding ~ ~~ "~"~k'i~',~ ..... '~,~'~¢ ...... ~,'~;~'~" Location of Property fi~;b ~o: ......... '~'~' ......... ~b~i ~ .............. {'~ .... h~ie~ Cowry Tax ~ap No. ]000 Section ............ 8[oc~ ............... ~ot ................. Sub.vision ............................... ~ed M~p No ......... Lot No .............. confor~s^substantiaJl~ to the &pl>lication for Building Permit heretofore filed in this office dated .................... .~.}.. pu~ant t~ch Building Pe=it No ...................... dated ............................ 19..., was issued, and conforms to a~ of the reqmrements of~he allplicabl~rl~r°visiQn~/°f'F-k IL/A ~ O £ the law.F g I'qlkx~The occ, upancylso~ 15 t L I ~-t 6,--f°r which this certificate is issued is ......... .......................... p~ i~.~ .Mu. ~ ...... t-1~ 5 % ........................ ~e ce~ificate is ~sued to ............................ : .............................. (owner, le~ or tenant) aforesaid building. Suffolk County Department of Health App~?)~ ] ~*~ ..... .~..~.~ g ............... ~ERWRITERS CERTIFICATE NO ................................................. x Building Inspector Rev 4/79 FOR~ NO. 2 TOWN OF SOUTHOLD BUILDIN~ DE~ARTblENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PkEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7881 Z Permission is hereby granted to: ~e~mut Hass ............... ~e. coni.a ............................................... to .b.'cd2......n~z...cm,a..l~tl~,...~elZJ~ .................................................................................. at premises located at ..... ~L,.L,,..,A...o$'.£...~/~..k e~e,~i~...B.d...[,p.~.~..~l...~..[LLl'f ..~_~::.~k ..... ................................................. S~u~thol~ ...... I% Y... ........................................................................... pursuant to application dated ............................ .¥vT,~...q.h.......1.~ ...... , 19..7.,~.., and approved by the Building Inspector. Fee $....2.~.o:.~Q ....... FORM NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructlons A. This application must be filled in typewriter OR ink, and submitted ~n DUPLICATE to the Building Inspector with the following; for new buildings or new use Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographm 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, Mulhple Residences and similar buildings and installations, o 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 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ..... ................. New Building .... .~.... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~....~..~.....,,~'./..4~.~........~....~....~..~.~.~...~...~.../'~.....~,.? ..... ~'.O.~ .7?T/~../~.4~1 ..................... Owner Or Owners Of Property ...~.~.Z...,~..~..~.......x~.¢~.~..~.. .......................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No..~.~.~,./~,. ....Date Of .................................................................. Health Dept. Approval .......... .,.~/,. ............................. Labor Dept. Approval ....... ~ .................................... Underwriters Approval .......... ~ ............................... Planning Board Approval ...~,. ................................... Request For Temporary Certificate ........................................ FinaJ Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicon* ~.... · .~,/~--/-~'~. · ./~.'~. · .................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Pubhc .................................... County June 11, 1979 Samuel Glickman, Esq. Corwin & Gliokman 114 Main Street Greenport, New York 11944 Re: Helmut Hass v. Southold Town Zoning Board of Appeals Dear Mr. Glickman~ Pursuant to our telephone conversation of this morning and my telephone conversation with George Fisher of the Building Department of the Town of SQuthold, I enclose herewith stipu- lation of discontinuance of the above captioned Article 78 proceeding. As I understand it, all the requirements of the Zoning Board of Appeals of the Town of Southold have been met by ~. Hass curing several of the violations and by a variance having been issued or about to be issued by the Housing Board of Appeals of the Town of Southold. Accordingly, once a decision has been rendered by the Housing Board of Appeals, I will advise Mr. Fisher that he can issue a certificate of occupancy and we