The URL can be used to link to this page

Home My WebLink About7980-z ~0~ 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? 7980 Z Permission is hereby granted to: ...~es.ter...3~gley.....~/.~..~..~o~an. c ~. ~ iscioz, .......... ~.:~e e.ntye~'.t- .............................................. to~...u~....Z..4...O,~.e, if.~...~n...e.~,s.C~4;..c.~.C.t.a~_s ......................................................................... at premises located at .... ~.O:123~..~J~ehr..JL~.a ...................................................................................... ............................................................ S~u2Ao3,ct .... ~' ..~ .................................................................. pursuant~ to opplic~tion dated ............................. ~.....~.[ ........... lg.~..~ .... ~nd ~pproved by the Building Inspector. Fee $.1.~.*.00- ........... Building Inspector FOR~ NO. $ TOWN OF SOUTHOLD , 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 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), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing oil property lines, streets, buildings end 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 o certificate. C?l~ees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land userS5.00 3. Copy of certificate of occupancy $1.00 New Buildmng ................ Addition ~(' Old or Pre-existing Building Vacant Land Location Of Pr~e~y U ~ u O ~ . Subdivision .......... ~ ................................................ ~LoJ No ...... ~... BI~E No.~ .......... House No~.~..~ No o, .............. Heolth ~p', Approvol .......... ~,.~.~.' ................... ~bor ~pt. Appr~al ........... ~.:,.~.Z ...................... Unde~rite~ Approval ............... ~..'..~.~ .................. Planning B~rd Approval .~.C.~ ......................... Request For Tempora~ Ce~ificate ........................................ Fin~ Ce~ificate .,.~ ................................. Fee ~bmi~ $ .................................... Const~ction on above described building and permit m~l~p~cable c~es and regulations. /Applicant ................. ~ ........ ,....~ .............................. Sworn to before me this/'/ ~ ~ ~ ........ ................... .................... ................................ .~., APPLICATION FC~ BUtLD1NG P[RMIT ~ ~ ~ , n uote ............ ~..~:...~ ...... ~.~ ......... , t~.,~.:. I~1 } ~ S INSTRUCTIONS ~~~ntto scale Fee according to schedule. lac~t~on of Io~ and of buddmgs on prem ses, ret3z onsh~p to adjoining premttes or pubhc streets or ~mg a c.t ,,.d c,%cr,:t'on of it'/out of p~opcrty must be drawn on d;agram v, htch ~s ~art of th~s apphcation c, The vcrK ccver~d L¢ tins ~pphtat~on may no~ be commeoced Lefore sscance of Sudomg Permit, d. Upon aogro,al of tb,s apphcat~o~, the Building Inspector wdi ~s~ue a S~ drag Permit to the applicant. Such perm:t2~ ;~I be kc;: -~ p,em~s~s ~va,~b~ for mspecuoq throughout ~he work e. No budd,ng snalt b~ occupmd or used ~n whole or m part for ~ny purpose whatever until a Certificate of Occupa~c¢ st~J~l hz~e b ,~*ted by the Bu,tdmg Inspector 4PPLICATIO?J tS HEREBY MADE to the Budding Department for the ,ssu~.nce of a Budd:ng Permit pdrsuant to th: Bu:,d,n, l__ ,-u,n~%e of the To~,n of Soutt~aM, Suffolk County, New York, and other aDCl,cgb~e Lows, Ordinances or Regulat;on~, for t'*~ cDi,strccl,~ ' b",d ngs, additions or a,terat~oos or for removal or demoht;on, as hereto descr:bud. The apchcanz ~grees to comply w~th a'i ;;c,,' 2., ~. rd~r a~ces, bd:'d~¢g c~dc, hou:,2; cod~, and regulations, and to adm,t au, honz;d ;nspec ............ ¢ *n.d m bu;ld,nB; for nec~s.a~'/,~,~p~cq. ~ (Signature of applicant, or n~me, ~f a corpcra'~o'0 90 Rzversmde D__v~, ,,,w ..... (Address of ~pphcantl 10024 ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, ,~lumb:r .~r ,.~ ..... Owner 3me of owner of premises * ~ ~=~' "~' '~ ' ~'=~- ,'" ap¢licant is a corporate, signature of duly authorized officer.. (Name and tide of corporale officer) Builders,' L,cens~t.~o .... .~..~..(~....~....