The URL can be used to link to this page

Home My WebLink About9082-z FORM 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 CQMPLETION OF THE WORK AUTHORIZED) N? 9082 Z Permission is hereby granted to: .~m. anc is..~er.~...&....,l£~ ............................... .................... Lake, ..~.i.e.w. _~ e~.rac e .......... ~,..14arion to .b.U.~..~...aTt...a.ckli.t ~3a.....on..exis ~n~..dws lling ............................................................. ot premises located at ...La~e.v.i~w...Te.~.A~6bo~ .................................................................................. ................................................... E~s.~..L~;~or~ .................................................................................. pursuant to application dated .........................}.L~,~'......J.3 .............. , 19..~.~..., and approved by the Building Inspector. Building inspector FORM NO. 6 TOWN OF $OUTHOLD , Building Depo~tment 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 "pre-existing" land uses: I. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. C,ertificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy ShOO /I-2/o 7' Date .......................... ~.. .................. New Building ................ Addition ...... ..~.' ....... Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ....................... ~ .......................................................... ~.. ............................. Subdivision ................................................................ Lot No ............. Block No ............. House No../..~..,.~.'..-' Permit No. ,,~.,.0.~.~....~... Dote Of Permit ...O~.:/../..-..'~..?Applicant ~ ~.~..~...~,..~.. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ................ ~. ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ................. ~ ...................... Fee Submitted $ ...~...m.~..~.. ................... Construction on above described budding and permit meets all ~llb~l~cabl~cJ~es and regulations. ...... .................. . :~worn to before me this ,~ J'"~/~,'S'/,_/~ ......... · ~,./. day of ........ /..~..?. ............... ./...~...../.../ (stamp or seal)~c~,/~L~ County Notary Public ........ '' K, BOARD THE NEW'¥oR OF FIRE UNDERWRITERS - BUREAU OF ELECTRICITY '~ .... 85 JOHN STREET, NEW YORK NEW YOR}~ 1~038 ' ;"' '' 4~? ? =~q~':~' "-;";' ~;:~".~n,~ November i0,-1977:_::. ~pt~io.~Vo.o./it~ 992978~ 'N OOOOOO ; electrical equipment ~ described below and introduced by t~ applicant ~d on the able applic~tlon .umber in the p~emtses-~f '~ ,', Frank Heroy, Bay Ave. Main Road, East Marion, L.I. ~ e~hmlned oa -':'-: November 7, 1977 , ~, undfound }o~be~n compliance with the Feqhiremeats of this Board. ' ~ Mike Sillrls Main Rd. must not be altered in~ any mantlet; returh to the office of the Board i~ incorrect. Inspectors ~noy be identified by 'rU = i~i ~:{~i::~c~P'i~ R C~A~D 'O F~:~IRE UNDERWRITERS" - ~,;,~,~o,~oo,,f~ 008813 ' ~ q~7'lA ES THAT '" : - ' ' : '' : '" ' ~ ~ ' ~ ~ ~L~.. a~d ~trod~ed ~v tt~ a~pllc~ aa~e~ o~ t~e ~ove apl)llcatlo~ ~tttnbfir ~n ~he pre;t~[ses o~. ,,,Fra~k,-Heroy,:,'~akevEew~:Te~race, ~ Bay Ave. ,East Meadow, L. l. April 21 j~ 1977 ' ,,,.~/o,,.,~ ~. ~ ;..o,.p~i.,.:,..,~ t~,~ ~.~.,.~,,~'~f FIXTURES T RAJ~GES OVENS EXHAUST FANS S E R'v'idE~J~-J~CO N'N E CT ~ ~ JViETER 4~N~] ~O OF CC COND J A~W. G T* NO OF N,-L[G Mike Sillrfs Main Road G~NE]~AL MANAGE~ , . , , ' . i e of che Boord if incorrect. Inspectors may be i~ent fled by thew credent~ats, THis cerhficote must nor ~e a~tere~ m a? TOWN OF SOUTHOLD SOUTHOLD, March Examined ........................................ , 19... Approved ........... ............ J..!....., 19o.o.V...?. Permit ..................... Disapproved a/c ,_.~~ INSTRUCTIONS 9o8 z Application No ................................. _,~ Date Mar 1 1 19...~ ~ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building eh 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 az 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 port 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 Ur P, egulations, for the construction af buildings, additions or alterations, or for removal or demolition, as herein describe~l. The applicant agrees to comply with all applicable laws, 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 corporat,~ U ...................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~...~'~.~:~¢.&~...A.,...~-]~e.~'.O.~...~::...W~.~. ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ..g..?....t.?~.~jj~.~..m.~...2 ............ Plumber's License No ........ .},j.a.;.%..~..J:.?...lz..e..~ ................... Electrician's License No .... .g..'.:....~g~,~..o.~].~.. ................ Other Zrade's License No ............................................... 1. Location of land on which proposed w~)rk will be done. Map No.: ......... :~.~.'~ ........................ Lot No ...... ..x..~.. ............. Street and Number ....]~J'&~.~.~,h~Q...,[~,E:~.Et.Q~ ........... ~t~.~,,L~.;~,;LO~ .................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ExisJting use and occupancy ...... .d;.~:r.~.~]...i..1.3;.g ....................................................................................................... b. Intended use and occupancy ............. ................................................................ 3. Nature of work (check which applicable}: New'Building'. ................. Addition .......~..~. ....... Alteration .....~ ...... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ............ .1.~.~.Q.C).Q....+,~ ......................... Fee ......... .'i..~:..O...0. ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units one Nuh r of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...~.e...s.~..e..n...e..e. .... 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 ...... 2.br. ......................... Rear ...... 2,~ ................. Depth ........ 2~ ........... Height .................... Number of Stories ....f)~e. .......................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... ,~.....~,lS.~ ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~P ........................................... 13. Will lot be regraded ......y.e..8 ............... Will excess fill be removed from premises: ( ~ Yes ( } No 14. Name of Owner of premises .~.~.~J,.~..~fl~'.cty...~..W .......... Address .......T;[~.e,~,~rJ.].~Le,. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor .....?.....~...Qw15.~' ................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 Dis,ns STA1-E OF NEW Y~r~,,~, [ c c COUNTY OF .............. ~, ~ ~:..u...~..~. ......... ~ ,,.,~ .................... ]?.~azt¢:.J.~.,~.ez':.o.~ ............................................. being duly sworn, deposes and says that he is the applicon (Name of individual signing contract) above named. He is the .................................. ..0-W.zJz..e.~....-....b.gJ~?.-.~. .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ar 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................. .1..1... day of .................... .]L~'.~Z~), ........... , ~9..~.2.. Notary Public, . .................. ~..1.~..£~J,~. .............. County [LIZ^I]E?H ANN N~ILI.~ NOTARY P[I8[IC, Slate of New York No. 52-8125850, Ruffo~kCou Term Expires ~arc~ 30, 19 .~....~.:.....i(Slgnature ................... of ipp~: .......................... ::'~' .... 2O -(