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Home My WebLink About9265-z FORM NO. 2 TO~N O~ $OUTNOLD BUILDING DEPARTMEHT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9265 Z Permission is hereby granted to: · ..,~L .z.,z. ~.~...~..z.~ ~..e.~..a.~ ................................... ............... .~..~..o...~;t.....~ .............. ~.,..v....~.~:l~ to install private abovegro~znf ~im~i~g pool .~..pgrsuant to application dated ........ :.: ........ ._ ........ ',~,~ ~..z..g~': .......... ,, 17....~, .qnd gpprg~ by the Building Inspector. ~ Fee $!.~.?..C..,O. ............ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Budding Department Town Hall $outhold, N.Y. ] 1B7~ 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~, ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali 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 p~operty 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. Data of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occ_upancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.0O 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ..0~be~.20.,..%98~ ..... NewConstructzon ...... Old or Pre-existing Building ............ Vacant Land ............. 1800 Grathwohl Road New Suffolk Location of Property ................................................................... House No. Street Hamlet Owner or Owners of Property .[ Wllllahl Blanchard County Tax Map No. 1000 Section ..... 1..1.7 ....... Block 04 Lot 02 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 9265Z Date of Permit .Applicant Willzam Blanchard N/A N/A Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...... N z'A ............. Request for Temporary Certificate ..................... Final Certificate ......... ~ ............. Fee Submitted $ ..:% 00 Construction on above described building and permit meets all apphcable codes and regulations. Applicant .................................................... R~v. 10-10-78 TOWN OF SOUTHOLD , Building Department Southold, N. Y. 11971 APPLIGATION FOR GERTIFIC~ATE OF OCGUPANGY 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 fram 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 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 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 $,.00~...~...-/- .-/- .~.. Date ................... ~.. .............. New Building ................ Addition ................ Old or Pm-existing Buildinfl ................ ¥~cont kond .............. Location Of Pro e ....... ....................... Owner Or Owners Of Property .~..,/..'~" .~. J.~f~.~/,/...~.~...~.c.~ .~.~?,~Z;~./~.~. ................................................. Subdivision ................................................................ Lot No. ............ Block No ............. House No.~...-Z.~.(~ Permit No .~..~,/--~...~... Date Of Permit .r~.:.~,~..~ ...... Applicant ~/../xf~ ...../~L.~3~.~P..~..{~. ................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..~..{~..C3 ................... Construction on above described building a~ per, mit meets all gt3pligpbl~codes Sworn to before me this ................ day of ............................................ (stamp or se~l) Notary Public .................................... County TOWN OF $OUTHOLD , 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 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 "pro-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 ...~.L~..~.~.~.ZtZ)./~/......~-.~ ........ ~,LE.~..~.~...~.L~..~..-T~./~...z,~ ..... L.'~..:."~.. ....... Owner Or Owners Of Property ...(<¢~...1.~..1~.~.1~...lt~ ..... ~,~.L.I.ZI~.i~,/F/..[~.I/.~.I~.. ....................................... Subdivision ................................................................ Lot No. ............ Block No ............. House No.L..-]..~ CD Pe. t No Date Of ................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ,.~.i~ ..................... Construction on above described building and pe. rmit meets all a~opli.~gble coj~s~--~egulations. Sworn to before me this ................ day of ............................................ (stamp or se~l) Notary Public .................................... County TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 January 8, 1987 To Whom It May Concern: ~ Permi% number 9265Z for above ground pool has been voided and the pool is to be removed. Yours truly, Victor Lessard Executive Administrator 76S-X8~ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: [ ] FINAL INSPECTOR Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF $OUTHOLD TOWN HALL, SOUTHOLD, N, Y. 11971 765-1802 TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. Ex°mined ...... App,cot,on .... .... ............. Disapproved a/c ........................................ __ APPLICATION FOR BUILDING PERMIT Date ........................... , I ,. INSTRUCTIONS o This application must be completely filled Jn 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, relahonsh~p to odloining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicati¢ 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 Budding Permit to the opphcont Such pern 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 t Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and ether applicable Lows, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describ, The opphcont agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budd. If applicant is a corporate, signature of duly authorized officer. (Nome and t~tle of corporate officer) Builder's License No ............ ~ .......... Plumber's License No ................................................. Electrician's License No. Other Trode's License No ............................................... ~ No, ~ ,,..~. Location of land on which proposed work.~dl be dope Map ~o .......................... > .... Lot ......... Street and Number ./,...~...~...~.. ......... ~~..~.....~,.....~... ......... ..~...~..~..~., ......... /' ~Aunicipality State existing use and occupancy of 7~ises a~ intended use and occupancy of proposed construction' a Exisitmg use and occupancy ..... ~ ........... .~ ........................................................................ b Intended use and occupancy ........................................ ~ ........................... 3 Nature of work (check which opphcable) Ne;;~B,~-A~g .................. Ack~'T~ ..~ ......... ....-~mm~n ........ Repair ............... Removal ............... Demoht~ar ...... Other Work ...................................... (Description) / 4. Est,mated CostJ~. ~.-~?~....~...:...~'...~.. ............................ Fee (to be pa~d on filing th~s opphcahon) ,5 If dwelling, number of dwelhng units ........................ Number of dwelhng umts 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~mensions of exmtmg structures, if any Front ................ Rear ................................ Depth .............. q ........... - Height ........................................ ~ '. .................................................................................... D~mensions of same structure with alterations or addmons Front .................................. Rear ....... Depth ............................ Height ................. Number of Storms ............................ 8 D~mens~ons of enhre new construchon' Front ................. . ............ Rear .....................Depth Height ................ Number of Stones ............. 9 Size of lot Front 11Oo ~-- I~o ¢ ................................................ Rear .................................. Depth ............................. 10 Date of Purchase ............................................. Name of Former Owner ...................................................... 11. Zone or use d~stnct m which premises are s~tuated ............................................................................ 12 Does proposed construchon violate any zoning law, ordinance or regulation ...................................................... 13 Will lot be regraded .................. Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises .......................................... Address ................................ Phone No ..................... Name of Architect ................................... Address ................................ Phone No ..................... Nome of Contractor ....................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether ex~stmg or proposed, and red,cate ail set-back d~mensions fror propcrty hnes Gwe street and block number or descnphon according to deed, and show street names and red,cat whether mtenor or corner lot STATE OF NEW YORI<, · ...~x~ch%~..~.~.~ .... .~x...~.~...~,~ ................. being duly sworn, deposes and says that he ~s the apphc~ (Name of ind,wduol s~gnmg contracf) above named He ~s the ................. (..,.~..~ ................................ (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and this opphcatJon, that all statements contained m th~s apphcgt~on are true to the best of h~s knowledge and behef, c thor the work wdl be performed m the manner set forth ~n the apphcat~on filed therewith Sworn to before me th~s ..,... ............. .......................... ....................... ~/ I~ E DAWSON ~OTARY PUBLIC, State o~ ~leW York I~o 52-4643721, Suffolk Term Expires March 30, Co