~,-,~ ............................. Ptumb~r s License No ......................... ~ ............................... Electrician's License No ..................................................... Other Trade's License No ................................................... t, Loca(,on o~ ',and un wh;c~,propoo=u ,,o;k ,'~;,I be done. ;",",ap [',o .................. ./..,.? ............. x~ ...... Lot No ........................ Mumc~p 2. St,:tc e <lst~;L~ u:c ¢¢;d occupar;cy ol: pre'zf'f~s and iqtendec use and occupancy of proposed construction: ........ ...... _ ,.._ ........ , ............................................................ Existing use and occupancy b. intended u~e,and occup.~ncy ..................... ~.! ............... ~~~/ ................................................... ...... Wood Deck 6!ature of work {check which app[icab!e): Ne, w Buddl ~ ....................... ~comon ..................... A[[e~u~on ............. Repair ......................... Removal ......................... Oemohdon ........................ Other W~rk ............................. 4. Estimat-d Cus~ $500.00 F~:e $15.00 5. ifd~,,~ n ,,n .... ,rofd.v?',',~m~ts ................ ~ ...... rofd¢,~*,l~ngumtsoncach floor ........................................ If ~,,r,,, , ~,~, ;,~; of c~s ....................................... : ................................................................................................. 6. Ifb~t~ .... c ',' rc~dorm~,~doccur~-uv,~- ;¢%' ~ :t :~e amd e ,'c~t of ~ach type of use ................................ 2~' - 0" . .....0" 1~' 0" 7. D'~'~~ - ' :: , t :~:': ::' rr~' d:'', F' '~ .......... 5 ,:r.~6' - D~sth ......: ..... i .................. .............. ~ ........ L~mLar of c ..... Oue D,m.x::o.v~oTs:'~,~ctructu~e. ,,,, : r..: :~c-.-_ u. ons. Front Rear ..................................... Depth ............................................ Hc~t ........................................ Number of Stories ....................................... ~ , ,, ] A ~ 0" 8. D~mens~ons of entire new construct,on. Frcnt ..&.Q.'...:...Q.'.'. .... Rear .~.~ ..... m..Q ........... Depth ..... ~ ...... : ................ .., 4~ 6" Height ................. ~ .............................. Numt~r of St3r~es ....................................................................................... 9. Size of lot. F~on: ........~.~.~ ..................... R=ar .......... ~.=.~ ..................... Depth 110+ 10. D~te ~f Purchc.~ ...~.A~...~.,...~.9.~ .... Nama of Former Owner .~l~D.~...g~.~..~.~[.~A~..~.i;:~:.lg ......... 11. Zon2 o~ u ~ ~' Ar~ct iR ~',~C;: S~eRiI::S "ur9 Slid:ted ................................................................................................... 12. Dc '~'~.'-' '::cstr,:ct,:"vc~zaan,/zonm3~a',',,c.'dmanceo~regu:at~on: ........ Nm. ............................................. . ' ..... ~ .............. %".',q exc ss fill be removed from premises: [ ] Yes [~] No ~A 13. 7.',fl ',',,. ~ re.-: ~d ...~ O ...... 14. ~:a~,~ ~f C,'.,:~r of prem~s:s .................................................................................................................................... IAddress) (Phone N~ Name cf "--~ '~ (Address) (Phone Name of Contractor ................................................................................................................................................. {Address) (Phone No ) PLOT DIAGRAM Locate clearly and distinctly all buitdin]s, whethar existing or proposed, and indicate all set-back dimen:;ons ftc property lines. Give street and block number or description according to deed, and show street names and inomste v'h?. er interior or corner lot. _h rATE OF NEW YORK OUNTY OF t (Name of uidn'~dual ~;q, tt,'Lz, contract) the ............ ~_~ ¢/J. J/,C-~,. ................................................................................................................................................................ (Cocttrac'tor, .gcn ', corporate o~¢tccr, crc ) ~a~d owner or ownera, ~nd Is duly authorized to ~rform or haw performed the sa~d work and to m~ke and fde th~s apphcahon, that ~tements conta~nLrJ m [h~s apphcat~o~ ar~ tCue to the best or h~s knowledge and behef, and that the work wdl be porformed m the ~EP~N P. ~8 - ';,.',',,:,n' "J WV'i' Not~ ~c, S~te ¢ Ne~ York ~ifi~ ~n New York ~t~ e~m~ ~trvs Marek ]0, 19~