will attend to filing of the stipulation with the Supreme C~3/rt. Very truly yours, FJY,sb Enclosures FRANCIS J. YAKABOSKI SMITH, FINKELSTEI~, LUNDBERG, CRIMMIi~$ AND YAKABOSKI P. O. BOX 389 RIVERHEAD, N.Y. 11901 June 11, 1979 Mr. George H. Fisher Southold Town Building Dept. Main Road Southold, New York 11971 Re: Helmut Hass v. Southold Town Dear George: I am enclosing herewith copy of a letter sent to Mr. Glickman this morning. Based on our discussions, I feel that once the Housing Board of Appeals has issued a variance on the ceiling height, you can as Building Inspector issue a certificate of occupancy for the Hass premises. I understand from our several conversations that the other violations have been cured by Mr. Hass making the necessary corrections to the premises. uly yours, FJY:sb Enclosure TOWN OF SOUTHOLD HOUSING CODE BOARD OF APPEALS TOWN HALL SOUTHOLD, NEW YORK 11971 Helmut Hass c/o Corwin & Glickmau 114 Main Street Greenport, New York Re: Helmut Hess --Dwelling Dear Sir: On Friday, July 25, 1979 the Housing Code Board of Appeals met to inspect the disapproval by the Building Inspector. In reply to your appeal of the disapproval by the Building Inspector on April 26, 1979, we met at the dwelling of Mr. Helmut Hass at 110 Beverly Road, Southold, New York. We visited the two bedrooms on the second floor and approved the less than 7'6" ceilings. EKT/pjs Yours truly, ~/~ E. KENNETH TABOR Chairman HOUSING CODE BOARD OF APPEALS BOARDMEMBERS PRESENT: E. Kenneth Tabor John Talbot Frank Lekich BUILDING INSPECTOR : Mr. George H. Fisher Senior Building Inspector FOI~.~ NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL ................. !../.~......~.!.~ ...... ..s. zE.E.E..~ .......... ~e ~~, ~-~ ~ ~ ~/ / ~ ~.~.~....~..~.., PLEASE TAKE NOTICE that your applicat,on dated .............................. 19..~. for permit to c~:~u~t ....................................... at the premmes Iocoted ~t .................................... ...... U.,~ ........ ~E~.~.~ .......... ~.~.~.. st~ so u ~ ~ o c~ r ~c ~' ~p .................................... Bloc~ ~ . .............. Lot ................................................ is .~.~ ............ .~ ....... ~.C.O ......... ~.~..~.~ ....... ~7.~ ........ .~.~, ...... ,~.~.~.?.~....E...~ .............. .EL~.~ ........... ~.k3.kL~.~.~. ........ Z.....~t~.~ .... ~..~J..L~.~.~., .......................................... /~0 ~ ~a - ~ - / ~~~....~.~. ........ ~... Building Inspector FOP,~I NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office 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 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 d~sposal--(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 comphance 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 buddings 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 Jrt- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 Rte ........ ............. New Building ..... ../....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ..... ~..~..~..~....~/~2.~.....~..~.....~...~'...~...~...~..Z...~...~..~...*..~....~U~.~.~ ....................... Owner Or Owners Of Property .... ~.~..~./.~..?. ...... .~..~.. ....................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No.....; ..... Permit No. ~.~..~c~/.~... Date Of Permit~.~..~.~..Z-~....Applicant .................................................................. Health Dept. Approval ....~.... .................................. Labor Dept. Approval // Underwriters Approval ..... ..../... .................................. Planning Board Approval .....~'.. ................................. Request For Temporary Certificate ........................................ Fincd Certificate ........ .../.... .......................