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Home My WebLink About9235-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERM[T MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHOI~IZED) - N? 9235 Z Permission is hereby granted to: , ~ . ~ ~ ........... · ~..~....:..,..,~a~, ,~ :~ ................. _ :...' .......................................... ,.~...t ....... ~..~...~.~ .... [~ ......................... premises l~ated at .... ~.~ ~ ~ ............ . ~u~u~nt to ~pplicotion d~ted ........... ];..;:.~ ...... L.~....~ ............~ ]9;~.~,..~ ~nd approved by the: FORM NO. $ TOWN OF SOUTHOLD 0 Building Department Town Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s applicohon must be filled in typewriter OR ink, and submitted in 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 topographic features 2. Final approval of Health Dept. of water supply and sewerage disposal--{S-9 form or equal). ,3. Approval af electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple 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 s,te 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $§.00 3 Copy of certificate of occupancy $1.00 ....... New BHilding ................ Addition ...,~.' ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .X~....~ ..... ~ ................................................................... Subdivision ..................................................... , .......... Lot No ............. B~ock No ............. Ho,gse No ............. Permit No .~c~..~.~... Date Of Perm, it ...'~.~...~'/.~.2Applicant .~ ..... ~~-~..., ...... Underwriters Approval ~..~..~.v/~.....~...~... .................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .... ~...,... .................... Fee Submitted $ ..~.......'~....Z..: ............... Construction on above described building a~oermit meets/~/o~le, codes and regulations. Applicant ~¢~/~...~~ ........................................... Sworn to before me this ......... /...nay of .......... Notary Public ....... ~.~..... County (stamp ~s~l) f vm,'~THE NEW YORK BOARD OF FIRE rills CERTIFIES THAT onty the e~ec~ric~l equipment ~ de~crlbed below ~nd lntr~uced h~ ~he app~ant ~m~ on the ah~e ~pticatm. .u~e~ i~ th~ pr~i~ ~ Mrs. Lilllan Qualts, Main gt. Rt.2~, Southstde, ¢ XTURE .......... ~ _... F XTURGS UT EtS RECEPIAC~S 5WITCHES ~ ~'- ~T ' ..... ,,~ ~otors:l-1/2tI.P. I- ~.F.I, 227 E. 'Breakwater Rd. Mattituck, N.Y. 11952 ~s ce~f~catq 'must not be oJfered _\ Examined ................. ~ ................ , Approved n ~ 1927.. TOWN OF SOUTHOLD ~/x/ ~ ~'~ ~ A TOWN CLERK'S OFFICE SOUTHOLD, H.Y. ~U,¢,~,~.,__.- ,~ Apphcation No..,?.,.~:.,.~.....~.....*~,. ..... Permit No ~')- '~ ~- ~-~- Disapproved INSTRUCTIONS a. Th~s application must be completely f, lled ~n by typewriter or. in ink and submitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoimng premises or public streets. areas, and giving a detailed descriphon of layout ofproperty must be drawn on the diagram which ~s part of this applicatio c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant. Such perm 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 tF Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulahons, for the construction of buildings, additions or aiterahons, or for removal or demolition, as herein describe. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and: admit authorized inspectors on premises and in buildings for necessary inspections. (Signatu/e' of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ............. ~.~ .......(~..~...~ ............................................................................................ If apphcant 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 ............................................. ~/'D' '~'~ Other Trade's License No ............................................... ~ ' t e~t and Number .~~...~.... ........ ...................................... ~. ........ MunicipaliW 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction' Repa,r .............. Removal ............... Demohhor ......... Other Work .~Z~'...~-- ¢/-"--" ................ ~ ~ ~4'//~ ~ (Description) 4 Est,mated Cost ¢~/ Oz~.~. ................................ Fee ..~....~... .......... ..?....~..!' ~ ...................................................... (to be pa~d on flhng th~s applicat,on) 5. If dwelhng, number of dwelhng umts ............. Number of dwelhng units on each floor ........................ If garage, number of cars ...... ~ ..................... ~ .............................................................................................. 6 If business, commercial or m~xed occuponc),, spec*fy nature and extent of each type of use ........................ 7 DImerssons of ex~stmg structures, ~f any' Front ........................ Rear ................................ Depth ............... Height ........................ Number of Stones ........................................................................................................ D~mens~ons of same structure with alterations or add,hans Front .................................... Rear ............... Depth .......................... Height ...................... l'lumb, er of Stones ............... , ......... ! 8 Dimensions of ent,re new construct,on' Front ......... ~¢~ ............... Rear ..... ¢~..~.. ............. Depth ..~?.~ ....... iii '~, .~.'..ii.. i E~eth; ~.~..~.. .......................... He,ght .............. Number of Stones ....................... .- 9 S,ze of Io, Front ...~ .... /.~.42~, Re,~r .' . ........................ 10 Date of Purchase ................................................... Nome of Former Owner ....................................................... 1 1 Zone or use district ~n which premises are s~tuated ...................................................................... 12 Does proposed construchon wolate any zoning Iow, ordinance or regulation: ....................................................... 13. W~II lot be regraded "~'~'~__ - .A~.Wlll excess__ .~ --/~fill be removed from premises: ( ) Yes f~ No 14 Nome of Owner of prem~ses/~.~f~.~-~.. ¢~.~.~ldress ~.~7~,¢~_..~(... .......... Phone Name of Architect ............................... Address ................................ Phone No ..................... Name of Contractor ........................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and mdzcate all set-bock d~mensions fror property hnes Gwe street and block number or description according to deed, and show street names and in&cat whether interior or corner lot STATE OF NEW-~O~ //~ ~S S (l~r~e '~Y'"~"i~J'~ol s,gn,ng .............. contract~ i ..... be,ng duly sworn, deposes and says th4at he ,s the apphcor homed He ~s ~he ................................. ~ ............................................................... (Co~actor, agent, corporate officer, etc ) of sam owner or owners, and ~s duly authorized to Berform or have performed the sa~d work and to make and f~l this applicohon; that oil statements contained m thru apphcot~on are true to the best of his knowledge and behef, an tha~ the work wdt be performed m the manner set fo~h m the apphcabon filed therewith Sworn ~o before me thru ........,---~.~ ....... day of .....~/~Z .. ., 19 N ora W Pub ' ,~¢~.f¢...~~ ....... Coun~ ~~.~~ (Signature of applicably ..................... ~RY E DAWSON NOTARY PUBLIC. State of New Yo~ ~o. 52-464372~, Suffolk C~un~ Term Expires A~p-~, 3~ 2~ SUFFOLK COUI~TY DEPART~fE]~T,T OF ~IEALTH SERVICES- APPROVED The water suppry & sewage dmposul sys- tems for th~s res~der~ce w~ll conform to the standards of the Suffolk Count]/ Deparb mant of Health Sen/mas, "W Unauthor,zed alfer(:hon or addthon to thru survey is a VIOIQhOD of sechon 7209 of the New York SlaVa £ducat,on Law Cop~os of tl,~s ~*m,cy rr~p nat bc% ~, ~ ¢ e I-, ~ s'rrwyor's inked scs, I c, ~l,' ' ~ I ',/i r,:' '~ c' ~ L~o v~d copy. r.. ct ~' ,, ~ .. ~' ~ ' ". n,n only Io the here.m.c.r d to ¢.o css~nc=~ o~ the Icud,.g mshtuhon Guaranlees or ce~hf~cohons ~ro not tronCeroble to odd~tton~[ mshluhons or subsequent owne~. SURVEY FOR M~IRVIN E. gl III&lAN QU~&I_S AT LAUREL TOWN OF SOUT~iOLD SUFFO~LK COUNTY~ N.Y. SCALE: I'= 50' APRIL 27, 1977 REFERENCE: ~UARANTEED L RIVERHEADt N.. Y. ~/~SL,~onzed alferoh6r~ or addition to this su~ is a violation ~hon 7209 of the New York State Educohon Law. Cop~s of t~as su~ey meg ncl bearing the land su~eyo~s ~n~ed Gua~:nt~es or cm.~chc. Z :cl~d he :cq ~ha run only to~ pemen far whom the t~ w' ,: [ rapareJ, end on h~s behalf to ~ n~t transferable to ad&honal mshtut~ 0q All dmtances to wells and ces~poals are by Iocahon from house owners and field observahons, since most wells and ce~- pools are not ws~ble these dimensions cannot be cerhfmd. suRvEY FOR MARVIN E. gl LILLIAN QUALLS AT LAUREL TOWN OF SOUT~IOLD SUFFOLK COUNTY, N.Y. SCALE: I"~ 50' APRIL 27'~ 1977 AUG. 15, 1977 REFERENCE' eUARANTEED TO~ IIIVERHEA-])~. Y. Office Of Gordon K. Ahlers, P. li:. .1