The URL can be used to link to this page

Home My WebLink About9237-z FORI~ 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) 9237 Z Date ........................ ~1,~' .......... ~ ............ , 19..~.. by-g tedt Permission is here mn o: '~ ............................... t ;~...~t.~!.~ .. ~.~! J,~ I .. ~,~[~tl .................................................................... .~°pmmi,~ l~t~ ~t ..... ~~8.~ .................................................................................. ............................................................................. d~t~ ..:....2 ...................... ~....~ ..........., 19.~.., ~nd opprovod by the 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 featu res. 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 buddings 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 dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 ~.~..~. ~.~, Date ............ ' ............ New Budding ~/ Old or Pre-existing Building Vacant Land Location of Property...??..~.q....~.../..~..~..~. · .~..~..~..~... ~ ..... .~..~..~-.~...~/..~?..~. ~..~. '...~.. House No. j ~ / ~treet . Hamlet Owner or Owners of Property ~--~/)/~//'~J~ ~ County Tax Map No. 1000 Section .... ./+.~. ........ Block ...... .2 ........ Lot ..... .'1.~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Date ......... ~ ~ Permit No.~.~'2.~..~'.... of Permitd~''?' ?ZApplicant.....'-~.../.~.~..-~....~.4./.~...-Z~'-..?./,.~. ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and ~t meets all a~;~'cabJe~codes and regulations. ^ ,.. pp ica t ..................... '~."..~./~..'..~..~.~, 7 ................ 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 August 1, q980 Mrs. Thomas Jurzena Silvermere Road, Greenport, New York 1194~ Dear Mrs. Jurzena : This is to advise you that the job under Building Permit No. 9237 Z issued to Thos. Jurzena on .May 9, 1977 for AccessorY('tr~'~ouse) appears to be completed as of our last inspection.' Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very truly yours, GEORGE H. FISHER Sr. Building Inspector encl. NE 1976 Examined .............. ~...~.....~....., Approved ............................... ~ ...... , TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWH CLI~RK'$ OFFICE SOUTHOLD, H. Y. l~,.i...,. P~rmit Na ................................... (Building Inspector)[ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildil 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 adjoining premises or pubhc streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatic c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector wdl issue a Building Permit to the applicant. Such porn 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 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County. New Yor.l~'-~ther applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or fo,/removals) or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, buildi~'g code,)fousing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary i~.sl~ectip~. (Address of applicant) State whether applicant ~essee, agent, architect, engineer, general contractor, electrician, plumber or budd, .... Name""'""'"'""'"'"'"""'"'"'"'""of owner of premises ............. ....... ' ......~ ~ ~~. ~ .~-~?~'" ....... " ....... "'"'"'""'"'"" ..... '"'"'"""'"'""""'"'"'"" ........................ .............. ~'"" ........................ ......... " ..... "" If apphcant is a corporate, signature of duly aL~-~3~ized officer. (Name and htle of corporate officer) Builder's License No .....................................................'~ Plumber's License No ................................................. L C~'~' Electrician's License No ............................................. (~ Other Trade's License No ............................................... ,D ~' 1 Location of land on which proposed work will be done. nnap No.' .................. .~. ...............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........,._._...._ .._..,, ~~...~~ ........................... ................................................. 3. Nature of work (check which applicable) New Building ~" Addition ,, AlteratiOn.. ............. Repair .............. Removal ................ Demolmor. ............ Other Work .................................................. (Description) 4 E~timated Cost ............... ~/...~..?..'"'"" ......................... Fee L'....O. ................................................................................. (to be paid on filing th~s application) 5 If dwelling, number of dwelhng units .......................... Number of dwelling units on each floor .......................... If garage, number of cars ...................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7 D~mens~ons of ex~stmg structures, ,f any: Front ........................... Rear ................................ Depth ................... Height ........................ Number of Storms .............................................................................................................. D~mens~ons of same structure with alterahons or addmons Front ................................... Rear ...................... Depth ................................ Height ................... Number of Stories ............................... 8 Dimensions of entire new construchon Front ...................................Rear ............................ Depth ..................... Height .................. Number of Stories .............................................................................................................. 9. S~ze of lot' Front ............................... .~ ........... Rear .......................................... De~th ............................... 10 Date of Purchase ............................ ..~..~ ............... Name of Former Owner ..... .~...;....'...~.~...~....~."'~' .................. 11 Zone or use district m which premises are situated .............................................................................................. 12 Does proposed construchon via/late any zoning law, ordinance or regulation: ....................................................... 13 Will lot be regraded .........../~.....o.'/ ........... Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises .............................................. Address ................................ Phone No. ..................... Name of Archnect ........................................... Address ................................ Phone No ...................... Name of Contractor ............................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether existing or proposed, and indicate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and indicat- whether interior or corner lot COUNTY OE -,~'..- .- ~,. -~ ............... fo.., CT ~ '~'~~ ~ J be,rig ......... ~-~Z~Z~f ind,~ "~idual s,gmng""~'""-'"'"-'"~' ................ above named. duly sworn, deposes and says that he ~s the opphcar He ~s the .................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have perfo_,~e said work and to make and fil this apphcat~on; that all statements contained in this apphcat~on are true to~,~ best of his knowledge and belief; an that the work wdl be performed ~n the manner set forth m the apphcot~j~, f. iJC~herewith. Sworn to before me this ~~ ~ ~ .......... ~ ...... day of ...... ~ ...................... , 19.~~ ~ / . ........................ ......... ~OT~y PUBLI~, Stat~ of New Yor~ No. 52-4643721, Surfak ~ Te~m ~Jres ~h 30,