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD Of FIRE UNDERWRITERS dj. BUREAU OF ELECTRICITY ~---85 JOHN STREET. NEW YORK, NEW YORK 10038 v,,~ Hatch 15, 3.976 ,~,~a,cat,o,~Vo.o,~r.,e 796793 N 273689 THIS CERTIFIES THAT , only th~ sl~trical squipm~nt as ~,cribod belo~ a~ introauc~y t~ appl{cant nam~ o~t~ ~ ~pp~at]on number in the pr~mls~s o~ Helmut Haas, Beverly Ro~d s/s Nort~ Roaa ox~ l'oe~ ~, Sou~old, L.I. tn thefollowingl~ationl ~ B~ement ~lst Fl. ~2nd rt. OU~S ~des~tio. at~ rot ~0~ ~.,,a,,~d o. March 11, 19 76 attd fouttd to be in compliance with the requ~retnents of thts Board. RX~UEE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUtLeTS I~EPIACL~$ SWITCHES INC~DE~EN/ Ft~SC~NI w~, ~T Z W ~I ~ W ~ K W ~T ~ W -- ~ 16.0 30 57 ~0 50 1 8.6 1 F DRYER~ FURNACE MOTORS FUTURE APPLIANCE FEEDERS ~SPECIAL REC'PT TtME C[~KS BELL UNITHEATERS ~MULTI'OUTLET DIMMERS SYSTEMS ~T K W O1[ H P GAS H ~ ~T HO A W G. ~T ~P ~T ~PS TRANS. ~T H P NO OF FEET ~T ~ WATI~ SER~I~ DI~NNECT NO OF '" - ,~ -n - ..... S E R V i C E ME~ER I~ 1~3W 3~3W 3~4W~ NOO~ CC C~O ~ WG J NO OF HIL~G ~ WG ~ OFH~UT~ X W G ~T ~P ~PE EQUIP PER ~ OF CC CONO OF HI t~G ~ N~UTRA~ .. OTHER APPARATUS 2-4.5~ fio~ ~e~ ~e~e~s I GIF d ~ rtd~cate must not be altered m an manner, return to the off~ce of the Board ,f incorrect Inspectors may be ~dent,f,ed by th~dentm s Th s ce Y 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 Underwriters. 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 Planning Board approval of completed site plan requirements where applicable. 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-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 / Date. ~.~..42.~.../.~..~.../.~.7.?. .... New Building c/ Old or Pre existing Buildi Vacant .Land ..... .....: ............. Jo'u;; ~;.' ....... ........ ~' ' ' '?; ' ' ' ~;;;; ......................... ~;;i~;- Owner or Owners of Property ....~..~.~..~.~?.?. ..... .~. h:~: ................................. · / Subdivision ................................. Map No ............... Lot No ............... Permit No. ?. ?.~..~...Date//of Perm,t-[.~../~ 7d .... Applicant' .~..~'~ ............ J/~¢'~' ~.~"J~-/ ........... Health Dept. Approval...~//~ .7./?.~. ~.7. ........ Labor Dept. Approval ........................ Underwriters Approval . . ' ~ ~./~'-//~;;;~-~ Planning Board Approval Request for Temporary Certificate ..................... F mai Certificate ....................... Fee Submitted $ ............................. Construction on above described building and pent'eats all app~ic,~le codes and regulations· Applicant.. Rev. 10-10-78 TOWN OF SGUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL ROad, PLEASE TAKE NOTICE that your application dated ............. ~......~ ..................... , 19.~... ecoup~ Map ~ Block ~ Lot ~ is V~olation Of ~ ~ ~ate build!~ ~iola~ion of ~thol~ To~ Ho~ ~de ~p. ~, ~de of To~ of THIS SUiq/IY 15 A VIOLATION Ol 7~(~! O1: 11~l NIEW YOILK $TAI1 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~i'~-~C} -2- APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Appl i cant ~Y~?'~+~ ./~m Phone Address ~ , 2. Property Location.. ,~_F~.~'j~/~/~ Vi'~ 1 age ~/i~./~.:~ ,~. ~? l~wnshl p 3. Public W&ter Company Name 4. Lot size: Width__feet Length feet 10. 11. 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main Seway~isposal System: A.~gallon septic tank: Precast//Equivalent Block B. Leaching pools: Number of pools Precast ~ Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity , y~ gallons B. Pump G.P.M. ~/ epth C. Total well D. Depth to groundwater E. Amount of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk Coun~ Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~' ~ ?~ Signed FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be ins'tailed on this plot. APPROVA DATE £ SIGNED C S-15 Rev. 4/1/73 After investigation and inspection, the Board finds that the applicant requests approval of building built in violation of the Building and Housing Codes, east side Beverly Road (Pvt. Rd.), Southold, New York. The findings of the Board are that the appli- cant has a self-imposed hardship. Mr. Hass failed to adhere to the building permit application in the following respects: Garage unit attached to main house without approval; second floor added to main house without approval; illegal kitchen unit was placed in garage. The Board finds that strict application of the Ordinance would not produce practical difficulties or unnecessary hardship; the hardship created is not unique and would be shared by all properties alike in the immediate vicinity of this property and an the same use district; and the variance will change the char- acter of the neighborhood, and will not observe the spirit of the Ordinance. ~HEREFORE IT WAS tLESOLVED, Helmut Hass, Middle Road, Peconic, New York, be DENIED approval of building built in violation of the Zoning, Building, and Housing Codes, east side Beverly Road, $outhold, New York, as applied for. Th_e second floor par~itions~ must be taken out ~npu~h support for the ridq. Building and Housing Code requirements including ~he doors and windows. The brgezeway, including the roof, must be completely removed, and the kitchen uni~ in the garage must be removed. Vote of the Board: Ayes: - Messrs: Gillispie, Bergen, G~igonis, Doyen. -p /. - - . _. . (tO TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N.Y. 765-2660 TOOL '_' NEW YORK STATE DEPARTMENT OF ENVIROA/~LENTAL CONSERVATION Mr. Helmut Hass Middle Road P.O. Box 1115 Peconic, New York Building 40 State University of New York Stony Brook, New York 11794 April 30, 1975 11958 Gentlemen: Re: Petition No. TW- 15277-0085 Your petition for a Tidal Wetlands Mo£ato£ium Permit has been reviewed by this office. As a result, we have detez~ined ~emt~t~°~g~ne~a~a~n(~df~{n~W~l~i~gn~a~Y required proper and legal grade adjacent to Arshamomaque Pond at Southold, Suffolk County, New York, will have n~ adverse affect upon adjacent tidal w6tL3~ds. Therefore, pursuant t,; Section 25-0202 of the Environmental Conservatiun Law and 6 NYGRR, Part 660.3 (c), you are hereby notified that no p~:rmit will be necessary. A copy of this d=termination must be available at the Job site at all times during construction activity. DJL: jk Sincerely yours, Local Tide ~W~t la nds Permit Admt~is tra tor cc: Corps of Engineers, New York District Louis M. Concra t~,j 36/ - 0~ .~ ~ XITC#~-/~I Examined Approved ................................................................................. A / .............................. ....... r~'~ ~ I ~- '/(i ~ TOWN GLIRK'S OFFICE _. ~ ~ ~ ~2.~ / ~. ..... ~"~ ......... : ::.~..~Perm~~Z~l~/: ~i ~t ~-~N °' '' '~'''~'~'''~'~' '~'' ............... ~ INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building 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 or areas, end giving a detailed description of layout ofpraperty 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 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, andto admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applJcaat is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...~.~.~.1k.,~8,~ ....................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Licease No ..................................................... Plumber's license No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............. ~ ...................... Lot No......Z~.. ................. Street and Number ~1~Q~[~.~.Y~-~.~.~C~E~.]~.~Q13.~~ ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: vacant lot a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ............ .............. i .......... 3. Nature of work (check which applicable): New Building.....;~r~.......3~. Addition .................. AItera,tion ................. Repair. ' ~ Removal ..................Demolition .................... Other Work .f~D.C.e.r..A¢c~...R].~~ ............. (Description) ~.*.1+0 Dwlj 1;0.00 Gar[ 1~,.00 fence= 0.1+0 4. Estimated Cost ............................................................ Fee ..................... ; .................................................... ~. .... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... O..~....e. .......... ;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 t~,pe 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 ............... ~.~, ................ Rear ...... 2..8. ................. Depth -.3.6. ................ Height .................... Number of Stories .O.~..e. .............................................................................................................. 9. Size of lot: Front ...~.~ ................................................ Rear ....... ?..~...+ ......................... Depth ...... .!~..0..--.+ ............. I0~ Date of Purchase ........................................................ Name of Former Owner ...... ~..*.....~.~;~.~.~ ....................... 11. Zone or use district in which premises are situated ...n...A..."...~.~..~. ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~ .................................................. 13. Vv'Jll lot be regraded . ......... ~.e,g. .......... Will excess fill be removed from premises: ( ) Yes (Z) No 14. Name of Owner of premises ...~,~g,~..~,~.~ ...................... Address ..~.9.g.9~3;~..e. ............. Phone No ....................... 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-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. see attached plans ~TATE OF NEW YQI~K .... I ¢ S OUNTY OF ......... ...... .......................... ,...,, ................................................................. being duly sworn, deposes, on, d soys that he is the applicant (Nome of individual signing contracf) above named. 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 make and file this application; that all statements contained in this 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. Swam to before me this .................. L day of ..... .......... , Notary Public, ................ ~ ..... County ...... , .~ .....~/~'~.. ~.~,~ ................................... -~/' _ ~ (S~.9~ure of applicant) Examined ........ .......... iwwl Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ P tN 7a~"~/ Z'"* ! 9 ........ ermi o ..................................... Application No ................................. Disapproved a/c (Buil~'ng In--tar) ( ~ ~, ~ ~ . APPLI~TI~ FOR BUILDING PE~IT Date ............ ~~..~ ~ INTRUSIONS a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building 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 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 work. e. No building shall be occupied or used in whole or in part for any purpos~ whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buil;:ling 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (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 ...l~l~I~..~lI~ ...................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............. M ...................... Lot No...~[ ................. Street and Number ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......l~....~....~...t,.....~..t? ................................................................................................... b. Intended use and occupancy ...................................................... l..I~.~l~ .................................... 3. Nature of work (check whieh applicable): New Building......~lj....jjjjAddition .................. Alteration ..., ............ Repoir .................. Removal .................. Demolition .................... Other Work "~'"~;i~ ............ 4. Estimated Cost ............................................................ Fee 5. If dwelling, number of dwelling units .. .........JJml~ .......... 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 ............... ~1~ ................ Rear ...... ~, ................. Depth ...~ ................ Height .................... Number of Stories '~llJ ............................................................................................................. 9. Size of lot: Front ...l~ll~ ............................................... Rear ....... ~..~, ....................... :. Depth ...... ,t30..e~~ ............. 10~ Date of Purchase ........................................................ Name of Former Owner ...... ~'~"~lJ~llJ~Jll~ ....................... 11. Zone ar use district in which premises are situated ..e~ll..Ijj,~ ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 'Jill .................................................. 13. Will lot be regraded ..........~jTj .......... Will excess fill be removed from premises: ( ) Yes (Il) No 14. Name of Owner of premises '"J~J~ll~"JJ~Jr~ ...................... Address "Jll~lllll~ .............Phone No ....................... Name of Architect ................ # ............... # ........................... Address ................................ Phone No ....................... Name of Contractor ................ e .............. e ........................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~c c COUNTY OF ........ ~ll~'tll~ ...... )' ~"~ ................................................................................................. being duly sworn, deP0se~ and soys that he is the applicam (Nome of individual signing contracf) above named. 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 make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ '~ day of ........../" .............. ~. .............. ' 19'~"":" ~ x :! .........................: Notary Public, . .................. ~.....~ ......... ~ ......... County ................... , ............. ..~ ....~ .................................... '~'~'~ ..... (S~u'~'e of applicant)